Challenging Behaviors MORC - Gentle Teaching International .ppt

							CHALLENGING BEHAVIOURS
  IN OUR COMMUNITIES:

    A STUDY OF VARIABLES
     CRITICAL TO SUCCESS
        Elwood study
• Literature Review

• Three Agency Review
  – Behavioral Institute in Los Angeles
  – Community Agency in Eugene Oregon
  – The HOME Society in Abbotsford BC
    Canada

                                          2
   SUPPORTING INDIVIDUALS WITH
   INTELLECTUAL DISABILITIES AND
      CHALLENGING BEHAVIOURS
       IN OUR COMMUNITIES:

 A STUDY OF VARIABLES CRITICAL TO
              SUCCESS

     A PARTNERSHIP BETWEEN
ELMWOOD RESIDENCES` INCORPORATED
   AND COMMUNITY LIVING DIVISION,
   SASKATCHEWAN SOCIAL SERVICES

          JANUARY 2000
                                    3
1. Philosophy of the Organization


The philosophy of the organization is
clear and guides all actions. It
embraces a total commitment to the
provision of supports individuals
require to live meaningful, satisfying
lives




                                         4
     2. Quality of Life

Quality of life is the focus of supports.
Measurement of quality of life includes the
amount of choice and control individuals
have over directing the course of their lives,
the development of meaningful social
relationships, and community integration.




                                                 5
3. Committed Leadership

Committed leadership is provided by
informed and involved individuals within
the organization. The leadership knows the
individuals in their program, what their
needs are, and whether or not they are being
successful in supporting these individuals.
Leadership ensures the program upholds its
philosophy.

                                               6
4. Recognition of the Contribution
   of Front Line Staff Members



The organization recognizes the contribution
of front line staff members in the provision
of supports to individuals they serve and are
committed to supporting front line staff
members in the fulfillment of their jobs.



                                                7
    5. Person Centered
         Planning
Person Centered Planning places the
individual at the center of planning and
focuses on the individual's abilities,
preferences and desired lifestyle outcome.
Planning occurs within a team comprised of
the individual, friends, family and staff
members. Inclusion on the planning team is
dependent upon a close relationship with the
individual requiring supports.
                                           8
6. Individualized Responsive
    and Flexible Supports
Supports are individualized, responsive and
flexible. Individuals receiving supports are
not expected to change to fit into the
program, rather the program adapts and
changes to better meet the needs of the
individuals it is supporting. Size of delivery
unit is important in maintaining the intimacy
required for the provision of individualized,
responsive and flexible supports.


                                             9
    7. Context of
Community Living Options

Programs are delivered in the context of
community living options. Individuals
receive the supports necessary to live in a
regular range of residential options and
participate in community life.




                                              10
   8. Flexible Funding

Funding is flexible and based upon
individual planning and assessment
outcomes




                                     11
       9. Supports to
 Front Line Staff Members

Supports to front line staff
members include training, the
availability of expert resources,
assistance in the development,
implementation and ongoing
evaluation of support plans.


                                    12
10. Ongoing Assessment,
Review and Adjustment of
     Support Plans

There is a commitment to ongoing
assessment, review and adjustment
of support plans. Review on an
ongoing basis ensures the
environment is best meeting the
needs of each individual requiring
supports.

                                     13
 Summary Statements: Philosophy
     and Guiding Principles

• Programs supported individuals to live the lives
  they wanted to live.

• There was a commitment to each individual so that
  if things went badly they were not excluded from
  the agency's supports.

• It was critical that one philosophy permeated the
  organization and was part of the organization's
  culture.

                                                      14
  Summary Statements: Administration
• Most programs served a limited number of individuals and
  wanted to remain small to maintain a personal touch
• In a larger organization, teams served a limited number of
  individuals to personalize each individual’s program
• Staff members had a valued role in all aspects of programming
• Decision making was based on a participatory model using
  planning and advisory groups and circles of support
• Staffing structure was hierarchical with an executive director,
  supervisory and front line members
• The management staff were knowledgeable about the
  individuals in the program and had direct input into the
  individualized program development process
• The board varied in size and included family; professionals
  from related fields; neighbors and community at large
                                                               15
 Summary Statements: Funding Models

• Regardless of funding model the agencies were accountable to
  meet the individual's needs.
• In most cases funding was initially linked to the individual's
  needs determined by pre-admission assessment.
• In general, funding fell into two categories:
    – Grant funding to an agency or program responsible to operate a program
      for a specific population.
    – Individualized funding where funds were directly linked to an individual
      and followed that individual.
• Several funding models and options were identified. These
  included program grants, individualized funding, service
  brokerage, micro boards, for-profit business and Co-
  operatives.
• Programs based on individualized funding stressed the
  importance of separating shelter, food and clothing from
  program support costs.


