UNIVERSITY OF NORTHERN COLORADO CENTER FOR URBAN EDUCATION

Gaining Compliance and

Reducing Latency With
Adults in Day Program
Settings
Using a Modified Precision Requests Process

Kaci M Philpot
7/15/2014





I. Description of the issue
The issue to be addressed is the latency period after adults are cued or directed
to perform behaviors and the frequency of compliance. This is a particularly difficult
subject to handle in the field of adult care because state laws are very strict on what is
considered abuse. In traditional school situations, students are considered to be
children and must comply with directives from an adult and if they do not do so,
punishment and consequences usually follow. When adults do not comply with
directions, using punishment
1
and forceful tones are considered to be abuse when
caring for an adult. This becomes a problem when the adults noncompliance causes
disruption in the learning or safety of other adult clients in the day program.
More often than not, staff working with noncompliant clients rely heavily on
conversation-like directives with a large amount of language for the client to process
before responding to the request. The reason for the conversation-like requests is staff
trying to treat clients like peers and capable adults instead of children (which would be
considered abuse). The problem with this approach in giving directives is that it draws
away from what needs to be done and leaves a heavy load to decipher for adults with
impaired cognition or language processing difficulties who require additional processing
time. This can prove to be even more difficult for clients with difficulties transitioning
between activities or when the directive involves a non-preferred activity. Typically,
adults who have a diagnosis under the umbrella of Pervasive Developmental Disorders
(formally Autism Spectrum Disorders ASD), shut down and refuse to comply with
directives communicated using too much language and rapid fire.

1
Defined as a process that weakens or suppresses behavior versus reinforcing behavior (Woolfolk, 2011) in the
context of educational psychology.
For the purposes of this Action Research Project, pre and post intervention data
will be taken on one client in order to measure the effectiveness of the intervention to be
proposed in Part III for increasing compliance and reducing latency periods.
II. Description of the Participant
The client to be observed for this assignment is named RJ. He attends the adult
day program at HighPointe Centers in Greenwood Village, Colorado five days a week.
RJ is 24 years old and attended Dakota Ridge High School where he was a part of the
Significant Support Needs Program. He also attended some general education classes
and participated in all school events. He attends HighPointe for the purpose of social
interaction, furthering education, and community outings.
RJs medical diagnosis includes Pervasive Developmental Disorder Not
Otherwise Specified (PDD-NOS), Cerebral Palsy (CP), and Attention Deficit Hyper
Activity Disorder (ADHD). The more prevalent diagnosis in regards to working with RJ is
PDD-NOS manifested through his behaviors, immature and nasal-heavy voice, stress
induced echolalia, difficulties maintaining conversation that is not of special interest,
difficulty communicating feelings, digestive system issues, inappropriate social
interaction, and sensory integration issues. RJs CP affects his ability to endure long
walks without breaks. He is interested in magic and believes he is in a fantasy world
where a young lady from high school is sabotaging his life through spells and trickery.
This obsession does not appear to be a negative paranoia; the Dakota woman was
the villain and he is the hero in the comic book plot of his life. RJ does best with a
consistent schedule and needs significant advance notice if major changes are made in
the schedule or longer processing time is needed for transitioning to an unscheduled
activity. He likes listening to music, riding the light rail, and bowling.
RJ exhibits a significant latency period at least one time per day between when a
directive is given and when he performs the requested behavior. When RJ comes in the
morning, he sits down at a table and eats his breakfast and listens to the discussion
about the news. The morning routine is to move the chairs against the wall for Zumba.
RJ is always prompted when Zumba is about to begin and he ignores the prompt. Once
it is time to move chairs, RJ refuses to move, and eventually, after staff approaches him
multiple times, he shuts down completely. It becomes a safety hazard to both the
clients (especially clients with a visual impairment) and RJ because he is sitting still in
the middle of a group moving in unison. The other problem with this behavior is that it
prevents RJ from getting the full experience of the program, especially on days of
scheduled outings where he refuses to comply and is often left behind at the facility.
Because RJ is in an adult program where formal assessment data is not known
or shared, normative assessment results in areas of cognition, intelligence,
communication, and academics are unknown. However there is a Client Strategies
Protocol which is similar to a behavior plan except it is less formal and provides tips for
preventing behaviors rather than reacting to and modifying behaviors. Baseline data
shows that the average latency period for RJ is 21.5 minutes which is very significant
especially if the behavior occurs more than once a day, which it often does. The
baseline data was only taken for half days and in some cases only in the first 30
minutes to one hour upon RJs arrival to the facility. Intervening on this behavior (to be
discussed in Part III: Literature review) will not only help RJ pursue personal growth, but
will also be conducive to a comfortable and pleasant environment for both clients and
staff.
III. Literature Review

