- EVALUATION OF THE TEACCH PROGRAMME
- RESEARCH STUDIES
- OUTCOME DATA
- INFORMAL MEASURES
In 1972 the North Carolina General Assembly passed legislation mandating creation of the Division for the Treatment and Education of Autistic and Related Communication Handicapped Children. Located in the Department of Psychiatry, School of Medicine at the University of North Carolina at Chapel Hill, the programme was named Division TEACCH. It was the first state-wide, comprehensive community-based programme dedicated to improving the understanding and services for autistic and communication handicapped children and their families. The TEACCH programme has received National and International recognition and is widely regarded as an outstanding model of service, training, and research. In 1972, the Programme was given the Gold Achievement Award by the American Psychiatric Association “for the establishment of productive research on developmental disorders of children and the implementation of an effective clinical application.” A National Institute of Mental Health Publication, Families Today, prepared for the 1980 White House Conference on the Family, described TEACCH as the most effective state-wide programme available to autistic children in the country. The American Psychological Association’s Division of Clinical Child Psychology recognised TEACCH as a model national programme for service delivery to children and their families. Numerous individual awards have also been given to the Founder and current Directors for their roles in implementing this exemplary model. Division TEACCH makes important contributions to service, training, and research.
Division TEACCH serves as an International model for delivering exemplary services to people with autism and their families throughout North Carolina. Operating with 6 Regional Centres, TEACCH provides diagnostic evaluation, individualised curriculum development, social skills training, vocational training, and parent counselling and training. In addition, TEACCH clinic staff provide consultation to classrooms, Group Homes, and other community agencies responsible for the welfare of handicapped children. School-age children attend public school programmes in the many TEACCH-affiliated school systems around the state. Other receive residential or vocational services from community agencies closely tied to the TEACCH programme.
Division TEACCH strives to implement exemplary services for the over 5000 people with autism in North Carolina and their families by assisting appropriate mental health agencies and developing necessary direct services if appropriate agencies are unavailable.
Division TEACCH is an international Centre for interdisciplinary training in autism. Professionals from over 45 states and 20 foreign countries have participated in TEACCH training activities during the last few years. Countries involved in TEACCH training efforts include the United States, England, (see courses work- shops. main menu) Denmark, Sweden, France, Belgium, Iceland, Brazil, Venezuela, Argentina, Taiwan, Hong Kong, Singapore, Israel, Saudi Arabia, Kuwait, Russia, Serbia and Poland among others. TEACCH training programmes are offered on several topics: diagnosis, assessment, structured teaching, educational services, residential and vocational programmes and parent training.
The TEACCH programme has maintained a rigorous empirical research orientation since its beginning as the Child Research Project in 1964. At the clinical and educational level, this means a diagnostic understanding of autism based on direct evidence rather than mere speculation. At the research level it means studies related to needs of clients and their families. Integration of intervention and research is a strength and important priority of the TEACCH programme. Division TEACCH has maintained a steady production of research and publications over the years. The Programme has published over 50 books, chapters and articles. TEACCH has been involved with research and development of diagnostic and assessment instruments, treatment approaches, social skills training programmes, medication, teacher training curriculum’s, and the nature of adolescents and adults with autism among others. Family studies have also played a central role in the TEACCH research efforts. The development of service, training, and research programmes and the ability to integrate them in one agency have been the hallmark of the TEACCH programme and important reasons for its enormous impact on services and understanding of autism throughout the world.
Evaluating the effectiveness of a large and complex programme such as Division TEACCH is difficult. The problem is compounded by the organic basis of autism, the focus of Division TEACCH, which does not lend itself to cures or clearly defined milestones. Multiple outcome criteria have been compiled to address the evaluation questions focusing on the following outcome measures: research studies on the effectiveness of specific techniques, outcome data, and anecdotal and statistical information about the impact of Division TEACCH.
