Impact Manual-Eng Finasl

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.
rom my heart, I am eternally than!ful to my friends and partners on the ""C#R team in $aia
Mare. They have taught me to have a better appreciation for those things that we all tend to
ta!e for granted. Their tireless and selfless wor! 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 than! you, on behalf of the children.
Than!s to my friends& 'elia, (tefan, and )tto, but especially to $ianca who has generously given
herself to assist in the creation of this document* and to 'ana, for her perfection in editing, as
well as her contribution to the material included in the manual. Than!s also to Ahmad, for his
design
and creativity of this final product.
)ver the last eight years, the partnership between ""C#R and Autistic (ervices, Inc. +(A, with
the support of the ,eneral 'irectorate for Child Protection, has made a profound impact on the
treatment of children, and child care overall, in Romania. I than! my team at Autistic (ervices,
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 loo! 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 than! you once again for trusting enough in me to ta!e a chance.
written by -eronica edericoni and $ianca
(tegeran
Introduction
$efore you begin learning the
material in this curriculum, be
prepared. /ou are about to
encounter ideas that may be unfamiliar to you and concepts that may be challenging to your current
e0pectations about people with special needs. At the foundation of IMPACT is the belief that people with
special needs can learn and grow. /es, they can even thrive and be recogni1ed as valuable members of the
community who have much to contribute. or these possibilities to become reality, we must change our
thoughts and beliefs about the supposed limitations of people with special needs. $e ready to open yourself
to new possibilities, perhaps very different from the current cultural mindset.
INNOVATIVE
)$23CTI-3(
Upon completion of this module, participants will be able to:
4 +nderstand that all children and adults with special needs have the same rights
as the typical population.
5 +nderstand the concept of special needs and define the characteristic challenges
associated with special needs.
6 'iscuss the need for and purpose of strategic intervention when wor!ing with
children and adults with special needs.
7 'emonstrate that their own beliefs, values and attitudes towards persons with
special needs affect their actions.
UNIT ONE
PRESENTATION
OUTINE
O!"
E#TI
$E
TI
%
E
#ONTEN
T
%E&I
A
NOT
ES
4.4.
7
8
m
in
.
)verview
of the
Convention
of
Children%s
Rights
)verh
ead
4.4.4
4.5
4
5
8
m
in
.
A
discussion
of the
concept of
special
needs and
their
characteris
tic
challenges
)verh
ead
4.5.4
)verh
ead
4.5.5
8verh
ead
4.5.6
)verh
ead
4.5.7
)verh
ead
4.5.9
4.6
4
5
8
m
in
.
A
discussion
of the need
for and
purpose of
strategic
interventio
n when
wor!ing
with
children
and adults
with
special
needs
)verh
ead
4.6.4
)verh
ead
4.6.5
4.7
7
8
m
in
.
A
discussion
of the way
in which
our beliefs,
values and
attitudes
affect our
actions in
general,
and
towards
persons
with
special
needs
)verh
ead
4.7.4
)verh
ead
4.7.5
)verh
ead
4.7.6
)$23CTI-3 ):3&
Participants will be able to understand that all children;adults with special needs have the
same rights as the typical population.
REcOmmENdEd TImE FRAmE: 40 minutes
#ONTENT O$ER$IE'
'uring this opening presentation, participants will discuss the 3uropean 'eclaration on
the "ealth of Children and /oung People with Intellectual 'isabilities and their amilies.
The overall purpose of this portion of the unit is to ma!e participants aware of their
responsibility to ensure that these rights are protected and respected, and that supports
are provided where deemed necessary.
INSTRU#TIONA STRATE(IES)#ONTENT
I. Using Overhead 1.1.1, discuss with participants the main ideas in the European
Declaration on the Health of Children and Young eople with Intellectual Disa!ilities and their
"amilies.
*+ Protect children and ,oun- 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.
.+ Enable children and ,oun- people to -row up in a famil, en/ironment+
Promoting secure attachments and improving family functioning limits the impact of
intellectual disability. )ngoing support to families is essential.
0+ Transfer care from institutions to the communit,+
Residential institutions that have a negative impact on the health and development of
children and young people should be replaced by high <uality community support. :ew
admissions to such institutions should be stopped through the development of community
services.
1+ Identif, the needs of each child and ,oun- person. 3arly diagnosis and
intervention improve long#term outcomes. Children and young people re<uire regular
ongoing assessments of their needs and planned support to ma!e seamless transitions at each
life stage.
2+ Ensure that -ood 3ualit, mental and ph,sical 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.
4+ Safe-uard the health and well5bein- of famil, care-i/ers+
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. 3nabling families
to care for their child from the time of diagnosis of intellectual disability through
adulthood can prevent harmful family strain or re=ection of the disabled child.
6+ Empower children and ,oun- people with intellectual disabilities to
contribute to decision5ma7in- about their li/es+
Children and young people with intellectual disabilities can and will ma!e their needs and
wishes !nown and contribute to their community, given appropriate support and a
receptive environment. amily members and advocates also need encouragement and
support to ma!e themselves heard.
8+ !uild wor7force capacit, and commitment+
The well#being of children and young people with intellectual disabilities is strongly
reliant on the !nowledge, s!ills, attitudes and commitment of staff in all settings and
sectors.
9+ #ollect essential information about needs and ser/ices and assure ser/ice
3ualit,. >uality standards and ade<uate information systems are needed to monitor <uality
of care, with transparent responsibilities for all sta!eholders.
*:+ In/est to pro/ide e3ual opportunities and achie/e the best outcomes+
3nsure fair and, if necessary, preferential spending on services from which intellectually
disabled children and young people and their families benefit.
)verhead 4.4.4
European &eclaration on the ;ealth of #hildren and <oun- People with
Intellectual &isabilities and their =amilies
*+ Protect children and ,oun- people with intellectual disabilities from harm
and abuse+
.+ Enable children and ,oun- people to -row up in a famil, en/ironment+
0+ Transfer care from institutions to the communit,+
1+ Identif, the needs of each child and ,oun- person+
2+ Ensure that -ood 3ualit, mental and ph,sical health care is coordinated and
sustained+
4+ Safe-uard the health and well5bein- of famil, care-i/ers+
6+ Empower children and ,oun- people with intellectual disabilities to
contribute to decision5ma7in- about their li/es+
8+ !uild wor7force capacit, and commitment+
9+ #ollect essential information about needs and ser/ices and assure
ser/ice 3ualit,+
*:+ In/est to pro/ide e3ual opportunities and achie/e the best
outcomes+
)$23CTI-3 T?)&
Participants will be able to understand the concept of special
needs and define the characteristic challenges associated with special needs.
#ONTENT O$ER$IE'
or this ob=ective, emphasis should be placed on those characteristics of persons with
special needs which may impact their daily lives, lead to feelings of frustration, or
contribute to their response in a crisis situation. :early any disability can affect a person%s
ability to handle a crisis.
INSTU#TIONA STRATE(IES)#ONTENT
I. Define the terms #special needs # and #pervasive developmental disorder$
Using a lecture format or discussion, introduce the term #special needs$ that will !e used
throughout the material. E%plain wh& it is preferred to use the term #special needs$ instead of
#disa!ilit&$ focusing on the need for a positive perspective when wor'ing with children
and adults with special needs.
The term @special needsA e<uals that of @pervasive developmental disorderA 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.A
According to '(M I-, Pervasive 'evelopmental 'isorders include& Autism, Rett (yndrome,
Childhood 'isintegrative 'isorder, Asperger (yndrome and Pervasive 'evelopmental
'isorders :ot )therwise (pecified BP''#:)(C.
In addition, a developmental disability&
D originates before the person attains age twenty#two
D has continued or can be e0pected to continue indefinitely
D decreases the person%s ability to function in society
D (ar&ing degrees of difficult& in an& of the following areas ma& !e e%perienced and
can differentiall& affect a person)s response in a crisis situation.