I chose to work with RJ for this action research project in order to decrease the
amount of time that RJ is not participating in the program (latency period) and to
decrease the amount of staff time wasted trying to gain compliance from RJ. It is
important for RJ to participate in the program because he is there for the purpose of
socializing, growing in academics, and experiencing the community, and when he does
not comply, he ultimately ends up missing out on the activities for which he attends the
program. In working with RJ, I feel the best intervention to employ would be precision
commands in order to decrease the period of latency between the directive given and
RJ complying.
Precision commands, also referred to as precision requests, structures
communication with the student in a concise, predictable, respectful format that
preserves adult authority and increases the likelihood of student compliance according
to Jim Wright from interventioncentral.org. Unfortunately, I was not able to find any
research that included using precision commands with adults with disabilities; however,
many adults in day programs are at the developmental level of students in a school
setting and a similar hierarchy of power is in place between clients and staff. In order to
properly fit the context of RJs situation I have modified Intervention Centrals definition:
precision commands structures communication with adults with developmental
disabilities in a concise, predictable, respectful format that maintains the authority of
staff members and increases the likelihood of client compliance.
The procedure and guidelines for using precision commands was consistent
throughout the various sources I used in developing my intervention plan. The
procedure has three components that are important to the success of the intervention;
these components include communication techniques, consistency, and pre-planning
(Musser). Pre-planning is the first step of the intervention where the staff member has to
decide the consequences of the persons response and the amount of wait time that will
be given to allow for compliance. This amount of time is anywhere between 3-10
seconds depending on the source and the population of the students. In most of the
procedures for precision commands, consequences are pre-planned for both
compliance and non-compliance. The consequences for compliance varied from simply
praising students to giving students stickers or tokens for individual or classroom
behavior management systems. The consequences of non-compliance were identified
as anything that was unpleasant for the student. Some studies used negative
consequences in the behavior management system or time-out. The second step of
precision commands is giving the first command or request for compliance. The first
command should be phrased in a specific and concise manner starting with please
followed by what behavior the person is expected to perform. After the first command is
given, the teacher or staff member waits for the pre-determined amount of time for the
student to process the request and comply. If the student complies, the teacher is to
reinforce compliance with the predetermined consequence. If the student does not
comply after the wait time, a second command should be given. The second command
should be said in the same tone but beginning with you need to in replacement of
please, and then repeat the specific behavior the student is expected to perform. The
teacher should give wait time again and reinforce for compliance or noncompliance
using the predetermined consequences. Every command should be given within three
feet of the student in an unemotional, but firm tone of voice while maintaining eye
contact.
Precision commands in general have a limited amount of research available on
the effectiveness, although I found that many reputable organizations such as
Intervention Central, Utah State Office of Education, and psychological organizations
recommend the intervention to help increase compliance. From what I gathered in my
research, it seems that in school settings it is simply a traditional and basic method of
giving directives that is natural enough to not warrant extensive research to prove its
effectiveness. That being said, there were a few research articles I was able to access
that included precision commands in the procedures.
The first article, written by Musser (2001), tested the effectiveness of a
multicomponent intervention that included precision commands. The other components
of the intervention were mystery motivators, public posting of classroom rules, and a
token economy with response costs. The results of this study found that the percentage
of disruptive intervals reduced significantly when comparing the base-line data with the
data taken after intervention implementation (Musser, 2001). Although this study
incorporated multiple elements in addition to precision commands, the results likely
would not have been as successful without using precision commands properly.
The second article, written by De Martini-Scully, Bray, and Kehle (2000) used the
same package of interventions that Musser et al. (2001) did but with the general
education population. The conclusion found that this packaged intervention using
precision commands was effective in reducing disruptive classroom behaviors and
proved to be more teacher friendly than modeling and other intervention techniques
used to reduce disruptive behavior.
The third article, by Firmin, Helmick, Iezzi, and Vaughn (2004), discusses the
effectiveness of the compliance seeker using the word please when making requests.
In the review of literature, many studies showed that building a relationship or the
perception of a relationship and maintaining regular dialogue with the target person led
to greater compliance. The dialogue didnt have to be on any particular subject to
increase compliance, there just needed to be regular interaction to at least create the
illusion of a relationship to the target person. The study conducted included participants
ages 18-24 years of age and eight typical college students who were specially trained to
make phone calls using a script. Four of the eight callers were a control and the other
four were reading the script including the word please. The tone and rate of speech
were consistent throughout the study to prevent confounding variables. The results of
the study yielded that using the word please in seeking compliance actually reduced
the rate of compliance instead of increasing it.
Although the results of using the word please do not support using please in
the intervention, the differences in the situations were very evident. The nature of the
request for the reviewed study was very much different because asking for money or
someone to buy cookies is different than a caregiver or authority figure requesting
compliance. Because of this major difference, using the word please when making the
initial request in the precision commands process is showing respect for the target
person and valuing them as an adult; the word please will remain in the script for the
initial request for compliance.
I believe that this intervention is best for RJ because it limits the language input
for him to process and gives very clear and concise directions that provide him with the
exact behavior to execute in a non-threatening way with respect while maintaining his
dignity.
IV. Intervention Plan
The intervention plan aligns closely with the process of precision commands
used in classrooms, as discussed in section III; some components of the procedure
were modified in order to accommodate the law and cognition of the participating client.
Preplanned consequences were not included in the set procedure because of the
nature of the laws in working with adults as mentioned earlier and the availability of
consequences in the setting. Because of RJs need for additional processing time, the
wait time standards were modified from 3-5 seconds to 20-30 seconds. This ensures
that RJ and others with developmental and intellectual disabilities have appropriate time
to process the request made, consider possible actions, and act accordingly. The flow
chart outlining the intervention procedure is below:





































