Today I started training for the Canisius College Y.A.L.T program through People Inc. The mission of People Inc states that it exists so that individuals with disabling conditions or other special needs have the support that they need to participate and succeed in an accepting society. The Young Adult Life Transition program (Y.A.L.T) is a program for young adults with developmental disabilities. It allows them to experience life on a college campus while developing functional skills and meeting individually set educational and life goals. This program exists with the hopes that people with disabilities can reach their highest level of potential in society through participation and active membership in their communities.

The training was four days long and the first day consisted of a series of PowerPoint presentations about respectful professionalism, O.S.H.A., Corporate Compliance, HIPPA, and Rights and Abuse. During the respectful professionalism PowerPoint, we learned about the values of People Inc, a background of the services they provide, as well as employee conduct, harassment, theft, consequences of unprofessional behavior and how to work with families of those with developmental disabilities.

We learned that the participation and interaction of family members within the program is a welcomed and helpful way for us to provide support for the individuals involved in the program. It is also important that we recognize that the families of a person with a disability may have feelings of regret, reduced expectations, or be in denial of the disability. This can lead to over-protectiveness or low expectations. While some families struggle with the disability other families accept the disability for what it is and are completely practical and realistic about their expectations in regards to their disabled family member.

We were taught to do our best to ensure the family that they can trust the staff working with their family member. Once this trust is built, acceptance of the program by the family is easier, making the transition into the program easier for the individual. When we are providing care or services to those with a disability, we should always remember G.E.M- Good Enough for Me. Would the services, treatment, and respect I am providing to the individuals that I am serving be good enough for me and my loved ones? This answer should always be yes.

We then discussed OSHA (Occupational Safety and Health Administration) topics such as blood borne pathogens (Hepatitis B and HIV), fire safety and hazardous communication. The blood borne pathogens section outlined how the blood borne pathogens may be acquired and universal precautions/safety methods. Fire Safety outlined the normal fire safety facts for how fires start, fire prevention, and evacuation protocols. People Inc. uses R.A.C.E. as their evacuation method. R=Remove everyone from danger and close doors. A=Alarm should be activated if not already sounding. C=Close all doors and windows to slow the spread of the fire and E= Evacuate all persons from the building. Hazardous Communication is a standard that keeps employees safe. It gives them the right to know what hazards they will face while working and how to protect themselves against these hazards.

We also outlined HIPPA (Health Insurance Portability and Accountability Act) in more depth. HIPPA is a federal law that protects health information linked to an individual being served by institutions such as People Inc. This does not mean that only the health status of an individual is protected, but all information that can be linked to the individual receiving services is protected and confidential. There are times when it’s necessary to disclose information without authorization to provide treatment or payment. In these circumstances, the minimum amount of information should be disclosed.
The last portion of training for today was about recognizing and reporting abuse and supporting individual rights. The individuals participating in programs at People Inc. have the same civil and human rights as expressed in the Constitution and the Bill of Rights of the United States. They also have the right to services that People Inc. promise to provide. For example, a safe and sanitary environment and freedom from abuse or unnecessary mechanical restraint are rights of those served by People Inc. They also have the right to be informed of program services and to communicate their concerns about the program or facility they are enrolled in.

We then went on to discuss the different types of abuse and their definition. There are ten types of abuse. They are physical, sexual, psychological, mistreatment, seclusion, neglect, unauthorized/inappropriate use of time-out, unauthorized/inappropriate use of restraint, unauthorized/inappropriate use of aversive conditioning, and violation of a person’s civil rights. Physical abuse is any physical contact that is not necessary for safety and causes discomfort. It can also include using more force than necessary in a given situation. Sexual abuse is any sexual act as a result of coercion, physical force, exploitation of a person’s disabilities, or when the persons involved are non-consenting or unable to give consent. Psychological abuse is verbal or non-verbal expression involving one or more participants that subjects them to ridicule, humiliation, scorn, contempt, dehumanization, demeaning language, yelling and offensive humor to name some examples. The tone of voice used to make a statement can be a deciding factor in whether a situation constitutes psychological abuse.

Mistreatment, defined as not following a treatment plan for an individual, is also a form of abuse. Seclusion and neglect are two more forms of abuse. Seclusion is locking or placing an individual in a secured room or area that they can not leave at will. Neglect is a failure to provide appropriate services, treatment, care, or a safe environment. This also includes failure to report suspected abuse immediately or intervene to protect an individual from harm or injury. Unauthorized/inappropriate use of time out would be using this method when it’s not part of an individual’s treatment plan. Unauthorized/inappropriate use of restraint is the use of a device or medication to restrain a participant without prior written approval or for the convenience of staff. Unauthorized/inappropriate use of aversive conditioning is the use of punishment or other unpleasant or intimidating stimulation in order to reduce or control undesired behavior that has not been approved as part of their treatment plan. The last form of abuse is violation of a person’s civil rights. A violation of a civil right is any action or inaction that deprives a person of the ability to exercise their legal and civil rights.

