Impact Manual-Eng Finasl Copy

IMPACT is respectfully dedicated to the beautiful children of Romania, who accepted and trusted in me to play a small part in giving them a second chance to live their lives to the fullest. It has been my absolute pleasure and honor to be a part of this positive transition.

From my heart, I am eternally thankful to my friends and partners on the HHC-R team in Baia Mare. They have taught me to have a better appreciation for those things that we all tend to take for granted. Their tireless and selfless work to do what is right for all children has humbled me. I have been given a gift in their relentless dedication to ensuring that Children’s rights are protected and respected. They are unwavering in their advocacy for those who have no voice. They are now heard, and for this I thank you, on behalf of the children.

Thanks to my friends: Delia, Stefan, and Otto, but especially to Bianca who has generously given herself to assist in the creation of this document; and to Dana, for her perfection in editing, as well as her contribution to the material included in the manual. Thanks also to Ahmad, for his design and creativity of this final product.

Over the last eight years, the partnership between HHC-R and Autistic Services, Inc. USA, with the support of the General Directorate for Child Protection, has made a profound impact on the treatment of children, and child care overall, in Romania. I thank my team at Autistic Services, Inc., who assisted those people who are committed and dedicated to the care of children, by giving them the tools necessary to improve and enhance the lives of so many.

I look forward to our continued partnership in helping vulnerable people live in an environment where they are respected, can grow, and have the chance to become contributing members of their community.

My friends in Romania, I thank you once again for trusting enough in me to take a chance.

written by Veronica Federiconi and Bianca

Stegeran

Introduction

Before you begin learning the material in this curriculum, be prepared! You are about to encounter ideas that may be unfamiliar to you and concepts that may be challenging to your current expectations about people with special needs. At the foundation of IMPACT is the belief that people with special needs can learn and grow. Yes, they can even thrive and be recognized as valuable members of the community who have much to contribute. For these possibilities to become reality, we must change our thoughts and beliefs about the supposed limitations of people with special needs. Be ready to open yourself to new possibilities, perhaps very different from the current cultural mindset.

INNOVATIVE

OBJECTIVES

Upon completion of this module, participants will be able to:

1 Understand that all children and adults with special needs have the same rights as the typical population. 2 Understand the concept of special needs and define the characteristic challenges associated with special needs. 3 Discuss the need for and purpose of strategic intervention when working with children and adults with special needs. 4 Demonstrate that their own beliefs, values and attitudes towards persons with special needs affect their actions.

UNIT ONE PRESENTATION OUTLINE

OBJECTIVE

TIME

CONTENT

MEDIA

NOTES

1.1. 40 min.

Overview of the

Convention of

Children’s Rights

Overhead 1.1.1

1.2

120 min.

A discussion

of the concept of

special needs and

their characteris

tic challenges

Overhead 1.2.1 Overhead 1.2.2 0verhead 1.2.3 Overhead 1.2.4 Overhead 1.2.5

1.3

120 min.

A discussion of the need

for and purpose of strategic

intervention when working

with children

and adults with

special needs

Overhead 1.3.1 Overhead 1.3.2

1.4

40 min.

A discussion of the way in which

our beliefs, values and attitudes affect our actions in general,

and towards persons

with special needs

Overhead 1.4.1 Overhead 1.4.2 Overhead 1.4.3

OBJECTIVE ONE:

Participants will be able to understand that all children/adults with special needs have the same rights as the typical population.

REcOmmENdEd TImE FRAmE: 40 minutes

CONTENT OVERVIEW

During this opening presentation, participants will discuss the European Declaration on

the Health of Children and Young People with Intellectual Disabilities and their Families.

The overall purpose of this portion of the unit is to make participants aware of their

responsibility to ensure that these rights are protected and respected, and that supports

are provided where deemed necessary.

INSTRUCTIONAL STRATEGIES/CONTENT

I. Using Overhead 1.1.1, discuss with participants the main ideas in the European

Declaration on the Health of Children and Young People with Intellectual Disabilities and their

Families.

1. Protect children and young people with intellectual disabilities from harm

and abuse.

All children and young people with intellectual disabilities, wherever they live, must be

guaranteed lives free from bullying, harm, abuse, or neglect, and they should not live in

fear.

2. Enable children and young people to grow up in a family environment.

Promoting secure attachments and improving family functioning limits the impact of

intellectual disability. Ongoing support to families is essential.

3. Transfer care from institutions to the community.

Residential institutions that have a negative impact on the health and development of

children and young people should be replaced by high quality community support. New

admissions to such institutions should be stopped through the development of community

services.

4. Identify the needs of each child and young person. Early diagnosis and

intervention improve long-term outcomes. Children and young people require regular

ongoing assessments of their needs and planned support to make seamless transitions at each

life stage.

5. Ensure that good quality mental and physical health care is coordinated and

sustained.

Children and young people with intellectual disabilities need the same access to health

care as other children but may also need access to specialist treatment and care.

6. Safeguard the health and well-being of family caregivers.

In order for a child with intellectual disabilities to grow up and develop within a family,

the health and well-being of the family as a whole should be supported. Enabling families

to care for their child from the time of diagnosis of intellectual disability through

adulthood can prevent harmful family strain or rejection of the disabled child.

7. Empower children and young people with intellectual disabilities to

contribute to decision-making about their lives.

Children and young people with intellectual disabilities can and will make their needs and

wishes known and contribute to their community, given appropriate support and a

receptive environment. Family members and advocates also need encouragement and

support to make themselves heard.

8. Build workforce capacity and commitment.

The well-being of children and young people with intellectual disabilities is strongly

reliant on the knowledge, skills, attitudes and commitment of staff in all settings and

sectors.

9. Collect essential information about needs and services and assure service

quality. Quality standards and adequate information systems are needed to monitor quality

of care, with transparent responsibilities for all stakeholders.

10. Invest to provide equal opportunities and achieve the best outcomes.

Ensure fair and, if necessary, preferential spending on services from which intellectually

disabled children and young people and their families benefit.

Overhead 1.1.1

European Declaration on the Health of Children and Young People with Intellectual Disabilities and their Families

1. Protect children and young people with intellectual disabilities from harm and abuse.

2. Enable children and young people to grow up in a family environment.

3. Transfer care from institutions to the community.

4. Identify the needs of each child and young person.

5. Ensure that good quality mental and physical health care is coordinated and sustained.

6. Safeguard the health and well-being of family caregivers.

7. Empower children and young people with intellectual disabilities to contribute to decision-making about their lives.

8. Build workforce capacity and commitment.

9. Collect essential information about needs and services and assure service quality.

10. Invest to provide equal opportunities and achieve the best outcomes.

OBJECTIVE TWO:

Participants will be able to understand the concept of special

needs and define the characteristic challenges associated with special needs.


CONTENT OVERVIEW

For this objective, emphasis should be placed on those characteristics of persons with

special needs which may impact their daily lives, lead to feelings of frustration, or

contribute to their response in a crisis situation. Nearly any disability can affect a person’s

ability to handle a crisis.

INSTUCTIONAL STRATEGIES/CONTENT

I. Define the terms “special needs “ and “pervasive developmental disorder”

Using a lecture format or discussion, introduce the term “special needs” that will be used

throughout the material. Explain why it is preferred to use the term “special needs” instead of

“disability” focusing on the need for a positive perspective when working with children

and adults with special needs.

The term “special needs” equals that of “pervasive developmental disorder” described in The

Diagnostic and Statistical Manual of Mental Disorders (DSM IV), as a severe and

pervasive deterioration in various areas of development accompanied by “the presence of a

behavior.”

According to DSM IV, Pervasive Developmental Disorders include: Autism, Rett Syndrome,

Childhood Disintegrative Disorder, Asperger Syndrome and Pervasive Developmental

Disorders Not Otherwise Specified (PDD-NOS).

In addition, a developmental disability:

• originates before the person attains age twenty-two • has continued or can be expected to continue indefinitely • decreases the person’s ability to function in society

• Varying degrees of difficulty in any of the following areas may be experienced and can differentially affect a person’s response in a crisis situation.

• Sensory / Motor Development (Overhead 1.2.1)

1. Disturbance in any of the senses

• hearing • vision • visual-perceptual difficulties

2. Disturbances in postural/motor skills and voluntary coordination difficulties

3. Others___________

B. Communication (Overhead 1.2.2)

1. Difficulty organizing or articulating a message

• No or poor verbal skills • No or poor manual signing skills • Unusual forms of communication • Difficulty finding words • Difficulty understanding word sequences • Does not use language well

2. Stereotyped and pervasive language

3. Limited ability to take listener’s needs into account

4. Others ____________

Cognitive Processing (Overhead 1.2.3)

1. Attention

2. Distractibility

3. Impulsivity

4. Comprehension

5. Encoding – decoding information

6. Memory difficulties

7. Central auditory processing difficulties

8. Limited problem solving skills/decision making skills

9. Others_____________

D. Social Development

Several authors have noted that relationship difficulties are likely to be more common in

persons with special needs than in the population in general. There are likely numerous

reasons which make forming attachments and developing supportive relationships

difficult for persons with special needs. Many individuals have been exposed to negative

social conditions over long periods of time, sometimes during critical developmental

phases in their lives.

Please present the following areas in which persons with special needs may have experienced

negative social conditions. See Overhead 1.2.4.

1. Labeling

It can lead to stigmatization. Historically the label “handicapped” or “retarded” has been

associated in the public’s mind with “abnormality” and “deviance.”

2. Rejection and Social Disruption

Persons with special needs often face rejection or neglect by peers as children and while

growing up. They may be separated from their families, institutionalized early. They may

experience placement in new services without considering the potential impact on the

person’s social relationships.

3. Segregation

Some persons have long histories of institutionalization in large facilities away from the

general public, often under poor social conditions.

4. Restricted opportunities

Persons with special needs may not have the usual opportunities for rewarding life. They

experience restrictions on where they live, what they do, what and when they eat, etc. The

majority will not experience dating, marriage or parenthood in their lifetime.

5. Victimization

Special needs have an associated increased risk of victimization. This may include

abuse, stealing of possessions, being taken advantage of financially or otherwise, being

made fun of, and sexual exploitation.

6. Infantilization

People with special needs have been referred to as “children,” “boys,” and “girls” despite

many of them being adults.

7. Isolation Persons with special needs often have inadequate access to social support

networks. Sometimes they are separated from their families and raised in community or

large institutions.

8. Other factors related to social development which may affect a person’s response in a

crisis situation include:

• Limited social skills • Limited social and vocational opportunities • Limited understanding of social expectations • Limited community exposure • Limited understanding of the law • Family issues • Others ___________

Emotional Development

Discuss the following issues regarding emotional development.

1 Some people with special needs have poor self-concepts or negative views of themselves. 2 Special needs have been often associated with expectation of failure. 3 Other factors related to emotional development which may affect a person’s response in a crisis situation include:

4 Limited coping and problem solving skills 5 Lack of appropriate alternative responses 6 A long history of inappropriate responses 7 Limited dealing with loss, death, grieving issues 8 Psychiatric conditions 9 Self-esteem issues 10 Emotional control difficulties 11 Difficulty reading own and others’ moods 12 Low tolerance for frustration 13 Others_______________ 14 Self-direction is related to motivation, self-expectations and independence. Social,

emotional, cognitive, communication and specific disability all contribute to a person’s ability to self-direct.

Other factors related to self-direction which may affect a person’s response in a crisis

situation include:

• Difficulty dealing with change • Problems establishing routines • Problem deviating from routines • Unrealistic expectations • Diminished planning skills • Others ________________

REVIEW

III. Summarize by reviewing the following points:

A. As previously noted, behavioral crises can occur when people have predisposing conditions

which do not permit them to adequately perceive, understand and interact with their world.

Many of these conditions have been noted above. These conditions paired with inadequate

social, emotional and self-direction skills contribute to how a person with special needs deals

with daily life.

Remember the following:

• Nearly any special need can affect a person’s ability to handle a crisis. • Dealing effectively with a person who exhibits challenging behavior consists of understanding the conditions that affect that person. Be realistic about a disability, but at the same time provide the supports and resources needed for the person to learn and grow. • Dealing effectively with a person who exhibits challenging behavior consists of presenting viable options to the person and ultimately teaching them more appropriate ways to meet their wants and needs.

SENSORY / MOTOR DEVELOPMENT

• Disturbances in any of the senses • Disturbances in postural/motor skills and voluntary

coordination difficulties

• Others __________________________

COMMUNICATION

• Difficulty organizing or articulating a message • Stereotyped or pervasive language • Limited ability to take listener’s needs into account • Others ________________________

COGNITIVE PROCESSING • Attention difficulties

• Memory difficulties

• Distractibility

• Central auditory processing difficulties

• Impulsivity

• Limited problem solving

• Comprehension difficulties

skills/decision making skills

• Encoding-decoding information difficulties

• Others ____________

SOCIAL DEVELOPMENT

• Labeling • Restricted opportunities •

• Rejection and Social • Victimization Disruption

• Infantilization • Segregation

EMOTIONAL DEVELOPMENT AND SELF-DIRECTION

• Limited coping and problem-solving skills • Lack of appropriate alternative responses • A long history of inappropriate responses • Limited experience with loss, death, grieving issues • Psychiatric conditions, e.g. dual diagnosis • Self-esteem issues • Emotional control difficulties

• Difficulty reading self or other’s moods

• Low tolerance for frustration • Difficulty dealing with change • Problems

establishing/deviating

(from) routines

• Unrealistic expectations • Diminished planning skills • Others _____________

OBJECTIVE THREE:

Participants will be able to discuss the need for and purpose of strategic intervention when working with children and adults with special needs


CONTENT OVERVIEW

This objective will focus on the “traditional” behavioral techniques and their negative and

positive elements. Participants will explore the various psychological, physical and

medical treatments used so far. Participants will discuss the difference between behavior

control and behavior support. Participants will also learn about IMPACT

program and the new ideas it reflects in response to the need for working with children

and adults with special needs and challenging behaviors.


I. Begin by discussing the “traditional” interventions used for challenging behavior.

Using a lecture format combined with group discussions, present the three types of practices

used in dealing with challenging behavior.

A. Chemical Interventions

1. Chemical Interventions are appropriate under certain circumstances. Usually

other alternatives should be tried first and side effects should always be monitored.

Chemical restrains are not the complete solution. They should be coupled with a

systematic, proactive treatment program that is created for the person. They may

mask challenging behavior rather than addressing it.

2. Chemical Interventions can be very effective. They may be used as a part of a person’s

treatment program when prescribed by a physician. (Point out that inappropriate use

of chemical restrains can be abuse.)

3. Long term use of chemical interventions can cause health problems: dependency

on the medication, slowing of reflexes, neurological damage, decreased learning

capacity, and other symptoms including tremors, drooling, lethargy, etc. Any of the

symptoms can be life-long despite stopping the medication. These factors are

considered during the prescribing of chemical interventions.

4. Promoting, supporting or teaching self-control may not be the focus of the staff

when chemical interventions are used.

A. Mechanical Restraints

1 Application – many times the energy required to place a person in a restraint device expends so much effort that by the time it is applied, it is no longer needed. 2 Serious health considerations for jacket-type sheet restrains include:

a. Problem of heat release from the person’s body. The jacket is usually made of

durable canvas-type material. It does not allow the body to expel heat though evaporation.

Thus the use of the jacket will result in increased body temperature

and/or dehydration if proper fluid intake is not maintained.

b. Isometric Danger – person pulls against immovable object resulting in rise of

blood pressure. This can cause a serious problem for people with hypertension and heart

problems.

1 Individuals could injure themselves trying to escape from the devices. 2 Use does not result in learning self-control or positive behaviors.

B. Non-programmatic Responses

1 Reactions to situations are based upon staff’s upbringing, learning and/or previous experience and these responses may not necessarily be the best response for the situation. 2 Individual handling of situations may personalize the situation and could result in power struggles. 3 Often results in uncoordinated staff efforts and inconsistent team efforts.

Compare the models of behavior control and behavior support. Use a lecture format to present the terms

behavior control

positive behavior support.

A. Behavior control

By behavior control practices, we are referring to those techniques by which behaviors

are systematically modified or changed in frequency through the programmatic

manipulation of positive and negative environmental consequences. Behavior management

techniques based on behavior control have been, and to a large degree still are, the

therapeutic tools with which challenging behavior is addressed. The use of these tools

focuses on decreasing the frequency of undesirable behavior through punishment or

extinction.

1 Show Overhead 1.3.1 which describes behavior control and behavior support practices. 2 Talk about the various types of consequences that have been used and give examples. 3 With severe challenging behavior, punishers and response costs are often used because they are viewed as a quick way to reduce the frequency of such behavior. However, it is important to continue to stress that the use of such means will not lead to a long term change in behavior. 4 There are potentially harmful “side effects” to the use of punishers and response costs. Ask the group to brainstorm what these side effects might be. The following is a list of possible side effects which should be discussed. Show Overhead 1.3.2.