D Sensor, ) %otor &e/elopment >O/erhead *+.+*?
4. 'isturbance in any of the senses
D hearing
D vision
D visual#perceptual difficulties
5. 'isturbances in postural;motor s!ills and voluntary coordination difficulties
6. )thersEEEEEEEEEEE
!+ #ommunication >O/erhead *+.+.?
4. 'ifficulty organi1ing or articulating a message
D :o or poor verbal s!ills
D :o or poor manual signing s!ills
D +nusual forms of communication
D 'ifficulty finding words
D 'ifficulty understanding word se<uences
D 'oes not use language well
5. (tereotyped and pervasive language
6. Fimited ability to ta!e listener%s needs into account
7. )thers EEEEEEEEEEEE
#+
#o-niti/e Processin- >O/erhead *+.+0?
4. Attention
5. 'istractibility
6. Impulsivity
7. Comprehension
9. 3ncoding G decoding information
H. Memory difficulties
I. Central auditory processing difficulties
J. Fimited problem solving s!ills;decision ma!ing s!ills
K. )thersEEEEEEEEEEEEE
&+ Social &e/elopment
(everal authors have noted that relationship difficulties are li!ely to be more common in
persons with special needs than in the population in general. There are li!ely numerous
reasons which ma!e forming attachments and developing supportive relationships
difficult for persons with special needs. Many individuals have been e0posed to negative
social conditions over long periods of time, sometimes during critical developmental
phases in their lives.
lease present the following areas in which persons with special needs ma& have e%perienced
negative social conditions. *ee Overhead 1.+.,.
*+ abelin-
It can lead to stigmati1ation. "istorically the label @handicappedA or @retardedA has been
associated in the public%s mind with @abnormalityA and @deviance.A
.+ Re@ection and Social &isruption
Persons with special needs often face re=ection or neglect by peers as children and while
growing up. They may be separated from their families, institutionali1ed early. They may
e0perience placement in new services without considering the potential impact on the
person%s social relationships.
0+ Se-re-ation
(ome persons have long histories of institutionali1ation in large facilities away from the
general public, often under poor social conditions.
1+ Restricted opportunities
Persons with special needs may not have the usual opportunities for rewarding life. They
e0perience restrictions on where they live, what they do, what and when they eat, etc. The
ma=ority will not e0perience dating, marriage or parenthood in their lifetime.
2+ $ictimiAation
(pecial needs have an associated increased ris! of victimi1ation. This may include
abuse, stealing of possessions, being ta!en advantage of financially or otherwise, being
made fun of, and se0ual e0ploitation.
4+ InfantiliAation
People with special needs have been referred to as @children,A @boys,A and @girlsA despite
many of them being adults.
6+ Isolation Persons with special needs often have inade<uate access to social support
networ!s. (ometimes they are separated from their families and raised in community or
large institutions.
J. )ther factors related to social development which may affect a person%s response in a
crisis situation include&
D Fimited social s!ills
D Fimited social and vocational opportunities
D Fimited understanding of social e0pectations
D Fimited community e0posure
D Fimited understanding of the law
D amily issues
D )thers EEEEEEEEEEE
E+
Emotional &e/elopment

G

Discuss the following issues regarding emotional development.
4 (ome people with special needs have poor self#concepts or negative views of themselves.
5 (pecial needs have been often associated with e0pectation of failure.
6 )ther factors related to emotional development which may affect a person%s response in a
crisis situation include&
7 Fimited coping and problem solving s!ills
9 Fac! of appropriate alternative responses
H A long history of inappropriate responses
I Fimited dealing with loss, death, grieving issues
J Psychiatric conditions
K (elf#esteem issues
48 3motional control difficulties
44 'ifficulty reading own and others% moods
45 Fow tolerance for frustration
46 )thersEEEEEEEEEEEEEEE
47 Self5direction is related to motivation, self#e0pectations and independence. (ocial,
emotional, cognitive, communication and specific disability all contribute to a person%s
ability to self#direct.
)ther factors related to self#direction which may affect a person%s response in a crisis
situation include&
D 'ifficulty dealing with change
D Problems establishing routines
D Problem deviating from routines
D +nrealistic e0pectations
D 'iminished planning s!ills
D )thers EEEEEEEEEEEEEEEE
REVIEW
III. Summarize by revieing the folloing !oints"
A. As previously noted, behavioral crises can occur when people have predisposing conditions
which do not permit them to ade<uately perceive, understand and interact with their world.
Many of these conditions have been noted above. These conditions paired with inade<uate
social, emotional and self#direction s!ills contribute to how a person with special needs deals
with daily life.
Remember the following&
D :early any special need can affect a person%s ability to handle a crisis.
D 'ealing effectively with a person who e0hibits challenging behavior consists of
understanding the conditions that affect that person. $e realistic about a disability, but at the same
time provide the supports and resources needed for the person to learn and grow.
D 'ealing effectively with a person who e0hibits challenging behavior consists of presenting
viable options to the person and ultimately teaching them more appropriate ways to meet their
wants and needs.
(3:()R/ ; M)T)R '3-3F)PM3:T
D 'isturbances in any of the senses
D 'isturbances in postural;motor s!ills and voluntary
coordination difficulties
D Others __________________________
COMMUNICATION
D 'ifficulty organi1ing or articulating a message
D (tereotyped or pervasive language
D Fimited ability to ta!e listener%s needs into account
D )thers EEEEEEEEEEEEEEEEEEEEEEEE
C),:ITI-
3
PR)C3((I
:,

Attention
difficulties

Memory
difficulties

'istractibility

Central
auditory
processing
difficulties

Impulsivity

Fimited
problem
solving

Comprehensi
on difficulties
s!ills;decisi
on ma!ing
s!ills

3ncoding#
decoding
information
difficulties
)thers
EEEEEEEE
EEEE
()CIAF '3-3F)PM3:T
D Fabeling Restricted opportunities
D
Re=ection and (ocial -ictimi1ation
'isruption

Infantili1ation
D (egregation
3M)TI):AF '3-3F)PM3:T A:' (3F#'IR3CTI):
D Fimited coping and problem#
solving s!ills
D Fac! of appropriate alternative
responses
D A long history of inappropriate
responses
D Fimited e0perience with loss,
death, grieving issues
D Psychiatric conditions, e.g. dual
diagnosis
D (elf#esteem issues
D 3motional control difficulties
D 'ifficulty reading self or
other%s moods
D Fow tolerance for frustration
D 'ifficulty dealing with change
D Problems
establishing;deviating
BfromC routines
D +nrealistic e0pectations
D 'iminished planning s!ills
D )thers EEEEEEEEEEEEE
)$23CTI-3 T"R33&
Participants will be able to discuss the need for and purpose of strategic intervention when
wor!ing with children and adults with special needs
C):T3:T )-3R-I3?
This ob=ective will focus on the @traditionalA behavioral techni<ues and their negative and
positive elements. Participants will e0plore 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 wor!ing with children
and adults with special needs and challenging behaviors.
I:(TR+CTI):AF (TRAT3,I3(;C):T3:T
I. $egin by discussing the @traditionalA interventions used for challenging behavior.
+sing a lecture format combined with group discussions, present the three types of practices
used in dealing with challenging behavior.
A. Chemical Interventions
4. Chemical Interventions are appropriate under certain circumstances. +sually
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
mas! challenging behavior rather than addressing it.
5. Chemical Interventions can be very effective. They may be used as a part of a person%s
treatment program when prescribed by a physician. BPoint out that inappropriate use
of chemical restrains can be abuse.C
6. Fong term use of chemical interventions can cause health problems& dependency
on the medication, slowing of refle0es, 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.
7. Promoting, supporting or teaching self#control may not be the focus of the staff
when chemical interventions are used.