We also discussed the signs and symptoms of abuse, protocol for stopping it and how to report abuse in the work place. This particular section of the training is related to my psychology classes where I learned about abuse and its drastic effects on the lifestyle and brain development of adults and children, emphasizing the importance that it should never happen in any programs, especially those designed to help individuals with developmental disabilities prosper. The effects of abuse are not only evident at the time of abuse, but may cause physiological, physical, and psychological changes that last throughout an individual’s lifetime, playing an important role in success and progression of that individual physically/developmentally, socially, and psychologically. Therefore, it is important to be able to understand and recognize the signs of abuse in order to stop abuse, decrease the incidence of abuse, and protect individuals from abuse if it occurs. The signs of abuse are changes in behavior, sudden aggression, changes in sleep patterns (normally an increase in sleeping), phobic fear of being touched by others and avoidance of the topic of sex. Signs that are common to sexual abuse include overly-sophisticated sexual behavior, sexual talk in public or avoidance of sexual talk, privacy violations, and sexualizing non-sexual cues from others.

To begin training today we started with how to lift and transfer an individual if they were unable to move their self because they are in a wheelchair or are completely unable to use their limbs. We learned how to use good body mechanics while lifting. Maintaining a center of gravity, lifting with your legs and moving your feet when you turn are examples of good body mechanics. I learned to manually lift through a pivot transfer, top/bottom lift, and a stand pivot transfer, as well as electronically through the use of a Capella or ceiling track. We also learned to use a Hoyer, which is a manually powered lift. In the YALT program I will probably never have to use this, but in the case that I do, I will know how to perform a lift and transfer, manually or by electrical machines. We also discussed driver safety and how to prepare food for those with special food needs. Both of these topics would be appropriate for a direct care facility, but I will probably not have to do either at the YALT program.

Developmental disability is a term used to describe life-long, deficits or disabilities attributable to mental, cognitive, sensorimotor, language, social and/or physical impairments, manifested prior to age 22. To understand developmental disabilities and work with individuals who have a developmental disability, it is important to understand basic development in all of these areas. Physical development is the development of growth and motor processes. It begins before the child is born and progresses in stages until death. Physical development is influenced by genetic, environmental, and emotional factors.

Cognitive development is the development of thinking processes, starting at birth and progressing in stages until death. These stages include sensory motor, pre-operational, concrete operational period and formal operation period. The sensory motor period is the time between birth and age two where an infant's knowledge of the world is limited to his or her sensory perceptions and motor activities. Behaviors are limited to simple motor responses caused by sensory stimuli. The pre-operational period is between ages two and six. During this stage, a child learns to use language, but does not yet understand concrete logic, cannot mentally manipulate information, and cannot take the point of view of other people. The concrete operational period is between ages seven and eleven. During this time children gain a better understanding of mental operations. They begin thinking logically about concrete events, but have difficulty understanding abstract or hypothetical concepts. The formal operation stage is a period between ages twelve to adulthood when people develop the ability to think about abstract concepts and develop skills such as logical thought, deductive reasoning, and systematic planning.

Sensory motor development is the coordination of senses into purposeful actions and is influenced by physical, cognitive and environmental factors. Language development is the development of communication abilities. It starts at birth through early vocalizations and increases in response to environmental stimuli. Language development is influenced by a combination of cognitive, emotional, and physical factors. Once these concepts of typical development are understood, it’s easier to understand the implications when development does not occur properly, in circumstances such as developmental disabilities.

The first disorder we discussed was intellectual disability (ID). ID is defined as limited functioning characterized as sub-average IQ with two or more limitations in adaptive skill areas. We learned strategies to work with individuals who are intellectually disabled based on their characteristics. It’s important to use all three types of learning every time you teach a skill or information. These types of learning are auditory (explain verbally), visual (show them the steps as you say them), and kinesthetic (have the individual repeat the actions as you verbally guide them). In order for those with ID to learn information or a task, teaching must be done daily, constantly, and for years. It’s important to make learning vivid and exciting so it is more likely to be remembered. People will accept and repeat pleasant experiences (successes) and avoid unpleasant ones (failures). The more frequent and positive the experience of learning is the more likely it will be remembered. If a skill is not practiced and used, it is forgotten. Frequent use allocates maintenance of skills. Once they are maintained they may be able to build on previously learned skills to increase their ability to learn new things. Not supporting, repeatedly focusing on failures, and ignoring a person’s interests can lead to frustration in learning and result in no desire to learn. First impressions are long lasting and memorable. A person learns through personal experiences quickly and as a result, wrong or inappropriate information learned first is harder to change later.