• Negative self-

image • Dislike/avoidance of

staff • Learning to avoid circumstances in which punishment occurs rather than really changing behavior

• Depression • Reliance on external rather than internal control of behavior • Frustration resulting in displaced aggression • Treating others negatively may come to be seen as acceptable by both staff and individuals

Positive behavior support

1 Positive behavior support employs positive use of elements from traditional behavior management, but it attempts to minimize the use of punishers and focuses more on the teaching of functional skills that will eliminate the need for negative behaviors. 2 Positive behavior support also requires a multi-component approach where several interventions are designed to be implemented at one time, all of which focus on the whole person.

II. Conduct a discussion on these two concepts asking students to reflect on the differences

between the two. Areas that should be addressed are:

1 Who has the control? 2 What is the desired change for the person in question? 3 What is the value to staff of using behavior support practices?

III. Conduct a discussion on the need for a consistent intervention when working with children

and adults with special needs and challenging behavior. Begin by discussing what we have

learned from our past efforts and how this has shaped our current ideas.

Think about the historical development of services for people with special needs and

challenging behavior, and focus on the need for a systematic approach for working with

children and adults with special needs because of the following:

1 Staff working with children and adults with special needs are not trained in this respect and therefore they cannot provide a consistent approach to their needs. 2 Many children and adults with special needs who display challenging behavior are restrained and not provided with any type of appropriate intervention to decrease their behavior except chemical and mechanical restraints. 3 Many children with special needs and challenging behavior end up in adult psychiatric units where their wellbeing and even lives are at risk.

Now discuss what IMPACT brings: 1. A new trend towards positive approaches and person centered planning

2. Improved capacity of staff working with children and adults with special needs

3. A training program that focuses on proactive, least restrictive approaches

4. An effective and humane training program for addressing challenging behavior

5. Improved reactions of care providers when responding to crisis situations

6. An increased awareness of the negative effects of institutionalization:

• Depersonalization • Lack of stimulation • Modeling of violence • Learned helplessness •

• Lack of freedom •appropriate outlets Regimentation for normal human emotions

Goal is to reduce frequency of negative behaviors

Goal is to meet people’s needs and to give people the skills to meet their own needs so that negative behaviors

will not occur Frequency of negative behavior is starting point for plan

Function or cause of negative

behavior is starting point for plan

Frequency of negative behavior is reduced by staff use of negative consequences (punishers, response costs)

Function of negative behavior

is replaced by assisting the

person to meet needs in socially

acceptable fashion Reinforcers/punishers may be unrelated to the behavior

Attempts are made to use “Natural Consequences”

Plans are primarily reactive in that they go into effect after the negative behavior occurs

Plans are primarily proactive in that

they focus on meeting needs and

training skills before negative behavior occurs

Behavior control vs Behavior support

SIDE EFFECTS OF PUNISHERS

• Negative self-image • Dislike/avoidance of staff • Learning to avoid circumstances in which punishment occurs rather than really changing behavior • Depression • Reliance on external rather than internal control of behavior • Frustration resulting in displaced aggression • Treating others negatively may come to be seen as acceptable by both staff and individuals

OBJECTIVE FOUR

: Participants will be able to demonstrate that their own beliefs, values and attitudes towards persons with special needs affect their actions.


CONTENT OVERVIEW

This objective focuses on the effects of our beliefs, values and attitudes, especially toward

persons with special needs who exhibit challenging behaviors. Discussions will examine

how changes in our beliefs may lead to changes in attitude and actions.


I. Begin by discussing the terms: beliefs, values, attitudes.

A. Use overhead 1.4.1 to define the following terms:

1. Beliefs – Are opinions, views, conclusions you have made.

a. Beliefs are generally internally held; cognitive.

2. Values – Are things or ideas of relative worth or importance

a. Values are generally reflected in our words or actions

3. Attitudes – Are postures or positions expressive of an action or emotion.

A position held in regard to a person, group or thing.

a. Attitudes are based on knowledge.

1. Present the following points about changing beliefs and attitudes.

A. Providing knowledge and understanding can lead to change in values and attitudes.

B. Changes in values and attitudes can lead to change in behavior.

C. If we maintain preconceived ideas about persons with special needs, we may fail to

appreciate the uniqueness of each person.

2. Use the following section to help participants visualize the impact of positive

attitudes on our behavior.

A. Display Overhead 1.4.2 and present the following points. Solicit reactions from the

participants regarding the statements. Discuss ways in which these positive beliefs

and attitudes can influence the outcome of planning in a positive way.

• Each person is unique in his or her needs or learning style. • We must be as free as possible of stereotyped notions of what persons with special needs are like and what they can or cannot do. • Regardless of the severity of one’s disability, all persons can learn and grow. • Each person is of equal human value and deserving of respect. • Expectations can either challenge or limit the growth of individuals. • Each person deserves quality services and is deserving of our best efforts. • We must learn to perceive and understand the thoughts, feelings, wants and needs of the people with whom we work. • Positive expectations have a positive effect on the behavior of others.

3. Summarize the points made in this objective. You may use Overhead 1.4.3 for this.

• Cultural, societal, and family factors influence our beliefs, values and

attitudes.

• These same factors have contributed to our beliefs and attitudes about persons with special needs, especially those who exhibit challenging behavior. • Beliefs and attitudes can change. • Our belief systems are likely to influence our own actions in dealing with

persons with special needs.

Beliefs: opinions, views, conclusions one has made; things one holds as fact.

Values: things or ideas of relative worth or importance

Attitudes: postures or positions expressive of an action or emotion. A position held in regard to a person, group or thing.

• Each person is unique in his or her needs or learning style • We must be as free as possible of stereotyped notions of what persons with special needs are like and what they can or cannot do. • Regardless of the severity of one’s disability, all persons can learn and grow. • Each person is of equal human value and deserving of respect.

• Expectations can either challenge or limit the growth of individuals.

• Each person deserves quality services and is deserving of our best efforts.

• We must learn to perceive and understand the thoughts, feelings, wants and needs of the people with whom we work.

• Positive expectations have a positive effect on the behavior of others.

• Cultural, societal, and family factors influence our beliefs, values and attitudes.

• These same factors have contributed to our beliefs and attitudes about persons with special needs, especially those who exhibit challenging behavior. • Beliefs and attitudes can change. • Our belief systems are likely to influence our own actions in

dealing with persons with special needs

INNOVATIVE

cHAPTER ENd

mULTI-dIScIPLINAR

OBJECTIVES


1 Understand the need for a multi-disciplinary approach when working with children and adults with special needs. 2 Understand the concept of challenging behavior and the importance of a positive behavior support approach. 3 Understand the importance of the environment when it comes to supporting people with special needs. 4 Discuss the five levels of intervention necessary for creating a successful and comprehensive plan for a person with special needs.

UNIT TWO PRESENTATION OUTLINE

OBJECTIVE

TIME

CONTENT

MEDIA

NOTES

2.1. 20 min.

Overview of the multi-

disciplinary

approach

2.2

180 min.

A discussion

about challenging behavior

and the meaning

of positive behavior support

Overhead 2.2.1 Overhead 2.2.2 Overhead 2.2.3 Handout 2.2.4 Overhead 2.2.5 Handout 2.2.6 Overhead 2.2.7

2.3

60 min.

A discussion about the importanc

e of the environment when working

with children

and adults with

special needs

Overhead 2.3.1 Overhead 2.3.2

2.4

180 min.

A discussion of the five levels of

intervention that

need to be considere

d when creating a meaningful plan for a person

with special needs

Overhead 2.4.1 Overhead 2.4.2 Overhead 2.4.3 Overhead 2.4.4

OBJECTIVE ONE:

Participants will be able to understand the need for a multi

disciplinary approach when working with children and adults with special needs.


CONTENT OVERVIEW

The purpose of this objective is to give participants an understanding of the importance of

a team approach when creating a plan for working with children and adults with special

needs. All specialists and other persons relevant to the child/adult with special needs

possess important information regarding the needs and interests for that child/ adult, and

their opinions are always welcome. It is recommended that the child/adult with special

needs be involved in the process of creating their plan. Their opinions should be taken

into consideration when decisions are made with respect to their lives.


I. Begin by asking for the participants’ input about who they consider to be relevant to

include when creating a plan for a child/adult with special needs. The conclusion of the

discussion should be: When creating a successful plan for working with children and adults with

special needs, the team should include, but not be limited to, the following:

• Person with special need • Parent/advocate/friend • Case manager • Educator/day center instructor • Music/art/dance instructor • Social worker • Occupational Therapist • Speech Therapist • Psychologist • Teacher

OBJECTIVE TWO:

Participants will be able to understand the concept of challenging behavior and the importance of a positive behavior support approach.


CONTENT OVERVIEW

The purpose of this objective is to introduce the concept that behavior, even challenging

behavior, is purposeful. People use behavior to achieve personal outcomes. Functional

analysis is a way of determining the intended outcome of a person’s behavior. Several

assessment techniques are used to produce the information needed to complete a

functional analysis. This part of the presentation will introduce these concepts and

participants will begin to be able to connect the ideas of function and behavior. They will

also understand the connection between assessment and our understanding of challenging

behavior.


II. Begin this objective by having participants suggest some reasons why the people they

work with display a given challenging behavior. Make a list which shows the target

behavior and gives the participant’s current judgment about why the person exhibits

the behavior. Make sure that the behaviors that are listed are truly problematic for

the person and the staff and not just a problem for staff. If you see the need, you

should define what is meant by the term challenging behavior.

1 Using the examples provided by the class, begin a discussion regarding the functionality of the behavior. 2 Introduce the concept of function of behavior. Then suggest some possible functions for the behaviors described by the class. Assure them that you are only guessing because you don’t have assessment data to support your judgment. 3 Use the points from Overhead 2.2.1 as a way of cementing the participants’

understanding of the importance of knowing the function of a behavior and using

that information to plan interventions for that person. The following list is more

expansive than the overhead. Use the extra phrases to enhance your discussion.

The participants’ view of challenging behavior and its purpose is key to the use of

positive strategies.

1 Problem behaviors are largely learned through a history of interactions between the person and the environment. 2 In general, problem behavior is seen as purposeful (functional and useful) within the context of the environment in which the behavior occurs. 3 Problem behavior may communicate something about a person’s unmet wants or needs. 4 Behavior is a function of the person interacting with the environment. 5 Behavior occurs within a social context. Therefore, interpersonal relationships are important in understanding problem behavior. 6 Behavior is more likely to change when the environment changes. 7 If you want to decrease a problem behavior, you need to teach a substitute skill that will take its place and serve the same function. 8 An individual’s problem behavior may be maintained by more than one mechanism or factor. 9 A group of problem behaviors may be members of a single response class (attention, sensory, tangible, or escape).

10 Define functional analysis 11 Use Overhead 2.2.2 (or prepare it as a handout) to present any or all of the following

definitions of functional analysis.

Functional Analysis:

1. The process of looking at relationships between behavior and the environment.

2. An assessment process for gathering information that can be used to build effective

treatment plans.

Identifies changes which positively impact the individual

s quality of life. This may

include skills, relationships, conditions or other aspects of the environment, medical interventions and other factors.

4. Focuses on the person and the environment in which the problem behavior is occurring.

5. Takes into account the life of the person and the context in which the problem

behavior is occurring.

6. Helps to identify the factors which contribute to the problem behavior – who, what,

when, where, etc.

7. Helps to understand why the behavior is occurring

8. Identifies skills for the person to learn.

B. Challenging behavior usually occurs for one (or more) of the four functional response

classes. Using response classes as a way of organizing our ideas and information about the

function of behavior can be very useful. Four general response classes are

explained below. Define each for the participants. Ask them to provide the group with

examples. Use Overhead 2.2.3.

1. Attention – a person can engage in problem behavior to get another person to attend

to or spend time with them. Attention can be verbal, physical, social, or related to

proximity (distance from the person). The length of attention can vary.

1 An example would be the adolescent in the classroom who makes snide remarks during class while the teacher responds in a socially disapproving manner. The attention, although negative, is likely reinforcing and maintaining the behavior. 2 Other examples can include: children who become aggressive to other children who are receiving attention, or children who become self-injurious when they do not receive attention.

Tangible

a person can engage in problem behavior to get access to an item, service, food, or activity.

1 A classic example is the child in the supermarket who picks up a piece of candy and tantrums until the parent purchases it. 2 Other examples would be that of children who ask excessively for food, and when not given, engage aggressive or self-injurious behavior.

3. Sensory – provide input into one or more sensory-perceptual pathways. Looks, sounds,

feels, smells or tastes good or otherwise produces pleasure for the person.

a. Examples here might include certain forms of repetitive movements (stereotypy or

“stimming”) such as rocking, head weaving or finger flicking. Such repetitive

behavior provides consistent internal sensory input the person needs. Therefore the

behavior may be reinforcing in and of itself.

4. Escape – a person can engage in problem behavior in order to avoid a demand, task, or

activity.

a. An example would be that of a person not performing a task because he perceives

the task to be too difficult or not interesting enough.

V. Group Exercise – pass out Handout 2.2.4. Break the large group into several small

groups of about four people each. Ask the group to review each situation on the handout and

make a general determination regarding the functions of the behavior. Point out that this

activity is aimed at helping participants become familiar with the four general response classes

and understand the concept of gathering assessment data. In reality, much more work would

go into determining the specific function of the behavior.

VI. Using a lecture format, describe the process of using functional assessment to

understand the function of the behavior. Use Overhead 2.2.5 to help you describe the four

requirements of functional analysis.

A. Four requirements for Functional Analysis

1. Challenging behaviors are specifically defined.

a. A description is needed of each problem behavior that fully describes what the

person is doing. Example: “The person got upset” would not be specific enough.

“Hitting others with fist” or “throwing furniture” would be more specific and

operational.

2. Events are identified that predict when the behavior is likely and not likely to occur.

a. Events that happen just before or at the same time as the behavior is occurring

need to be identified. These events and stimuli are important because they may

increase the probability of the behavior occurring again. Changing these events

and stimuli will reduce the probability that the behavior will occur. Tools such as

A-B-C (Antecedent – Behavior – Consequence) tracking sheets, which is shown

at the end of this objective, are helpful in identifying such events and stimuli.

3. Hypotheses or ideas are developed as to the function(s) of the behavior.

a. What is maintaining or reinforcing the behavior? It is important to develop

ideas as to why the behavior is occurring. Identifying the function of the behavior will

aid in developing a functional strategy for dealing with the behavior. The four

response classes noted earlier are applicable here. Is the behavior occurring for one or

more of these reasons?

4. Data is collected to confirm whether:

1 Events that predict the behavior are accurate 2 Hypotheses about the function of the behavior are correct

Describe a few of the tools that may be used to complete a functional analysis. Make sure to explain that several of these tools should be combined into an

assessment package

to produce a clear functional analysis. One should not stand on its own.

1. Motivation Assessment Scale (MAS) – Handout 2.2.6

This short scale developed by Durand and Crimmins is used for analyzing the

relationship between environmental events and the person’s problem behavior, and

helps answer questions regarding the function of the problem behavior. This aids in

developing ideas about the function of the behavior (why it is occurring). Explain that

this tool helps to determine which of the four response classes might serve as the

function of the challenging behavior.

2. A-B-C Tracking Sheet – Overhead 2.2.7

Another way of assessing antecedents and consequences to behavior is by charting

ABCs. Information is entered in narrative form in each column for every occurrence of

the behavior. Day, date and time are also entered. This sheet can be used to get an idea

about antecedents to the behavior as well as outcomes for the person.

UNDERSTANDING CHALLENGING BEHAVIOR

• In general, challenging behavior is seen as serving a purpose for an individual.

• Challenging behaviors are largely learned through a history of interactions between the person and the environment.

• Problem behavior may communicate something about a person’s unmet wants and needs.

• A single behavior may be maintained by more than one outcome. • A group of behaviors may be used to achieve a single outcome.

WHAT IS FUNCTIONAL ANALYSIS?

• The process of looking at relationships between behavior and the environment.

• A full range of strategies used to identify the antecedents and consequences that control problem behavior.

• An assessment process for gathering information that can be used to build effective behavioral support plans.

ATTENTIO

N

TANGIBLE

SENSORY

ESCAPE

Handout 2.2.

GROUP EXERCISE WORKSHEET

What may be the function of the behavior?

Ana loves going to school and seeing her friends. She prefers to work in groups with her peers.

Over the past three months, staff have noticed an increase in Ana’s behavior challenges in the

afternoon. When teachers are walking with Ana to her 1:1 speech therapy session, she has

begun to drop to the ground and cry. Sometimes it takes up to an hour for staff to encourage

Ana to get off of the ground, causing her to miss her speech session. What might be the

function of her behavior?

David and the staff from his home go to the store each Saturday to purchase groceries for the

week. They have done this together for over a year and this activity is very meaningful to

David. Recently, the staff David goes with has begun to invite one of David’s housemates,

Maria, to go with them. Maria is learning to pick out healthy choices at the store and requires

quite a bit of help from staff. David has begun to cry every time Maria needs assistance from

the staff. What might be the function of his behavior?

Daniel lives in a home with 5 other people. One of Daniel’s housemates, Stefan, is celebrating

his birthday today. Stefan has invited some members of his family as well as friends from his

work. There is food cooking in the kitchen and music playing as people are arriving. Suddenly,

Daniel begins to throw things around his bedroom and yell. What might be the function of his

behavior?

