Download - Helping People Without Making Them Helpless: Fun, Functional, and Other F Words Tim Feeney, Ph.D. Project Director New York Neurobehavioral Resource Project.

Helping People Without Helping People Without Making Them Helpless:Making Them Helpless:

Fun, Functional, and Other “F” WordsFun, Functional, and Other “F” Words

Tim Feeney, Ph.D.Project Director

New York Neurobehavioral Resource ProjectBinghamton, NYClinical Director

School and Community Support Services600 Franklin Street

Suite 110Schenectady, New York USA 12305

[email protected]

““I’m a person, not a patient; I’m a person, not a patient; and I’m not ‘and I’m not ‘yoursyours’!”’!”

Grandma Masse’s Rules for Success:Grandma Masse’s Rules for Success:

““The smart guys are the guys who learnThe smart guys are the guys who learnfrom the other guys. Don’t get all caught up from the other guys. Don’t get all caught up

in one thing; everyone believes their thing is in one thing; everyone believes their thing is the best thing and they’re usually wrong.the best thing and they’re usually wrong.

So, shut-up and listen and learn and change.”So, shut-up and listen and learn and change.”

In order to be successful In order to be successful you’ve got to be eclectic; moreover, you’ve got to be eclectic; moreover,

we need to learn from other literatures we need to learn from other literatures from other populations from other populations

More Grandma MasseMore Grandma Masse

““Models collect dust on shelves.”Models collect dust on shelves.”

Don’t fall in love with a particular Don’t fall in love with a particular approach – approach –

ideally, you’ll/we’llideally, you’ll/we’ll

create a framework for intervention (a create a framework for intervention (a working theory) that will evolve with working theory) that will evolve with

experience and evidenceexperience and evidence

You can make peopleYou can make peopledo things that theydo things that they

just don’t want to dojust don’t want to dobut the price for doingbut the price for doing

so will be highso will be high

Poodle

FUNCTIONALFUNCTIONAL

does not equaldoes not equal

Increased/Improved Increased/Improved performance onperformance on

standardized testsstandardized tests


does not equaldoes not equal

BowlingBowling

or theor the

The Friday OutingThe Friday Outing

or theor the

The really neat, The really neat, really expensive,really expensive,

simulated. . . simulated. . .


equalsequals

Creating stable routines of life thatCreating stable routines of life thatenable me to do what I need to doenable me to do what I need to do

when I need to do it.when I need to do it.

“ “ A coach gets guys to do the things A coach gets guys to do the things they don’t want to do so they they don’t want to do so they can become the players that can become the players that

they want to be.”they want to be.”- Walt Harris

““We’re all coaches”We’re all coaches”

A good coach:A good coach:

• • Alters his/her coaching to Alters his/her coaching to reflect the needs of the player reflect the needs of the player and conditions of the context.and conditions of the context.

• • Never tries to play the gameNever tries to play the game him or herself.him or herself.

The glass ain’t half empty, The glass ain’t half empty, it’s half full!it’s half full!

andand

You can teach 1/2 emptyYou can teach 1/2 emptypeople to become 1/2 full peoplepeople to become 1/2 full people

(it’s hard to teach 1/2 empties to(it’s hard to teach 1/2 empties tobecome 1/2 fulls)become 1/2 fulls)

PERSON

Motor SKills

Cognition Language Emotion Volition Behavior

Human beings are a collection of Human beings are a collection of relatively independent structures, relatively independent structures,

processes, and systemsprocesses, and systems

John’s Cognition

Attention Perception Memory Organization Reasoning EF

ArousalSelectDirect/ FilterMaintainDivideShift

Encode/Store/RetrieveEpisodic/SemanticExplicit/ImplicitDeclarative/ProceduralInvoluntary/StrategicWorking Memory/ Knowledge BaseRemote/RecentPro/retrospectiveIconic

SequenceCategorizeAssociateAnalyzeSynthesize

InductiveDeductiveAnalogicalDivergentConvergent

Goals for John - John will:1. Increase duration of maintained attention2. Increase prospective memory from 3 to 5 minutes3. Increase category naming from 3 to 5 members per category

John’s Language

Phonology MorphologySyntax Semantics Pragmatics

Receptive vs. ExpressivePhrase Structure RulesEtc.

