Residential Program Quality Indicators for Adults with Autism
Residential Program Quality Indicators: A Guide for Families
Common Challenges IF YOU ARE A PARENT LOOKING FOR A RESIDENTIAL PROGRAM FOR YOUR ADULT CHILD WITH AUTISM, THERE ARE NO EASY CHOICES. The first challenge you face is making that initial, emotionally charged decision. Simply coming to terms with the fact that your child may need a residential program can be difficult, especially if they have never lived outside your family home. Both you and your child might be facing a complex mixture of emotions, coming to terms with your aging and mortality, and confronting social stigma in which residential settings are seen as “sending a child away.” Finding any program that has availability might be the next big challenge. Supportive housing and residential programming providers struggle to keep up with intense demand. As a result, families are frequently faced with the illusion of choice – or, more accurately, the reality of few choices. It can be hard enough finding a program that is accepting new residents, let alone one where you can see your child feeling at home. It is tough to see past these huge hurdles and feel like you are in the position to evaluate a program at all. It might feel like you need to take what you can get. However, knowing what questions to ask can help you make the best of a difficult decision. You are entitled to decide what is meaningful to you and your family. It’s all about finding the right framework to evaluate your options.
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Starting With What You Want
It is frequently helpful to start the search for a residential program by doing an inventory of all the things that you hope to see in a residential placement.
| What do you hope or imagine your child’s life will look like? | What are the things they need? | What things do they enjoy? | Will the residential placement you’re considering offer these things?
A NOTE ABOUT TERMINOLOGY: For the reader’s convenience, the authors of this publication have made several choices about the words that we use. First, there is a divide within the autism community about whether to use person-first language (person with autism) or identity-first language (autistic individual). We value both perspectives and have attempted to use both with equal frequency throughout. This guide is written for the families of those with moderate to profound autism, who cannot make decisions on their own. As a result, this guide is written primarily using the word “parent” to refer to the decision maker. We also acknowledge that parents are not the only ones who have to make these choices. Frequently, it is a sibling or another family member who occupies the role of caretaker. We honor the deep, intimate, challenging, complicated, and rewarding relationship that caretakers can have with those they support. We also acknowledge that autistic individuals may also have a chosen family, rather than a biological family. However, to make this guide easier to read, we’ve stuck with the word “parent” instead of using another word that – for some – may better describe them. If that is the case for you, we hope you still find the information in this guide useful. Similarly, you will see the word “child” used throughout this text. While some use that word to refer only to young people, we recognize that parents of adults don’t lose the parent-child relationship simply because their child has reached their 18th or 21st birthday.
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Adult Program Quality Indicators
Here are a few categories to think about:
4. Qualified Personnel 5. Families and Community 6. Program Evaluation
1. Value-Driven Programming 2. Maximizing Quality of Life 3. Individualized Assessment and Intervention
VALUE-DRIVEN PROGRAMMING
A quality residential program for autistic adults takes every measure possible to ensure individuals with autism experience dignity, respect, and inclusion.
Ask how the program:
| Ensures that the individual’s health and safety is protected | Ensures that its staff treat everyone with dignity | Provides the appropriate level of privacy and autonomy | Evaluates consumer happiness | Maintains a good relationship with the surrounding community | Values and honors the individual’s preferences | Obtains informed consent from parents and assent from the individuals who live there | Provides developmentally appropriate materials, activities, and choices | Offers evidence-based and effective treatment to increase new skills such as choice-making and decrease challenging behavior such as aggression, self-injury, and other behavior that presents imminent harm to the individual and others
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MAXIMIZING QUALITY OF LIFE
Residential programs for adults with autism should prioritize all major quality of life concerns and utilize professionally-developed curricula to maximize individuals’ skills.
Ask how the program:
LEVELS OF SUPERVISION:
| Teaches safety skills | Engages health and medical care | Keeps track of residents’ diagnoses, allergies, and diets | Maintains a detailed schedule of residents’ medical, dental, and therapy appointments and ensures that residents attend those appointments | Provides appropriate supervision | Develops emergency and crisis plans | Offers socialization opportunities | Supports emotional and behavioral development through constructive dialogue between residents and staff | Helps with Activities of Daily Living (ADLs), including food and meal-related skills, toileting and hygiene, housecleaning, dressing, and finances | Creates opportunities for preferred recreational activities | Coordinates with employment, day programming, and/or transportation
When you consider whether a residential
program will maintain appropriate levels of supervision for your child, you shouldn’t limit your child’s options by thinking in terms of “staff ratios.” Think instead of “levels of supervision.” When parents ask about staff ratios, they often do so in an attempt to maximize the support for their child and make sure that there is a staff member who is always at the ready to help them. For example, some families may ask for a 1:1 staff ratio, or ask that an individual direct support professional be “assigned” to their child. Counterintuitively, that might result in less supervision. What happens when that specific staff member needs to use the restroom? Instead, focus on the level of supervision : how close should any given staff member be to your loved one and over what time frames? What level of supervision do they need to stay safe?