Eric Schopler, in his doctoral dissertation, established the foundation for Structured Teaching by demonstrating that visual information is more easily processed by people with autism than verbal information (1966). Following this study and related observations of children with autism in the 1960′s, Structured Teaching was developed as a programme for working with them (Mesibov, Schopler, and Hearsey, 1994; Schopler, Mesibov, & Hearsey, 1995). According to Division TEACCH, Structured Teaching helps people with autism by organising their environments providing clear, concrete, and meaningful visual information. An early study by Schopler, Brehm, Kinsbourne and Reichler (1971) demonstrated the effectiveness of Structured Teaching by altering the degree of structure in a teaching programme for students with autism. The investigators found improved attending, relatedness, affect, and general behaviour in the structured learning situation. Other investigators have reported similar success with Structured Teaching approaches (Lockyer & Rutter, 1969; Rutter, Greenfield & Lockyer, 1967). Marcus, Lansing, Andrews, and Schopler (1978) showed that parents could be trained to use Structured Teaching principles with their children. Using pre- and post-test videotaped observations of parent-child interactions to assess the impact of six to eight hours of parent training, they demonstrated improved effectiveness in the parents’ use of Structured Teaching techniques following a carefully designed training programme. Following this programme, parent- child interactions were assessed as more positive and enjoyable and there was an increase in child co- operation as well. Short (1984) examined the effects of the TEACCH Structured Teaching application by comparing child behaviours in the time interval between referral and actual diagnostic evaluation with behaviours during a similar time interval after Structured Teaching parent training had commenced. Compared with their behaviour during the waiting period, children whose parents received intensive TEACCH Structured Teaching training showed a significant increase in appropriate behaviours. This improvement generalised to settings outside of the Clinics where the training had occurred as well.
Several outcome studies have examined parent reports of the effectiveness of Structured Teaching and the TEACCH intervention programmes. Schopler, Mesibov, DeVellis, and Short (1981) received completed questionnaires from 348 families who had participated in the TEACCH programme. Parents consistently and with overwhelming enthusiasm, reported that their relationships with Division TEACCH were positive, productive, and enriching. Most impressive were the parents’ reports of the high percentage of their adolescent and adult children with autism who were still functioning in community-based programmes. Of the families with older children among the respondents, 96% reported that their children were still living in their local communities. This response compared favourably with concurrent follow-up studies showing that between 39% and 74% of autistic adolescents and adults were generally in large residential programmes outside of their local communities (De Myer, Pontius, Norton, Barton, Allen, & Steele 1972; Rutter et al., 1967).
The number of clients successfully working in the TEACCH Supported Employment Programme is another important outcome measure, perhaps even the most important because it represents the culmination of TEACCH’s many intervention activities, early identification, parent training, education, social and leisure skill development, communication training, and vocational preparation. Successful Supported Employment placements are a major goal of many programmes serving people with autism and related disabilities. Division TEACCH is using three models of supported Employment: individual competitive placements, dispersed enclaves, and mobile crews. All of these models have clients working a minimum of 15 hours per week earning minimum wage or above with an adult to client supervision ratio of 3:1 or less intensive. Over 130 vocational placements have been obtained through TEACCH’s Supported Employment Programme, the largest number of Supported Employment placements reported to date by any programme serving clients with autism. TEACCH was the first Supported Employment Programme serving clients with autism to receive the J.M. Foundation award for Excellence. Supported employment clients earn an average hourly wage of $5.30 working an average if 28 hours per week. The following chart breaks down these figures by programme model.
Parent satisfaction and well being are other positive outcome measures demonstrating the effectiveness of the TEACCH programme. Bristol and Schopler (1983) have reported on the relationship between family stress and support networks among consecutive referrals to the TEACCH programme. Parents reported that TEACCH was the most helpful among both their formal and informal support systems in reducing their stress. In a later study, Bristol, Gallagher and Holt (1933) found a decrease in depressive symptoms over time for parents participating in the TEACCH program. In contrast, mothers of developmentally handicapped children without this intervention showed no change in depressive symptoms over time.