A+ %echanical Restraints
4 Application G many times the energy re<uired to place a person in a restraint device
e0pends so much effort that by the time it is applied, it is no longer needed.
5 (erious health considerations for =ac!et#type sheet restrains include&
a. Problem of heat release from the person%s body. The =ac!et is usually made of
durable canvas#type material. It does not allow the body to e0pel heat though evaporation.
Thus the use of the =ac!et will result in increased body temperature
and;or dehydration if proper fluid inta!e is not maintained.
b. Isometric 'anger G person pulls against immovable ob=ect resulting in rise of
blood pressure. This can cause a serious problem for people with hypertension and heart
problems.
4 Individuals could in=ure themselves trying to escape from the devices.
5 +se does not result in learning self#control or positive behaviors.
!+ Non5pro-rammatic Responses
4 Reactions to situations are based upon staff%s upbringing, learning and;or previous
e0perience and these responses may not necessarily be the best response for the situation.
5 Individual handling of situations may personali1e the situation and could result in
power struggles.
6 )ften results in uncoordinated staff efforts and inconsistent team efforts.
I
.
Compare the models of behavior control and behavior support. +se a lecture format to
present the terms
@
behavior control
A
and
@
positive behavior support.
A

A+ !eha/ior control
$y behavior control practices, we are referring to those techni<ues by which behaviors
are systematically modified or changed in fre<uency through the programmatic
manipulation of positive and negative environmental conse<uences. $ehavior management
techni<ues 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 fre<uency of undesirable behavior through punishment or
e0tinction.
4 (how )verhead 4.6.4 which describes behavior control and behavior support practices.
5 Tal! about the various types of conse<uences that have been used and give e0amples.
6 ?ith severe challenging behavior, punishers and response costs are often used because
they are viewed as a <uic! way to reduce the fre<uency 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 !ehavior.
7 There are potentially harmful @side effectsA to the use of punishers and response costs. -s'
the group to !rainstorm what these side effects might !e. The following is a list of possible side
effects which should be discussed. (how )verhead 4.6.5.
:egative self#
image
'isli!e;avoidance of
staff
Fearning to avoid circumstances in which punishment occurs rather than
really changing behavior

'epression
Reliance on e0ternal rather than internal control of
behavior
rustration resulting in displaced
aggression
Treating others negatively may come to be seen as acceptable by both staff
and individuals
$.
Positive behavior support
4 Positive behavior support employs positive use of elements from traditional behavior
management, but it attempts to minimiAe the use of punishers and focuses more
on the teachin- of functional s7ills that will eliminate the need for ne-ati/e
beha/iors+
5 Positive behavior support also re<uires a multi#component approach where several
interventions are designed to be implemented at one time, all of which focus on the whole
person.
II. Conduct a discussion on these two concepts as'ing students to reflect on the differences
!etween the two. -reas that should !e addressed are.
4 ?ho has the controlL
5 ?hat is the desired change for the person in <uestionL
6 ?hat is the value to staff of using behavior support practicesL
III. Conduct a discussion on the need for a consistent intervention when wor'ing with children
and adults with special needs and challenging !ehavior. /egin !& discussing what we have
learned from our past efforts and how this has shaped our current ideas.
Thin! about the historical development of services for people with special needs and
challenging behavior, and focus on the need for a systematic approach for wor!ing with
children and adults with special needs because of the following&
4 (taff wor!ing with children and adults with special needs are not trained in this
respect and therefore they cannot provide a consistent approach to their needs.
5 Many children and adults with special needs who display challenging behavior are
restrained and not provided with any type of appropriate intervention to decrease their
behavior e0cept chemical and mechanical restraints.
6 Many children with special needs and challenging behavior end up in adult
psychiatric units where their wellbeing and even lives are at ris!.
REVIE
W
#o discuss hat IM$%&T brings"
4. A new trend towards positive approaches and person centered planning
5. Improved capacity of staff wor!ing with children and adults with special needs
6. A training program that focuses on proactive, least restrictive approaches
7. An effective and humane training program for addressing challenging behavior
9. Improved reactions of care providers when responding to crisis situations
H. An increased awareness of the negative effects of institutionali1ation&
D 'epersonali1ation Fac! of stimulation
D Modeling of violence Fearned helplessness
D
Fac! of freedom
appropriate
outlets
Regimentation
for normal
human emotions
,oal is to reduce
fre<uency of
negative behaviors
,oal is to meet
people%s needs and
to give people the
s!ills to meet their
own needs so that
negative behaviors
will not occur
re<uency of
negative behavior
is starting point
for plan
unction or cause
of negative
behavior is starting
point for plan
re<uency of
negative behavior
is reduced by staff
use of negative
conse<uences
Bpunishers,
response costsC
unction of
negative behavior
is replaced by
assisting the
person to meet
needs in socially
acceptable fashion
Reinforcers;punis
hers may be
unrelated to the
behavior
Attempts are made
to use @:atural
Conse<uencesA
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 s!ills
before negative
behavior occurs
!eha/ior control /s !eha/ior support
SI&E E==E#TS O= PUNIS;ERS
D :egative self#image
D 'isli!e;avoidance of staff
D Fearning to avoid circumstances in which punishment
occurs rather than really changing behavior
D 'epression
D Reliance on e0ternal rather than internal control of
behavior
D rustration resulting in displaced aggression
D Treating others negatively may come to be seen as
acceptable by both staff and individuals
)$23CTI-3 )+R
& Participants will be able to demonstrate that their own beliefs, values and attitudes towards
persons with special needs affect their actions.
C):T3:T )-3R-I3?
This ob=ective focuses on the effects of our beliefs, values and attitudes, especially toward
persons with special needs who e0hibit challenging behaviors. 'iscussions will e0amine
how changes in our beliefs may lead to changes in attitude and actions.
I:(TR+CTI):AF (TRAT3,I3(;C):T3:T
I. $egin by discussing the terms& beliefs, values, attitudes.
-. Use overhead 1.,.1 to define the following terms.
4. $eliefs G Are opinions, views, conclusions you have made.
a. $eliefs are generally internally held* cognitive.
5. -alues G Are things or ideas of relative worth or importance
a. -alues are generally reflected in our words or actions
6. Attitudes G Are postures or positions e0pressive of an action or emotion.
A position held in regard to a person, group or thing.
a. Attitudes are based on !nowledge.
1. resent the following points a!out changing !eliefs and attitudes.
A. Providing !nowledge and understanding can lead to change in values and attitudes.
$. 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 uni<ueness of each person.
+. Use the following section to help participants visuali0e the impact of positive
attitudes on our !ehavior.
-. Displa& Overhead 1.,.+ and present the following points. *olicit reactions from the
participants regarding the statements. Discuss wa&s in which these positive !eliefs
and attitudes can influence the outcome of planning in a positive wa&.
D 3ach person is uni<ue in his or her needs or learning style.
D ?e must be as free as possible of stereotyped notions of what persons with special
needs are li!e and what they can or cannot do.
D Regardless of the severity of one%s disability, all persons can learn and grow.
D 3ach person is of e<ual human value and deserving of respect.
D 30pectations can either challenge or limit the growth of individuals.
D 3ach person deserves <uality services and is deserving of our best efforts.
D ?e must learn to perceive and understand the thoughts, feelings, wants and needs
of the people with whom we wor!.
D Positive e0pectations have a positive effect on the behavior of others.
1. *ummari0e the points made in this o!2ective. You ma& use Overhead 1.,.1 for this.
Cultural, societal, and family factors influence our beliefs, values and
attitudes.
D These same factors have contributed to our beliefs and attitudes about persons
with special needs, especially those who e0hibit challenging behavior.
D $eliefs and attitudes can change.
D )ur belief systems are li!ely to influence our own actions in dealing with
persons with special needs.
!eliefs:
opinions, views, conclusions one has made* things one
holds as fact.