Receptive vs. ExpressiveLexiconSemantic RelationsDiscourse Structures

Receptive vs. ExpressiveSpeech-act CompetenceConversational CompetenceSocio-linguistic Competence

Goals for John: John will1. Decrease mean naming latencies from 3 to 2 seconds2. Include 5 basic story grammar elements in retellings3. Use politeness markers in greeting people: 90%

John’s Behavior

John

b1 b3 b12 b4 b1 b7 b62 b17 b17 b17 b4 b6 b9 b17 b12 b3 b8 b8 b5 b6 b17

Goals for John: John will1. Increase frequency of b3 and b122.Decrease frequency of b17

John is the totality of his behaviors and the systematic relationships among them

Alternative Understanding of Human Beings

Sarah

Pursuing personally meaningful goals

While participating in culturally valued activities

Using cultural tools, such as language, category schemes,mathematics, organizational supports, domain-specific strategies

Mediated as necessary by individuals with greater expertise in that domain

In social, cultural, and historicalcontexts

In the presence of varied context facilitators and barriers

Intervention GoalsIntervention Goals

Sarah will successfully complete ___ meaningful task, with ___ supports, possibly using ___ “tools/strategies”, in ___ context (setting, people, activities), in order to achieve ___ goal.

Possibly focusing intervention attention on some specific aspects of cognition, communication, social skills, behavioral self-regulation, or educational/vocational skills – aspects that are either particularly weak or particularly important for Sarah.

Research-Based Intervention Strategies Related to Common Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain InjuryCharacteristics of Individuals with Brain Injury

Characteristic: Fluctuating AttentionFluctuating Attention

Strategy: Appropriate PacingAppropriate Pacing

Delivering material in small increments and requiring Delivering material in small increments and requiring responses at a rate consistent with the individual’s responses at a rate consistent with the individual’s processing speed increases the acquisition of new processing speed increases the acquisition of new materials.materials.

Research-Based Intervention Strategies Related to Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain InjuryCommon Characteristics of Individuals with Brain Injury

Characteristic: Memory ImpairmentMemory Impairment

Strategy: Errorless learning and high rates of Errorless learning and high rates of success in interactionssuccess in interactions

Acquisition and retention of new information tends to Acquisition and retention of new information tends to increase with high rates of success (and error increase with high rates of success (and error frequency increases with frequent errors and error frequency increases with frequent errors and error correction).correction).


Characteristic: Organizational Impairment and Organizational Impairment and Inefficient LearningInefficient Learning

Strategy: Task analysis of activities and advance Task analysis of activities and advance organizational supportorganizational support

Careful organization of learning and tasks including Careful organization of learning and tasks including systematic sequencing of intervention targets and systematic sequencing of intervention targets and advanced organizational supports increases success.advanced organizational supports increases success.


Characteristic: Inefficient Learning and Inefficient Learning and Inconsistency in PerformanceInconsistency in Performance

Strategy: Massed practice and review including Massed practice and review including frequent cumulative review frequent cumulative review

Acquisition and retention of new information and Acquisition and retention of new information and consolidation of old information in memory is consolidation of old information in memory is increased with frequent, routine-based review.increased with frequent, routine-based review.


Characteristic: Inefficient Feedback Loops and Implicit Inefficient Feedback Loops and Implicit Learning of ErrorsLearning of Errors

Strategy: Errorless learning combined with corrective Errorless learning combined with corrective (and brief) feedback when errors occur. (and brief) feedback when errors occur.

Many individuals with severe memory and learning Many individuals with severe memory and learning problems benefit from errorless learning. When errors problems benefit from errorless learning. When errors occur, learning is enhanced when those errors are occur, learning is enhanced when those errors are followed by non-judgmental corrective feedback. followed by non-judgmental corrective feedback.


Characteristic: Frequent Failure of Transfer/Concrete Frequent Failure of Transfer/Concrete Thinking and LearningThinking and Learning

Strategy: Facilitation of transfer, generalization, and Facilitation of transfer, generalization, and maintenance via contextual teaching. maintenance via contextual teaching.