V. Tools Used
To ensure fidelity in implementing the modified precision commands intervention,
a quick reference checklist will be used as an aide in the intervention process (Utah
RJ,
Please_________.
Wait 20-30 seconds
Compliance
Reinforce
Noncompliance
Record latency period
Noncompliance
RJ, you need to
___________, now.
Compliance
Reinforce
State Office of
Education). For precise
record of latency period,
a latency recording form
from Denver Public
Schools was used (see
Figure A for baseline data) for raw data. The form includes places for the date, start
time, end time, and total latency period. In this case, the start time of the behavior is the
time of the first request and the end time would be the end of the refusal to comply with
the given request.
Figure A.
Baseline Data
Date Time (start) Time (compliance) Latency
1/31/14 11:15 11:30 15 min.
2/3/14 9:05 9:20 15 min.
2/4/14 10:15 10:45 30 min.
2/4/14 11:10 11:20 10 min.
2/5/14 10:05 10:20 15 min.
2/7/14 9:15 9:20 5 min.
2/7/14 10:40 11:15 35 min.
2/7/14 11:35 11:50 15 min.
2/10/14 9:13 9:19 6 min.
2/10/14 1:00 1:40 40 min.
2/10/14 1:55 2:45 50 min.
VI. Research Report and Summary
The results of the modified precision requests intervention were inconclusive.
The original hypothesis of eliminating the language input and being direct and concise
using the modified precision requests process to reduce the latency period was not
supported by the post-intervention data. The average latency period in the baseline data
was 21.5 minutes and the average latency period of the post-intervention data was 32.4
minutes; for individual latency periods, see Appendix B. Although the data shows that
the hypothesis was not supported, there were two variables that adversely affected the
fidelity of the intervention process, thus resulting in inconclusive results.

Appendix B.
Intervention Data
Date Time (start) Time (compliance) Latency
4/28/14 9:23 11:15 112 min.
4/29/14 9:37 9:37 0 min.
4/29/14 10:25 12:05 105 min.
5/2/14 9:15 9:16 1 min.
5/7/14 9:17 9:20 3 min.
5/7/14 10:07 10:47 40 min.
5/7/14 11:47 12:04 17 min.
5/7/14 12:50 1:20 30 min.
5/15/14 9:21 9:22 1 min.
5/15/14 10:05 10:20 15 min.