$alues:
things or ideas of relative worth or importance
Attitudes:
postures or positions e0pressive of an action or emotion.
A position held in regard to a person, group or thing.
D 3ach person is uni<ue in his or her needs or learning style
D ?e must be as free as possible of stereotyped notions of what
persons with special needs are li!e and what they can or cannot do.
D Regardless of the severity of one%s disability, all persons can
learn and grow.
D 3ach person is of e<ual human value and deserving of respect.
D 30pectations can either challenge or limit the growth of
individuals.
D 3ach person deserves <uality services and is deserving of
our best efforts.
D ?e must learn to perceive and understand the thoughts,
feelings, wants and needs of the people with whom we wor!.
Positive e0pectations have a positive effect on the behavior of
others.
Cultural, societal, and family factors influence our beliefs,
values and attitudes.
D These same factors have contributed to our beliefs and
attitudes about persons with special needs, especially those who
e0hibit challenging behavior.
D $eliefs and attitudes can change.
D )ur belief systems are li!ely to influence our own actions in
dealing with persons with special needs
INNOVATIVE
cHAPTER ENd
mULTI-dIScIPLINAR
Y
)$23CTI-3(
4 +nderstand the need for a multi#disciplinary approach when wor!ing with children
and adults with special needs.
5 +nderstand the concept of challenging behavior and the importance of a positive
behavior support approach.
6 +nderstand the importance of the environment when it comes to supporting people
with special needs.
7 'iscuss the five levels of intervention necessary for creating a successful and
comprehensive plan for a person with special needs.
UNIT T'O
PRESENTATION
OUTINE
O!"
E#T
I$E
T
I
%
E
#ONTEN
T
%E&
IA
NO
TES
5.4.
5
8
m
i
n
.
)verview
of the
multi#
disciplinar
y
approach
5.5
4
J
8
m
i
n
.
A
discussion
about
challengin
g behavior
and the
meaning
of positive
behavior
support
)verh
ead
5.5.4
)verh
ead
5.5.5
)verh
ead
5.5.6
"and
out
5.5.7
)verh
ead
5.5.9
"and
out
5.5.H
)verh
ead
5.5.I
5.6
H
8
m
i
n
.
A
discussion
about the
importanc
e of the
environm
ent when
wor!ing
with
children
and adults
with
special
needs
)verh
ead
5.6.4
)verh
ead
5.6.5
5.7
4
J
8
m
i
n
.
A
discussion
of the five
levels of
interventi
on that
need to be
considere
d when
creating a
meaningf
ul plan for
a person
with
special
needs
)verh
ead
5.7.4
)verh
ead
5.7.5
)verh
ead
5.7.6
)verh
ead
5.7.7
)$23CTI-3 ):3&
Participants will be able to understand the need for a multi
disciplinary approach when wor!ing with children and adults with special needs.
#ONTENT O$ER$IE'
The purpose of this ob=ective is to give participants an understanding of the importance of
a team approach when creating a plan for wor!ing 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 ta!en
into consideration when decisions are made with respect to their lives.
I. /egin !& as'ing for the participants) input a!out who the& consider to !e relevant to
include when creating a plan for a child3adult with special needs. 4he conclusion of the
discussion should !e. ?hen creating a successful plan for wor!ing with children and adults with
special needs, the team should include, but not be limited to, the following&
D Person with special need
D Parent;advocate;friend
D Case manager
D 3ducator;day center instructor
D Music;art;dance instructor
D (ocial wor!er
D )ccupational Therapist
D (peech Therapist
D Psychologist
D Teacher
)$23CTI-3 T?)&
Participants will be able to understand the concept of challenging behavior and the
importance of a positive behavior support approach.
#ONTENT O$ER$IE'
The purpose of this ob=ective is to introduce the concept that behavior, even challenging
behavior, is purposeful. People use behavior to achieve personal outcomes. unctional
analysis is a way of determining the intended outcome of a person%s behavior. (everal
assessment techni<ues 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. /egin this o!2ective !& having participants suggest some reasons wh& the people the&
wor' with displa& a given challenging !ehavior. 5a'e a list which shows the target
!ehavior and gives the participant)s current 2udgment a!out wh& the person e%hi!its
the !ehavior. 5a'e sure that the !ehaviors that are listed are trul& pro!lematic for
the person and the staff and not 2ust a pro!lem for staff. If &ou see the need, &ou
should define what is meant !& the term challenging !ehavior.
4 Using the e%amples provided !& the class, !egin a discussion regarding the functionalit&
of the !ehavior.
5 Introduce the concept of function of !ehavior. 4hen suggest some possi!le functions for
the !ehaviors descri!ed !& the class. -ssure them that &ou are onl& guessing !ecause &ou don)t
have assessment data to support &our 2udgment.
6 Use the points from Overhead +.+.1 as a wa& of cementing the participants)
understanding of the importance of 'nowing the function of a !ehavior and using
that information to plan interventions for that person. 4he following list is more
e%pansive than the overhead. Use the e%tra phrases to enhance &our discussion.
4he participants) view of challenging !ehavior and its purpose is 'e& to the use of
positive strategies.
4 Problem behaviors are largely learned through a history of interactions between the person
and the environment.
5 In general, problem behavior is seen as purposeful Bfunctional and usefulC within the
conte0t of the environment in which the behavior occurs.
6 Problem behavior may communicate something about a person%s unmet wants or needs.
7 $ehavior is a function of the person interacting with the environment.
9 $ehavior occurs within a social conte0t. Therefore, interpersonal relationships are
important in understanding problem behavior.
H $ehavior is more li!ely to change when the environment changes.
I If you want to decrease a problem behavior, you need to teach a substitute s!ill that will
ta!e its place and serve the same function.
J An individual%s problem behavior may be maintained by more than one mechanism or
factor.
K A group of problem behaviors may be members of a single response class Battention,
sensory, tangible, or escapeC.
48 Define functional anal&sis
44 Use Overhead +.+.+ 6or prepare it as a handout7 to present an& or all of the following
definitions of functional anal&sis.
unctional Analysis&
4. The process of loo!ing at relationships between behavior and the environment.
5. An assessment process for gathering information that can be used to build effective
treatment plans.
6
.
Identifies changes which positively impact the individual
%
s <uality of life. This may
include s!ills, relationships, conditions or other aspects of the environment, medical
interventions and other factors.
7. ocuses on the person and the environment in which the problem behavior is occurring.
9. Ta!es into account the life of the person and the conte0t in which the problem
behavior is occurring.
H. "elps to identify the factors which contribute to the problem behavior G who, what,
when, where, etc.
I. "elps to understand wh, the behavior is occurring
J. Identifies s!ills for the person to learn.
/. Challenging !ehavior usuall& occurs for one 6or more7 of the four functional response
classes. Using response classes as a wa& of organi0ing our ideas and information a!out the
function of !ehavior can !e ver& useful. "our general response classes are
e%plained !elow. Define each for the participants. -s' them to provide the group with
e%amples. Use Overhead +.+.1.
*+ Attention G 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
pro0imity Bdistance from the personC. The length of attention can vary.
4 An e0ample would be the adolescent in the classroom who ma!es snide remar!s during
class while the teacher responds in a socially disapproving manner. The attention, although
negative, is li!ely reinforcing and maintaining the behavior.
5 )ther e0amples can include& children who become aggressive to other children who are
receiving attention, or children who become self#in=urious when they do not receive attention.
.+
Tan-ible
G
a person can engage in problem behavior to get access to an item, service, food, or activity.
4 A classic e0ample is the child in the supermar!et who pic!s up a piece of candy and
tantrums until the parent purchases it.
5 )ther e0amples would be that of children who as! e0cessively for food, and when not
given, engage aggressive or self#in=urious behavior.
