2 DISABILITY ETIQUETTE Presentation Objectives: Identify the different modes of communication that individuals with DD utilizeDiscuss general communication strategies when working with individuals with DDIdentify actions to take when individuals with DD have behavioral issues.
3 Communicating with Individuals with Developmental Disabilities MYTH # 1People with DD cannotunderstand speech, letalone medicalinformation
4 Premise #1 Many people with DD can effectively communicate their needs People with DD have a wide variety of communication skills and abilities
9 Premise # 2People with developmental disabilities participate in decision making in a variety of ways.
10 PREMISE #2 (cont’d) Many individuals with DD are their own guardians Many individuals with DD are capable of informed consent for medical procedures / treatment.
11 MYTH #3 People with DD are sick. People with DD are dependent on others to meet many / all of their needs.
12 Premise #3Many people with DD are not sick, incompetent, dependent, unintelligent or contagious. They are like the typical population, i.e. healthy, chronic medical conditions, mental health diagnoses and acute care issuesPeople with DD have master’s degrees, work full-time, drive, own businesses, participate on committees, are married and have children.They are individuals and you use the same assessment skills as with typical population.
13 Premise #3 – (cont’d) Triage Communication issues Baseline health Mirrors other individuals that may be in shelters, with mental health issues, alzheimers, elderly, typical population.Cooperative, communcative and compliant
14 MYTH #4People with disabilities canaccess health care easily.
15 Premise #4 Healthcare providers may have to adapt their physical environment andinteraction techniques.
16 Premise #4Talk to the person, rather than through their caregiver or sign language interpreter.If the caregiver needs to be involved in their healthcare conversation, ask the individual’s permission.Listen patiently. Don’t complete sentences for the person unless he/she looks to you for help.
17 Premise #4Allow extra time for the visit and give specific directions.Don’t pretend you understand a person with a speech disability just to be polite.Be prepared for various devices or techniques used to enhance or augment speech.
18 General Communication Strategies R (adapted from Seigel-Causey and Guess, 1989)
19 Nurture Develop a trusting and supportive environment Show real interest in communicatingAct and speak naturally
20 OpportunityCommunicate about what is happening nowProvide choices
21 U “You” always play a key role in assuring effective communication Talk to the personAsk permission to talk with whoever is assisting themListenClarifyRestate
22 Sensitivity Recognize an individual’s readiness to communicate Respond at the person’s levelRecognize the communication modes of the individualRespond appropriately to all communicative attempts
23 Sender Get the person’s attention Present info using person’s receptive modeRepeat the message once, then restateRephrase using different words or modesRecognize all attempts to respond
24 SenderTreat Adults as AdultsDo not shout at the person with DD
25 Receiver Pay attention and be aware Ask for clarification when needed Be honestEncourage individual to use many modes
26 Cognitive Disability Use very clear, specific language Be patient. Allow the person time to tell or show you what he or she wants.Condense lengthy directions into stepsUse short, concise instructions(Commission for People with Disabilities, November 2007)
27 Cognitive DisabilityPresent verbal information at a relatively slow pace, with appropriate pauses for processing time and with repetition if necessary, e.g. “In five minutes, we’ll be going to lunch.”
28 Cognitive Disabilities Reinforce information with pictures or other visual imagesUse modeling, rehearsing and role playingUse concrete rather than abstract languageLimit the use of sarcasm or subtle humor
29 Cognitive Disabilities If you are not sure what to say or do, just ask the person what he/she needs.
30 Dealing with Behavioral Issues Dual Diagnosis:Individuals who haveboth a mental illnessand a developmentalor intellectualdisability.Increase incidence ofmental health issues within people with DD – maybe due to brain pathology.
31 Behavioral Issues“Unlike the general population, individuals with a dual diagnosis may be more likely to exhibit sign and symptoms of their disorders in the form of behavioral outbursts including verbal or physical aggression, self-injury, property destruction, impulsive behaviors and/or elopement .”(Family Crisis Handbook, Donna Icovino & Lucille Esralew, Ph.D.July, 2009)
32 Behavioral IssuesNot uncommon for people with Pervasive Developmental Disorder (PDD) or Autism to display aggressivebehavior.May be a response to frustration, pain and limited communication skills.
33 Behavioral IssuesFor individuals who are non-verbal, behaviors may be their way of expressing frustration and/ or pain.
34 How to Cope with Behaviors During a Disaster Stay calmUse verbal and non-verbal techniques including relaxed body positionLimiting space by directing the person to another room or area away from othersSoothing tone of voiceAvoid giving commands
35 How to Cope with Behaviors During a Disaster Identify feelings (if able)Ask Caregiver for assistance with behavior (may be aware of behavior plan to de-escalate aggressive behaviors)Redirect to a different activity, preferably something soothing
36 Self-Injurious Behavior For some individuals, i.e, people with autism and those who are non-verbal, aggression may be expressed by self-injurious behavior.Head banging, hitting themselves, biting themselves.Interventions are the same as previously discussed.
37 A FINAL WORDPeople with DD are individuals with families, jobs, hobbies, likes and dislikes, problems and joys. While the disability is an integral part of who they are, it alone does not define them. Don’t make them into disability heroes or victims.Treat them as individuals.
38 RESOURCES www.disabilityisnatural.com Commission for People with Disabilities(November, 2007)The Ten Commandments of Communicating with People with DisabilitiesOhio Developmental Disabilities CouncilSelf Advocates Being Empowered