Gabriela is walking down the street with her family. In the past, Gabriela has had difficulty

going into the community with her family because of her challenging behavior. Today, on the

way to the park Gabriella walked past a store that was selling candy, her favorite food.

Gabriela quickly ran into the store and became upset, yelling and crying when her mother told

her that they would not be purchasing any candy. What might be the function of her

behavior?

FOUR REQUIREMENTS FOR FUNCTIONAL ANALYSIS

Challenging behaviors are specifically defined.

Events are identified that predict when the

behavior is

likely and not likely to occur.

Hypotheses or ideas are developed as to the

function(s) of the behavior. Data is

collected.

QUESTIONS

ANSWERS

Never

Almost never

Seldom

Half the time

Usually

Almost always

Always

1.Would the

behavior occur

continuously, over

and over, if this person

was left alone for

long periods of time? (For example, several hours)

0 1 2 3 4 5 6

2.Does the behavior

occur following a request to perform a difficult task?

0 1 2 3 4 5 6

3.Does the behavior seem to occur in response to your

talking to another

person in the room?

0 1 2 3 4 5 6

4.Does the behavior

ever occur to get a

toy, food or activity that this

person has

0 1 2 3 4 5 6

Handout 2.2.6

MOTIVATION ASSESSMENT SCALE (DURAND)

Name _______________________________________________

Date _____________________

Behavior Description ________________________________________________

Instructions: The Motivation Assessment Scale is a questionnaire designed to identify those

situations in which an individual is likely to behave in certain ways. From this information, more

informed decisions can be made concerning the selection of appropriate reinforcers and

treatments. To complete the Motivation Assessment Scale, select one behavior that is of

particular interest. It is important that you identify the behavior very specifically. Aggressive for

example is not as good a description as hits his sister. Once you have specified the behavior to be

rated, read each question carefully and circle the one number that best describes your

observations of the behavior.

been told he/she cannot have?

Handout 2.2.6 (cont.)

QUESTIONS

ANSWERS

Never

Almost never

Seldom

Half the time

Usually

Almost always

Always

12.Does the

behavior stop

occurring shortly

after you give this person a toy, food

or activity he/she has requested?

0 1 2 3 4 5 6

13.When the

behavior is occurring, does the person

seem calm and

unaware of anything else going on around him/her?

0 1 2 3 4 5 6

14.Does the

behavior stop

occurring shortly

(one to five minutes) after you

stop working or

making demands

of this person?

0 1 2 3 4 5 6


15.Does this person seem to do

the behavior to get you to spend

some time with

him/her?

0 1 2 3 4 5 6

16.Does the

behavior seem to occur

when this person has been told

that he/she can’t do

something he/she

wanted to do?

0 1 2 3 4 5 6

DAY, DATE AND TIME

DESCRIBE THE SITUATIO

N

DESCRIBE THE

BEHAVIOR What

did the person

do?

DESCRIBE YOUR RESPONSE What

did you do in

response to

person’s

behavior?

MOTIVATION ASSESSMENT SCALE

Sensory Escape Attention Tangible

1._______ 2._______ 3.________ 4.________

5._______ 6._______ 7.________ 8.________

9._______ 10._______ 11.________ 12.________

13._______ 14._______ 15.________ 16.________

Total Score =

A-B-C TRACKING SHEET

OBJECTIVE THREE:

Participants will be able to understand the importance of the environment when it comes to supporting people with special needs


CONTENT OVERVIEW

This objective focuses on helping participants see the importance of a supportive and

functional environment to a person with special needs and challenging behaviors.

Participants will have the opportunity to discuss the nature of the environment in which they

work and its impact on the behavior of the individuals who live in that environment.


I. Use lecture and discussion to produce two lists of words, one reflecting “supportive” and

the other reflecting “functional” environments. Keep track of responses on a flip chart and use the

overhead for summary and follow-up. Define “Functional” and “Supportive,” (see Overhead 2.3.1

for sample lists). Consider the following: “supportive” refers primarily to the social environment

and “functional” refers primarily to the physical environment.

II. Discuss emotional reactions to functional/non-functional, supportive/non-supportive

environments and how non-functional and non-supportive environments may serve as a “breeding

ground” for problem behaviors. The discussion may focus on situations in which participants found

themselves in non-supportive and non-functional environments and how they reacted to them.

III. When supporting positive behavior it is important to assess the environment carefully. Discuss

those aspects of a person’s environment which require special attention. List the five major

categories of the Positive Environment Checklist on Overhead 2.3.2 and discuss how problems in

any of these areas lead to challenging behaviors.

A. Physical setting

B. Social setting

C. Activities and instructions

D. Scheduling and predictability

E. Communication

III.Discuss existing major barriers to creating positive environments (e.g. scheduling, budget,

low staffing, dealing with challenging behaviors, staff burnout). Brainstorm ways of

overcoming those barriers.

Supportive Positive

Functional Meets needs

Encouraging Consistent

Useful Consistent

Patient Safe

Forgiving Empathic Non-judgmental Caring Generous

Flexible Organized Choices available Fun Accessible

Flexible Comforting Trusting Rewarding Promotes growth Honest

Therapeutic Age-appropriate Educational Adaptive (equipment) Motivating Comfortable

Understanding Helpful Respectful

Interesting Intelligent Dependable

Accepting Optimally stimulating

A “positive environment” is one that is both “functional” and “supportive.”

The following lists consist of terms that have been suggested as reflecting “functional” and

“supportive” environments.

POSITIVE ENVIRONMENT

CHECKLIST PHYSICAL SETTING

SOCIAL SETTING ACTIVITIES AND

INSTRUCTION SCHEDULING AND

PREDICTABILITY COMMUNICATION

OBJECTIVE FOUR:

Participants will be able discuss the five levels of intervention

necessary for creating a successful and comprehensive plan for a person with special needs.


CONTENT OVERVIEW

This objective focuses on helping participants understand that in order to create a

successful and comprehensive plan for a person with special needs, there are five levels

of intervention needed. It is important to become aware of their importance and to

understand that no level should be left out during the development of such a plan.


I. Using a lecture format or discussion, introduce Maslow’s hierarchic theory of needs. This

discussion is meant to lead the participants into understanding that every individual’s needs are

unconsciously prioritized. Based on Maslow’s theory and using Overhead 2.4.1, discuss the

importance of fulfilling each need based on the following two aspects:

Each of the first four layers of need must be properly fulfilled for the individual to

be ready to meet the secondary or higher levels of need.

no layer of need can be left out.

Maslow’s Hierarchy of Needs states that five levels of need exist. These needs are often

portrayed in the shape of a pyramid, with the most fundamental at the bottom and the need

for self-actualization at the top.

Maslow’s basic needs are as follows:

• Physiological Needs

These are biological needs. They consist of needs for oxygen, food, water, and a relatively

constant body temperature. They are the strongest needs because if a person were deprived

of all needs, the physiological ones would come first in the person’s search for satisfaction.

• Safety Needs

When all physiological needs are satisfied and are no longer controlling thoughts and

behaviors, the needs for security can become active. Adults have little awareness of their

security needs except in times of emergency or periods of disorganization in the social

structure (such as widespread rioting). Children often display the signs of insecurity and

the need to be safe.

• Need for Love, Affection and Belonging

When the needs for safety and for physiological well-being are satisfied, the next class of

needs for love, affection and belonging can emerge. Maslow states that people seek to

overcome feelings of loneliness and alienation. This involves both giving and receiving love,

affection and sense of belonging.

• Need for Esteem

When the first three classes of needs are satisfied, the need for esteem can become

dominant. These involve needs for both self-esteem and the esteem a person gets from

others. Humans have a need for a stable, firmly based, high level of self-respect, and

respect from others. When these needs are satisfied, the person feels self-confident and

valuable as a person in the world. When these needs are frustrated, the person feels

inferior, weak, helpless and worthless.

• Need for Self-Actualization

When all of the foregoing needs are satisfied, then and only then are the needs for self-

actualization activated. Maslow describes self-actualization as a person’s need to be and do

that which the person was “born to do.” “A musician must make music, an artist must paint,

and a poet must write.” These needs make themselves felt in signs of restlessness. The person

feels on edge, tense, lacking something, in short, restless. If a person is hungry, unsafe, not

loved or accepted, or lacking self-esteem, it is very easy to know what the person is restless

about. It is not always clear what a person wants when there is a need for self-actualization.

Maslow believed the only reason that people would not move well in the direction of self-

actualization is because of hindrances placed in their way by society.

Using a lecture format, introduce the participants to the 5 levels of intervention that

have to be taken into consideration when creating a plan for a person with special needs.

Explain each using Overhead 2.4.2.

1. SENSORY DIFFERENCES AND BIOLOGIAL NEEDS

• Provide a sensory diet •• Monitor and address environmental stressors:

Sound, light, proximity/personal space, texture Movement needs • Monitor and address: Appetite/hunger Arousal/activity level (e.g., fatigue, hyperactivity) Posture and movement

Medical needs

Using Overhead 2.4.3 discuss with the participants about sensory issues that are common

for people with special needs.

Sensory issues, referring to the seven types of sensory dysfunctions:

Smell Taste Touch Visual Input

Auditory Vestibular (balance)

Proprioception (body awareness)

• Sensory dysfunction influences all aspects of a person’s life.

Ask participants about some physical reactions they experienced when feeling anxious. For

example, tell them to think about how they felt when they had to speak in public.

Many people are often unaware that physical symptoms of anxiety do exist. They think of anxiety

as a wholly emotional reaction. Many people who suffer from anxiety often recount

how the physical symptoms of anxiety become prominent first and then trigger an increased

emotional reaction.

Anxiety can have physical symptoms which generally fall into one of two categories. There are

symptoms that occur in a physical manner before they occur mentally (or instead of any mental

symptoms at all), or physical symptoms that arise after a person has become emotionally

anxious. The conclusion of this discussion should be the following: if an intervention reduces

anxiety, it is helping to meet a sensory/biological need.

2. REINFORCEMENT

“Instead of yelling and spanking, which don’t work anyway, I believe in finding creative

ways to keep their attention - turning things into a game, for instance. And, when they do

something good, positive reinforcement and praise.” - Patricia Richardson

I. Ask participants to think about the following idea “Consequences influence

behavior” and try to give examples to sustain the validity of this idea.

The conclusion they have to reach is the following: people do things because they know other

things will follow. Thus, depending upon the type of consequence that follows, people will

produce some behaviors and avoid others.

The classical reinforcement theory, used by most of the practitioners, describes the following

three circumstances: 1 If a behavior is rewarded, it is more likely to occur. It will be more intense and more frequent. 2 If a behavior is followed by a punisher, it is more likely to decrease in its intensity and frequency. 3 If a behavior is followed neither by a reward or a punisher but it is ignored, the behavior will extinguish.

Identifying the right reinforcers

Reinforcers are identified by their function. Candy increases child cooperation, but has no value

as payment to a teacher. Thus, you have to observe your students very carefully to discover the

things they find most rewarding. And, once you do find things that function effectively, you can

be seriously disappointed to discover that they lose their value over time. As children become

accustomed to receiving some reward (say, candy or stickers), they may grow bored over time.

This is perhaps the greatest challenge for any teacher. Finding good rewards requires a great deal of

experience and insight.

b. Controlling all sources of reinforcement.

Teachers often must compete with the child’s peer group. Peers provide an extremely important

source of reinforcement, sometimes greater than any reward a teacher can give. The child’s parents

and family are another source of reinforcement. Teachers sometimes think their reinforcement

applications are failing because they are not using the “right” reward. Instead, the problem may be

that the student wants or needs the reinforcers the peer group offers more than the ones the teacher

gives.

c. Internal changes can be difficult to create.

One side-effect of reinforcement theory is that children learn to perform behaviors we want them to

show only when the reward is available. If the reward is not present, then the child will not show

cooperation, good effort, or attention. The child becomes little more than a well-trained monkey

who does a trick, then holds out a hand waiting for the banana. In this case, the child has not

internalized the behavior. This means that the teacher must work hard to provide the correct

consequences for the desired behaviors at the right time.

Principles of reinforcement:

1. The source is well-trained in the theory and practice of reinforcement.

2. The source has complete control of all significant reinforcers for all receivers.

3. The source has complete control of each receiver (i.e. what the receiver does, when the receiver does it, what other receivers are in the situation).

4. The source has a detailed and consistent plan of reinforcement.

5. The reinforcers are always delivered under the same conditions to each different receiver.

6. The reinforcement must be contingent on the target behavior. That is, the child only earns the predetermined consequence if and when he/she performs the requested behavior.

The use of punishers is controversial. Receiving punishment is an extreme consequence for all

living things. Whether it is a dog, a parrot, a child, or an adult, punishing consequences can

produce extremely rapid, strong, and memorable changes, but not necessarily positive changes.

One problem is that effective punishment demands specific and consistent conditions for its

implementation, according to some research. This theory holds that effective punishment must

be: 1) immediate (right now!), 2) intense (the biggest possible stick), 3) unavoidable (there is no

escape), and 4) consistent (every time). If you cannot deliver punishment under these

conditions, then the punishment is likely to fail. This research may not be applicable to people with

special needs, such as those on the autism spectrum and others, whose sensory systems

may not process cause and effect the same way as neuro-typicals. Punishment is, by definition,

an aversive, painful consequence. People experience very negative emotional states when they get

punished. Thus, when a care-giver uses punishment, even when the connection between cause and

effect is made, the person will probably feel angry, fearful or hopeless, and they will then connect or

associate these negative feelings with the source of the punishment, the caregiver. Yet, some persist

in using weakened forms of punishment, often with unsuccessful and frustrating effects.

As a professional, one wants to use positive, influential tools to accomplish important learning

goals. If a tool produces negative effects it is a counter-productive strategy. The conditions for

effective use of punishment are unrealistic: even if the punishment helps accomplish one goal,

it is making other goals more difficult to achieve.

4. STRUCTURE AND VISUAL/TACTILE SUPPORT “And it is best if you know a good thing

is going to happen, like an eclipse or getting a microscope… And it’s bad if you know

a bad thing is going to happen like having a filling or going to France. But I think it

is worst if you don’t know whether it is a good thing or bad thing which is going to

happen.”

-The Curious Incident of the Dog in the Night Time, by Mark Haddon, 2003

I. Ask participants to give you some examples of visual supports that people use in

everyday life. Use Overview 2.4.4. to support the idea that everybody needs and uses

visual supports in order to organize their daily activities. Ask participants to think

about how they feel when they don’t know what is going to happen next. Use this

discussion as a starting point to underline the importance of structure and visual

support for children and adults with special needs.

Structure makes expectations clear and explicit and increases the understanding of the environment. It reduces anxiety by helping children and adults with special needs to make more sense of the world. It also assists learning and communication, helps develop independence, enables anticipation of events and encourages the development of strategies to cope with change and transition.

Visual supports provide children and adults with special needs a clear structure within routines. They

allow the child to build a sense of predictability to events and clear routines during the day. Visual

supports: • Pictures of individual objects – can be used to signify activities to children and can cue the child to the next activity. Over time, a sequence of objects can be used to assist transition between activities. • Photographs – photographs of the child engaging in various activities can be used to provide a visual timetable to the child. • Line drawings -more abstract, are often preferred as they contain minimum distracting features. • Written words – can be used at the appropriate age and stage Visual supports help us develop a systematic approach that will help the child attend to tasks and develop skills.

5. TASK DEMAND Any aspect of a task that must be met is a task demand. Behavior problems are

often caused by demands exceeding a person’s ability. In other words, if a task is too demanding, the

person will fail. Intervention on Task Demand level involves adjusting the demands and/or increasing

supports in order to balance the person’s ability with the task presented. Reducing the demand and/

or increasing support are both Task Demand interventions that help to create the balance.

I. Ask the participants to watch the video and make suggestions regarding the adjustments

that could be done to the task demand shown in order to increase the support needed for the

development of skills.

6. SKILLS TO TEACH Only when the sensory system is calm, reinforcement is available, the

environment is made predictable through structure and visual/tactile supports, and task demands are

carefully designed, can skills be effectively demonstrated and taught.

Overhead 2.4.2

Overhead 2.4.3

Overhead 2.4.4

mULTI-dIScIPLINARY

cHAPTER ENd

PERSON-cENTERE

OBJECTIVES


1 Understand the person-centered approach and that people with special needs can always learn if provided with the necessary support to be successful. 2 Analyze the level of supervision a person may require in order to create opportunities for achievement. 3 Understand the concept of Pro-active Approach to behavior.

UNIT THREE PRESENTATION

OUTLINE

OBJECTIVE

TIME

CONTENT

MEDIA

NOTES

3.1.

40 min.

A discussion about the person-centered approach.

3.2

90 min.

Overview of levels of supervision

Handout

3.2.1

3.3

60 min.

Overview of Pro-active Approach

Overhead

3.3.1 Hand

out 3.3.2

OBJECTIVE ONE:

Participants will be able understand the person-centered approach and the concept that people with special needs can always learn, if provided with the necessary support to be successful.