0+ Sensor, G provide input into one or more sensory#perceptual pathways. Foo!s, sounds,
feels, smells or tastes good or otherwise produces pleasure for the person.
a+ 30amples here might include certain forms of repetitive movements Bstereotypy or
@stimmingAC such as roc!ing, head weaving or finger flic!ing. (uch repetitive
behavior provides consistent internal sensory input the person needs. Therefore the
behavior may be reinforcing in and of itself.
1+ Escape G a person can engage in problem behavior in order to avoid a demand, tas!, or
activity.
a. An e0ample would be that of a person not performing a tas! because he perceives
the tas! to be too difficult or not interesting enough.
V. 'rou! ()ercise 8 pass out Handout +.+.,. /rea' the large group into several small
groups of a!out four people each. -s' the group to review each situation on the handout and
ma'e a general determination regarding the functions of the !ehavior. oint out that this
activit& is aimed at helping participants !ecome familiar with the four general response classes
and understand the concept of gathering assessment data. In realit&, much more wor' would
go into determining the specific function of the !ehavior.
(I. Using a lecture format, descri!e the process of using functional assessment to
understand the function of the !ehavior. Use Overhead +.+.9 to help &ou descri!e the four
re:uirements of functional anal&sis.
A. our re<uirements for unctional Analysis
4. Challenging behaviors are specifically defined.
a. A description is needed of each problem behavior that fully describes what the
person is doing. 30ample& @The person got upsetA would not be specific enough.
@"itting others with fistA or @throwing furnitureA would be more specific and
operational.
5. 3vents are identified that predict when the behavior is li!ely and not li!ely to occur.
a. 3vents that happen =ust 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#$#C BAntecedent G $ehavior G Conse<uenceC trac!ing sheets, which is shown
at the end of this ob=ective, are helpful in identifying such events and stimuli.
6. "ypotheses or ideas are developed as to the functionBsC of the behavior.
a. ?hat is maintaining or reinforcing the behaviorL 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 reasonsL
7. 'ata is collected to confirm whether&
4 3vents that predict the behavior are accurate
5 "ypotheses about the function of the behavior are correct
(II
.
Descri!e a few of the tools that ma& !e used to complete a functional anal&sis. 5a'e sure to
e%plain that several of these tools should !e com!ined into an
#
assessment pac'age
$
to produce a clear functional anal&sis. One should not stand on its own.
4. Motivation Assessment (cale BMA(C G "andout 5.5.H
This short scale developed by 'urand and Crimmins is used for analy1ing the
relationship between environmental events and the person%s problem behavior, and
helps answer <uestions regarding the function of the problem behavior. This aids in
developing ideas about the function of the behavior Bwhy it is occurringC. E%plain that
this tool helps to determine which of the four response classes might serve as the
function of the challenging !ehavior.
5. A#$#C Trac!ing (heet G )verhead 5.5.I
Another way of assessing antecedents and conse<uences to behavior is by charting
A$Cs. Information is entered in narrative form in each column for every occurrence of
the behavior. 'ay, 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.
+:'3R(TA:'I:, C"AFF3:,I:, $3"A-I)R
D In general, challenging behavior is seen as serving a purpose
for an individual.
D Challenging behaviors are largely learned through a history of
interactions between the person and the environment.
D Problem behavior may communicate something about a
person%s unmet wants and needs.
D A single behavior may be maintained by more than one
outcome.
D A group of behaviors may be used to achieve a single
outcome.
?"AT I( +:CTI):AF A:AF/(I(L
D The process of loo!ing at relationships between behavior and
the environment.
D A full range of strategies used to identify the antecedents and
conse<uences that control problem behavior.
D An assessment process for gathering information that can be
used to build effective behavioral support plans.
ATTENTIO
N
TAN(I!E
SENSOR<
ES#APE
Handout +.+.
,
(ROUP EBER#ISE 'ORCS;EET
'hat ma, be the function of the beha/iorD
Ana loves going to school and seeing her friends. (he prefers to wor! in groups with her peers.
)ver the past three months, staff have noticed an increase in Ana%s behavior challenges in the
afternoon. ?hen teachers are wal!ing with Ana to her 4&4 speech therapy session, she has
begun to drop to the ground and cry. (ometimes it ta!es up to an hour for staff to encourage
Ana to get off of the ground, causing her to miss her speech session. ?hat might be the
function of her behaviorL
'avid and the staff from his home go to the store each (aturday to purchase groceries for the
wee!. They have done this together for over a year and this activity is very meaningful to
'avid. Recently, the staff 'avid goes with has begun to invite one of 'avid%s housemates,
Maria, to go with them. Maria is learning to pic! out healthy choices at the store and re<uires
<uite a bit of help from staff. 'avid has begun to cry every time Maria needs assistance from
the staff. ?hat might be the function of his behaviorL
'aniel lives in a home with 9 other people. )ne of 'aniel%s housemates, (tefan, is celebrating
his birthday today. (tefan has invited some members of his family as well as friends from his
wor!. There is food coo!ing in the !itchen and music playing as people are arriving. (uddenly,
'aniel begins to throw things around his bedroom and yell. ?hat might be the function of his
behaviorL
,abriela is wal!ing down the street with her family. In the past, ,abriela has had difficulty
going into the community with her family because of her challenging behavior. Today, on the
way to the par! ,abriella wal!ed past a store that was selling candy, her favorite food.
,abriela <uic!ly ran into the store and became upset, yelling and crying when her mother told
her that they would not be purchasing any candy. ?hat might be the function of her
behaviorL
)+R R3>+IR3M3:T( )R +:CTI):AF A:AF/(I(
#hallen-in- beha/iors are specificall, defined+
E/ents are identified that predict when the
beha/ior is
li7el, and not li7el, to occur+
;,potheses or ideas are de/eloped as to the
function>s? of the beha/ior+ &ata is
collected+
>+3(TI
):(
A:(?3R(
:
ev
er
Al
m
ost
ne
ve
r
(el
do
m
"
alf
th
e
ti
m
e
+s
ua
lly
Al
m
os
t
al
wa
ys
Al
w
ay
s
4.?ould
the
behavior
occur
continuous
ly, over
and over, if
this person
was left
alone for
long
periods of
timeL Bor
e0ample,
several
hoursC
8 4 5 6 7 9 H
5.'oes the
behavior
occur
following a
re<uest to
perform a
difficult
tas!L
8 4 5 6 7 9 H
6.'oes the
behavior
seem to
occur in
response
to your
tal!ing to
another
person in
the roomL
8 4 5 6 7 9 H
7.'oes the
behavior
ever occur
to get a
toy, food
or activity
that this
person has
8 4 5 6 7 9 H
Handout +.+.;
%OTI$ATION ASSESS%ENT S#AE >&URAN&?
:ame EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
'ate EEEEEEEEEEEEEEEEEEEEE
$ehavior 'escription EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
Instructions& The Motivation Assessment (cale is a <uestionnaire designed to identify those
situations in which an individual is li!ely to behave in certain ways. rom this information, more
informed decisions can be made concerning the selection of appropriate reinforcers and
treatments. To complete the Motivation Assessment (cale, select one behavior that is of
particular interest. It is important that you identify the behavior very specifically. -ggressive for
e0ample is not as good a description as hits his sister. )nce you have specified the behavior to be
rated, read each <uestion carefully and circle the one number that best describes your
observations of the behavior.
been told
he;she
cannot
haveL
Handout +.+.;
6cont.7
>+3(TI
):(
A:(?