Supplementing these rigorous studies are more formal measures of the effectiveness of the TEACCH programme. These measures include TEACCH’s state and private funding; state, national and international interest and recognition; and overwhelming parent enthusiasm and support. A substantial informal measure of the TEACCH programme’s effectiveness is the funding it generates above and beyond its generous state support for six regional clinics and a co-ordinating agency providing services to over 4,000 North Carolinians with autism and their families. For each $1.00 that the state provides for Division TEACCH, the programme raises and additional $1.00 from state and federal contracts and grants, training activities, private foundations, and individual donations. Division TEACCH’s unique strength as an internationally recognised model for research, training, and service delivery also attracts many national and international visitors who come to observe the programme or to receive specialised training. (Last year, 457 visitors from all over the world came to observe the programme. These visitors came from 32 states and 17 foreign countries including every continent and major region of the world. An additional 725 parents and professionals attended the annual TEACCH conference or participated in summer training opportunities. Many of these visitors are involved in sustained efforts to implement Structured Teaching in their local programmes. International film-makers from Japan and Belgium have made a total of eight films about the programme). Professionals from other states and countries have been enthusiastic about the impact of Division TEACCH in their areas. A child psychiatrist from Tokyo wrote: “If we consider that the TEACCH programme had its start in Japan with the visit of a Japanese team 10 years ago, we can consider that t revolution has occurred in the teaching of autistic children in Japan over the past 10 years.” A professional in Belgium has summarised the perceptions of the international professional community: “TEACCH has become a synonym for quality and many TEACCH-inspired services now stand as models for many European countries including France, Denmark, Switzerland, Sweden and Norway.” Division TEACCH and its leaders have been recognised with many major state, national, and international awards for excellence. The TEACCH programme first received national and international recognition in 1972 when the Gold Achievement Award was given to TEACCH by the American Psychiatric Association “for the establishment of productive research on developmental disorders of children and the implementation of an effective clinical application.” Further commendation was granted when the National Institute of Mental Health, in its publication, Families Today, prepared for the 1980 White House Conference on the Family, described TEACCH as the most effective state-wide programme available to autistic children in this country. Recent recognition as a model programme was given by the section on Clinical Child Psychology of the American Psychological Association. (Mesibov, in press). In 1985, the founder and then director of TEACCH, Eric Schopler, received the O. Max Gardner Award, the only state-wide honour given to faculty members by the Board of Governors of the University of North Carolina, for major contributions to human welfare. In the same year, Schopler received the Distinguished Professional Contributions to Public Service Award from the American Psychological Association. More recently, Schopler received North Carolina’s highest honour, the Governor’s Award, for his exemplary work in public service in establishing the TEACCH Programme. In addition to Schopler’s recognition, the programme’s current Director, Dr. Gary Mesibov, has recently been recognised with the highest achievement awards of the North Carolina Psychological Association and Opleidingscentrum Autisme in Belgium. Testimonials to TEACCH’s effectiveness have not come exclusively from outsiders; praise has come from within the University of North Carolina as well. In November 1992, the Chairman of the Department of Psychiatry at the University of North Carolina, after joining TEACCH’s social club for a barbecue, wrote: “Not only was it totally enjoyable, but completely exemplified TEACCH’s rare combination of love and respect for its patients/clients, its international reputation as a world leader in the field of autism, and its devotion to training and teaching. I doubt there is a treatment institution in the world which would have such a rare combination of people come together to have a great time.” The Chancellor of the University of North Carolina at Chapel Hill recently wrote, “Your insights gained locally, through individual children and their teachers, have meaning for others everywhere. Does not that epitomise what collaboration, at its best, does for the whole human race?” No programme designed to serve parents of children with autism could claim success without achieving a high degree of parental enthusiasm. In addition to the studies and informal data already cited, parents have offered numerous spontaneous expressions of appreciation. Parent appreciation is most typically expressed for the positive TEACCH approach, its comprehensive-ness, and the dedication of the TEACCH staff. These letters are typical of what parents write:
“Nowhere have we found another programme which matches TEACCH’s emphasis on the strengths and the abilities – not the weaknesses – of disabled persons. Nowhere else have we seen an agency match the success TEACCH has in helping handicap (sic) persons develop their potential.”