CONTENT OVERVIEW

The purpose of this objective is for the participants to understand that the person-centered

approach is a concept that places the person with special needs in the center of all focus and

program development. The person with special needs drives the team approach to take

notice of the abilities, strengths and, most importantly, interests of the person with special

needs. When the team understands the abilities, strengths and interests of a person with

special needs, they are able to build upon each of them, and provide the support needed to

promote independence, individuality, inclusion and productivity in all aspects of the lives of

those they support.


I. Discuss with participants the concept of person-centered planning and its principles.

Person-centered planning is a process of life planning for people with special needs. It is

based on the principles of inclusion and productivity. It always ensures that the focus

on the person is central and that the person is in control. The plan is flexible, setting no

limits to the person’s wants, needs and dreams for their life.

In person-centered planning, the process, as well as the product, is owned and controlled

by the person (and sometimes their closest family and friends). There are no prescribed

forms or checklists; the resulting plan of support is totally individual. It creates a

comprehensive portrait of who the person is and what they want to do with their life and

brings together all of the people who are important to the person, including family, friends,

neighbors, support workers and other professionals involved in the person’s life.

Person-centered planning focuses on a person’s gifts, capacities, and personal dreams, and

utilizes a circle of committed friends, family and community members to help realize those

dreams and assist people with special needs in moving toward full citizenship.

All Person-Centered Planning approaches are characterized by five elements (O’Brien &

Lovett, 1996) that have been identified as fundamental:

1 The person at the focus of the planning and his or her loved ones are the primary authorities on the person’s life direction. The essential questions are “Who is the person?” and “What community opportunities will enable this person to pursue his or her interests in a positive way?” 2 Person-Centered Planning aims to change common patterns of community life. It stimulates involvement with the community and enlists all community members to work incusively toward a desirable future. It helps create positive community roles for people with disabilities. 3 Person-Centered Planning requires learning through shared, collaborative action, and fundamentally challenges practices that separate people and perpetuate controlling relationships. 4 Person-Centered Planning can only come from respect for the dignity and completeness of the focus person as he/she is. 5 Assisting people to define and pursue a desirable future tests one’s clarity, commitment and courage.

If the goal is to not only create a vision with the focus person, but also to effectively support

them in making that dream come true, we will need to work on doing a better job at inviting

non-paid community members into the lives of people with special needs.

OBJECTIVE TWO:

Participants will be able to analyze the level of supervision a person may require in order to create opportunities for achievement.


CONTENT OVERVIEW

The purpose of this objective is for participants to understand the concept of levels of

supervision and become aware of their importance.


I. Discuss with participants the concept of “levels of supervision” and its importance.

Levels of supervision refer to the support children and adults with special needs may

require when accessing different environments. Usually children and adults with special

needs access three types of environments: small family home, day centre and community.

Therefore, levels of supervision must be established separately for each of these

environments. Levels of supervision may differ according to the accessed environment.

There are three levels of supervision:

• One – Direct

A staff member will be within one meter (within reach) of the individual at all times. The

staff member will observe the person at all times. Both the person and the environment

will be monitored for potential problems at all times.

• Two – Close Proximity

A staff member will be in the same room with the individual (“eyes on”), or nearby, at

all times.

• Three – Occasional

A staff member will monitor the person’s routine. The staff member will monitor every 10

minutes or so to make sure that the individual is following the program. At each interval,

the staff member will monitor both the person and the environment for potential

problems.

Why are levels of supervision important?

• According to the level of supervision, the ideal staff-to-child/adult ratio may be

appropriately determined.

• The child/adult:

• Is monitored in a safe environment • His/her individual needs may be met • Is provided an environment that will offer the necessary support to be successful

• The staff member:

• Knows the level of support the child/adult must receive to be safe • Knows how much input the child/adult requires in order to meet his/her needs and will not be more intrusive or restrictive than necessary

• Criteria for determining levels of supervision

1. Pica: If the individual has the habit of swallowing inedible objects or substances.

2. Aggressive, self-aggressive or destructive behavior: If the individual is self-aggressive, has the tendency to destroy objects when he/she is upset or when not directly monitored; if the individual has the tendency to hit, bite, scratch peers or staff; the frequency of this behavior.

3. Toilet training: If the individual knows how to appropriately use toilet paper and washes hands after using the toilet with no support needed; if the individual ingests or plays with feces; if he/she displays rituals while in the bathroom; if he/she has self-care abilities while in the bathroom.

4. Safety: If he/she is aware of danger while in the kitchen or community; if he/she can use a knife or other sharp objects; if he/she is aware of danger when next to hot objects or surfaces; if he/she can cross the street and is aware of dangers in the street.

5. Issues regarding community access: If he/she is aggressive towards small children,

older people, etc., when angry or upset; if he/she is bothered by noise or specific loud sounds;

if he/she is easily distracted and becomes aggressive in crowded places; if he/she is afraid of

dogs or other animals; if he/she stays with the group or has the tendency to leave the group

and explore the surroundings.

Medical issues

: If he/she has asthma or allergies; if he/she has seizures/epilepsy; if

he/she has difficulty walking; if he/she is suicidal; if he/she drinks too much liquid or

eats too much.

7. Independence: If he/she needs support throughout the daily routine; if he/she needs

more support during specific activities or when accessing specific environments; if he/ she

may be by him/herself for a specific period of time or in certain environments.

8. Environment: If the environment is safe for the individual; if the individual has access to

lethal substances or medication; if the environment is dangerous for the individual.

• Levels of supervision depend on the child/adult and differ according to the accessed

environment. For example, a child may receive an occasional (3) level of supervision

when in the small family home where he/she is familiar with the environment and a

direct (1) level of supervision while in the community because he/she is afraid of dogs

and becomes self-aggressive when scared.

• Levels of supervision may change over time and should be revised periodically for each person. As the person gets used to going out in the community or to a day centre, and acclimates him/herself to new rules and environments, the level of supervision may become less and less restrictive. • Once a level of supervision is established for each of the environments the person has access to, the next step is for the intervention team to discuss the reasons a level is established, and set up intervention plans to overcome those issues. The intervention plans should focus at all times on reducing restrictions so the person will become as independent as possible and stay safe at the same time.

OBJECTIVE THREE:

Participants will be able understand the concept of Proactive Approach. Participants will discuss how proactive, active and reactive interventions are used to address challenging behavior.


CONTENT OVERVIEW

The purpose of this objective is to introduce the concept and techniques of proactive

interventions for persons with special needs who may exhibit challenging behavior.


I. Using a lecture or discussion format, review the following concepts. Explain that this

unit will address the subject of proactive interventions. Subsequent units will focus on active

and reactive interventions.

A. Proactive – the prefix “pro” means “before in time.” Thus, proactive interventions are

those which address people’s needs before problems arise. If proactive interventions are effective,

challenging behavior should become rare.

B. Active – if needs are not met, problems begin to bubble up as warning signs. Active

interventions are designed to help people calm so that their needs may be addressed. Note:

Although active interventions involve calming, in order to truly resolve problems, people’s needs

(which are currently met through challenging behavior) must be addressed.

C. Reactive – the prefix ”re” means “back in time.” Reactive interventions are those which

deal with challenging behaviors as they occur. We must then wait for the person to calm and go

back to a point where it is possible to address needs (proactive and active interventions). Reactive

interventions include but are not limited to personal interventions. They may be spoken

reprimands, lost of privileges, etc. Reactive interventions deal with controlling the behavior

rather than dealing with the cause of the challenging behavior. The goal of a proactive

approach is to reduce the need for any reactive interventions.

I. Use Overhead 3.3.1, the IMPACT Gradient, to illustrate that “proactive” interventions

permit the most control by the individual and require less support from the staff.

“Reactive” interventions require the most support from the staff, and permit relatively

little control by individuals. It is therefore desirable to move away from reactive interventions toward proactive interventions whenever possible. The IMPACT Gradient refers to the level of restrictiveness of a staff response given a crisis situation, in other words, the level of support needed from staff for the person to regain self-control. Staff must constantly monitor this intervention as they intervene with individuals to ensure

that they are providing enough (but not too much) support.

II. Introduce participants to the Gateways of Proactive Management, Handout 3.3.2.

Discuss each question with participants to see how it might be used as an alternative in their

settings. Suggest that these alternatives might have a significant impact on the reduction of

crisis situations and help set their mind on being proactive.

SCIP-r Gradient: The level of restrictiveness of a staff response given a crisis situation. In other words, the level of support needed from staff for the person to regain self control; using the least restrictive technique first.

Handout 3.3.

Gateways – Proactive Management

Before using personal interventions consider these 10 points first

Communication

Have you offered an opportunity for the person to communicate using objectives,

signs, symbols, or speech, and have you responded positively?

What did you do?

Choice Have you offered another activity and encouraged the person to choose? What

did you do?

Environment

Have you offered a change of location or setting e.g. a smaller space, a low

distraction area and have you adapted the environment to support the person?

What did you do?

Physical Needs

Have you considered hunger, thirst, pain, heat, cold, tiredness, activity or need of

toilet ….?

What did you do?

Interaction Have you offered a change of staff and responded to the need for attention?

What did you do?

Handout 3.3.

(cont.)

Therapeutic Alternatives Have you offered music,

aromatherapy, massage? What did you do?

Relaxation Have you tried deep breathing, yoga?

What did you do?

Calming techniques

Have you used verbal and non-verbal calming to provide: reflection, empathy,

reassurance, redirection, incentives and rewards?

What did you do?

Listening techniques

Have you listened, read the signs, picked up cues, and given prompts rather than

hurrying to give advice?

What did you do?

Sensitivity

Have you helped to restore the individual’s confidence and dignity by sensitivity

rather than by being confrontational and have you offered a constructive,

functional activity?

What did you do?

PERSON-cENTEREd

cHAPTER ENd

OBJECTIVES


1 Understand that sensory and/or environmental stimulation is essential for the growth and well-being of people with special needs. 2 Understand the concept of sensory integration and be familiar with the signs and severity levels of sensory disintegrative disorders. 3 Design interventions which address sensory needs and provide environmental stimulation, and understand the importance of establishing a “sensory diet” for people with special needs. 4 Understand that active treatment is an ongoing process which utilizes every moment of a person’s day as a teachable moment and an opportunity to learn.

UNIT FOUR PRESENTATION

OUTLINE

OBJECTIVE

TIME

CONTENT

MEDIA

NOTES

4.1.

120 min.

Discussion about

the importan

ce of sensory

stimulation of

children and

adults with

special needs

4.2

12o min.

Provide the

definition of sensory integratio

n and discuss specific sensory

disintegrative

disorders and their severity levels.

4.3 60 min.

Introduce types of sensory

defensiveness and discuss sensory

treatment objectives for people

with special needs before

covering

the steps involved

in establishi

ng a “sensory

diet.”

4.4

40 min.

Discussion about active

treatment as an on-

going process which

utilizes every

moment of a

person’s day as a

teachable moment.

Overhead 4.2.1

OBJECTIVE ONE:

Participants will be able to understand that sensory and/or environmental stimulation is essential for the growth and well-being of people with special needs


CONTENT OVERVIEW

During this opening presentation, participants will discuss sensory stimulation that

should be provided to people with special needs. The overall purpose of this portion of the

unit is to become aware of the importance of creating an environment which is

stimulating and supports and enhances incidental learning through curiosity.


I. Discuss with participants the concept of sensory integration.

Sensory Integration: The Concept

All of the information we receive about the world comes to us through our sensory

systems. Because many sensory processes take place within the nervous system at an

unconscious level, we are not always aware of them.

Just as the eyes transmit visual information to the brain for interpretation, all sensory

systems have receptors that pick up information to be processed by the brain. Cells within

the skin send information about light, touch, pain, temperature and pressure. Structures

within the inner ear detect movement and changes in the position of the head.

Components of muscles, joints, and tendons provide an awareness of body position.

The Sense of Touch

Although the senses of touch, movement and body position are less familiar than vision

and hearing to most people, they are critical to helping us function in daily life. For

example, the sense of touch (the tactile sense) makes it possible for a person to find a

flashlight in a drawer when the lights are out. Tactile sensation also plays an important

role in protection from danger. For example, it can signal the difference between the

soft touch of a child’s fingers and the crawling legs of a spider.

The Sense of Movement

The vestibular sense responds to body movement through space and change in head

position. It automatically coordinates the movements of one’s eyes, head and body. If this

sense were not functioning well, it would be impossible to look up and down

at something without losing one’s balance. It would be difficult to walk along a rocky

path without falling, or to stand on one foot long enough to kick a soccer ball. The same

vestibular sense is central in maintaining muscle tone, coordinating the two sides of the

body, and holding the head upright against gravity. The vestibular sense can be thought of

as a foundation for orientation of the body in relation to surrounding space.

The Sense of Body Position

Closely related to the vestibular sense is the sense of proprioception. which gives us the

awareness of body position. It is proprioception that makes it possible for a person to

skillfully guide his arm or leg movements without having to observe every action. When

proprioception is functioning efficiently, an individual’s body position is automatically

adjusted to prevent falling out of a chair. Proprioception also allows objects such as

pencils, buttons, spoons and combs to be skillfully manipulated by the hand. Because of

proprioception we are able to synchronize our steps according to the ground.

OBJECTIVE TWO:

Participants will be able to understand the concept of sensory integration and become familiar with the signs and severity levels of sensory disintegrative disorders.


CONTENT OVERVIEW

During this portion of the discussion, participants will learn the definition of sensory

integration and explore specific sensory disintegrative disorders. We will discuss some

specific signs of these disorders, and cover the levels of severity that may be present.

Organization of The Senses

The tactile, vestibular and proprioceptive systems begin to function very early in life, even

before birth. These basic senses are closely connected to each other and become

interconnected with other systems of the brain as development proceeds. The interplay

among the various senses is complex, and is necessary in order for a person to interpret a

situation accurately and give an appropriate response. This organization and utilization of

the senses is termed “sensory integration.”

Motor Planning

Sensory integration allows us to respond appropriately to incoming sensations and it

guides the way we act on the environment. Motor planning involves having an idea

about what to do, planning an action, and finally executing the action. When motor

planning occurs, a person is able to deal with a completely new task by implementing

a new action. When a child encounters a new riding toy for the first time, he is able to

figure out how to get on and off without any instructions or help. Motor planning

involves conscious attention to the task, while relying on stored information regarding

unconscious body sensation.

Sensory Integrative Disorders

For most children, sensory integration develops in the course of ordinary childhood

activities. Motor planning ability is a natural outcome of the process, as is the ability to

respond to incoming sensation in an adaptive manner. But for some children, sensory

integration does not develop as efficiently as it should. When the process of sensory

integration is disordered, a number of problems in learning, development, or behavior

may become evident.

Signs of Sensory Integrative Dysfunction

Not all children with learning, developmental, or behavioral problems have an underlying

sensory integrative disorder. There are certain indicators that can signal that such a

disorder may be present. The following are a few of the possible signs.

Overly sensitive to touch, movement, sights, or sound

This may manifest in behaviors such as irritability or withdrawal when touched, avoidance

of certain textures of clothes or foods, distractibility, or a fearful reaction to ordinary

movement activities, such as those typically found on a play ground. He/she

may manifest difficulty climbing in and out of cars, difficulty going up and down stairs.

He/she may fall out of chairs or walk into objects.

Other examples:

a. Difficulty using “pull toys”

1 Problems using tricycles or bikes 2 Continuing to have accidents after being fully potty trained

3 Approaching an activity each time as if it were the first time 4 Difficulty doing puzzles – manipulating pieces or determining where pieces

belong 5 Difficulty guiding food to mouth

g. Clothing strong clothing preferences dislikes sleeves

hitting wrists/only wears long or short sleeves sensitive to collars

hitting neck

does not want to wear a belt or anything that ties around the

waist is bothered by seams in clothing experiences difficulty

manipulating buttons, zippers, snaps or ties

wants all tags in clothing removed either

wants feet or body totally covered or uncovered

90

insists on wearing a coat with the hood up in spite of hot weather

insists on wearing T-shirts in spite of cold weather

sensitive to temperature

sensitive to texture

heightened awareness of flavor/lack of awareness of flavor

difficulty manipulating eating utensils

frequently spills both food and drinks

chews with mouth opened

bites fingers and tongue while eating

dribbles food and drink down chin

drops food on the floor unintentionally

dislikes carbonated beverages

Under-reactive to sensory stimulation

In contrast to the overly sensitive child, an under-responsive child may seek out intense

sensory experiences such as body whirling or crashing into objects. He or she may seem

oblivious to pain or to body position. Some children fluctuate between the extremes of

over- and under-responsiveness.

Activity level that is unusually high or unusually low

The child may be constantly on the move or may be slow to activate and fatigue easily.

Again, some children may fluctuate from one extreme to the other.

Coordination problems

This can be seen in gross or fine motor activities. Some children may have unusually poor

balance, while others have great difficulty learning to do a new task that requires

motor coordination.

Delays in speech, language, motor skills, or academic achievement

These may be evident in a preschooler along with other signs of poor sensory integration.

In a school-aged child, there may be problems in an academic area despite normal

intelligence.

Poor organization of behavior

The child may be impulsive or distractible and show a lack of planning in approach to

tasks. Some children have difficulty adjusting to a new situation. Others may react with

frustration, aggression, or withdrawal when they encounter failure.