3R(
:
e
v
e
r
Al
m
ost
ne
ve
r
(el
do
m
"
al
f
th
e
ti
m
e
+s
ua
lly
Al
m
os
t
al
wa
ys
Alwa
ys
45.'oes
the
behavior
stop
occurring
shortly
after you
give this
person a
toy, food
or activity
he;she has
re<uestedL
8 4 5 6 7 9 H
46.?hen
the
behavior is
occurring,
does the
person
seem calm
and
unaware of
anything
else going
on around
him;herL
8 4 5 6 7 9 H
47.'oes
the
behavior
stop
occurring
shortly
Bone to five
minutesC
after you
stop
wor!ing or
ma!ing
demands
of this
personL
8 4 5 6 7 9 H
Handout +.+.;
6cont.7
49.'oes
this person
seem to do
the
behavior
to get you
to spend
some time
with
him;herL
8 4 5 6 7 9 H
4H.'oes
the
behavior
seem to
occur
when this
person has
been told
that
he;she
can%t do
something
he;she
wanted to
doL
8 4 5 6 7 9 H
Handout +.+.;
6cont.7
&A<,
&AT
E
AN&
TI%
E
&ES#
RI!E
T;E
SITU
ATIO
N
&ES#
RI!E
T;E
!E;A
$IOR
'hat
did the
person
doD
&ES#
RI!E
<OUR
RESP
ONSE
'hat
did ,ou
do in
respon
se to
personE
s
beha/i
orD
%OTI$ATION ASSESS%ENT S#AE
(ensory 3scape Attention Tangible
4.EEEEEEE 5.EEEEEEE 6.EEEEEEEE 7.EEEEEEEE
9.EEEEEEE H.EEEEEEE I.EEEEEEEE J.EEEEEEEE
K.EEEEEEE 48.EEEEEEE 44.EEEEEEEE 45.EEEEEEEE
46.EEEEEEE 47.EEEEEEE 49.EEEEEEEE 4H.EEEEEEEE
Total (core M
A5!5# TRA#CIN( S;EET
)$23CTI-3 T"R33&
Participants will be able to understand the importance of the environment when it comes to
supporting people with special needs
#ONTENT O$ER$IE'
This ob=ective focuses on helping participants see the importance of a supportive and
functional environment to a person with special needs and challenging behaviors.
Participants will have the opportunity to discuss the nature of the environment in which they
wor! and its impact on the behavior of the individuals who live in that environment.
I. Use lecture and discussion to produce two lists of words, one reflecting #supportive$ and
the other reflecting #functional$ environments. <eep trac' of responses on a flip chart and use the
overhead for summar& and follow=up. Define #"unctional$ and #*upportive,$ 6see Overhead +.1.1
for sample lists7. Consider the following. #supportive$ refers primaril& to the social environment
and #functional$ refers primaril& to the ph&sical environment.
II. Discuss emotional reactions to functional3non=functional, supportive3non=supportive
environments and how non=functional and non=supportive environments ma& serve as a #!reeding
ground$ for pro!lem !ehaviors. 4he discussion ma& focus on situations in which participants found
themselves in non=supportive and non=functional environments and how the& reacted to them.
III. >hen supporting positive !ehavior it is important to assess the environment carefull&. Discuss
those aspects of a person)s environment which re:uire special attention. ?ist the five ma2or
categories of the ositive Environment Chec'list on Overhead +.1.+ and discuss how pro!lems in
an& of these areas lead to challenging !ehaviors.
A. Physical setting
$. (ocial setting
C. Activities and instructions
'. (cheduling and predictability
3. Communication
III.Discuss e%isting ma2or !arriers to creating positive environments 6e.g. scheduling, !udget,
low staffing, dealing with challenging !ehaviors, staff !urnout7. /rainstorm wa&s of
overcoming those !arriers.
Supporti/e
Positive
=unctional Meets
needs
3ncouraging
Consistent
+seful Consistent
Patient (afe
orgiving
3mpathic :on#
=udgmental
Caring ,enerous
le0ible )rgani1ed
Choices available un
Accessible
le0ible
Comforting
Trusting
Rewarding
Promotes
growth "onest
Therapeutic Age#
appropriate 3ducational
Adaptive Be<uipmentC
Motivating Comfortable
+nderstanding
"elpful
Respectful
Interesting Intelligent
'ependable
Accepting )ptimally stimulating
A @positive environmentA is one that is both @functionalA and @supportive.A
The following lists consist of terms that have been suggested as reflecting @functionalA and
@supportiveA environments.
POSITI$E EN$IRON%ENT
#;E#CIST P;<SI#A SETTIN(
SO#IA SETTIN( A#TI$ITIES AN&
INSTRU#TION S#;E&UIN( AN&
PRE&I#TA!IIT< #O%%UNI#ATION
)$23CTI-3 )+R&
Participants will be able discuss the five levels of intervention
necessary for creating a successful and comprehensive plan for a person with special needs.
#ONTENT O$ER$IE'
This ob=ective 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 5aslow)s hierarchic theor& of needs. 4his
discussion is meant to lead the participants into understanding that ever& individual)s needs are
unconsciousl& prioriti0ed. /ased on 5aslow)s theor& and using Overhead +.,.1, discuss the
importance of fulfilling each need !ased on the following two aspects.
3ach of the first four la&ers of need must !e properl& fulfilled for the individual to
!e read& to meet the secondar& or higher levels of need.
no la&er of need can !e left out.
Maslow%s "ierarchy of :eeds states that five levels of need e0ist. These needs are often
portrayed in the shape of a pyramid, with the most fundamental at the bottom and the need
for self#actuali1ation at the top.
Maslow%s basic needs are as follows&
Ph,siolo-ical Needs
These are biological needs. They consist of needs for o0ygen, 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.
Safet, Needs
?hen 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 e0cept in times of emergency or periods of disorgani1ation in the social
structure Bsuch as widespread riotingC. Children often display the signs of insecurity and
the need to be safe.
Need for o/e, Affection and !elon-in-
?hen the needs for safety and for physiological well#being are satisfied, the ne0t class of
needs for love, affection and belonging can emerge. Maslow states that people see! to
overcome feelings of loneliness and alienation. This involves both giving and receiving love,
affection and sense of belonging.
Need for Esteem
?hen 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. "umans have a need for a stable, firmly based, high level of self#respect, and
respect from others. ?hen these needs are satisfied, the person feels self#confident and
valuable as a person in the world. ?hen these needs are frustrated, the person feels
inferior, wea!, helpless and worthless.
Need for Self5ActualiAation
?hen all of the foregoing needs are satisfied, then and only then are the needs for self#
actuali1ation activated. Maslow describes self#actuali1ation as a person%s need to be and do
that which the person was @born to do.A @A musician must ma!e music, an artist must paint,
and a poet must write.A These needs ma!e themselves felt in signs of restlessness. The person
feels on edge, tense, lac!ing something, in short, restless. If a person is hungry, unsafe, not
loved or accepted, or lac!ing self#esteem, it is very easy to !now what the person is restless
about. It is not always clear what a person wants when there is a need for self#actuali1ation.
Maslow believed the only reason that people would not move well in the direction of self#
actuali1ation is because of hindrances placed in their way by society.
II.
Using a lecture format, introduce the participants to the 9 levels of intervention that
have to !e ta'en into consideration when creating a plan for a person with special needs.
E%plain each using Overhead +.,.+.
*+ SENSOR< &I==EREN#ES AN& !IOO(IA NEE&S
D Provide a sensory diet
D
Monitor and address environmental
stressors&
(ound, light, pro0imity;personal space,
te0ture Movement needs
D Monitor and address& Appetite;hunger
Arousal;activity level Be.g., fatigue,
hyperactivityC Posture and movement
Medical needs
Using *verhead +.,.- discuss with the participants a!out sensor& issues that are common
for people with special needs.
(ensory issues, referring to the seven types of sensory dysfunctions&
(mell Taste Touch -isual Input
Auditory -estibular BbalanceC
Proprioception Bbody awarenessC
Sensor, d,sfunction influences all aspects of a personEs life+
-s' participants a!out some ph&sical reactions the& e%perienced when feeling an%ious. "or
e%ample, tell them to thin' a!out how the& felt when the& had to spea' in pu!lic.
