" You are important to me " Help DSPs be the best they can be John Dickerson, Mary Ciccarelli, Kelly Hartman September 2018
1. Improve training of Managers and DSPs 2. Discuss emerging client heath and wellness issues Objectives 3. Discuss emerging behavioral health issues 4. Establish a culture of workforce well-being
1. 70% Women – moving from second paycheck in family to only paycheck 2. 40% are recent immigrants to this country 3. $400 unexpected bill is crisis point 4. 60% are underbanked – have checking account with debit card no checks or savings DSP Workforce 5. Growing number of immediate family members are now direct staff for their family member- estimated 20% in Indiana 6. Subject to payday lenders predatory practices 7. Transportation and day care are critical parts of their lives 8. 50% turnover – most moving from one agency to another
Make no mistake : Raising salaries and benefits for our workforce is absolutely essential - but there is so much more we need to do.
Think of the very best staff you have hired in the last six months
Mindful Communication Three takeaways that you Building Your Culture can start practicing today! Hiring, promoting the right people
15 minutes a day looking for the extraordinary Tell your team about their success Mindful Five Dime exercise Communication Look to your email, texts and voice mails Realize how your staff communicate today is different than how you do Everyone responds to positive attention What behaviors do you model, talk about with your managers Rowers, Sitters, Drillers
Answer the question “How much time do you spend developing the culture of your organization?” Building Your What’s your cultural Culture address? Ask others what brings them joy? Do more of it!
Do it Better … One at a time
Orientation ID future all-stars Keep list of people to mentor-encourage Promote people who get to know their staff, their family situation, their kids Hiring, Would you take an 8 hour road trip with promoting the this new hire? right people Coverage or Character Ambassadors – your best recruiters Ask your staff what brings them joy?
Intro
Summary
Let’s make it simple. “You are important to me.” DSP staff are important to their employer organization. DSP staff themselves are important to the people they serve. Helping persons with intellectual disabilities doesn’t have to be highly scientific or complex. Let’s build concrete, small steps to better serve this population. Use reflections: Walk just a minute in my shoes. Introduction Ask questions: What am I trying to tell you with my words and actions? What do I feel and sense? About my body? About you? About my world? What are my brain's strengths and weaknesses? Expand your basic understanding of the persons we serve.
Intellectual Disability Mild IQ 50–55 to 70 Moderate IQ 35–40 to 50–55 Severe IQ 20–25 to 35–40 Profound IQ < 20–25
What does this mean? Adaptive function with significant limitation before age eighteen Issues with Perceptions, Reasoning, Memory, Speed Patient has areas of need in their life: Communication, handling money, self-managing Interacting with others, following rules Daily activities – taking care of own body and home, getting around
A. Social communication and interaction 1. Usual back and forth of interaction between people AUTISM 2. Showing emotions, acting typically within a society What does this mean? 3. Maintaining relationships – distinguishing different interactions or desire to interact with others B. Restricted, repetitive patterns 1. Echoing language, doing something over and over 2. Uses rituals - can’t change pattern of behavior, selective eating, asking same question 3. Fixated on something – i.e. loving trains or dinosaurs or a TV show 4. Oblivious or bothered by sensory information, i.e. pain, smells, noises
Health Habits
How does the patient communicate? Is receptive language better than expressive language skills? Verbal language Sign language Switches Communication Pictures Augmentative Communication Devices Proloquo2Go on ipad
How does the patient manifest pain? Pain
Does the patient manage own body cues and health habits? Continence, swallowing, thirst, sleepiness, hunger, etc. Health Habits Does anyone observes activities of daily living? Eating, toileting, etc. Value of Health Habit Education Special Olympics Indiana project Value of Comprehensive Health Check Prevent predictable problems Royal College of GPs’ guidelines: Annual Health Checks in people with learning disabilities
Eating Food selectivity Choking Over/underweight Hydration Body cues: Toileting What do we Diarrhea & constipation know? Urinary incontinence Menstrual hygiene Hygiene Wash hands, bathe, cut nails, etc. Sleep problems
Individuals with ID increased morbidity & mortality 1. Aspiration 2. Dehydration 3. Constipation 4. Seizures “The Fatal Four” & Perceptual Morbidity associated with limits in perceptual reasoning Reasoning Sensing information from one’s body and reasoning next steps “Is my bladder full? If I don’t listen to that cue, I have an accident.”
Interventions Set mealtimes and meal durations Minimize distractions (TV, phone) Food cravings & refusal Keep meals calm w/ goal as enjoyable experience Selectivity & texture specificity Adults sit down with children and eat Fussy Eating same foods Specificity in presentation Offer the child what everyone else eats, also provide a preferred food Grazing Refrain from pleading and threatening Disruptive mealtimes Use ignoring or brief time-outs if Cramming, pace, poor chewing needed After family finishes, allow child also Kodak T. Child & Adol Psych Clinics to leave table NA, 2008 Don’t provide food until next scheduled meal/snack Intensive programs
Toileting issues Kids with PDD GI 46% had GI sx Daytime behavioral problems 45% diarrhea/constipation 19% diarrhea, 19% constipation, 7% alternate diarrhea & constipation Rectosigmoid loading54% , acquired megarectum 24% c/w 2%–5% gen peds popln Erickson CA. J Autism & Dev Disorders, 2005. https://www.youtube.com/watch?v=SgBj7Mc_4sc
What do you drink? How much? What color is your Hydration pee? Use a water jug for the day.
Timed sitting Toileting aids Visual supports Step by step process Awareness of sensory issues Treat constipation Clean out Floppy colon Maintenance and Flares Wheeler, M. Toilet Training for Individuals w/ Autism & Related Disorders
How much sleep do you need? Principles of sleep hygiene Regular and consistent bedtime Structured bedtime routine Avoid caffeine Regular exercise Avoid interfering activities (e.g., TV in bed) Restriction of daytime sleep Consider sensory appropriate bedding textures Sleep Melatonin decreases sleep latency and onset Risk - alter seizure threshold 0.5 -1 mg at 1 hour before bedtime “Resets” Light therapy Consider iron deficiency Malow BA. Mental Retard & Dev Dis Res Rev, 2004. Wirojanan J. J of Clin Sleep Med, 2009.
Hygiene – training and reminders
Increased dental caries risk Dental hygiene needs Ritual Type of toothbrush Source of fluoride Marshall J. Ped Dentistry, 2010. Dental Hygiene Weekly tooth-brushing instruction Improved dental care 8.8 > 48.8% all surfaces Bizarra F. Intl J Dentl Hygn, 2009.
Checklists
Behav avior or 32
Situation –> Behavior yell, scream, cuss Argument with partner slam doors, throw things Feel achy all over drink, smoke, take drugs Remember funny joke bite your nails Bad day at work withdraw, sleep, eat Nervous about traveling laugh out loud, repeat self 33
Labels Separate People yell, scream, cuss > VERBAL AGGRESSION > PHYSICAL AGGRESSION slam doors, throw things > SELF INJURY drink, smoke, take drugs > ANXIETY bite your nails > DEPRESSIVE SYMPTOMS withdraw, sleep, eat > PSYCHOSIS laugh out loud, repeat self 34
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PBS 101 Positive Behavior Supports What PBS is: Belief that all behavior is a form of communication. Understanding that people don’t randomly have behaviors – there is a reason We want to develop strategies to help people get what they want safely Preventative, Proactive, Supportive Person Centered Based on strong functional assessment (The team has to know WHY!) 38
PBS 101 Positive Behavior Supports What PBS is NOT: Generic Aversive Restrictive Use of manual or mechanical restraints Crisis Intervention 39
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