Some examples of levels of supervision are:
| 2-hour periodic checks | 5-minute periodic checks | Line-of-sight during all waking hours | Arm’s length at all times
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SAFEGUARDS AND BUILT IN FLEXIBILITY Direct support providers and residential staff have an important job. It’s their responsibility to make sure they maintain the appropriate level of supervision for all residents at all times. Depending on the ways that the residents’ levels of supervision fit together, that allows for a lot of flexibility. One staff member can attend to someone within arm’s reach and still be supervising another individual within their line-of-sight. THE IMPORTANCE OF STAFF TRANSITIONS Each staff member should make sure they know who is supervising which individual in the residence. When a staff member who’s supervising someone needs to step away, or pay attention to something else, there should always be an explicit hand off so that all staff know what the plan is. For example, a staff member might turn to their colleague and say, “Can you stay within arm’s length of so-and-so while I go to the bathroom?” While the wording is not important, it is crucial that: • An explicit, spoken exchange takes place, and both staff members understand what is about to happen • The program has a policy that ensures that staff know to communicate with their colleagues when they can no longer meet a resident’s level of supervision EMERGENCIES When there is a crisis, even high quality programs may occasionally fall below the appropriate level of supervision. Emergencies in a residential setting can happen quickly and affect everyone in the residence. A staff member who is meeting your child’s level of supervision may have to make a real time decision to jump in and help. On the other hand, this flexibility might be a good thing. Consider the scenarios where your child is the one with the emergency: Perhaps they are choking on a piece of food, they have fallen and hurt themselves, or an electrical fire has started in their room. It can be reassuring to know that, even when someone else has the staff’s attention, the staff will be able to help your child in a crisis.
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INDIVIDUALIZED ASSESSMENT AND INTERVENTION Quality of life measures in the previous section should be individually assessed, addressed, and evaluated to further advance individuals’ opportunities to meaningfully participate in their homes and communities.
Ask how the program:
| Offers comprehensive assessments that • Identify specific skills to increase and challenging behaviors to decrease • Provide a clear set of recommendations for intervention planning and the resources needed for the plan to be successful | Monitors progress on both adaptive and challenging behavior goals through Individualized Service Plan (ISP) evaluation | Engages professionals from the following disciplines as needed and ensures that they adhere to the ethical and practice standards of their professions and any state regulations, such as licensing: assistive technology, behavior analysis, counseling, medicine (e.g., generalists and specialists), occupational therapy, psychology, psychiatry, social work, and speech therapy | Adjusts instructional methods to reflect the individual’s needs and strengths | Has open lines of communication between staff and residents and ensures that staff are friendly with, attentive to, and demonstrate respect for all residents | Offers a continuum of support that can be adjusted as your child’s needs change • If your child needs higher levels of support and structure, how would the program adapt? • If your child becomes ready for greater independence, how would the program offer more choices and greater autonomy?
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COMPARE THE FOLLOWING SCENARIOS:
Scenario 1: You arrive at your child’s residence for a routine visit. When you walk in the common room, staff are on one side of the room and the residents are on the other. The staff are speaking with one another, not interacting with anyone that lives there. Scenario 2: You show up for the same
visit, but you arrive to find the staff members actively engaged with your child and others who live in the home. They’re participating in the same activity that the residents are – perhaps they’re watching your child’s favorite TV program or helping them complete a puzzle. These tangible differences in your child’s overall experience in their home can reflect a potential difference in a program’s training, approach, and philosophy. Scenario 1: When you visit your child’s home, you see both staff members with their attention on their cell phones. One has a headphone ear bud in one ear, and the other is scrolling short form social media videos. Neither are giving your child or their roommates their full attention. Scenario 2: While visiting your child, you see them discussing a favorite sports team with a member of the staff. They won last night’s game, but your child unfortunately missed the TV broadcast. The staff member takes out their cell phone to look up the final scores, sharing them with your child and enriching the conversation. Few residential programs have blanket bans on staff cell phones. A house staffed by people with no cell phones can pose a safety risk. However, there is a big difference between appropriate and inappropriate phone usage when staff are on duty. Nevertheless, a quality residential program should have a clear policy on cell phone usage. In short, cell phones should not interfere with any staff member’s ability to serve, support, or supervise the residents according to their level of need and their ISP.
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QUALIFIED PERSONNEL Residential programs should ensure that qualified and competent personnel are available to provide services, their responsibilities are clearly defined, and measures to evaluate their performance and maintain their job satisfaction are instituted.