The first variable was the gap in time between when the baseline data was
recorded and when the intervention was implemented. In this time RJs refusal behavior
significantly increased to the point that he would sometimes refuse the entirety of the
day and sit in the same chair all day without talking or moving unless he was eating his
lunch or picking at his socks. This change in RJs behavior makes comparing baseline
data and post-intervention data an inaccurate representation of the effectiveness of the
intervention.
The second variable that adversely affected the fidelity of the intervention
process was other staff attempting to intervene using previous methods of request for
compliance which did not align with the modified precision requests process. This would
cause problems especially when staff intervened during the set 20-30 second wait time.
This only happened two times, and I informed those staff that I was conducting
research. The staff were huge supporters of my research, so they began coming to me
first before trying to intervene. It is hard to say how at what degree this variable affected
the compliance of RJ, but deviating from the intervention procedure, decreasing the
fidelity, reduces the reliability of the latency period data.
Although the results were inconclusive, there were some improvements in the
intervention period. When baseline data was being recorded, RJ never once
demonstrated compliance immediately after directives were given. However, in the
intervention period, RJ demonstrated compliance in the first round of the modified
precision commands process three times, with compliance after the first request one
time and compliance after the second request two times.
After conducting this action research project I have learned many things about
working in the adult day program setting as well as conducting research and taking
data. I learned that when working in the adult day program setting, it is often difficult to
maintain communication between staff about the current behavioral or emotional state
of a particular client due to the client to staff ratio, large number of clients having issues
at any given moment, and the high demand for staff to multi-task. Staff at day programs
such as HighPointe are required to keep on top of medical care needs of clients, teach
or direct, problem solve unexpected schedule and operations issues, mediate client
conflicts, and communicate with each other all while having to manage a large number
of clients. This sometimes chaotic environment makes it difficult to maintain consistency
in handling client behaviors and following particular procedures and strategies that are
specific to the individual needs of the clients.
What I learned in terms of data collection and research will greatly help me in
future behavior and academic intervention situations. When I began the intervention
process I realized that I had created more work for myself in data collection than what
was really needed. In addition to the latency recording form, I used the quick reference
checklist to aide in the fidelity of the intervention process. As it turned out, this checklist
only took away from the focus on the latency recording process and made data
collection more time consuming and redundant. In the future, if I conduct this same
intervention, I would choose to use the flow chart as a reference while implementing the
intervention and just use the latency recording form with a small comments/notes
column for recording data.
As for the intervention process itself, I would only change one part. I
implemented the intervention in rounds where there was not compliance after the first
two requests, I would give another round of precision requests after several minutes in
attempt to gain compliance. This was not effective as RJ only complied with the second
round of requests one time. Throughout the whole intervention process, modified
precision commands were implemented in a total of 15 rounds. If I conduct this research
again in the future, I will only implement one round of modified precision commands for
individual attempts at gaining compliance.
Overall this research project was an informative and educational experience and
I look forward to continuing to seek answers to the issue of gaining compliance from
adults with developmental disabilities.
References
De-Martini-Scully, D., Bray, M. A., & Kehle, T. J. (2000). A packaged intervention to
reduce disruptive behaviors in general education students. Psychology in the
Schools, 37, 149-156.
Firmin, M. W., Helmick, J. M., Iezzi, B. A., & Vaughn, A. (2004). Say please: The effect
of the word "please" in compliance-seeking requests. Social Behavior and
Personality, 32, 67-72.
Jenson, W. R., & Rhode, G. (2003). The tough kid parent book: practical solutions to
tough childhood problems. Longmont, CO: Sopris West.
Musser, E. H., Bray, M. A., Kehle, T. J., & Jenson, W. R. (2001). Reducing Disruptive
Behavior in Students with Serious Emotional Disturbances. School Psychology
Review, 30, 294-304.
Utah State Office of Education: LRBI resources. (n.d.). Retrieved March 22, 2014, from
http://www.iseesam.com/teachall/text/behavior/LRBIpdfs/Precision.pdf
Woolfolk, A. (2011). Behavioral views of learning. Educational psychology: active
learning edition. Boston, MA: Pearson.
Wright, J. (2014, January 1). How to: Manage problem behaviors: precision requests.
Retrieved March 21, 2014, from www.interventioncentral.org