Cerebral Palsy (CP) is characterized as a group of motor difficulties and physical disorders that result from brain injury or abnormal development of the brain that occurred before, during or after birth. As a result, there is a loss of control over voluntary muscles in the body. Muscles that are affected are in one part or side, or affect the entire body. Intellectual disability is not a characteristic of Cerebral Palsy, but it may be a co-morbid disorder. The type of CP can be classified by the type of muscle movement problems created by the disorder. For example, spastic CP results in an inability of muscles to relax. Muscles are tight and stiff. Movements are typically stiff, jerky, and uncoordinated. This is the most common type of CP. The other type of CP is athetoid which is characterized by an inability to control movement of affected muscles. Involuntary movements in the face, arms and trunk occur and can interfere with eating, speech, reaching, grasping, and other skills that require coordinated movements (i.e. sitting, walking, and maintaining posture). Ataxic CP is characterized by low muscle tone/weak muscles and poor coordination of movement. Another way to classify CP is by the area of the body that is impaired. When two primary areas are affected CP is classified as diplegia. When four primary areas are affected by the disability, CP is classified as quadriplegia. Hemiplegia refers to CP that affects one half or one side of the individual’s body. Difficulty in movement of the face, jaw, and torso are also common problems resulting from CP. Once we understand where and how CP affects an individual, a treatment plan can be developed and specialized for that individual to participate in society and be as independent as possible.

Epilepsy is a brain disorder where clusters of nerve cells or neurons in the brain signal abnormally. It’s characterized by two types of seizures, generalized and partial seizures. Generalized seizures affect the whole brain at once and it is common that the person loses consciousness during the seizure. A partial seizure only affects a part of a brain, and may or may not cause a loss of conscious during the seizure. A grand mal or tonic-clonic seizure is the most common type of seizure experienced by all ages. It is characterized by total body stiffening, followed by jerking muscle contractions, and possibly loss of consciousness and bladder control. Some other examples of generalized seizures are tonic, absence, clonic, myoclonic, and atonic. In contrast to a generalized seizure, during a partial seizure the person appears to be conscious, but in reality they are unaware of the events taking place. For this reason, partial seizures are probably the most common seizures but are rarely diagnosed because they are mistaken for behavioral problems. An example of a partial seizure is a simple-partial seizure. It starts at one extremity of the body, such as the arm or leg, and as more neurons are affected it progressively moves upward to other areas on that side of the body. Other examples include complex-partial and secondarily generalized seizures.

When caring for a person who is having a seizure, it is important to help the person lie down. If the seizure is convulsive, put something soft under their head for protection from injury. It is also important to loosen tight clothing at the neck, chest and waist to ease breathing. Contrary to common belief it is also important that you don’t force anything into the person’s mouth or try to restrain them.

Another developmental disability is autism which affects communication, social interaction skills and behavior. Social deficits experienced by those with autism are a result of an inability to relate to others and their environment. Individuals with autism often have an odd sounding speech (overly precise or obscure), hold one-sided conversations, preoccupation with specific topics, avoidance of other topics, motor clumsiness, facial grimaces or tics, lack of eye contact, odd hand gestures or body movement and intrusiveness or difficulty recognizing social boundaries. These behaviors make it difficult for the individual to develop socially acceptable interaction skills, thereby alienating them from social relationships. These individuals do not enjoy social separation or isolation and therefore, social interactions create a great deal of stress, sadness, and invoke feelings of rejection. Individuals with autism also have many distinct sensory and cognitive characteristics. Individuals with autism exemplify a rigid style of thinking. They visualize a task as one complete event. Changing any part of a task leaves them in fear and confusion and therefore, they do not like change. In fact, rules help them understand their environment. The autistic mode of thinking can be described as thinking in pictures instead of terms of language. Their thoughts are like videotapes running in their imagination. They also have a literal interpretation of language and difficulty comprehending slang or “figures of speech”. Those with autism see minor incidents or small failures as overly important leading to feelings of worthlessness and self deprecation. This is called catastrophizing. Atypical sensory interpretation of their environment is also a characteristic of autism. This means that individuals with autism do not experience the sensory world the same way in which we do. For example, they may have hyper sensitive hearing or hypersensitivity to clothing, lights, texture, etc.