Generalization is more likely when skills are taught in the Generalization is more likely when skills are taught in the context in which they will be used (context is encoded context in which they will be used (context is encoded with information). In addition, using a general case with information). In addition, using a general case approach (wide range of examples and settings) increases approach (wide range of examples and settings) increases generalization.generalization.


Characteristic: Unpredictable Recovery, Unusual Unpredictable Recovery, Unusual Profiles, and Inconsistency in BehaviorProfiles, and Inconsistency in Behavior

Strategy: Ongoing assessment and flexibility in Ongoing assessment and flexibility in curricular modification. curricular modification.

Adjustment of interaction based on ongoing assessment Adjustment of interaction based on ongoing assessment of the individual’s progress facilitates learning and of the individual’s progress facilitates learning and allows for curricular modifications “on the fly”.allows for curricular modifications “on the fly”.


Characteristic: Impaired Strategic Behavior/ Impaired Strategic Behavior/ Impaired Organizational FunctioningImpaired Organizational Functioning

Strategy: Strategy-based intervention. Strategy-based intervention.

Organized intervention designed to facilitate a strategic Organized intervention designed to facilitate a strategic approach to difficult tasks, including organizational approach to difficult tasks, including organizational strategies.strategies.


Characteristic: Decreased Self-Awareness/ Denial Decreased Self-Awareness/ Denial of Deficitsof Deficits

Strategy: Self-awareness/attribution trainingSelf-awareness/attribution training

Facilitation of individual’s understanding of his/her Facilitation of individual’s understanding of his/her role in learningrole in learning


Characteristic: Behavioral DifficultiesBehavioral Difficulties

Strategy: Positive behavior supportsPositive behavior supports

Using an approach to behavior intervention that Using an approach to behavior intervention that focuses primarily on the antecedents of behavior in the focuses primarily on the antecedents of behavior in the broadest sense (including setting events and broadest sense (including setting events and establishing operations), environmental management, establishing operations), environmental management, and role improvement.and role improvement.

Fun as an Important Element of Fun as an Important Element of RehabilitationRehabilitation

Therapeutic:Therapeutic: Serving to sure or heal Serving to sure or heal

Fun:Fun: Lively, joyous, playful Lively, joyous, playful

Do you ever ask yourself:Do you ever ask yourself:

““Where is the fun?”Where is the fun?”

rather thanrather than

““Are we having fun yet?”Are we having fun yet?”

FUN IS NOT:FUN IS NOT:

Worrying about being politically correctWorrying about being politically correct Going to “therapy”Going to “therapy” Doing a workbook activityDoing a workbook activity Working on fricatives in the speech closetWorking on fricatives in the speech closet Working to meet some fricking criterion onWorking to meet some fricking criterion on

some fricking test before I can get out ofsome fricking test before I can get out ofthis fricking placethis fricking place

Being told to “be realistic”Being told to “be realistic” Being told to “be realistic” by some snot-Being told to “be realistic” by some snot-

nosed twenty-something who hasn’t lived lifenosed twenty-something who hasn’t lived lifelike I havelike I have

FUN IS:FUN IS: The 1st timeThe 1st time KidsKids PlayPlay JokingJoking FriendsFriends SpongeBob SquarepantsSpongeBob Squarepants LaughterLaughter HopeHope Feeling connectedFeeling connected Feeling usefulFeeling useful ViagaraViagara Being naughtyBeing naughty LoveLove Pure joyPure joy Doing something you really like with someoneDoing something you really like with someone

you really likeyou really like Accomplishing something meaningfulAccomplishing something meaningful

It’s important to have fun It’s important to have fun with and create opportunitieswith and create opportunities

for fun and to laugh a lotfor fun and to laugh a loteven in the face of even in the face of

significant challengessignificant challenges

MINDSETS NOT CONDUCIVE TO FUN:MINDSETS NOT CONDUCIVE TO FUN:

The Oprah TypeThe Oprah Type - victim/tragedy/altruist - victim/tragedy/altruist Typical utterances:Typical utterances:

““Suffers from . . .”Suffers from . . .”““Victim of . . .”Victim of . . .”

