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Division of Developmental
Disabilities
The Historical Perspective – an Introduction to Supporting Persons with Challenging
Behaviors
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The Historical Perspective
Based on a belief that peoples differences are more important than their similarities
From 1880 to 1950 people were served in institutions.
Our 1st institution was Lakeland Village established in 1905.
By the 1950’s over 4,000 people lived in institutions –isolated from their home communities.
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The Historical Perspective
1950s to 1960s – Families Demand Community Services
Willowbrook - Exposed by Geraldo Rivera
Kay Epton – powerful woman legislator in the 60’s started the Epton Centers
The migration began from the institutions to Group Homes
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The Historical Perspective
1970s – Professional Influence
Mark Gold – People can learn – if one way doesn’t work, try another way.
Education for ALL 1974 – WA first in 1972
John and Connie Lyle O’Brien – the perceptions you hold can actually hurt other people - PASS workshops
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The Historical Perspective
Mid – 70s Created a field operation case services & family support known as Home Aid.
Realized large group homes (20-30 people) was not where people wanted to live.
Started AL and SL
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The Historical Perspective
The 1980’s “Be careful what you build” – The further you get from typical, the more likely you will soon have to tear it down. Published the Residential and County Guidelines – 6 benefits
Start moving towards full employment
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The Historical Perspective 6 Benefits –
Hospital
Health and Safety
Personal Power and Choice
Personal Value and Positive Recognition By Self and Others
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The Historical Perspective 6 Benefits (continued) A Range of Experiences Which Help People Participate in the Physical and Social Life of Their Communities
Good Relationships with Friends and Relatives
Competence to Manage Daily Activities and Pursue Personal Goals
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The Historical Perspective
The 1990’s- Quality Assurance
Measure Success by evaluating against the 6 Benefits
Parent Coalitions
Self – Advocates demand respect, homes and jobs.
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The Historical Perspective
The 2000s- Partnerships If you want to know your partners, look for the person in your way – Linda Rolfe
9 Critical Audits shaped our future
Opportunity to improve our data, show the impact of not serving families.
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The Vision for the Future
We will continue the work, create a “real” life for people with Developmental Disabilities. We will build better partnerships. We will remain constant in our VALUES.
Don’t try to figure out who did something wrong, focus on what is right.
Linda Rolfe- Division Director – Residential Conference - 200738 years of service in 3 different regions
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Supporting Persons With Challenging
Behaviors
Tom James Ph.D. DDD Region 5 Field Services
Psychologist [email protected]
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DDD POSITIVE BEHAVIOR SUPPORT POLICY 5.14
Describes the Division's general approach to promoting quality of life and adaptive behavior ….. by
providing positive behavior support for individuals with
challenging behaviors.
Positive behavior support must be emphasized in all services
funded by DDD for persons with developmental disabilities.
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POSITIVE BEHAVIOR SUPPORT
Is an approach for dealing with challenging behavior that
focuses on changing the environment and skill deficits that contribute to the person’s problem
behavior.
Is based on respect, dignity, and personal choice.
It helps develop effective means of meeting a person's needs and helps
reduce problem behaviors.
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COMMON TYPES OF SUPPORT
Assisting a person to live in a home that is safe, attractive, and in a
location that is readily accessible to the community, activities, friends, and
relatives
Providing a person opportunities and assistance to:
Learn how to make choices and exercise personal power
Manage daily activities, pursue personal
goals, and access good health care
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Form and maintain significant friendships and relationships
Participate in a broad range of activities that the person enjoys
Promote positive recognition by self and others,
Include work, leisure, socialization and personal interests.
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THINGS TO DOTO SUPPORT A PERSON
WITH CHALLENGING BEHAVIORS
OR
HOW TO UNCOVER THE REAL THINGS THAT A
PERSON MIGHT NEED SO THAT YOU CAN BE MORE
SUPPORTIVEFrom 10 Things You Can Do To Support A person With Difficult Behaviors David Pitonyak PhD 2002, my mentors,
the persons with challenging behaviors I have been privileged to know and to learn from, Ruth Ryan MD, and Wade Hitzing PhD
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GET TO KNOW THE PERSON
The Whole Human Being, not just the their labels,
behaviors etc.
Spend time with the person in places they enjoy,
at times of the day they choose.
Tell the person about your concerns
and ask for their permission to help.