• Typically, a child with a sensory integrative disorder will show more than one of the

above signs.

LEVELS OF SEVERITY

• Level I – Mild

Children with mild defensiveness might be described as “picky,” “over-sensitive,” “slightly

overactive,” “resistant to change,” or slightly “controlling.” They can act mildly irritated by

some sensations but not by others. They may be picky about clothes or food. While these

children can achieve at age level in school or have good social relations, they may have to

use enormous control and effort to succeed in these areas. When they can no longer

maintain the level of effort required to do so, they may “fall apart” emotionally under

apparently little or no stress.

• Level II – Moderate

A moderate sensory defensiveness is one that affects two or more aspects of a child’s

life. At this level, children often have difficulty with social relations, either being overly

aggressive or isolating themselves from others. Many self-care skills are disrupted,

such as dressing, bathing and eating. They may be having difficulty with attention and

behavior. Exploration and play may be limited due to fearfulness of new situations and

resistance to change.

• Level III – Severe

A severe sensory defensiveness disrupts every aspect of a child’s life. These children

usually have other diagnoses for various areas of dysfunction (i.e. severe developmental

delay, autism, autistic-like behavior or emotionally disrupted). Strong avoidance of

some kinds of sensations or the reverse, intense sensory-seeking are common. Sensory

defensiveness may block development and/or interfere with the child’s treatments.

Treating sensory defensiveness first, reduces sensory problems and increases the

effectiveness of other forms of intervention.

OBJECTIVE THREE:

Participants will be able to design interventions which address sensory needs and provide environmental stimulation, and understand the importance of establishing a

sensory diet

for people with special needs.


CONTENT OVERVIEW

We will introduce the types of sensory defensiveness and discuss sensory treatment

objectives for people with special needs before covering the steps involved in establishing a

“sensory diet.”

INTERVENTION APPROACHES

Treatment for sensory defensiveness falls into three categories: 1) Awareness; 2)

Planned and scheduled activity program called a sensory diet; 3) A professionally

guided treatment program.

AWARENESS

One of the more important steps in treating sensory defensiveness is acquiring

awareness of the symptoms and behaviors associated with the problem. By doing

that, we can see that most people are doing the best they can to feel safe and adapt to

their disorder. Once we understand their behavior we can provide activities and

sensory input that can eliminate the defensiveness.

SENSORY DIET – PLANNED AND SCHEDULED ACTIVITY PROGRAM

The “sensory diet” concept is based on the idea that each individual requires a

certain amount of activity and sensation to be the most alert, adaptable and skillful.

This is much like a person’s nutritional requirements. Certain kinds of activity seem

to be very helpful for individuals with sensory defensiveness, and

each type of activity seems to reduce the defensiveness for a specific time period.

For example: activities which require whole-body action and make the muscles work

hard have a therapeutic effect which lasts for about two hours; the effect

of deep pressure on the skin lasts up to two hours; the benefits of low rhythmic

movement can last from two to six hours. Activities planned for the purpose of

calming include slow, boring, rhythmic movement, pressure on the skin, neutral

warmth, activities in upside down postures, joint traction and compression, heel

to head rocking (especially when lying on stomach), total body activities and those

that demand heavy work from the muscles. Through careful planning, we can use

sensory input to make a child feel safe and organized throughout the whole day.

For the “sensory diet” to be best effective it is important to use special activities

scheduled throughout the day to help the child feel calm, alert, and organized most

of the time. When very disruptive events are about to occur, specific sensory input

can prepare the child and prevent defensive responses. Activities are much more

beneficial when the child selects them out of interest and need. Adult direction and

involvement should be limited to making activities available, setting up environments

and supervising safety.

Establishing a sensory diet

Structuring the time 1 Determine a predictable flow for the day 2 Incorporate times for sensory input 3 Establish routines 4 Alternate passive and active / sitting and moving activities 5 Start activities with preparation time for getting calm, settled, and organized 6 Allow plenty of time and a method for transition

Structuring the space 1 Organize the space to be inviting, soothing, calming, and organized. Beware of the total environment 2 Have a predictable, organized space for sit-down activities, eating, quiet zone and play zone 3 Avoid multiple use of space 4 Use identifiable visual cues, colors, names, and décor for set spaces 5 Consider visual stimulation (walls, bright colors) 6 Consider lighting (natural as much as possible, lamps) 7 Consider sounds (voices, background, time to process, background music) 8 Consider odors: as a rule do not wear perfumes 9 Have a quiet, organized place (been bag, big pillow, chair, tent)

Structuring the activities

1 Provide heavy work opportunities that are calming for the child 2 Incorporate active participation of the child 3 Incorporate strong sensory elements 4 Use a main theme 5 Provide frequent movement breaks with rhythmic (calming) movements (slow body stretch, carry/pull/push heavy objects, wall pushups, squish ball) 6 Never impose sensory input. Watch for signs of distress!

Structuring your interaction

1 Invite/offer/encourage. Do not push, demand, or force sensory activities 2 Provide plenty of time, do not rush, move on too fast, or change activity too fast 3 Limit verbalizations, yet reinforce communication 4 Protect the child from stimulation they cannot handle 5 Stay relaxed, use appropriate tone of voice (soft for relaxing, happy for arousing) 6 Have interaction be pleasurable. Look for smiles. 7 Use firm, constant pressure touch (light touch is alerting, triggers protective system) 8 Stop activity after 30 seconds at the most if you see an adverse or negative affect

Some basic principles to consider:

While remembering that everyone is different and that people’s responses will vary, we can

consider some general principles in promoting sensory integration:

Remember all the senses

Touch and movement are at least as important as vision and hearing, if not more so, in

helping an infant learn about the world. As a person grows older, vision and hearing will

become critical for learning. Physical contact is particularly important not only for the

sensation that it provides but also for the opportunity to enhance the caregiver-child

relationship.

Be sensitive to the child’s reactions to activities

It is important to recognize and understand how each child perceives and is affected by

different experiences. While light touch may be pleasing to some, for others it may

be irritating and distracting. Similarly, some people may react negatively to loud noises or

certain types of sounds, or may have trouble turning out background noises in order

to attend to specific sounds (i.e. your voice). Some may exhibit negative responses to

heights and certain types of movement, while others may seem to seek excessive amounts of

movement. Once it is understood how a person perceives the world, we are more able to

respond effectively to that person’s needs and to help them cope by either adapting or

avoiding certain situations. For example, people who are irritated by light touch often respond more positively to firm touch or deeper pressure. This is why hugging is calming to

most people. Or for the person who has difficulty tuning out background noises to attend to

a task, a special quiet place could be set up for that specific task.

Look for clues from the person

People often seek the type of sensory experience their nervous systems need. If a person

appears to be looking for sensory input, whether it is touch, movement, smell, sight, or

sounds, this may be a clue that a certain type of sensation is desired. If a person seeks a great

deal of movement, touch, pressure, vibration, visual or auditory stimuli, try to provide some

of these sensations in normal play activities. For example, if a person seems to want a lot of hugging and firm pressure, a caregiver might try neighborhood hiking with

weighted back packs, rolling games, or hide-and-seek under large pillows – all activities that

provide deep proprioception.

Recognize the person’s abilities

Consider the demand placed on a person to process and respond to activities. Someone who

enjoys movement and who has a good balance may be able to interact with you while

swinging. Someone who is fearful of movement, however, may need to concentrate intensely

just to maintain balance, so may not be able to swing and interact with you at the same time.

Remember that one person may not process sensory information or respond to it as

automatically as another.

Involve the person in activities

Active involvement depends on the person initiating, planning, executing, or dynamically

responding to an activity. A passive activity may provide sensation or movement that does

not necessarily require a response. Active involvement provides the best opportunity for

changes in the brain that lead to growth, learning, and better organization of behavior. When

someone is actively involved, he or she has more control over the situation. Therefore, when

planning new sensory and movement experiences, it is usually best to emphasize active

participation on the part of the person.

OBJECTIVE FOUR:

Participants will be able to understand that active treatment is an ongoing process which utilizes every moment of a person

s day as a teachable moment and an opportunity to learn.


CONTENT OVERVIEW

This objective will focus on the idea that children and adults with special needs require

continuous, consistent development on an ongoing basis. Staff working with persons

with special needs should promote the personal growth of people with special needs and help

them increase skills development and lead functional independent lives.


1. Discuss the following areas of interest regarding people with special needs: independence,

inclusion, individualization, and productivity. Use Overhead 4.2.1.

INDEPENDENCE • Attainment of responsible behaviors • Improving self-care skills • Increasing involvement in the community • Improving self-advocacy skills • Improving eating skills • Self-administration of medication

INCLUSION • Developing appropriate social behavior • Developing and maintaining a valued social role • Developing knowledge and access to community resources • Increasing community participation

INDIVIDUALIZATION • Improving self-expression • Improving understanding of decision-making and consequences • Increasing participation in choice making

PRODUCTIVITY • Increasing recognition of own abilities • Increasing acquisition of skills/desired behaviors • Increasing problem solving and conflict resolution skills • Increasing involvement in preferred recreational and vocational activities

2. Introduce participants to the Elements of Active Treatment.

1 Interests, strengths, and needs of the individual have been accurately assessed. 2 Priority needs are addressed formally through activities which are relevant and responsive to individual interest, choice and need. 3 Each person receives consistent development, treatment, and services by trained staff. 4 New skills and socially acceptable behaviors are encouraged and promoted. 5 Each person has the adaptive equipment and assistive technology necessary to promote increased independence. 6 Routines and environments are organized to facilitate acquisition of skills, choices and socially acceptable behaviors. 7 Individual performance is accurately measured and programs are modified accordingly. 8 Persons with degenerative conditions receive training and services to maintain skills and prevent regression.

INDEPENDENCE • Attainment of responsible behaviors • Improving self-care skills • Increasing involvement in the community • Improving self-advocacy skills • Improving eating skills • Self-administration of medication

INCLUSION • Developing appropriate social behavior • Developing and maintaining a valued social role • Developing knowledge and access to community resources • Increasing community participation

INDIVIDUALIZATION • Improving self expression • Improving understanding of decision making and consequences • Increasing participation in choice-making

PRODUCTIVITY • Increasing recognition of own abilities • Increasing acquisition of skills/desired behaviors • Increasing problem-solving and conflict resolution skills • Increasing involvement in preferred recreational and vocational activities

AcTIVE

cHAPTER ENd

cONTINUOU

OBJECTIVES


1 Understand the importance of providing positive behavior support for people with behavioral challenges. 2 Understand and use pro-active strategies, relaxation techniques, non-verbal and verbal calming techniques to help people with special needs re-gain self-control.. 3 Demonstrate Core Personal Interventions. 4 Demonstrate Specialized Personal interventions.

UNIT FIVE PRESENTATION OUTLINE

OBJECTIVE

TIME

CONTENT

MEDIA

NOTES

5.1.

60 min.

Discussion

regarding the types

of interventi

on specific to positive behavior support

that have a

significant impact

on challengi

ng behaviors

Overhead 5.1.1

5.2

120 min.

Discussion

regarding non-

verbal and

verbal calming

techniques.

Overhead 5.2.1 Overhead 5.2.2 Overhead 5.2.3 Overhead 5.2.4 Handout 5.2.5

5.3

6-12 hours

Demonstrate Core Personal

Intervention

5.4

6-12 hours

Demonstrate

Specialized

Personal Interventi

on

OBJECTIVE ONE:

Participants will be able to understand the importance of providing positive behavior support for people with behavioral challenges.


CONTENT OVERVIEW

This objective focuses on setting up individualized positive behavior support plans.


Use lecture/discussion format to introduce five elements of supporting positive

behavior. Use Overhead 5.1.1 the blank Behavior Support Planning Tool to show how

all five elements should be incorporated into a treatment plan. Discuss the five

major elements in the table. Have participants identify examples of intervention falling

within each type.

Lifestyle Enhancement

Offering people with special needs a wide range of choices and opportunities will help

them develop a positive self-image and a sense of personal control.

Environmental Changes

Removing any dysfunctional or non-supportive elements in the surrounding environment

may reduce the occurrence of challenging behavior in persons with special needs. This

would be similar to changing “A” in the A-B-C model. For example, if a person often

exhibits negative behaviors in noisy environments, the environment may be altered in a

variety of ways. Have participants give examples of ways to avoid noise and reduce

noise in the environment.

Elements A. and B. relate directly to the previous discussion of “Positive and Supportive

Environments” in the “Multi-disciplinary” chapter, and typically involve changing antecedents.

Consequences to Behavior

Focus on the use of positive reinforcers, and natural, as opposed to artificial,

consequences. The “Interrupt – Ignore – Redirect – Reward” sequence is an example of

the use of consequences contained in the Pro-Active Approach section of the “Person-

Centered” chapter.

Teaching Substitute Skills

Doing a functional analysis will give insights into the function(s) of challenging

behavior. (Functional analysis is previously discussed in the “Multi-Disciplinary”

chapter.) With “Pro-Active Approaches,” the idea is to teach the person positive skills

that will have the same or a similar function or outcome for the person as the problem

behavior. For example, if a person is stealing another’s property, skills may be taught to

help the person get what he or she wants in a more socially acceptable fashion. Have

participants give suggestions.

Teaching General Alternatives

General Alternatives include communication skills, social skills, relaxation

training, self confidence, problem solving and coping skills. Such skills provide

people with special needs with the tools they need to deal appropriately and

successfully with a variety of difficult situations which might otherwise result in

challenging behavior. Any intervention developed to reduce challenging behavior

should be designed based on information gained from a functional analysis where a

hypothesis regarding the function of the challenging behavior is developed and

tested. Multi-component interventions then focus directly on assisting a person with

special needs to achieve the purpose of their challenging behavior in a more

functional manner.

Summarize the material in this objective by reflecting the following points

It is important for participants to be aware that the interventions described are very

effective in reducing the occurrence of challenging behavior. This is because the

individual’s needs are being met in ways that are proactive and functional.

When appropriate positive behavior supports are integrated into a person’s life, incidents

of crisis intervention are often reduced to zero or near zero.

OBJECTIVE TWO

: Participants will be able to understand and use pro-active strategies, relaxation techniques, non-verbal and verbal calming techniques to help people with special needs re-gain self-control.

Non-Verbal Calming Techniques

Redirect to Another Activity – starting a person on a different activity, especially one that is

motivating, may serve to defuse the situation. This is also referred to as “stimulus change. “

Eye Contact – making eye contact often helps people to regain control by reminding them of

their personal relationship with staff. Note that many people with special needs, especially

people with autism, may become more agitated in response to attempted eye contact. KNOW

THE PERSON.

Close Proximity – standing close to people may make them feel more secure, but it may also

be seen as threatening. KNOW THE PERSON.

Touch – some people may find light physical contact reassuring and supportive. KNOW

THE PERSON.

Effective Use of Space – try to position yourself and the individual so as to ensure safety and

relieve tension.

Body Posture – try to convey a calm, in-control mood by adopting a relaxed, non-threatening

stance and gestures.

Planned Ignoring – this is used to “extinguish” negative attention-seeking behavior and

should be used only as part of a treatment plan. It involves not giving people attention for mildly

disruptive behavior.

Facial Expression – as with body posture, relaxed and friendly facial expressions tend to be

calming.

Provide access to preferred objects and environments.

Verbal Techniques: present these using the same instructional strategies described

above. They are listed on Overhead 5.2.3.

Ventilation – listening to a person’s concerns in a non-judgmental way may help the person to

regain control.

Use active listening.

Distraction – asking questions related to people’s interests may serve to distract them from the

situation. You might also make a “help me” request. Reassurance – let people know that you

are there to help them to deal with problems. Understanding – acknowledge that the person is

angry or upset without judging the

individual or the reason why the person is angry. Modeling – control your tone of voice,

speaking softly in short, simple sentences. Humor – the use of positive, good natured humor

can alleviate tension in some cases. Never

use sarcasm or ridicule. KNOW YOUR PERSON.

One-to-one – talking in private may help by providing people with needed attention and

removing them from the source of tension. Make sure that other staff are available if needed.

Encourage alternative coping strategies that the individual has or is working on.

Remind people of the skills they already have to deal with difficult situations. Do not, however,

try to teach new skills when a person is upset.

Remind the person of the natural consequences of their behavior. Try to do this in a

positive, non-threatening way, focusing on people’s positive motivations and your concern for

them.

Use Positive Language – even if you have to set limits, the use of positive language is an

effective calming strategy in that it supports the person’s self esteem.

Facilitate relaxation – move to a quiet place.

Escalators: discuss the types of responses that might make a situation worse:

Escalators are the opposite of calming techniques in that they typically increase tension and the potential

for crisis. Staff should therefore be able to identify “escalators” and consciously avoid them when dealing

with people showing early signs of crisis.

There are several types of responses that may be initially perceived as verbal calming, but which

really function as escalators. When using verbal calming, staff should be aware of the potential

negative impact of the following types of statements.

Don’t plant the suggestion of misbehavior.

Tendency is to say “now don’t bite anyone…” or “don’t break a window…” planting a suggestion that a

person might act on. Don’t threaten the consequences of misbehavior which could serve as a dare to the

person. Don’t present commands in the form of a question. This often confuses the person by allowing

the person to think that they have a choice when they do not.