Ask how the program:
| Has clearly defined job descriptions and personnel who meet those descriptions | Collaborates with all professionals across disciplines both within the agency and in the community | Ensures resident and staff safety | Handles staff turnover | Implements and complies with the standards set out in Implementing the New DSP Training Standards: A Guide for DDD Providers | Provides comprehensive onboarding training, professional development opportunities, and competency-based performance evaluations | Includes effective supervisors who motivate staff to perform consistent with job expectations and at high levels
TOO FEW STAFF
One of the ways that quality programs ensure the safety of both staff and residents is by staffing residences with the appropriate number of employees. The “appropriate” number will differ, based on the unique needs of the individuals that live there, but should always be enough to maintain each person’s level of supervision. The number of staff present should also be high enough so that staff can intervene if necessary to maintain everyone’s safety.
TOO MANY STAFF
Staffing a residential program is not always a “more is better” proposition. Having too many staff in one residence can create an overstimulating environment for residents. It may also get in the way of residents’ ability to exercise their independence. Your child should be encouraged to be as independent as possible, according to their individual abilities and needs, and a program that is overstaffed may make that difficult. A good conversation to prompt is: “To what extent do staff promote resident independence?”
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QUALITY PROGRAMS PLAN FOR THE UNEXPECTED
While residential programs are expected to follow staffing schedules that reflect appropriate levels of supervision, unexpected absences—due to illness, personal emergencies, or transportation issues—are an unavoidable reality. In these situations, strong programs distinguish themselves by having clear, well-communicated systems in place to respond quickly and maintain resident safety. Staff calling out should be given clear guidance on exactly who to contact and within what time frame. Equally important is setting the expectation that staff already on shift may need to stay until coverage arrives, ensuring that no one is left without the appropriate level of supervision. Programs should maintain an up-to-date list of on-call personnel who have a defined process for securing coverage. On-call staff should understand their responsibility to seek coverage if they are going to be absent. They should also be trained to make a report to their supervisors if a colleague fails to show up. Having these systems clearly outlined and consistently reinforced ensures that, even in the face of unexpected staffing challenges, residents remain safe.
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FAMILIES AND COMMUNITY
Residential programs should ensure that every effort is made to include guardians and family members in the life of the individual via communication, visits, and activities (as desired and appropriate) and to answer communication from the guardians and family promptly and professionally.
Ask how the program:
| Answers communication from the guardians and family promptly and professionally, including how long it should take to get a response to a routine question versus a more urgent issue
| Who to contact about which issues
| Informs guardians and family members of individuals’ rights, service options, agency and related policies, DDD policy, regulations, and circulars, and how to formally provide positive and constructive suggestions
| Clearly defines and agrees upon roles and responsibilities of guardians and family members that are in the best interest of the individual
| Offers written quarterly reports regarding the individual’s health and well-being, progress toward ISP goals, and any improvements and regression since the previous quarter | Promotes community participation based on individual’s preferences and the team’s ability to maintain everyone’s safety
| Works with community members to develop community accommodations as needed
PROGRAM EVALUATION
Residential programs should encourage the individual toward building a fulfilling life for themselves.
Ask how the program:
| Implements a systematic examination of program outcomes, including percentage of individuals’ goals met and stakeholder satisfaction
| Determines its major performance indicators
| Chooses the person or team responsible for quality monitoring
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Residential Placement Referrals After learning what questions to ask, many families want to know where they can find a list of residential programs. Unfortunately, it’s not quite that simple, as finding a residential program often requires lining up funding, availability, and fit, all three of which can feel like moving targets. A good place to start for parents of adults enrolled in and receiving services from the Division of Developmental Disabilities (DDD) is to contact their support coordinator. Support coordination uses a person-centered team approach to help adults with autism plan and budget their services. They also connect individuals to DDD- approved resources, services, and supports.
Families can also browse iRecord, the state-maintained database of all DDD- approved providers, to find the providers that offer individual supports.
Families can also contact our 800.4.AUTISM Helpline at any time with questions about services and requests for referrals.
They can also search the Autism New Jersey online referral database, using the search term “Adult Services - Individual Supports.”
For more information about housing for adults, visit our Introduction to Housing article and read our publication The Journey to Community Housing with Supports: A Road Map for Individuals and Their Families in New Jersey .
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NOTES |
Download the Residential Program Quality Indicators Workbook to guide your questions and keep detailed notes.
Darren Blough MSW, BCaBA, LaBA Public Policy & Clinical Partnerships Director
Jon Gottlieb, Esq. Helpline & Family Advocacy Director
For their expertise, dedication to the field, and help in the creation of this publication, Autism New Jersey would like to extend our thanks and appreciation to:
Dennis H. Reid, Ph.D., BCBA-D Director, Carolina Behavior Analysis and Support Center
Elizabeth M. Shea, Esq. Of Counsel, Porzio Bromberg & Newman P.C Managing Partner, ZT Solutions Group
800.4.AUTISM | www.autismnj.org
May 2026
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