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ALL BEHAVIOR IS MEANINGFUL
Challenging Behaviors are messages
about unmet needs and the quality of a person’s life:
I don’t feel safe I have no power
I’m lonelyI’m bored
You don’t value meI don’t know how to tell you what I
needMy body hurts
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Ask the person and their supporters what the person needs to be happy.
Find out who the person counts on
in a pinch.
How often does the person see loved ones or friends?
What are the person’s favorite
things to do?
Where does the person like to go
to?
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What leads to the person becoming unhappy?
Who are the people the person does not like?
How often does the person see
them?
What are the person’s least favorite
things to do?
Does the person have a way to let others know what they need and
how they feel?
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Is the person in physical or psychological distress?
What kinds of medications is the
person taking?
Do the medications help?
Are there times when the person’s challenging behaviors happen more
frequently?
Are there times when the person’s challenging behavior happen less
frequently or not at all?
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HELP THE PERSON DEVELOP
A SUPPORT PLAN
Not a plan to “Fix” the person,a plan to support the person
having a real and authentic life:
How can we help the person to achieve
health and well being?
How can we help the person to maintain
their relationships and to make new ones?
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How can we help the person to increase
their presence and participation in everyday community life?
How can we help the person to have more choices in life?
How can we help the person to learn skills
that enhance their participation in community life?
How can we help the person to make a
contribution to others?
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DEVELOP A SUPPORT PLAN FOR THE
PERSON’S SUPPORTERS
What can be done to increase support staff’s level of safety and comfort
when someone is behaving dangerously?
What can be done so that everyone,
the person and support staff, have more fun at work?
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How can staff have more control over their schedule?
How can support staff get more training and consultation
to better understand the needs of the people they are
supporting?
How can support staff have more input into decisions?
How can managers better support, support staff?
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DON’T ASSUME ANYTHING
Don’t underestimate a person’s potential because of labels, or
because they have failed to acquire certain skills.
People have gifts and capacities
that outshine our labels.
A person’s potential depends largely upon the adequacy of their supports
rather than on their inherent flaws or “defects”.
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Always speak directly to the personand explain things as clearly as you
can, even if the person’s labelsuggests that they cannot
understand.
Never speak about a person
as though they were not in the room.
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RELATIONSHIPS MAKE ALL THE DIFFERENCE
Loneliness is the most significant disability of our time.
Connection to other human beings is vital to quality of life.
All too often, the only relationships the person we support has
are paid staff.
There are many people in the community who could benefit from
knowing this person we are supporting.
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HELP THE PERSON TO DEVELOP A POSITIVE
IDENTITY
Help the person to find a way to make a contribution.
Help the person to learn how to support friends.
Help the person and others to see strength
and the capacity to give, when deficits
were all that anyone ever saw before.
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INSTEAD OF ULTIMATUMS, PROVIDE
CHOICES
If the person’s behavior challenges you,
help them find more desirable ways to express the need that underlies
the behavior.
Provide opportunities for the person to make decisions throughout the
day.
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If the person has trouble making choices, find a way
to help them to make choices.
Make a commitment to fairness in your relationship
with the person you support.
The goal is to teach the person that giving is a two way street.
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HELP THE PERSON TO HAVE MORE FUN
Fun is a powerful antidote to challenging behaviors.
Count the number of things
the person enjoys, the number of places they like to
go.
Compare this to the number of things other people enjoy,
and the number of places other people go.
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Is this person having fun?
Is this person experiencing enough joy?
Is this an interesting life, with
things to look forward to?
Help the person to add to their list of really interesting and fun things to do and places to go. Spend time
with the person in regular community places where people
hang out.
Make fun a goal.
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ESTABLISH A GOOD WORKING RELATIONSHIP
WITH THE PERSON’S PRIMARY HEALTH CARE
PHYSICIAN
Many people who exhibit challenging
behavior do so because they don’t feel well.
Physicians, like many other people have difficulty understanding the communication of a person with
substantial disabilities.
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Help the physician to understand the person’s ways of communicating.
Help the physician by learning what
information they need and by making a sustained effort to provide good
information to them.
Don’t be afraid to tell the physician that you don’t understand a finding or
a recommendation. It is important that
you get clear and straight forward answers
to all of your questions, so that you have a clear understanding of how to
support the person.