We also learned some important differences between an individual who has autism and an intellectually disabled (ID) individual. Those with ID have an IQ that is significantly below average, while those with autism have IQs at any level, from profound to superior. ID may be a secondary diagnosis for autism, but is not a requirement. Those with ID normally have an even profile of deficits, meaning that all areas of impairment are a similar level. Those with autism have a scattered profile of deficits. This means that some skills may be grossly impaired while others may be superior, within the same person. ID involves a lag in development. Individuals experience the world and behave in ways that are normal to non-disabled individuals at earlier stages in development. Autism is an idiosyncratic development. They experience and behave in ways atypical to individuals without a disability at any stage of development. Their interpretation of stimuli is often unique and out of their control.

Other developmental disabilities are categorized under neurological impairments. Neurological impairments are a group of disorders associated with the central nervous system. They may affect an individual’s speech, motor skills, vision, memory, muscle actions, learning abilities, etc. Neurological impairments are categorized into three major types: childhood aphasia, minimal brain dysfunction, and learning disability. Some examples of these types of impairment are Narcolepsy, Spina-Bifida, Corticobasal degeneration, Tourette’s syndrome, and Prader-Willi Syndrome. Although there is no way to cure these disorders, treatment is based on the individual’s disability, environment in which they live, physical and mental health, as well as their personality and interests. This treatment plan will strive to best accommodate the individuals needs, wants, and goals without sacrificing safety and the law.

It’s interesting to learn about typical development in classes such as developmental psychology, and compare and contrast that to atypical development, as learned in child psychopathology and abnormal psychology but it’s incredible to see how this pathology affects the progression of a child and continues into adulthood. The Y.A.L.T program will allow me to see developmental disabilities away from the textbook since many of the same pathologies manifest in individuals differently. It is one thing to read and learn about the possible pathology, developmental impairments, and unique characteristics of those with developmental disabilities, but that knowledge can only be solidified and validated through experience.

Today we learned about SCIP- Strategies for Crisis Intervention and Prevention. The first thing that was discussed during SCIP was the concept of behavior support. Behavior support is defined by the individuals needs, wants, and is proactive. It strives to surround an individual with activities that create a satisfying and successful life. The program stressed lifestyle changes and rejected the use of punishment to change behavior. Punishment aims to minimize behavior but often doesn’t because a replacement behavior is not taught. The idea of behavior support leads to person centered planning where support and services are provided that meet the needs and wants specific to the person. The person’s independence, opportunity to communicate their feelings, opportunity to make life choices, and desired relationship with their family, friends and community should never be sacrificed in meeting the individual’s program goals.

We also learned how our attitudes, beliefs, and values toward individuals with disabilities affect their growth, development, and actions. The beliefs, attitudes, and values of society and staff can affect the way they treat and deal with individuals with disabilities. If attitudes and beliefs are positive they can empower individuals to believe in themselves, reach their full potential and be accepted into society. If they are negative they stunt growth, hinder potential, and facilitate rejection and isolation. Many individuals are exposed to negative social conditions over long periods of time. It’s important to realize and try to avoid labeling, rejection, restriction of opportunities, infantilization, victimization and segregation of those with disabilities.

We also learned some history of the treatment of mental illness and disability in institutions. The effects were mostly negative and included depersonalization, lack of freedom, regimentation, lack of stimulation, modeling of violence, and learned helplessness. Learned helplessness, regimentation, and lack of freedom are three negative effects that may also have the potential to occur at my site. Learned helplessness is a condition in which an individual has learned to behave helplessly, even though they have the ability to help themselves. When the opportunity arises, they do not because they have become dependent. Regimentation is when activities happen at the same time everyday. A lack of freedom is the inability to do as one wants, or leave a place when one wants. When interning in the YALT program it will be important for me to actively avoid the occurrence of these three things in order facilitate growth, independence, and success of the individuals enrolled in the YALT program.