                                                                            16
 Summary Statements: Evaluation of
     Program and Outcomes

• Staff members understood the desired program
  outcomes and how well the program was achieving
  these outcomes.

• Assessment was related to outcomes that were of
  value to the individual.

• Not all organizations formally assessed their
  programs; those that did regarded this as an
  important responsibility.

                                                    17
Summary Statements: Family Involvement




• Programs tried to maintain or increase family
  involvement similar to relationships with other adult
  family members.

• Family involvement included planning
  supplemental funding, reciprocal visiting, staff
  hiring, educating and participating on the board.



                                                      18
Summary Statements: Population
   Movement and Linkages

  In the very few instances where service had been
  discontinued, it was because of illness or death,
  moves to be closer to family, or philosophical
  differences between program and family.

• Generally admissions had been primarily from
  family residences and institutions.




                                                      19
Summary Statements: Assessment of and
   Response to Community Needs


• The organizations did not have a mandate to
  formally assess and plan for the community's future
  needs.
• Organizations readily responded to needs presented
  to them but were not proactive regarding long-term
  community needs.




                                                    20
 Summary Statements: Relationships
  with Other Professional Services

  Programs had different levels of internal expertise
  for specifics such as behavior technology and
  psychiatric care.

• The programs accessed services within the
  community but arrangements varied from site to
  site.

• At some sites community based professional
  services to the individual were delivered at the site
  itself
                                                          21
Summary Statements: Admission and
      Discharge Practices

• Program populations were stable with limited
  admissions and few discharges.
• Most admissions were based on government agency
  referrals.
• Organizations did not have waiting lists; these were
  maintained by local or regional government
  agencies.
• The pre-admission protocols were extensive and
  varied from formal to less formal.
• Discharges for behavioral reasons were very rare.

                                                     22
    A Focus on Change
We were committed to changing
  – Our Agency
  – Our Processes and
  – Our Selves




                                23
        Agency Change
• Need to provide 24/7
  response by Coordinators
  and Ex. Dir.

• Fluid response and
  transitions – no failures, no
  more revolving doors, use of
  in home emergency respite

• Commitment to work closely
  with external agencies;
  Police, 911, Emergency
  Services, Mental Health,
  Forensics, and Courts
                                  24
           Change our
            Approach
•   Gentle Teaching Philosophy
•   Warmth – 1,000 hugs a day
•   Support Families - No more blame
•   Change language- Companions, care givers, those
    we support, the person you hangout with.
•   Use of Mentors
•   Welcoming Neighbors
•   Constant Evolution of HOMES
•   The HOMES family – Life time commitment

                                                      25
      Change our own lives
•   Keep each other safe and valued
•   Open our homes to those were support
•   Involve our families – GT is a Way of Life
•   24/7 response from managers
•   Reach out to families and neighbors
•   Mentor and honor our care givers
•   1,000 hugs a day for our own families and
    those we support.




                                                 26
 Our dual Focus
1.   Those individuals coming from
     years of institutionalization

2.   Young folks who repeatedly
     failed to live in the Community.
     Often FAS, may live with
     Personality Disorders, Dual
     Diagnosis, often known to the
     Legal System




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     Those individuals coming from years of
           Institutionalization

www.WeSurvived.net

Gentle Teaching is many things. Gentleness toward others, in spite
    of what anyone does or does not do, is the critical factor. It is a
    paradox.
Fists are met with hugs. Cursing is met with words of affection and
    nurturing. Spiteful eyes are met with warmth.
Gentleness recognizes that all change is mutual and interwoven. It
    starts with caregivers and, hopefully, touches those who are
    most marginalized. Its central focus is to express unconditional
    love.
The main idea of gentleness is not to get rid of someone else’s
    behaviors, but to deepen our own inner feelings of gentleness in
    the face of violence or disregard.
                                                                     28
       Transition from Institution
Visits to Institution
     Reports tell the worst
     Use an informal friendly approach
     Which care givers are the favorites?
     What’s the off the record description?

New home preparation
     Martha Stewart approach- colors, texture, smells, sounds, lighting, and furniture
     Food- snacks, drinks, treats, varied locations Use food to explore home and
     surroundings

     Food becomes a way of connecting




Welcome Ceremony
 Group gathers to honor and Welcome new arrivals. May
 include drumming and smudging ceremony.