“The lives of many people we know who have disabilities, and their families, have been enriched substantially by TEACCH services. TEACCH greatly expands its influence, and contributes to other missions of the University, by integrating service activities with teaching and research.”
“In the 20 years of living in and out of different places, I have had numerous agencies, organisations, doctors, social groups, advocates and schools make promises to call me or follow through on something they had committed to. Almost all of them never even bothered to pick up a phone and call me to let me know what was happening. Now that I am in North Carolina I have slowly begun to trust people. I sincerely want to thank all concerned with TEACCH for caring, thoughtfulness, and professionalism in dealing with people with autism and their families. TEACCH has reinstated my faith in humankind and I now feel that there is hope for the future.”
“In any event, we are both enormously excited. Matt is relieved, positive, very “up” about joining what we both found to be a warm, accepting group that seems to cherish each person’s individuality. For my part, it’s hard to put words to the gratitude I feel for the existence of TEACCH, for Matt’s welcome to the programme, and for the wonderful people associated with it. TEACCH was a breath of warm, fresh air blowing through my life after the most severe emotional winter I’ve known.”
“Division TEACCH is a beacon of hope for parents all over the world. Knowing what you are accomplishing in North Carolina in the United States of America gives us the strength to continue because your existence inspires our hope in a brighter future.”
From its start as a research project in the mid-1960′s, Division TEACCH has developed, delivered and continues to provide, exemplary services to people with autism and their families in North Carolina while revolutionising concepts and approaches throughout the world. The programme’s strong collaborations between parents and professionals, as well as between the University and the state delivery system, have been potent forces in providing comprehensive services for North Carolina’s citizens with autism and relate disorders. Traditionally competitive and often adversarial, parents, the University, and North Carolina’s state agencies have been able to co-ordinate their respective interests to develop a programme that is an international model of excellence in service, training and research. The empirical research orientation that generated the Structured Teaching approach has been critical to the programme’s evolution. Grounded in a strong scientific tradition, Structured Teaching has evolved and expanded through the day-to-day clinical activities of the programme. Division TEACCH is a vibrant example of how science can contribute to society and society can inspire the evolution of science when the two cooperate with shared goals. when co-operative efforts such as TEACCH occur, the benefits to society, and especially to people with autism and their families, are immeasurable.
Bristol, M.M., Gallagher, J.J., & Holt, K.D. (1993)
Maternal depressive symptoms in autism: Response to psycho-educational
Psychology, 38, 3 – 10.
Bristol, M.M., & Schopler, E. (1983)
Stress and coping families of autistic adolescents. In E. Schopler & G.B.
Mesibov (Eds), Autism in adolescents and adults (pp. 251 – 278), New York: Plenum.
DeMyer, M.K., Pontius, W., Norton, J.A., Barton, S., Allen, J., & Steele, R. (1972).
Parental practices and innate activity in normal, autistic and brain-damaged infants. Journal of Autism and Childhood Schizophrenia, 2, 49-66
Lockyer, L., & Rutter, M. (1969).
A five to fifteen follow-up study of infantile psychosis. III. Psychological aspects. British Journal of Psychiatry, 115, 865 – 882
Marcus, L., Lansing, M., Andrews, C., & Schopler, E., (1978) Improvement of teaching effectiveness in parents of autistic children. Journal of the American Academy of Child Psychology, 17, 625 – 639.
Mesibov, G.B., Schopler, E., & Hearsey, K.A., (1994)
Structured Teaching. In E. Schopler & G, B. Mesibov (Eds.), Behavioural issues in autism (pp. 193 – 205). New York: Plenum.
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