After the SCIP program outlines history and how problem behavior was controlled previously, current attitudes, and why crisis management is necessary, they begin to discuss awareness of physical and emotional responses during a crisis situations. Previously three techniques were used to control problem behavior, chemical interventions/restraints (sedatives), mechanical restraints (straight jackets), and non-programmatic responses (staff acting outside of a treatment program, relating to their own beliefs, values, etc.). These methods do not look at the individuals’ needs and wants, and do not explore the cause of the behavior to find a resolution. They are done for the convenience of the staff and to temporarily stop the behavior. SCIP emphasizes the importance of a rational response in a crisis situation where a behavior problem is occurring. Emotional involvement and negative cues and feelings can impact your ability to respond rationally, escalate a crisis and hinder a successful resolution. For this reason, it’s important to understand that stress and our perception of a situation affect our emotions, and behavior. Working with people who have developmental disabilities is stressful because it can be unpredictable, communication may be difficult and you may be responsible for another person. It’s important to know your limits, the person’s treatment plan, work as a team and seek assistance when necessary.

One of the crucial aspects of learning to work with individuals with developmental disabilities is to understand behavior. Behavior serves a purpose for an individual. In general, challenging behavior is learned through repeated interactions between the person and the environment. Behavior is a way to communicate something about a person’s unmet needs or wants. For example, if a person runs away they may be looking to escape or for attention. This is why it is important to perform a functional analysis of behavior. Functional analysis is a way of determining the intended outcome of a behavior considering the environment it occurs in. There are four parts to functional analysis. The first is defining the behavior. The second is identifying the causes of the behavior; followed by developing ideas as to the behavior’s function (What do you think they are using the behavior for?). The final step is data collection of the entire situation (Results, what worked to stop it, etc.).

There are four common reasons for behavior. First and foremost, one should check if the behavior is a result of something medically related. If it is not, the behavior could be serving a sensory function: intended to provide input into sensory pathways (ex. self injurious behavior, self stimulating etc.). The behavior could also be serving a tangible purpose: intended to gain access to an item, activity, or food (ex. Stealing). The behavior could also be an escape: intended to avoid a demand or task (ex. Sit on floor to avoid going somewhere, run away etc.) or lastly, attention: intended to get another person to attend (ex. tap, punching to get someone’s attention etc.).

There are many different internal conditions and external antecedents that can interact to affect behavior. When a new behavior develops in a person with developmental disabilities or a current behavior worsens, the most important question is what changed. It is also important to know antecedents and use them to create a positive environment for a person. Examples of external antecedents that may affect behavior are crowding, noise, chaos, being threatened or assaulted, or being caught doing something inappropriate. Some internal antecedents are inadequate communication skills, acute medical conditions, disability specific conditions, chronic conditions, age-related conditions, medication-related conditions and psychological conditions. Deficits in sensory/motor development, communication, cognitive processing, social development, emotional development, and self-direction can cause frustration when they amplify daily struggles and they realize that they do not have adequate skills to resolve a problem. Normally, skill deficiencies are associated with challenging behaviors. In this way, characteristics of a person’s developmental disabilities can affect their response in a crisis/behavioral problem situation.

There are three levels of intervention in responding to challenging behavior. Proactive intervention is promoting safety and meeting needs and wants in order to avoid crisis before it happens. Active intervention is supporting someone while something is happening; warning signs are present at this point. Reactive intervention is supporting a person after or during a behavior. The lowest level of restrictiveness of the staff response should be performed first, followed by more restrictive if necessary. A supportive and functional environment should be provided to the individual.

In discussing intervention techniques the word support has been used. Behavior support, in this case, has a goal to meet people’s needs and give them the skills to meet their own needs so negative behaviors won’t occur. The function or cause of the negative behavior is examined, and then replaced by assisting the person to not only meet their needs, but in a socially acceptable fashion. Through this method the consequences of the behavior are natural as opposed to unnatural such as reinforcement or punishment. Reinforcement and punishment are used during behavior control, which is an attempt to reduce the frequency of negative behaviors. The problem with behavior control is that the behavior is temporarily stopped but no replacement behavior is put into affect so resolution is only temporary.

Mastery of calming techniques is critical because, if used effectively, they can diffuse negative situations and avoid the use of reactive interventions. There are several verbal and non verbal techniques that can be used to calm a person in duress. Things as simple as making eye contact, being in close proximity, a light touch, your body posture, and using positive language are all appropriate and attainable uses of calming techniques. Other techniques include planned ignoring, which is the removal of attention for mildly disruptive behavior, and preferred objects and environments, which allows the individual to calm themselves down with their preferred method or in their preferred area. Listening to concerns in a non-judgmental way and repeating what the person said to indicate understanding are called ventilation and active listening respectively, which are two verbal forms of calming. Modeling an appropriate behavior, reminding of previous coping strategies, as well as providing reassurance, positive language and facilitating relaxation are also useful in many negative behavior circumstances. After a behavioral incident recovery is crucial. Rebuild a relationship with the individual by teaching them a replacement behavior or skill.