Many people are often unaware that physical symptoms of an0iety do e0ist. They thin! of an0iety
as a wholly emotional reaction. Many people who suffer from an0iety often recount
how the physical symptoms of an0iety become prominent first and then trigger an increased
emotional reaction.
An0iety 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 Bor instead of any mental
symptoms at allC, or physical symptoms that arise after a person has become emotionally
an0ious.
4he conclusion of this discussion should !e the following. if an intervention reduces
an)iety, it is hel!ing to meet a sensory.biological need.
.+ REIN=OR#E%ENT
@Instead of yelling and span!ing, which don%t wor! anyway, I believe in finding creative
ways to !eep their attention # turning things into a game, for instance. And, when they do
something good, positive reinforcement and praise.A # Patricia Richardson
I. -s' participants to thin' a!out the following idea #&onse/uences influence
behavior$ and tr& to give e%amples to sustain the validit& of this idea.
The conclusion they have to reach is the following& people do things because they !now other
things will follow. Thus, depending upon the type of conse<uence 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&
4 If a behavior is rewarded, it is more li!ely to occur. It will be more intense and more
fre<uent.
5 If a behavior is followed by a punisher, it is more li!ely to decrease in its intensity and
fre<uency.
6 If a behavior is followed neither by a reward or a punisher but it is ignored, the behavior
will e0tinguish.
a.
Identif&ing 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 Bsay, candy or stic!ersC, they may grow bored over time.
This is perhaps the greatest challenge for any teacher. inding good rewards re<uires a great deal of
e0perience and insight.
!. Controlling all sources of reinforcement.
Teachers often must compete with the child%s peer group. Peers provide an e0tremely 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 thin! their reinforcement
applications are failing because they are not using the @rightA 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 !e difficult to create.
)ne 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 mon!ey
who does a tric!, then holds out a hand waiting for the banana. In this case, the child has not
internali1ed the behavior. This means that the teacher must wor! hard to provide the correct
conse<uences for the desired behaviors at the right time.
Principles of reinforcement&
4. The source is well#trained in the theory and practice of reinforcement.
5. The source has complete control of all significant reinforcers for all receivers.
6. The source has complete control of each receiver Bi.e. what the receiver does, when the receiver
does it, what other receivers are in the situationC.
7. The source has a detailed and consistent plan of reinforcement.
9. The reinforcers are always delivered under the same conditions to each different receiver.
H. The reinforcement must be contingent on the target behavior. That is, the child only earns the
predetermined conse<uence if and when he;she performs the re<uested behavior.
The use of punishers is controversial. Receiving punishment is an e0treme conse<uence for all
living things. ?hether it is a dog, a parrot, a child, or an adult, punishing conse<uences can
produce e0tremely rapid, strong, and memorable changes, but not necessarily positive changes.
)ne 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& 4C immediate Bright now.C, 5C intense Bthe biggest possible stic!C, 6C unavoidable Bthere is no
escapeC, and 7C consistent Bevery timeC. If you cannot deliver punishment under these
conditions, then the punishment is li!ely 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 conse<uence. People e0perience 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. /et, some persist
in using wea!ened 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 ma!ing other goals more difficult to achieve.
4. (TR+CT+R3 A:' -I(+AF;TACTIF3 (+PP)RT 0%nd it is best if you 1no a good thing
is going to ha!!en, li1e an ecli!se or getting a microsco!e2 %nd it3s bad if you 1no
a bad thing is going to ha!!en li1e having a filling or going to 4rance. 5ut I thin1 it
is orst if you don3t 1no hether it is a good thing or bad thing hich is going to
ha!!en.6
5The #urious Incident of the &o- in the Ni-ht Time, b, %ar7 ;addon, .::0
I. -s' participants to give &ou some e%amples of visual supports that people use in
ever&da& life. Use Overview +.,.,. to support the idea that ever&!od& needs and uses
visual supports in order to organi0e their dail& activities. -s' participants to thin'
a!out how the& feel when the& don)t 'now what is going to happen ne%t. Use this
discussion as a starting point to underline the importance of structure and visual
support for children and adults with special needs.
(tructure ma!es e0pectations clear and e0plicit and increases the understanding of the environment.
It reduces an0iety by helping children and adults with special needs to ma!e 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.
-isual 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. -isual
supports&
D Pictures of individual ob=ects G can be used to signify activities to children and can cue the
child to the ne0t activity. )ver time, a se<uence of ob=ects can be used to assist transition between
activities.
D Photographs G photographs of the child engaging in various activities can be used to provide a
visual timetable to the child.
D Fine drawings #more abstract, are often preferred as they contain minimum distracting
features.
D ?ritten words G can be used at the appropriate age and stage -isual supports help us develop
a systematic approach that will help the child attend to tas!s and develop s!ills.
5. TA(N '3MA:' Any aspect of a tas! that must be met is a tas! demand. $ehavior problems are
often caused by demands e0ceeding a person%s ability. In other words, if a tas! is too demanding, the
person will fail. Intervention on Tas! 'emand level involves ad=usting the demands and;or increasing
supports in order to balance the person%s ability with the tas! presented. Reducing the demand and;
or increasing support are both Tas! 'emand interventions that help to create the balance.
I. -s' the participants to watch the video and ma'e suggestions regarding the ad2ustments
that could !e done to the tas' demand shown in order to increase the support needed for the
development of s'ills.
6. (NIFF( T) T3AC" )nly when the sensory system is calm, reinforcement is available, the
environment is made predictable through structure and visual;tactile supports, and tas! demands are
carefully designed, can s!ills be effectively demonstrated and taught.
*verhead +.,.+
*verhead +.,.-
*verhead +.,.,
mULTI-dIScIPLINARY
cHAPTER ENd
PERSON-cENTERE
d
)$23CTI-3(
4 +nderstand the person#centered approach and that people with special needs can always
learn if provided with the necessary support to be successful.
5 Analy1e the level of supervision a person may re<uire in order to create opportunities for
achievement.
6 +nderstand the concept of Pro#active Approach to behavior.
UNIT T;REE
PRESENTATION
OUTINE
O!"
E#T
I$E
T
I
%
E
#ONTE
NT
%E&
IA
NO
TES
6.4.
7
8
m
i
n
.
A
discussio
n about
the
person#
centered
approach.
6.5
K
8
m
i
n
.
)verview
of levels
of
supervisi
on
"and
out
6.5.4
6.6
H
8
m
i
n
.
)verview
of Pro#
active
Approach
)verh
ead
6.6.4
"and
out
6.6.5
)$23CTI-3 ):3&
Participants will be able understand the person#centered approach and the concept that people
with special needs can always learn, if provided with the necessary support to be successful.
#ONTENT O$ER$IE'
The purpose of this ob=ective is for the participants to understand that the person#centered
approach is a concept that places the person with special needs in the center of all focus and
program development. The person with special needs drives the team approach to ta!e
notice of the abilities, strengths and, most importantly, interests of the person with special
needs. ?hen the team understands the abilities, strengths and interests of a person with
special needs, they are able to build upon each of them, and provide the support needed to
promote independence, individuality, inclusion and productivity in all aspects of the lives of
those they support.
I. Discuss with participants the concept of person=centered planning and its principles.
Person#centered planning is a process of life planning for people with special needs. It is
based on the principles of inclusion and productivity. It always ensures that the focus
on the person is central and that the person is in control. The plan is fle0ible, setting no
limits to the person%s wants, needs and dreams for their life.
In person#centered planning, the process, as well as the product, is owned and controlled
by the person Band sometimes their closest family and friendsC. There are no prescribed
forms or chec!lists* the resulting plan of support is totally individual. It creates a
comprehensive portrait of who the person is and what they want to do with their life and
brings together all of the people who are important to the person, including family, friends,
neighbors, support wor!ers and other professionals involved in the person%s life.