                                                                                         29
The Young and the
     Restless

•   Have a history of problem solving by running
    away or getting tossed from programs.
•   Don’t hesitate to test out what the boundaries are.
•   May be addicted to alcohol and drugs
•   Thrive on excitement
•   May not hesitate to steal or sell personal property.
•   May exchange sex for drugs or alcohol
•   Cells, text messaging, chat lines and MSN are a way of life for these
    young folks.
•   Don’t learn from past mistakes.
•   The young women can be surprisingly violent. The women usually have
    limited police or court response. “They have tried to charge me 156
    times and it was always thrown out. You can’t do anything to me”
    spoken to a Police Psychiatrist.
                                                                        30
Fast Paced Response
•   Challenging situations quickly go from line care giver to team
    leader to coordinator to ED and or directly to 911- This can be
    self initiated. It is not uncommon for the excessive use of
    stimulants like tobacco alcohol to proceed a crisis.

                            •Response must be warm and caring - assuring that
                            all are safe and loved
                            •Rush to the crisis but walk through the door.
                            •Line care givers need 24/7 response if the
                            revolving door is to be stopped.
                            •Don’t provoke violence
                            •Less talk, slow the pace, sit down, model cooling
                            things down, share some tea, make few demands



                                                                          31
 Outside Protocols
• In the same evening 911, Police,
  hospital emergency, and mental health
  services may all be involved – the
  need for a plan and protocols is
  obvious
• To complicate life, the above agencies
  have rotating staff often working 12
  hours shifts and one rarely sees the
  same people or professionals twice.
• Use appropriate generic services as
  required or requested but keep a line
  of communication open with liaison
  staff and remind all of protocols. Don’t
  abandon some one in an ambulance or
  hospital
• Remind them that you are there to
  keep them feeling safe and loved.
  Nurture with food, words and touch         32
            Crisis Support
            • Downplay the crisis. Walk in as if you
              are just visiting – greet with hugs
            • Use a tag team approach to give relief

• Broaden the space for movement.
• Work to reconnect the care giver.
• Ignore the incident if possible – clean up and get on
with life. Use the cleanup as a way of connecting.
• In extremes be prepared for suicide attempts after
critical incidents
• Use emergency respite to avoid crisis rather than a
response to crisis.
                                                          33
      Time                               Heals
• A crisis can come on fast but be over in 10-15 minutes.
  Provide face saving options – go for a coffee, make a
  phone call etc.
• Don’t attach blame – tough times are part of all out
  lives
• Use humor. Bring the energy down.
• Value care givers through verbal praise, emails, team
  meetings and lots of hugs
• In the middle of a crisis at the emergency ward it is not
  uncommon for the person to decide to go home.
• Thank the hospital staff before heading home.

• Even in a crisis it is important that everyone feel
   SAFE, LOVED, ENGAGED and LOVING
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Prayer of Saint Francis of Assisi

Lord, make me an instrument of your peace.
Where there is hatred, let me sow love;
where there is injury, pardon;
where there is doubt, faith;
where there is despair, hope;
where there is darkness, light;
and where there is sadness, joy.


O Divine Master, grant that I may not so much seek
to be consoled as to console;
to be understood as to understand;
to be loved as to love.
For it is in giving that we receive;
it is in pardoning that we are pardoned;
and it is in dying that we are born to eternal life. Amen


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    Thanks for your time




www.HomeSociety.com   www.GentleTeaching.com




                                               36
                            Typical Questions
1) When the person presents a danger (e.g., sexual attacks, house burning, severe aggression) what do you
    do? How do you respond? Your house, Dave's, sometimes jail, sometimes a hospital)

2) How do you make sure no one gets hurt--the person, staff, the neighborhood, the community at large?

3) How do you teach everyone Gentle Teaching and keep it up over time?

4) How do you make a culture of Gentleness?

5) How do you, or do you, write this up?

6) How do you get accredited?

7) What is your cost?

8) What does a culture of gentleness look like at HOMES?

9) What kinds of environmental modifications do you do to protect or slow down someone?

10) How do you make sure staff are gentle?

