Bittersweet Farms in Ohio has served adults with severe autism since the 1980s, transforming lives of upheaval and isolation to lives of engagement and purpose.
There is an urgent need to develop new residential programs for the vast and growing population of adults with severe autism. The preeminent example of a successful model for those who enjoy the outdoors and farm-related activities is Bittersweet Farms in Ohio. A new books delves into the stories of many of the residents, the program philosophy, and a few of the operational details, including staff management. Check it out
What are the secrets to Bittersweet's success? While the book does not cover the vital aspect of financial structure and how they cover operating costs with Medicaid HCBS, ICF and private dollars, we do learn the land for their sites was essentially free, which no doubt was one very helpful factor. But it does go into detail about what makes things work from a programmatic perspective, for both its residential and day programs, to wit:
• Appropriate setting. The book offers voluminous evidence that a farm setting provides the calm, tranquility, nature, open spaces and physical activity that benefits many adults with severe autism. The setting greatly reduced anxiety and stress in the clients, who often suffered intense sensory overload. And knowing how isolated and small their clients' lives were beforehand, building a sense of belonging and connected community is a core aspect of Bittersweet's approach.
• Person-centered planning. Everything about their program is built around the specific needs and desires of the clients. And the staff is always looking for the positive in every client, no matter how challenging, and improving communication is a key focus.
• Abundant choices of activities. This was impressive! Pretty much a dream come true. Walking, hiking, swimming, crafts, weaving, woodworking, farming, groundskeeping, bicycling, sports, music, bell choir, and work related to produce sales to name some. None of these were mandated, and none meant foregoing broader engagement in the community.
• Structure. Most of the clients have a high degree of inflexibility. The individualized programs are well structured and predictable.
• Staff qualities and retention. Let's just say the word "patience" is very often used to describe a key trait of those who work there. The job descriptions at pages 70-79 are probably the most important part of the book — the list of qualifications and tasks was jaw-dropping, and the book admits to the challenges finding and keeping good staff.
• Partnerships with other professionals, including behavior therapists and speech therapists. More details about psychiatric and medical management would have been helpful.
The book does not beat around the bush about its clients' behavioral challenges. We hear about aggression toward others, unpredictable hitting, self-injury, constant screaming, eating of inedible objects, eloping, inappropriate sexual behavior, throwing bicycles, plugging toilets, and more. But in detailed client histories we see how their behavior and adaptive skills improved over time in the program.
Bottom line: we oh-so desperately need more models like Bittersweet. While the so-called "disability rights" movement would like to shutter farmsteads by irresponsibly and misleadingly likening them to "institutions," let us remember that Bittersweet was created as a therapeutic and humane alternative to institutions. Farm life is nothing short of a person-centered lifesaver for many autistic adults who would suffer immeasurably isolated in an urban apartment. While farmsteads are definitely not the solution for every case, they represent an essential segment of the full continuum of care, and we need legislation ensuring their replication and continued success.
—Jill Escher