The Dr. Kildare TypeThe Dr. Kildare Type - medical orientation - medical orientationTypical utterances:Typical utterances:

““The patient . . .”The patient . . .”

The Dr. Phil TypeThe Dr. Phil Type - control/territorial - control/territorialTypical utterances:Typical utterances:

““You gotta . . .”You gotta . . .”““We tried that before, it’ll never work”We tried that before, it’ll never work”““Because I’m the expert”Because I’m the expert”““This is my area, don’t mess with me!”This is my area, don’t mess with me!”

MINDSETS CONDUCIVE TO FUN:MINDSETS CONDUCIVE TO FUN:

FlexibleFlexibleTypical utterances:Typical utterances:

““Yeah, we can do that.”Yeah, we can do that.”““That looks interesting, different than I thoughtThat looks interesting, different than I thought but it’s worth a try.”but it’s worth a try.”

CollaborativeCollaborativeTypical utterances:Typical utterances:

““Whaddaya think?”Whaddaya think?”““Geez, that’s a good idea, let’s give it a shot.”Geez, that’s a good idea, let’s give it a shot.”

MatureMatureTypical utterances:Typical utterances:

““You’re right!”You’re right!”““Some things I can’t change.”Some things I can’t change.”

MINDSETS CONDUCIVE TO FUN:MINDSETS CONDUCIVE TO FUN:•• Risk takingRisk taking

Typical utterances:Typical utterances:““Well, I don’t know what might happen . . .”Well, I don’t know what might happen . . .”““What’s the worst that could happen?”What’s the worst that could happen?”““What’s the benefit?”What’s the benefit?”““Sometimes it’s easier to ask for forgivenessSometimes it’s easier to ask for forgiveness than for permission”than for permission”

• • HopefulHopefulTypical utterances:Typical utterances:

““Hey, we’re onto something here!”Hey, we’re onto something here!”““Let’s give it a shot.”Let’s give it a shot.”““Sure, we can do that.”Sure, we can do that.”

••Self-EffacingSelf-EffacingTypical utterances:Typical utterances:

““I don’t think I could think like that.”I don’t think I could think like that.”““I couldn’t ever.”I couldn’t ever.”

FriendlyFriendly (adj.) 1 like, characteristic of, or suitable for a friend, friends, or friendship; kindly 2 not hostile; amicable 3 supporting; helping; favorable

FellowshipFellowship

(n.) 1 a mutual sharing, as of experience, activity, interest, etc. 2 a group of people with the same interests; company; brotherhood

Frequent Frequent (adj.) 1 occurring often; happening repeatedly at brief intervals 2 constant; habitual.

FaithfulFaithful (adj.) marked by or showing a strong sense of duty or responsibility

Feeling Feeling (v.) to be moved by or very sensitive to

Fair Fair (adj.) just and honest

Fabulous Fabulous (adj.) very good; wonderful

FantasticFantastic

(adj.) seemingly impossible; incredible

FollyFolly (n.) 1 a lack of understanding, sense, or rational conduct; foolishness 2 any foolish action or belief 3 any foolish and useless but expensive undertaking.

FoolhardyFoolhardy (adj.) bold or daring in a foolish way; rash; reckless

FiascoFiasco (n.) a complete failure.

FailFail (v.) to be deficient or negligent in an obligation or duty

FecalFecal (adj.) of or consisting of feces

Four Lessons to Live by:Four Lessons to Live by:

• Hope is an essential part of

any successful plan of support.

• Form follows function. Think

about what the individual needs

and then create a way for that

to happen in a flexible manner.

• The more you try to force something

or someone to change, the more

it (or he or she) changes you.

• When all else fails, a sense of joy

and a sense of humor can get you

through a whole lot!

FinishedFinished (adj.) 1 ended; concluded 2 completed 3 highly skilled or polished; perfected; accomplished 4 given a certain kind of finish or surface, as of paint, wax, etc. 5 defeated, ruined, dying, etc. 6 no longer dealing with or concerned with.