Development of morning self-care routines in multiply handicapped persons

This study describes the use of reinforcement procedures to develop and maintain a complete morning self-care routine in multiply-handicapped and mentally retarded persons. Following the completion of initial training in each of six skill areas--toileting, showering, dressing, toothbrushing, bedroom cubicle cleaning, and bed linen removal--baseline data were taken on the extent to which 40 institutionalized adolescents and adults completed each task on a daily basis. Token reinforcement was later provided for the completion of each skill (single response contingency) using a multiple baseline design across behaviors. Results showed performance increases in five of the six behaviors, with some response decrement over time. During a final condition in which no tokens could be earned unless all six behaviors were completed (chained contingency), performance of each skill either increased further or was maintained at a high level.