Don’t restart the confrontation by immediately demanding emotionally difficult actions.

Don’t rehash the incident in front of the person. Don’t have more than one staff member give directions

to a person. This will be confusing to the person and may give them the idea that they don’t have to listen

to anyone. Don’t ignore attempts at communication. Ignoring is in this case a major escalator.

Present the Six-Step Calming Process found on Handout 5.2.5.

Identify – be sure to correctly identify how the person is feeling.

Reflect – reflect your understanding of the emotion back to the person.

Reassure – give a concrete example that shows you understand how the person is feeling.

Redirect – assist the person in transferring their energy to another task or object. Praise –

respond positively to any steps the person makes to regain control. Follow up – use teachable

moments to work on relevant skills.

PHASE 1 : SETTING EVENTS

PHASE 2 : EARLY WARNINGS

PHASE 3 : CRISIS

PHASE 4 : RECOVERY

NON-VERBAL TECHNIQUES

Redirect to Another Activity Eye Contact Close Proximity Touch

Effective Use of Space Body Posture Planned Ignoring Facial Expression Provide Access to Preferred Objects

andEnvironments

VERBAL TECHNIQUES

Ventilation Active listening

Distraction Reassurance

Understanding Modeling Humor

One-to-one Coping strategies

Natural consequences of

behavior Positive Language Facilitate

relaxation

Escalators 1. Planting the suggestion of misbehavior.

e.g.: “Don’t hit me …”

2. Threatening the consequences of a behavior.

e.g.: “if you throw that toy I’ll take it away.”

3. Presenting commands in the form of a question.

e.g.: “Are you ready to get in the van now?”

4. Restarting confrontation by immediately demanding emotionally difficult actions.

e.g.: “You hit Maria, now apologize to her.”

5. Rehashing the incident within hearing range of the individual.

e.g.: “Did you hear what Olga did last night?”

Handout 5.2.5

The following is a six-step sequence that can be used by staff to help individuals to calm themselves

and deal more effectively with challenging situations.

Step One – IDENTIFY

Evaluate the situation and the person’s emotional reaction to it. Try to correctly

identify the person’s feelings and the cause. Ask more questions if you are not sure

what the person is feeling. If you are uncertain, don’t guess at emotions and causes.

However in such situations it may be effective to use more general emotional terms

like “upset” or “uncomfortable”.

Step Two – REFLECT

If you feel reasonably confident that you have accurately assessed the situation, reflect

this to the person. For example “You look upset that you can’t find your glasses.” or

“I’ll bet you’re angry that John took your work.” This type of reflection serves two

purposes. First, it helps the person to define his/her emotional reaction and may

facilitate independent identification of emotions. Second, it lets the person

know that you understand how he/she feels and why he/she feels this way. This helps

the person to feel less isolated and increases the likelihood that he/she will be willing

to participate in a socially acceptable solution.

NOTE: Showing that you understand does not mean that you condone inappropriate

behavior. Limits should be set on behavior while acknowledging the validity of the person’s

emotional response. (e.g., I know that you are angry that Joan teased you but hitting is not

allowed”).

Step Three – REASSURE

Let the person know that you are ready to help to deal with the situation. If possible,

have the person suggest solutions to the problem. If this is not effective, show the

person how to handle the problem on his or her own. Having people participate in the

solution gives the situation a positive twist that serves to enhance self-image and to

increase behavioral/emotional self control.

NOTE: Under no circumstances should you make promises that you may not be able to keep.

Handout 3.3.

(cont.)

Step Four – REDIRECT

Get the person moving (physically involved) in a different direction so he/

she can’t sulk, dwell on the problem or become further agitated. Ideally have

the person do something that he/she sees helpful to you or others since this

elevates the person’s self-esteem, cements your relationship and creates an

opportunity for reinforcing socially desirable behavior.

Step Five – PRAISE

Be sure to reinforce the person when he/she recommences constructive

activity.

Include praise for discussing feelings and for handling the problem in a

positive manner. Reflect that the person should feel good about controlling,

or regaining control of, his/her behavior.

Step Six – FOLLOW UP

Once the individual has regained sufficient self-control, it may beneficial to

use the “teachable moment” to work on relevant skills.

If you create a plan with the person as part of the resolution of the problem, you need to take

responsibility to ensure that the plan is implemented.

If the situation is part of an ongoing problem that is not currently being addressed, bring this

to the attention of the treatment team and try to develop a positive and proactive approach to

dealing with it.

OBJECTIVE THREE:

Participants will be able to perform Core Personal Interventions

REcOmmENdEd TImE FRAmE: 6-12 HOuRs

CONTENT OVERVIEW

Participants will review and practice Personal Intervention Techniques, (PIT), which will vary based

on number of trainees and number of interventions taught. The interventions are organized into

Core, Specialized and Restrictive. The core interventions are to be the only ones to be taught to all

trainees. The others may be taught based on person-specific needs.


Before demonstrating and practicing intervention techniques, lead the group through 5 minutes

of gentle stretching as a warm-up to prepare for session.

Teaching intervention skills should be based on positive learning. The supportive aspects of the

techniques should be stressed whenever possible. Participants are guided in a step-by-step fashion

through the appropriate techniques. Participants will require a significant degree of verbal and

physical assistance as they first learn the techniques. Participants should not move on to the next

step of technique until having properly completed the previous step. The person being held should

offer no resistance until the trainee can correctly apply the technique; graded levels of resistance

can be then be allowed in a “controlled” fashion. This approach has been more effective in both

increasing correct performance and reducing the potential for injury. The instructor should

structure the skill training so that correct responses are the norm.

Each participant goes through all steps until no errors are present. The instructor may initially

give verbal and physical help. Competency in the techniques must be evaluated by the instructor.

Each participant must demonstrate the core techniques independently to the instructor’s

satisfaction. STOP POINT is used at various places with the techniques. These are places where a trainee can

stop and go no further with a technique.

When teaching interventions, instructor to participant ratio must never exceed 1 to 10. It is

recommended that teaching teams should be used for this section. The time needed to allow

participants to master the core techniques is 6-12 hours. This will depend on the size and proficiency

of the group. Additional time must be added when optional and/or restrictive techniques are

taught.

Instructors should caution participants to pass if they feel that they are unsure or unable to

perform the technique because of physical limitations or medical problems. Participants

should also be cautioned about the importance of practicing with partners of approximately

the same size and weight to promote safety during the training.

As an initial approach to any intervention, the following is to be considered:

AVOID – the preferred method of avoiding injury is to avoid any physical contact entirely. Here are

the basic principles of avoidance. Feet – should be spread about shoulder-width apart with one foot

somewhat in front of the other. Body weight – should be centered between the feet and rotated

slightly upward on the balls of the feet.

Knees should be slightly flexed to allow for smooth and rapid movement of the body weight.

Movements – should be made in circular patterns so that the energy of an attack is deflected off the edge of a moving circle rather than absorbed by a stationary target. The feet are moved in

coordination with the hands in a manner similar to a tennis player preparing to receive the ball.

DEFLECT – when deflecting blows, physical contact is only momentary, there is no attempt to hold

or control the attacker.

The goal of deflection is to use the force of the attack to provide part of the necessary momentum in

moving away. Spring back on to the side to allow contact to pass by.

PROTECT – when a physical confrontation cannot be avoided or deflected, the defender attempts to

cover everything that won’t heal quickly while at the same time moving away.

While turning front away from the person, cover ear with fist so that forearm covers side of face to

protect eyes, nose and mouth area. Head is

tucked so elbow reaches chest/rib area

Opposite arm wraps around ribs and fisted hand (thumb over fingers).

Crouch body to decrease exposed, and therefore vulnerable, areas.

STABILIZE – when a challenging behavior results in a capture such as hair-pulling, biting,

scratching, pinching and choking, the defender moves his/her body weight quickly toward the point

of capture to minimize the risk of injury prior to attempting an escape.

Application of Technique

The techniques are selected to allow a maximum of use of strength of many body parts. All

available strength is concentrated in applying a specific technique. An important aspect of

this principle is the efficient use of energy. This allows a person who is physically weaker

to hold a person physically stronger. Strength can be maximized by using good body

mechanics and leverage.

Speed and Control

One of the most important aspects of performing a technique is the use of speed. Speed is

important but ineffective without good control. It is therefore important to keep the

various muscles loose and relaxed to be able to respond instantly to a situation. If the

muscles are already tensed they cannot respond rapidly to any given moment.

Timing

Correct timing is of utmost importance in applying techniques. If timing is faulty, the

technique will fail. A move too soon or late is often fruitless. The start of the technique is of

first importance in any consideration of timing.

Judgment

Judgment implies careful consideration of the situation and choosing wisely between several

possible responses. It marks the difference between using one’s head and acting blindly; between

intelligent and unintelligent choice.

Use of intervention should be done with a high degree of rationality and low degree of emotionality.

Any time personal intervention is required, it should begin with the least amount of force needed

to help the person gain control. If more support becomes necessary, then more restrictive

techniques should be applied. Techniques should be presented in terms of the amount of support

offered to a person through the application of the technique.

Handout 5.3.1 contains general information that should be used to summarize this discussion

DO’S DON’TS

Know the people you are working with: typical behavioral

responses in various situations, physical conditions/medical

problems, significant reinforcers, overall program goals or ongoing services

pertaining to maladaptive behavior.

Use less intrusive interventions (e.g.

verbal calming, humor, redirection) whenever possible.

DO NOT overreact to behavior problems! DO

NOT take a person’s behavior personally.

DO NOT feel it is your responsibility to control

another person’s behavior. Instead,

figure out what will enable that person to regain self-control.

Get out of the way!

When a personal intervention needs to

be used to help a person regain self-

control, try to lessen the potential for injury. Call for

assistance, move uninvolved persons

away from the immediate area, move

furniture away and move towards area

where there are fewer hard surfaces/edges.

DO NOT continue to progress to a “hold” if the person becomes calm. Think about

STOP POINTS.

During implementation of

personal interventions, monitor

the person’s respiration and

general physical well-being at all times

(remember BANC*). Release the person from the restrictive

hold if he/she becomes calm.

Keep calm! The intent of PIT is to reduce the

potential for injury and to help the person

regain control of his/her behavior.

DO NOT personalize the intervention. DO

NOT get involved in a “power play.” DO NOT take a person’s behavior

personally.

Handout 5.3.1

GENERAL TIPS for Personal Intervention Techniques (PIT)

As the person gradually regains

his/her composure, gradually

fade the amount of DO NOT use personal

intervention restriction placed on him/her. Reinforce

calm,

to “punish” person who misbehaves.

controlled behavior. Check for injuries. After a behavioral incident requiring implementation of

personal intervention, fully document use of

PIT, noting antecedents, any

injuries or suspected injuries and ultimate

result/outcomes.

*BANC = Breathing, Ability to move, Noise/sound, Color of facial skin

PERSONAL INTERVENTION TECHNIQUES (PIT

CORE : To be taught to all certified staff

Touch One-Person Escort One-Person Escort –

Seated Variation Two-Person Escort – Seated

Variation Arm Control by One Person or With

Assistance Standing Wrap

Front Deflect

Bite Release One-Arm Release Two-Arm Release

Front Choke Windmill Release Back Choke Release

Front Hair Pull Stabilization/Release Back Hair Pull

Stabilization/Release Back Hair Pull

Stabilization/Release With Assistance

SPECIALIZED : To be taught based on program needs

Blocking Punches

Seated Wrap

Head Support

Approach Prevention

Front Arm Catch

Bite Prevention Front Hold

Front Choke Release

Head Lock Prevention

Head Lock Release

Slip Punch to Wrap

Front Kick Avoidance/Deflection

Back Choke Arm Catch to Wrap

Back Hold Under Arm Release Back

Hold Low Over Arms Back Hold

High Over Arms to Wrap

Chair Deflection

Protection from a Chair as a Weapon

Protection from Thrown Objects One

Person Wrap/Removal Two-Person

Removal

RESTRICTIVE To be taught on an as needed basis only

Two-Person Take Down Two- or Three-

Person Supine Control One-Person Take

Down One-Person Take Down to Side

Control One-Person Take Down to Seated

Control Seated Control to Supine Control

Core Technique

Techniques in this section are required for certification in IMPACT

Touch

Description of the technique:

Touch is a proactive intervention used as a support technique, a calming technique or a form of early intervention. It is an overhand touch on the shoulder, arm or wrist of a person. Touch may be used as a first step to assess if a more supportive intervention is necessary. Touch is the least restrictive personal intervention technique.

Reasons for using technique:

To encourage verbal exchange. To assess the muscular tension of an person. To provide support without

a full force intervention. May be all that is needed to let the individual know you are aware of a situation

and willing to help resolve it. To be in a good position to step back and reassess. To be in a good position

to offer support.

Reasons not to use this technique:

Person does not like to be touched.

Use touch support to provide support to an individual at any time. Touch support can be given by touching a person on the shoulder, arm or wrist.

When using, try to move off to the side of the person, but maintain face to face contact if possible.

Touch can be applied as a simple touch and then moved to a grasp if necessary.

To prevent scratching, place your hand over the individual’s wrist.

Do know the individual!

Do use touch along with other verbal and/or non verbal calming techniques.

Don’t use on someone who does not like to be touched.

Notes: This is often a very effective intervention to let the person know you are aware of the situation.

One-Person Escor


Staff provides physical support to move a person to another location. May be used when an individual needs assistance in moving from one place to another or in maintaining a standing position (i.e.: when a participant is weak, wobbly or unsteady for whatever reason).


To assist person in moving from place to place if unsteady.

To prevent a possible injury (fall) to a person because they are unsteady.

To offer physical support to assist a person to regain control.

To avert a crisis by changing a person’s environment. Looks

appropriate in the community.

Reasons for not using this technique:

If person is physically out of control.

If person is much larger than you (recommend 2 person escort).

Steps to apply the technique:

Grasp person’s nearest arm just above the wrist (overhand grasp) with your outside hand.

Reminder: loose clothing – ie., the strings on a sweatshirt are a hazard. Tuck person’s elbow

between person’s hip and yours. Reach behind the person with your other hand and grasp his/her

wrist/forearm with an overhand grip. Your arm should be between the person’s arm and body.

Pull person close to your body (hip to hip). This prevents any unnecessary back strain. Slowly proceed forward maintaining a ‘tight package’ with person.

If the person gains self-control and needs less support, you may release his/her outside arm,

moving your body slightly away from his/hers. Eventually, you may regrasp the person’s inside

arm above the elbow with your inside hand. If person drops to the floor – DO NOT try to hold

him/her up. Staff should carefully lower

themselves with the person to the floor to avoid back injury. Re-evaluate the situation.

DO NOT try to prevent someone from dropping to the floor. DO continually evaluate

the person’s need for support.

1. 2.

4.

5.

One-Person Escort

Seated Variatio


This technique uses the same physical steps as an escort in a seated position.

Reasons for using the techniques:

Useful in transportation situations. It also might be useful in community settings to help a person regain self-control.

To keep the vehicle safe.

Reasons for not using technique:

If you cannot safely provide support on your own, the two-person escort is recommended.


Follow the steps for one-person escort. You may move from standing to seated. Maintain your grasp and

hip to hip position as you move. 2a. If technique started from a seated position, maintain the same escort

grasp and position. If more support of the legs is required, you may put your leg over the person’s inside

leg.

DO continually evaluate the person’s need for support.

2.

3.

Two-Person Escor


This technique may be used if more support is needed, to assist a person in moving from place to place, or to assist a person in maintaining a standing position. This technique may also be used when a participant is weak, unsteady, sleepy, etc.

Reasons for using the technique:

To assist an individual in moving from place to place. To

prevent possible fall of a person if they are unsteady.

Provide physical support to a person who is losing control.

To avert a crisis by changing the person’s environment.

Reasons for not using the technique:

If person is in need of greater support than this technique provides.

If the technique cannot be applied correctly for the situation.

If the person is known to drop to the floor.


Staff member 1 implements a one-person escort as previously instructed. If staff feels he/she needs assistance he/she asks for it. Staff first on the scene maintains rapport with the individual and directs the

implementation of the technique. Staff 2 grasps person’s nearest wrist with an underhand grip using

staff’s outside hand. Staff 2 tucks person’s elbow between his hip and person’s hip. Staff 2 reaches

behind person with other hand and grasps his/her forearm with an overhand grip. Staff 2 – arm may be

over or under staff 1 arm. Staff 1 changes the grip at the wrist to an underhand grip.

Staff 2 – pull person (and staff 1) close to body (hip to hip) to create a “tight package.”

Staff 1 and staff 2 must keep hips together and move person forward. All must move together as one unit.

If person drops to floor, both staff should ease person down moving to the floor with the person to prevent possible back injury.

DO remember head position (both staff) to avoid possible “head butt” situation.

DO communicate with your partner; it is vital to the success of the technique!

DON’T use with potentially aggressive individuals. DO use to move the person

to a safe place. DON’T use on stairs.

DO know where you are going.

Two-Person Escort: Seated Variatio


A two-person escort in a seated position.

Reasons to use the technique:

Provides more support than a one-person seated escort.

