7 TRADITIONAL PERSPECTIVES This person is disabled The disability is a problem This problem needs to be fixed Special people are needed to fix it It can only be fixed in special places It needs to go to one of those special places to be fixed It can only come back when it is fixed
8 FORM VS. FUNCTION Function = the purpose of the behavior, service, objective, etc.
10 ICF/MR FOCUSED TRAINING “The most critical deficiency in typical assessment is the emphasis on teaching skills of a specific form rather than focusing on training relevant behavior.” (Campbell and Bricker)
11 MORE HELPFUL ASSUMPTIONS Autonomy and Independences Individuality Love and Acceptance Stability and Continuity Continuous Growth and Learning Community Status Protection of Rights and Personal Interests ALL PEOPLE SHARE THE SAME BASIC NEEDS: People with disabilities do not have qualitatively different needs.
12 ICF/MR FOCUSED TRAINING “The description of the disability is relevant only to the extent that the condition complicates the fulfillment of the above- mentioned needs. What people with disabilities do not have in common is the independent ability and means to create conditions, situations and experiences to meet all of their basic needs.”
27 ICF/MR FOCUSED TRAINING Muscle tone & movement affect smell & taste Taste requires smell Open mouth affects both Smell/Taste
28 ICF/MR FOCUSED TRAINING Joint sense Place in space Righting reactions Movement causes pain Tactile/Proprioceptive
29 ICF/MR FOCUSED TRAINING How the person uses hands Hand development takes many months Sensory preparation Manipulative
30 ICF/MR FOCUSED TRAINING Response to possible enforcers Consequence Preference
31 ICF/MR FOCUSED TRAINING Primary circular reactive Object permanence Use of Objects
32 ICF/MR FOCUSED TRAINING Willingness to cooperate Creative communication used so you will “buzz off” Compliance
33 ICF/MR FOCUSED TRAINING Knowing things continue to exist Indicates “readiness” for symbols Object Permanence
34 ICF/MR FOCUSED TRAINING Seeking interaction with others Range of behaviors used to control social environment Social Responsiveness
35 ICF/MR FOCUSED TRAINING Imitates movement sequence modeled by others Motor Imitation
36 ICF/MR FOCUSED TRAINING Imitates sounds or parts of sounds initiated by others Vocal Imitation
37 Top Ten Approaches for Functional Assessment 1. Discover the Person
38 Top Ten Approaches for Functional Assessment 2. Evaluate from more than one point of view.
39 Top Ten Approaches for Functional Assessment 3. Are skills present in different places (Grandma’s Law).
40 Top Ten Approaches for Functional Assessment 4. What supports are needed to do valued things?
41 Top Ten Approaches for Functional Assessment 5. Make sure they don’t already have it.
42 Top Ten Approaches for Functional Assessment 6. Identify splinter skills and fill in the blanks.
43 Top Ten Approaches for Functional Assessment 7. Discover how (not if) the person controls environment.
44 Top Ten Approaches for Functional Assessment 8. Identify developmental obstacles.
45 Top Ten Approaches for Functional Assessment 9. Find the passionate relationship in the person’s life.
46 Top Ten Approaches for Functional Assessment 10. Ask: If the person can’t do it, will we have to hire someone to do it for him/her?
47 Basic Guides for Helping 1. Pass the Dead Person’s Test, e.g. “If a dead person can do it, it’s not an objective!” e.g. tolerating side lying.
48 Basic Guides for Helping 2. Real Life, e.g. What would an able-bodied person of the same age and sex be doing?
49 Basic Guides for Helping 3. Pay attention to the antecedents in the A-B-C (antecedent-behavior-consequence).
50 Basic Guides for Helping 4. Demystify Clinical Skills-a person who implements clinical interventions must be directly trained, and supervised. And clinician must be accessible for change.
51 Basic Guides for Helping 5. Make everyday activities therapeutic rather than doses of treatment, e.g. 15 seconds X 10 X per day.
52 Basic Guides for Helping 6. If immediate results not apparent, problem is probably with the program and not the person. “It’s difficult to give a person a choice of what she wants for breakfast if the only word she knows is eggs!”
53 Activity: Some of JJ’s Goals @ 40 1. Given a well aligned left sidelying position JJ ill breathe deeply for 60- 90 seconds X 4 times per day. 2. JJ will eat a full meal in 30 minutes or less using active lip closure to pull food from a spoon. 3. JJ will consume 240 cc of thickened fluid X 5 times per day in 30 minutes or less using an independent consecutive swallow. 4. JJ will indicate choices of food, clothing, activities using a yes/no response 5 X/day. 5. JJ will participate in 2 off site activities of his choice per week.
54 Activity: Some of JJ’s Goals @ 60 1. JJ will use a motorized chair to participate in a senior program. 2. JJ will use an augmentative communication device to participate in recreation programs at the senior center. 3. JJ will make personal functional choices during 3 community outings per week—(e.g. food, brands of personal products. 4. JJ will choose from a range of menu items for 3 meals a day.
55 Activity: Goals for JJ UUsing JJ’s goals @ 40, determine when, where, and how you might implement each goal. UUsing each of JJ’s goals @ 60, write objectives and/or strategies for either a money management program, or a self-administration of drugs program.