11) How can you create a system that cuts through all the bureaucracy and still meets basic regulations?
                                                                                                            37
     Typical Questions
1) When the person presents a danger (e.g., sexual
   attacks, house burning, severe aggression) what
   do you do? How do you respond? Your house,
   Dave's, sometimes jail, sometimes a hospital)

•   Companionship
•   Sean
•   Chad
•   Heather




                                                 38
     Typical Questions
2) How do you make sure no one gets hurt--the
   person, staff, the neighborhood, the community at
   large?
• Focus on the person – build a life
• Best Care Givers work with the newest and
   potentially the most challenging
• Flexible scheduling
• Training
• Dual coverage using managers
• Side by side homes
• Good fences
• Hire Neighbors – teens
• Play out scenarios - chess                       39
          Typical Questions
3) How do you teach everyone Gentle Teaching and
keep it up over time?

• Go for the heart – lots of hugs
•   Begins with hiring
•   Orientation
•   Receptionist’s role is to greet warmly with hugs
•   Office is a center of warmth and caring
•   Surround ourselves with partners who are also warm & caring
     • Ladybug Organics, Valley Water, Habitat for Humanity, Rose’s
     Flower Shop, Cob’s Bread etc.
     • Lots of Family events
     • Create ambassador’s of Gentleness - Tasha



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      Typical Questions
4) How do you make a culture of Gentleness?

• What is culture – Tradition, Food, Music,
Gatherings, words, photos, video, etc.
• Celebrations – Entire community
• We don’t do fund raisers – we ask for help and
ask what we can do in return
• Lots of warmth
• First Nations circles and ceremonies have taught
us much
• Encourage our care givers to share their cultures
• Encourage family visits to care giver homes.


                                                      41
       Typical Questions
5) How do you, or do you, write this up?

 •   250 page RFPs
 •   Stop focusing on programs
 •   Don’t do RFPs anymore
 •   5 Video’s, many thousands of photos, let those we serve
     and their families act as the spokes people for HOMES
 •   Lots of web sites GTI for last 12 years
 •   CARF – Behavioral Standards – Former Restraint and
     Seclusion – Now “Non Violent Practices”
 •   Emails to CLBC
 •   Tours


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     Typical Questions
6) How do you get accredited?

   • Wow – Accreditation Canada
   • You are welcome to any thing we have
   • Heading toward CARF but want to combine
   standards. Behavioral Health and Community
   Living etc.
   • ShareVision – Technology and warmth.
   • Our restraint and Seclusion Policy is




                                                43
E.140 Restraint and Seclusion Policy

PURPOSE
The H.O.M.E. Society follows the practices and philosophy of Gentle Teaching
    and therefore does not support restraints, seclusion or restrictive practices.
    We believe in teaching by example, providing direction, and giving praise.

POLICY
The H.O.M.E. Society will not approve of any of the following interventions for
    managing the behavior of the men and women we support. Examples of
    restrictive methods include, but not limited to:

Exclusionary time out
Seclusion time out
Mechanical Restraints
Physical Punishment
Electric shock
Noxious Stimuli
Deprivation of basic Rights
Punitive withdrawal or restriction of food.
7) What is your cost?

  •   4 Person Home
  •   2 Person home
  •   1 Person home
  •   Supported Family Care

  Wage rates:
  Admin 7.2%
8) What does a culture of gentleness look like at
   HOMES?

   •   In the moment
   •   Warm greetings and partings
   •   Teaching our companions to be warm and loving with others
   •   Looking for opportunities for relationship and community
       building
   •   First time interviews
       •   “Wow! – He or seems to be a good fit for HOMES”


   •   Welcome ceremonies.
   •   Gifts, photos, testimonials
   •   Newsletter totally created by caregivers and their companions
   •   Warm greetings for visitors
   •   Mini Videos
10) How do you make sure staff are
  gentle?

  •   Begin at recruitment
  •   Model and Mentor
  •   Train
  •   Celebrate
  •   Repeat values
  •   Photos and Videos
11) How can you create a system that cuts through all
  the bureaucracy and still meets basic regulations?

   •   Keep then safe and loved
   •   Invite bureaucrats to meet people. Connect them.
   •   Ask them how you might improve given limited budgets
   •   Change the words.
        •   Facilities become homes
        •   Consumers become men and women supported
        •   Agency’s facility becomes Tom and Ted’s home
        •   Residential and Day programs become Tom’s day
   • Don’t go for basic go for the best. Better to fail while striving for
     the best that to succeed at achieving the basic requirements.
   • Our budgets are higher than most but everyone knows that we
     strive to give the best possible value and service.
   • Favorite quote with bureaucracy “We can be more costly that
     others. Why don’t you try others first and if it does not work out
     give us a call”