Works well in transportation situations.

Reasons not to use the technique:

The person does not need this level of support.


You may move from standing to seated as with one-person escort, seated variation. If starting

from a seated position, maintain the two-person escort grasp and hip-to-hip position.

Arm Control by One Person or With Assistanc


The technique involves holding the person’s arm while the person is seated, without restricting the movement of their arms. May be used to protect the person from injury i.e.: self-abusive gestures.


To prevent participant from engaging in self-injurious behavior (SIB).

To prepare for the use of a seated wrap

if necessary. To provide support in a

van or car. To transition to the seated

wrap.


If touch would provide enough support to

redirect the behavior. If the person is highly

aggressive. If it causes the person’s agitation

to increase.


Stand beside the person, facing the same direction.

With your outer arm, gently but firmly grasp the person’s wrist overhand.

With your inside hand, grasp the person between the elbow and shoulder and place the person’s elbow against your hip.

Allow the person’s arm to move, but hold it firmly enough so that they may not continue to self

abuse. Lean away slightly and allow for movement while using your body weight as

resistance.

STOP POINT

If needed call for assistance. A second person may assist on

the other arm in the same way. Maintain technique until the

person is calm.

DO use an overhand grasp.

DO use this technique with persons who exhibit self-injurious behavior, but are not assaultive toward others.

DO communicate with staff partners.

DO maintain good body alignment.

DON’T use this technique with a highly aggressive individual.

DON’T put pressure on shoulder joints – the person’s shoulders should be level.

1. 2.

3.

5.

Standing Wra



Person is out of control and endangering self,

When other techniques that are less intrusive

others or the environment.

will work.

To impede self-injurious

behavior until the

As a display of power.

person can be redirected to another activity.


To assist a person who is losing control and prevent injury to self or others by wrapping your arms around the person in a standing position.


Approach the person from the side. (There may be times when it is possible to approach from behind.) Hug the person over their arms. Keep your head low on the person’s back.

Slide around the person’s back – maintaining hug and crouched position. Keep head low. Make a “pair of feet” with your inside foot next to the person’s foot. When you are hugging from behind, slide down to just above the person’s wrist, grasp wrist and pull across person’s arm to hold their other arm to their body.

STOP POINT

If the person does not calm and/or removes their free arm, reach across his/her body grasping the free arm just above the wrist.

Move the arm across the person’s body making an “X” with their arms. Keep your hands in the vicinity of the person’s front pants pockets.

Remain in crouch/front to back position. Maintain balanced stance. Keep your shoulder touching the person’s back and keep your head down.

STOP POINT

Maintain a wide stance, lean back on your outside leg supporting the person’s weight against your body. Wait for the person to regain control.

DO continually monitor your stance. It is critical to this technique. DO keep head down when doing

technique. DO keep full grip on the arms. DO be aware of furniture, surroundings and exits. DO keep

your arms below the individual’s arms (which are being held at the hip level) to avoid being

bitten. DO continually evaluate the person’s level of self-

control. 137

2.

3.

5.4.

Front Deflectio


If someone is coming towards you with their arms up to grab you, it may be possible to deflect them away.

Reasons to use technique:

If you feel threatened.

Reasons not to use:

If you can move out of the way.

Steps to apply technique:

When a person comes towards you with their arms out to grab you, raise your arms.

Step to one side and deflect the person’s outstretched arms away…

While moving away into the proper stance.

DO determine what the person wants from you.

Bite Releas

Description of technique:

To be used when a person bites and does not let go.


To minimize the possibility of injuries when a person is bitten.

Reasons not to use technique:

May compromise the individual’s breathing.


Push the area being bitten against the person’s mouth using just enough pressure to seal that area.

Many people who bite will release voluntarily. Wait a few seconds before going to Step 2. Gently

pinch the person’s nostrils shut. A second staff may assist by covering the person’s eyes. As soon as

the person opens their mouth to breath, pull the bitten area away. Move away from the person so

that they cannot bite you again.

DO know the individual who bites and employ preventive measures. DON’T pull the bitten part of

your body away while the person is still biting. DON’T push quickly or roughly against the person’s

mouth when attempting to seal the area. DON’T continue to pinch the person’s nose shut if signs of

distress from having the airway closed are present.

One-Arm Releas


This technique is a means of releasing a grasp of your arm.


To release an arm grasp. The

person won’t let go voluntarily.

Reasons not to use technique: The person may be trying to communicate with you. Do not assume that physical contact is aggressive.

It may be safer to remain in a “grabbed” position until the person is calm.


If a person grabs your arm and they don’t let go and you feel threatened,

Make a fist, rotate your arm towards the persons thumb and pull away quickly.

DO try a verbal request or ask the person what they want before moving. DO pull in the

direction of the weakest part of the grasp – usually in the direction of the thumb. DO think

what the person is trying to communicate to you. DON’T abandon the person after he/she has

let go.

One-Arm Release, Variation


If you are grasped and verbal techniques are unsuccessful,

Make a fist. Bend your arm, keeping your upper arm close to your side.

Rotate your arm in the direction of the person’s thumb and quickly pull through the person’s grasp.


First stabilize the person’s arm with your free hand either overhand… Or

thumb down so you can easily move the person’s side. ? Rotate and pull

your arm quickly. From this point, you can decide whether or not to maintain support with your hand.


If a person grasp your arm with two hands,

Make a fist.

Grab your own hand with your free hand. And pull up across

your body to avoid hitting yourself in the chin.

1. 2.

4.

Two-Arm Releas


This technique may be used when grasped by both arms.


If a person grasps both your arms with their hands and verbal techniques are not successful in getting them to release the grasp…

Make fists, and

Pull up towards your body.

DO try verbal request first. DO try a verbal request or ask the person what they want

before moving. DO pull in the direction of the weakest part of the grasp – usually in the

direction of the thumb. DO think what the person is trying to communicate

to you. DON’T abandon the person after they let go.

Front Choke Windmill Releas


To be used if being choked from the front.


If you are choked from the front and the person does not let go when you ask them… Raise your right

arm up. Rotate your body to the left. Take a short step forward and to the left with your right foot.

Bring your arm down over the

person’s arms to release the grasp from your throat.

Deflect the person’s arms away from you with your arm.

DO keep your arms straight and be aware of the person’s head position to avoid butts.

DO find out why the person wanted your attention.

3. 4.

6.

Back Choke Releas


A means of releasing a choking grasp applied form behind.


If you are choked from behind, ask the person to let go. If verbal intervention is unsuccessful,

Raise your right arm.

Turn in the same direction. Use your raised arm to release the choke. Maintain a firm, balanced stance.

DO ask the person what they want.

DO follow up with support

Front Hair Pull, Stabilization and Releas


To be used when hair is being grasped from the front.


If a participant pulls your hair form the front.

Reasons for not using this technique:

If you feel you cannot free yourself without assistance, use version of this technique with assistance.


If a person grabs your hair from the front, quickly secure his/her hand with both your hands, (to stabilize him/her from pulling your hair out), by pushing the person’s hand towards your head.

Stabilize the person’s hand on your head by placing both your hands over his/her fist. Wait and see if the person will let go voluntarily.

STOP POINT

Once you have person’s hand stabilized; form a “U” grip (with hand) and slide to participant’s

wrist maintaining stabilization with other hand. If you feel you are able to remove the person’s

hand from your hair, push up on the person’s wrist with your “U” grip and down on the person’s hand thereby causing the person’s fingers to relax.

After backing away, maintain an appropriate stance to prepare yourself for the person’s response.

DO this maneuver quickly. DO STABILIZE before you attempt release. DO know the

person! DO wear long hair in a ponytail or wear a cap. Avoid leaving an open

target. DON’T allow a person who has tendencies to pull hair that close to you. DO

find out what the person wanted.

1. 2.

4.

5.

Back Hair Pull Stabilization/Releas


Used if a person grabs your hair from behind.


If a person grabs your hair from behind – quickly secure his/her hand with both your hands (to stabilize him/her from pulling hair out) by pushing the person’s hand towards your head.

One you have person’s hand stabilized, bend forward at the waist (this causes the person to be thrown slightly off balance). Place your thumbs on the person’s wrist. Wait for the person to let go.

STOP POINT

If the person doesn’t let go, bend more sharply at the waist pushing up on the person’s wrist with your thumbs.

If possible, slide the hand off the back of your head and move away.

DO this maneuver quickly. DO remember to STABILIZE before trying to free yourself to

prevent any unnecessary hair loss. DO ask the person to let go. DO wear long hair in a pony tail

or wear a cap. Try not to leave an open target. DO try not to have your back to a person who you

know pulls hair.

1. 2.

Back Hair Pull Stabilization/Release (PonyTail)

1. 2.3.

Back Hair Pull Stabilization/Releas

with Assistanc


To be used if you are unable to free yourself from a person who pulls your hair from behind.


You are unable to free yourself when a person pulls your hair from behind.


Implement back hair pull stabilization release as previously taught. If you feel you are

unable to free yourself, call for assistance, while maintaining stabilization (bend sharply at waist with person’s waist with person’s hand secured with your 2 hands).

Staff 2 should implement touch to person’s “free hand”.

Staff 2’s other hand should cover person’s eyes making sure thumb is tucked close to hand. When person’s eyes are covered, this confuses them and they may let go. The person is only able to process so many situations at once. Remember they are off balance already, and now they cannot see which may present enough of a novel stimulus to encourage them to release the hold.

DO stabilize before release. DO know your own person. DON’T try to free

yourself if you don’t think you can. DON’T have your back turned to a

person who has a tendency to pull hair. DON’T bend down in front of the

person.

DO try to avoid a punch.

DO try to block punches with arm rather

DO use calming techniques.

than hands to avoid injury to fingers.

DO use redirection.

163 DO follow up with support.

Specialized TechniquesTechniques in this section are to be

taught based on program needs

Blocking Punches


This technique is a way to use your body in ways which protect you from being hit by a punch.

Reasons to use this technique: Reasons not to use this technique:

To avoid being struck. If you can move out of the way.

Steps to using the technique:

Maintain a balanced stance with a wide base of support.

Present the smallest area of your body (use a “side facing” position)

Put your arms up to protect your face and head.

Make sure you think more about avoiding than blocking.

If a person attempts to strike you with an over hand blow, raise your forearm close to your forehead in a horizontal position and rotate your forearm thumb side down, blocking the blow with the arm nearest the striking blow.

For punches to the side of the face or body, bend your arm in a vertical position close to your body. Absorb the blow by moving in slightly.

If a person attempts to strike you with a straight punch, try to misdirect the punch with a deflection.

If you are already holding one of the person’s arms, you can push that arm up to deflect a punch

from the other hand.

1. 2.

4.

5. 6.

Seated Wrap


This technique can be applied from the two-person arm control while person is still in a chair.

Reasons to apply the technique:

To offer more support to a person who may be struggling to self-abuse, until the person regains self-control.


When other techniques of redirection or environmental change would help the person re-gain self-control.


From the two-person arm position, one person drops to one knee, keeping head tucked below the person’s shoulder. Move the person’s wrist across his torso. Face to the rear.

Move behind the chair and grasp the person’s arm just above the wrist with your other hand. Slide your hand to the person’s elbow and signal your partner to send the other wrist across the torso.

Your partner mirrors your move, completing the wrap. Both should maintain a firm, balanced

position. The partner may leave unless needed for head support. Support person in this

position keeping your head low and your shoulder against the chair.

DO talk to your partner. DO hold your arms below the person’s

arms to avoid being bitten. DO kneel low behind the person to

avoid head butts. DO pass the arm “low across the body” to avoid

staff being bitten. DO be aware of the chair – can it support the

person? DO keep arms low to avoid pressure on the abdomen.

1. 2.

4.

Head Suppor


A person’s head may be supported while in a seated wrap-up.

Reason for using the technique:

To support a person’s head if they are struggling and trying to strike with their head.


Place your hand on the person’s shoulder while cradling his head with your other arm.

Place the index finger of the arm cradling the head beneath the lower lip above the jaw with your thumb tucked down. Place your remaining three fingers under the jaw.

If necessary, move your hand at the shoulder to the person’s forehead for more support.

DO maintain proper hand position keeping your fingers away from the person’s mouth.

DO gently cradle the person’s head holding it close to your body to reduce head butting.

DON’T pull or twist the person’s head or neck. DO be careful not to poke the person’s

eyes.

Approach Preventio


This technique is a means to keep someone from grabbing you as they approach from the front.

Reasons to use the technique:

If deflection and avoidance did not work.

Depending on the person, may prevent from assaulting you.


If the person attempts to hold from the front.

Quickly straighten your outstretched arms and step back into a firm, balanced stance.

DO use this technique to maintain appropriate distance between yourself and others. DO NOT

use with a highly aggressive person. DO NOT use with a person whose arms are much longer than

your own, should that person become aggressive.

DO find out what the person wants.

Front Arm Catc

Description of the techniques:

This technique is a means of containing a person’s arms to prevent possible choke.


When a person approaches you from the front to grab or choke you, and deflection or prevention is not possible, you may stop them by catching their arms.


If the person reaches towards you, grasp their arms just above the wrist. Crisscross the arms

using their momentum. Straighten your arms and bring the person’s wrists together and down.

Step back and maintain a firm balance.

DO keep your arms outstretched and straight to avoid head butts.

DO teach alternative communication skills.

Bite Prevention Front Hol


Use this technique as a means of preventing a person from biting from the front.


If a person reaches and grabs you from the

front… Bring your arms up close to your chest…

Form a V-shape under the person’s chin.

DO know your person and take steps to avoid being bitten.

Front Choke Releas


When being choked from the front, this is a method to release the grasp.


If you are being choked from the front …

Quickly grasp both the person’s arms just above the wrists and use a circular motion to push up

on one wrist and pull down on the other... Straighten your arms and crisscross the person’s

arms… Bringing the person’s arms together and down.

Step back and maintain a firm, balanced stance.

DO follow up with support. DO teach alternative

methods of communication.

Headlock Preventio


If a person attempts to place you in a headlock, this is a way to prevent it.


If a person attempts to place you in a headlock… Immediately tuck your chin into

your shoulder, and … Bend sharply forward at the waist, stepping out and back to

the side of the person.

DO avoid facing away from a person who uses this behavior.

Headlock Releas


You can use this technique to release yourself from a headlock.


If you are grabbed from behind in a headlock, immediately grasp the arm of the person who is holding

you near their wrist and elbow. Tuck your chin into their elbow. Bend forward and step back while

holding the arm near the elbow and wrist. Turn your face to the person’s body and place both hands on

the person’s arm just above the wrist. Push down on the person’s arm, and… Step back and out of the

headlock.

DO make space with your chin at the person’s elbow. DO

protect your neck. DO follow up with support. DON’T face

away from a person who exhibits this behavior.

3.

4. 5.

Slip Punch to Wra


If a person swings at you, this is a way to avoid being hit by deflecting the arm and placing the person in a wrap.


When the person needs this level of support after you have avoided a punch.


If a person swings at you, lean back and push the person’s arm in the direction of the swing. Let

the person’s momentum turn them. Once they are turned, place your arms over theirs and push

them forward. Grasp their top arm just above the wrist with your hand, keeping your head behind

their shoulder.

Grasp the other arm near the wrist with your free hand and maintain a firm, balanced stance.

DO keep the person’s arms low at their hips. DO keep your head behind

their shoulder. DO maintain a firm balanced stance. DO communicate

with the person. DON’T try to duck under a punch. DO block with your

arm rather than with your hand to avoid finger injury.

Front Kick Avoidance/Deflectio


Use this technique to avoid or deflect a kick from a person who is facing you.


If a person kicks you and you are unable to step back to avoid it, bring one foot back, use the arm of the same side of your forward leg to reach down, and…

Gently deflect the kick across the person’s body.

DO step back and avoid a kick if possible.

DON’T grab or hold the person’s leg.

Back Choke Arm Catch to Wra


Use this technique to move from a Back Choke Arm Catch to a Wrap.

Reason for using technique:

If you are being choked from behind, this is a way to release that choke and provide additional support.


If you are being choked from behind and you need to release it…

Quickly raise your right arm and turn in that direction.

Continue turning and swing your arm over the top of the person’s arms, disengaging the choke while wrapping their arms with your arm.

Begin to move around the person while holding their arms. STOP POINT: decide at this

time if the person requires the support of a

wrap. If so,

As you move behind them…

Begin to apply the wrap.

End with the wrap, maintaining a firm, balanced stance.

DO continually evaluate the level of support that the person needs to be safe.

DO allow the person to regain self-control.

1. 2.3.

Back Hold Under Arm Releas


To be used if you are held from behind in a bear hug under your arms.


If a person holds you tight under your arms from behind, ask them to let go. STOP

POINT: wait to see if the person will let go voluntarily. If not, go to Step 2. Quickly raise

your arms and grasp the person’s arms just above the wrists by slipping your thumbs between your body and the person’s arms. Push down on the

person’s arms by straightening your arms. Once the grasp is broken,

push the person’s wrists tightly to your legs. Move away and reassess

the situation.

DO determine what the person wants.

DO ask the person to let go.

Back Hold Low Over Arm


If you are held over your arms in a low position, this is a way to release the hold.


If you are held over the arms from behind, straighten your legs and bend forward – begin by requesting that person to let go.

STOP POINT: wait to see if the person will let go voluntarily.

If you still need to release this hold, lean sideways to make space and pull one arm free.

Pull your arm out, and…

Grasp the person’s arm just above the wrist on the same side.

Lean the other way and pull your other arm free.

With that arm, grasp the person’s other arm near

the wrist.

Straighten your arms and push down on the

person’s arms. Push the person’s wrist onto

your legs. Step away and reassess.

DO remember that size and strength differences make this a very difficult technique to

perform. DO try asking the person to let go. DO put your thumb between the person’s arm and

your body. DO teach the person another means of getting your attention.

1.2. 3.

7. 8.9.

Back Hold (High) Over Arms to Wra


If you are held from behind high over your arms and you need to free yourself and offer the person further support.


If you are held from behind high over your arms and need to get free...

Roll your shoulders forward and bend at the knees.

Reach between the person’s arm and your body and grasp their opposite wrist.

Raise the elbow and shoulder of your arm and release the hold.

Step to the other side while holding on to the person’s wrist and slide your head down and out.

Step behind and release if possible. STOP

POINT: decide here if you need the

support of a wrap.

If more support is necessary, move to a wrap.

DO continually evaluate the person’s need for support.

DO realize that you are doing the same thing to the person that was done to you. This may be a bad message.

DO find out what the person wants.

1.2. 3.

Chair Deflectio


If a person has a chair raised to throw and hit someone, it is possible to deflect it down.


If a person has a chair raised and poised to throw, and you are close… Quickly approach the

person from the side, grasp the chair, and quickly pull it forward and down.

DO use verbal calming techniques.

DON’T sit in the chair to hold it down.

DON’T hesitate.

Protection from a Chair as a Weapo


When a person uses chair as a weapon, you may be able to use another chair for protection.


If a person tries to use a chair as a weapon… Quickly

grab a chair. Use it to shield yourself from the person’s

chair, while…

Forcing the chair to the floor if possible.

DO remember to use calming techniques

Protection from Thrown Object


To avoid or deflect objects thrown as weapons.


Pick up an object to use as a shield (couch cushion, pillow, blanket, jacket, etc.)

Deflect object down and away.

DO be aware of objects that are potential

projectiles. DO use verbal calming techniques.

DON’T deflect objects at people, windows, TV, etc.

One-Person Wrap Remova


Staff stands behind the person, reaching around his/her waist and placing downwards pressure on the arms. Staff keeps his/her head low and stance from front to back.


Staff stands behind the person, reaching around his/her waist and placing downwards pressure on the

arms. Staff keeps his/her head low and stance from front to back. Initially, step back maintaining a

wide stance. Pull the person into your base of support. Slide the foot closest to the person back to you.

Continue to move out of the area in this fashion.

DO use the “step and slide” method. DO keep your head at, or below the shoulder, to avoid head butts.

DO keep a full grip on the wrists and keep your arms below the individual’s arms to avoid being bitten.

DO support the individual’s weight against your hip to protect your back. DO plan where you are

going.

1. 2.

4.

Two-Person Remova


Reasons for not using the

technique: Person is out of control, endangering self and/or

If other less intrusive technique

will work, others, and cannot be assisted by one person.

i.e., Two-person escort.


A means to move a person backwards while supported on either side by staff.


When a two-person removal is needed, two staff approach the person from the side. One staff attracts the

person’s attention, possibly through a touch on the shoulder. Staff 1 then grasps the person’s wrist with their

outside arm. Immediately after, Staff 2 then grasps the person’s other wrist with their outside hand. Both

staff members now quickly lock their arms under the person’s arms grasping the shoulders and

securing the person’s upper arms in their arms. Walk the person backwards while keeping staff’s hips

close to the person’s hips, and the person’s shoulders supported.

DO communicate with your partner. DO keep the

person’s hips close to your hips. DO maintain proper

arm position to avoid being bitten. DO know where you

are going.

3. 4.

5.

7.

Restrictiv

Two-Person Take Down


If a person is to be taken to the floor, it can be done with two people from the two-person removal position.


From the two person removal position, both staff place inside legs and hips behind the person with their heels behind the person’s heels.

While supporting under the shoulders with upper arms, staff take one step forward with their outside legs.

Staff kneel on their inside knees and carefully lower person to floor while keeping hips close. Slide arms out at the same time as the person slides down. Slide your arms out from under the person’s shoulders once the person is on the floor.

Two- or Three-Person Supine Contro


Once on the floor, after a two-person take down, it is possible to maintain control using two or three people.


From the two person take down on the floor, hold the wrist and the shoulder while keeping your

hips in close to avoid kicks. It is possible to stop here. STOP POINT: wait a moment for the

person to calm… If there is a need for more support of the person’s legs, staff may begin to move

the person’s arms over their head. One staff moves over the person’s head, and … Takes both wrists in a reverse grasp

to avoid scratching. The second staff person now moves down,

past the person’s chest and stomach to the person’s legs…

Until they are able to wrap their arms around the person’s thighs just above the knees. The first staff person should allow limited arm movement.

It is possible for a third person to assist in holding someone on the floor. Two staff members apply pressure to the person’s arms just above the wrists and elbows with their knees just below the shoulders. The third person controls movement of the person’s legs by wrapping his/her arms around the person’s thighs just above the knees.

DO communicate with each other. DO

monitor vital signs. DO stop and release

if the person calms.

One-Person Take Dow


If you are unable to support a person in a wrap position and assistance is not available, a one-person take down is possible.


From a standing wrap position… Step outside the person’s foot and bend your

knees. Drop to your knees gently while keeping the person close in a balanced

position. Carefully set person down on their side using your leg as a cushion if

necessary.

DO provide support throughout the technique. DO be aware of

vital signs. DO always release if possible to move to a less

restrictive position. DON’T allow the person to fall to the floor or

hit their face or neck. DON’T do this technique with a person with

Down Syndrome.

2.

4.

One-Person Take Down to Side Contro


A restrictive technique used only to interrupt a truly dangerous situation where a person is threatening to injury self, staff or others.

Reasons for using this technique:

To interrupt a truly dangerous situation when a person is threatening to be a danger to self, staff or others.


From one person wrap, take the person down to a kneeling position.

After the person has been taken down to a kneeling position, the staff then pulls the person across their lap and lowers the person to their side.

While maintaining the person on their side, staff lowers themselves to the side, behind the person, keeping their head tucked into the person’s back, facing towards the floor and knees drawn up. This is the side control position. The staff can raise their upper leg as protection against kicking. A second staff can assist by approaching from front and wrapping the person’s legs above the knees.

If the person is forcefully trying to roll on to their stomach and cannot be maintained on their side, staff should release the person, allowing them to roll forward. Staff should roll backward in the opposite direction, moving to a position in which they can re-engage the person if necessary.

Must release the side control position after 20 minutes.

DO utilize the stopping points whenever possible. DO keep your head tucked into the person’s back or to

the side. DO get into a tight position to avoid injury. DO release the person if they are attempting to roll

over onto their stomach. DO monitor vital signs at all times. DO roll in the opposite direction of the person

when releasing. DON’T ever roll the person over onto their stomach or place any pressure on the person’s

back. DON’T use this technique if two staff are available to intervene. Must release after 20 minutes. DO

avoid pressure against the diaphragm. If the person’s upper shoulder moves forward to touch

the floor, release the grasp.

DO not place leg over the person’s neck.

maintain support by using your grasp on the upper hand

not by hugging more tightly.

turn your head toward the floor when using side control, to protect your neck.

Follow up

Check the individual when calm for injuries.

Document intervention.

Repeat steps 1-4 from One Person Take Down

5.

6. 7.

One-Person Take Down to Seated Control to Side Control


A restrictive technique used to interrupt a truly dangerous situation where a person is threatening injury to self, staff or others. Seated control and side control are stop points to the One-Person Take Down.


To interrupt a truly dangerous situation where a person is threatening injury to self, staff or others.

Reason for not using the technique:

If two people are available, use two-person supine control.


Using the one-person take down, take the person to a kneeling position.

After the person has been taken down to a kneeling position, the staff then moves to the side of the person so that both staff and the person are in the seated position, staff leaning in toward the inside thigh and buttock with knees bent. Staff should keep head low and tucked into the person’s back to the level of the person’s armpit. This seated control position is a stable position and considered a STOP POINT to end the one-person take down.

If the person forcefully tries to lower themselves to the floor, and staff person can no longer support them, staff should pull the person toward their body, lying down on their side behind the person with head tucked into the person’s back, and facing towards the floor with knees drawn up. This is the side control position and is the final stopping point to the one-person take down. Do not maintain this position for more than 20 minutes.

If the person is forcefully trying to roll on to their stomach and cannot be maintained on their side, the staff should release the grasp on the person’s wrists, allowing the person to roll forward and away, while staff rolls backward in the opposite direction, moving to a position from which they may re-engage the person if necessary.

DO utilize the stopping points whenever possible.

DO keep your head tucked into the person’s back or to the side.

DO get into a tight fetal position to avoid injury.

DO release the person if they succeed in rolling over on to their stomach.

DO monitor vital signs at all times.

DO roll in the opposite direction of the person when releasing.

use this technique if two staff are available. Use two-person take down to supine control instead.

DON’T EVER roll a person over onto their stomach or place any pressure on the person’s back. Must release after 20 minutes.

Follow up

Check the person when calm for injuries. Document intervention.

Decide what can be done to avoid this level of intervention in the

future.

Repeat steps 1-4 from One Person Take Down

5. 6.

7. 8.9.

Seated Control (one-person

to Two-Person Supine Contro


To be utilized when in the seated control position (after a one-person take down) and another staff becomes available to assist. The second staff person assists in transitioning from seated control to two-person control.

Reasons for using the technique:

To interrupt a truly dangerous situation when a person is threatening to be a danger to self, staff or others.

When assistance is available after utilizing the seated control technique, staff may transition to a two-person supine control technique if additional control is needed.


Person has stopped struggling and no longer needs this level of support.


From the seated control position, a second staff person enters to assist from the rear on the opposite side, placing their inside hand on the person’s shoulder and their outside hand on person’s closest wrist.

Supporting the person’s back, both staff members move the person backward so that the person’s legs are now in front of their body. Staff then lower the person’s upper torso.

While maintaining control of the person’s wrists and shoulders, both staff shift around to the side of the person with their inside hips overhanging the person’s hips in order to restrict the person’s lower body movement.

The staff member who is grasping the person’s bottom wrists moves his hand from the person’s shoulder to the opposite top wrist, then moves his hand from the bottom wrist to the person’s near shoulder. This is not a stop point. Pressure must be removed from the person’s abdomen by continuing with the rest of the technique.

The other staff member then moves the hand from the person’s shoulder to the opposite (bottom) wrist, then the hand from the person’s near (top) wrist to the person’s near shoulder.

DO practice hand placements. DO NOT apply any pressure to the

person’s abdomen or diaphragm.

Follow up

Check the person when calm for injuries. Document intervention.

Determine what changes could be made to avoid the situation in the future.

213

1. 2.

4.

5. 6.

Seated Control (one-person)to Two-Person Supine Control

(cont.)

7. 8.

10.

11.

cONTINUOUS

cHAPTER ENd

TRANSFORmATIO

Person centered, proactive approaches are at the foundation of the IMPACT curriculum. These

concepts, when put into practice, lead to positive transformation for persons with special needs

and support providers alike. Transformation is not exclusively a goal or destination, but rather a

journey; along the way caregivers have an opportunity to create exciting possibilities that enrich

the lives of people with special needs. Profound changes occur when IMPACT is used to design

innovative learning strategies and new approaches for active treatment. You will discover much

about those you support, and a great deal about yourself. The education and awareness gained

from IMPACT training provides the tools necessary to develop and grow in your work, to reach

the highest standards of excellence as a Support Professional. Engage in creative problem-solving

together with colleagues. Attend yearly training updates to reinforce your knowledge and stay

current with the latest information. Become mentors, model the IMPACT philosophy to others

where you live, and take part in transforming the community at large.

OBJECTIVE ONE:

Participants will be able to use all they have learned from the IMPACT curriculum to design person-centered, proactive approaches and provide high quality support to people with special needs.


CONTENT OVERVIEW

Review the importance of person centered, proactive approaches, and reinforce the idea that

these concepts are at the foundation of the IMPACT philosophy. Then encourage participants

to think about ways they may utilize these concepts.


Lead participants in a discussion about the importance of person centered, proactive

approaches, which are at the foundation of the IMPACT curriculum. Invite them to share

examples of person-centered approaches they have designed or anticipate using for those

they support.

Transformation is not exclusively a goal or destination, but rather a journey; along the way

caregivers have an opportunity to create exciting possibilities that enrich the lives of people

with special needs. Profound changes occur when IMPACT is used to design innovative

learning strategies and new approaches for active treatment. You will discover much about

those you support, and a great deal about yourself.

OBJECTIVE TWO:

Participants will understand that they can positively transform the quality of life for those with special needs, reach new standards of excellence as Support Professionals, and take part in transformation that also extends to the community at large.


CONTENT OVERVIEW

The purpose of this objective is for participants to understand that IMPACT curriculum

concepts, when put into practice, lead to positive transformation for persons with special needs

and support providers alike.


Invite participants to share the ways in which IMPACT has changed the way they view their

role as Support Professionals. Invite participants to envision ways Transformation may

extend to all community members.

The education and awareness gained from IMPACT training provides the tools necessary to

develop and grow in your work, to reach the highest standards of excellence as a Support

Professional. Engage in creative problem-solving together with colleagues. Attend yearly

training updates to reinforce your knowledge and stay current with the latest information.

Become mentors, model the IMPACT philosophy to others where you live, and take part in

transforming the community at large.

OBJECTIVE THREE:

Participants will understand Essential Elements of Transformation


CONTENT OVERVIEW

Introduce the Essential Elements of Transformation and provide details which expand

on the meaning of each.


Provide the following list as a handout or use as an overhead.

Essential Elements of Transformation

Observation: Allow time to slow down and get to know the person you support on

their terms, through observation. Let them express their individuality first, without

attempting to change who they are. Look for clues to hidden strengths and abilities.

Intention: Much of what we communicate is non-verbal. People with special needs,

like those in the typical population, often pay more attention to how we say something,

not only what we say. If your respect and intention to care is present, it will positively

affect your relationship with those you support.

People: Transformation requires people who are committed to providing genuine care,

understanding, and continuity for people with special needs. With social contact,

community involvement, and public awareness, people with special needs can flourish.

This encompasses family members, friends, neighbors, employers, and extends to all

members of the community.

Environment: Provide environments for people to safely test their capabilities.

Encourage them to expand their experiences with new activities and materials.

Providing this kind of stimulation helps bring out hidden abilities and interests.

Increase your expectations – you won’t know unless you explore it. This is especially

true of activities that are intrinsically motivating to the person.

Perseverance: Results can occur unexpectedly or can sometimes take a great deal of

time. Providing choices in a relaxed environment will often bring about positive

behavioral changes. Be open to the possibility that positive change may be taking place

in small increments very gradually, over a long period of time.

OBJECTIVE FOUR:

Participants will share their own Transformative experiences in an effort to model creative problem-solving skills they have learned to one another.



Provide the following two Transformation stories to participants in a handout and/or

read aloud. Ask the group to break into “teams.” Request that each team present their own

Transformation story to the whole group, based on their experiences, utilizing the elements of

Transformation.

TRANSFORMATION STORIES

The Story of Matt: Matthew and his brother attend a Supplemental Day Hab program.

On the first day, while Matt’s brother walked directly into the building to the correct

room, Matt was outside, running into neighboring properties, with his mother chasing

close behind. Eventually she delivered Matt to the front door where staff greeted them,

at which point Matt ran through the halls of the facility, destroying signs and other

objects he encountered along his path. This pattern repeated every program night.

Then staff put strategies in place - Matt was given choices about which door he would

use to enter the building, which rooms he would visit, and preferred activities were

offered throughout duration of the program. His 1:1 staff provided visual support in the

form of picture symbol cards, which Matt could use to communicate requests. Matt

became calmer and more willing to enter the classroom for increasingly longer periods

of time. After almost a year, Matt was able to participate in activities of his choice

alongside his peers for nearly the entire duration of program.

The story of Ricky: Ricky is non-verbal and deaf. His family struggled with Ricky’s

out of control behavior throughout his young adulthood. When first attending Day Hab,

Ricky sat at a desk writing his name over and over again. He was given the opportunity

to attend art classes but did not even enter the room for over a year. However, provided

with an enriching environment and the ability to make choices, Ricky was able to

expand on one of his special interests – his collection of small plastic animals – and

create photographs of his animals in his own hand drawn color field environments. Today

Ricky is an award-winning, widely exhibited artist. More importantly, Ricky has a new

awareness of his identity as a creative person and a calmness within himself.

CONCLUSION?

What stories can you share about transformation since using

IMPACT? With each experience your understanding will grow,

as you witness those you support reach unforeseen milestones.

This is just the beginning of many new stories to be told…

TRANSFORmATION

cHAPTER ENd

Reference

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