Person#centered planning focuses on a person%s gifts, capacities, and personal dreams, and
utili1es a circle of committed friends, family and community members to help reali1e those
dreams and assist people with special needs in moving toward full citi1enship.
All Person#Centered Planning approaches are characteri1ed by five elements B)%$rien O
Fovett, 4KKHC that have been identified as fundamental&
4 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 <uestions are @?ho is the personLA and
@?hat community opportunities will enable this person to pursue his or her interests in a positive
wayLA
5 Person#Centered Planning aims to change common patterns of community life. It
stimulates involvement with the community and enlists all community members to wor!
incusively toward a desirable future. It helps create positive community roles for people with
disabilities.
6 Person#Centered Planning re<uires learning through shared, collaborative action, and
fundamentally challenges practices that separate people and perpetuate controlling relationships.
7 Person#Centered Planning can only come from respect for the dignity and completeness of
the focus person as he;she is.
9 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 ma!ing that dream come true, we will need to wor! on doing a better =ob at inviting
non#paid community members into the lives of people with special needs.
)$23CTI-3 T?)&
Participants will be able to analy1e the level of supervision a person may re<uire in order to
create opportunities for achievement.
#ONTENT O$ER$IE'
The purpose of this ob=ective is for participants to understand the concept of levels of
supervision and become aware of their importance.
I. Discuss with participants the concept of #levels of supervision$ and its importance.
Fevels of supervision refer to the support children and adults with special needs may
re<uire when accessing different environments. +sually 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. Fevels of supervision may differ according to the accessed environment.
There are three levels of supervision&
One F &irect
A staff member will be within one meter Bwithin reachC of the individual at all times. The
staff member will observe the person at all times. $oth the person and the environment
will be monitored for potential problems at all times.
Two F #lose ProGimit,
A staff member will be in the same room with the individual B@eyes onAC, or nearby, at
all times.
Three F Occasional
A staff member will monitor the person%s routine. The staff member will monitor every 48
minutes or so to ma!e 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.
7hy are levels of su!ervision im!ortant8
According to the level of supervision, the ideal staff#to#child;adult ratio may be
appropriately determined.
The child)adult&
D Is monitored in a safe environment
D "is;her individual needs may be met
D Is provided an environment that will offer the necessary support to be successful
The staff member&
D Nnows the level of support the child;adult must receive to be safe
D Nnows how much input the child;adult re<uires in order to meet his;her needs
and will not be more intrusive or restrictive than necessary
#riteria for determinin- le/els of super/ision
*+ Pica& If the individual has the habit of swallowing inedible ob=ects or substances.
.+ A--ressi/e, self5a--ressi/e or destructi/e beha/ior& If the individual is self#
aggressive, has the tendency to destroy ob=ects when he;she is upset or when not directly
monitored* if the individual has the tendency to hit, bite, scratch peers or staff* the fre<uency
of this behavior.
0+ Toilet trainin-& If the individual !nows 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.
1+ Safet,& If he;she is aware of danger while in the !itchen or community* if he;she can use
a !nife or other sharp ob=ects* if he;she is aware of danger when ne0t to hot ob=ects or
surfaces* if he;she can cross the street and is aware of dangers in the street.
2+ Issues re-ardin- communit, 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 e0plore the surroundings.
4+
%edical issues
& If he;she has asthma or allergies* if he;she has sei1ures;epilepsy* if
he;she has difficulty wal!ing* if he;she is suicidal* if he;she drin!s too much li<uid or
eats too much.
6+ 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+ En/ironment& 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.
Fevels of supervision depend on the child;adult and differ according to the accessed
environment. or e0ample, a child may receive an occasional B6C level of supervision
when in the small family home where he;she is familiar with the environment and a
direct B4C level of supervision while in the community because he;she is afraid of dogs
and becomes self#aggressive when scared.
D Fevels 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.
D )nce a level of supervision is established for each of the environments the person has
access to, the ne0t 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.
)$23CTI-3 T"R33&
Participants will be able understand the concept of Proactive Approach. Participants will discuss
how proactive, active and reactive interventions are used to address challenging behavior.
#ONTENT O$ER$IE'
The purpose of this ob=ective is to introduce the concept and techni<ues of proactive
interventions for persons with special needs who may e0hibit challenging behavior.
I. Using a lecture or discussion format, review the following concepts. E%plain that this
unit will address the su!2ect of proactive interventions. *u!se:uent units will focus on active
and reactive interventions.
A. Proactive G the prefi0 @proA means @before in time.A Thus, proactive interventions are
those which address people%s needs before problems arise. If proactive interventions are effective,
challenging behavior should become rare.
$. Active G if needs are not met, problems begin to bubble up as warning signs. Active
interventions are designed to help people calm so that their needs may be addressed. :ote&
Although active interventions involve calming, in order to truly resolve problems, people%s needs
Bwhich are currently met through challenging behaviorC must be addressed.
C. Reactive G the prefi0 AreA means @bac! in time.A Reactive interventions are those which
deal with challenging behaviors as they occur. ?e must then wait for the person to calm and go
bac! to a point where it is possible to address needs Bproactive and active interventionsC. Reactive
interventions include but are not limited to personal interventions. They may be spo!en
reprimands, lost of privileges, etc. Reactive interventions deal with controlling the behavior
rather than dealing with the cause of the challenging behavior. The -oal of a proacti/e
approach is to reduce the need for an, reacti/e inter/entions+
I. Use Overhead 1.1.1, the I5-C4 @radient, to illustrate that #proactive$ interventions
permit the most control !& the individual and re:uire less support from the staff.
@ReactiveA interventions re<uire 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 ,radient
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. (taff
must constantly monitor this intervention as they intervene with individuals to ensure
that they are providing enough Bbut not too muchC support.
II. Introduce participants to the @atewa&s of roactive 5anagement, Handout 1.1.+.
Discuss each :uestion with participants to see how it might !e used as an alternative in their
settings. *uggest that these alternatives might have a significant impact on the reduction of
crisis situations and help set their mind on !eing proactive.
S#IP5r (radient. 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 techni<ue first.
Handout 1.1.
+
(atewa,s F Proacti/e %ana-ement
$efore using personal interventions consider these 48 points first
#ommunication
"ave you offered an opportunity for the person to communicate using ob=ectives,
signs, symbols, or speech, and have you responded positivelyL
?hat did you doL
#hoice "ave you offered another activity and encouraged the person to chooseL ?hat
did you doL
En/ironment
"ave 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 personL
?hat did you doL
Ph,sical Needs
"ave you considered hunger, thirst, pain, heat, cold, tiredness, activity or need of
toilet P.L
?hat did you doL
Interaction "ave you offered a change of staff and responded to the need for attentionL
?hat did you doL
Handout 1.1.
+
6cont.7
Therapeutic Alternati/es "ave you offered music,
aromatherapy, massageL ?hat did you doL
RelaGation "ave you tried deep breathing, yogaL
?hat did you doL
#almin- techni3ues
"ave you used verbal and non#verbal calming to provide& reflection, empathy,
reassurance, redirection, incentives and rewardsL
?hat did you doL
istenin- techni3ues
"ave you listened, read the signs, pic!ed up cues, and given prompts rather than
hurrying to give adviceL
?hat did you doL
Sensiti/it,
"ave you helped to restore the individual%s confidence and dignity by sensitivity
rather than by being confrontational and have you offered a constructive,
functional activityL
?hat did you doL
PERSON-cENTEREd
cHAPTER ENd
AcTIV
E
)$23CTI-3(
4 +nderstand that sensory and;or environmental stimulation is essential for the growth
and well#being of people with special needs.
5 +nderstand the concept of sensory integration and be familiar with the signs and
severity levels of sensory disintegrative disorders.
6 'esign interventions which address sensory needs and provide environmental
stimulation, and understand the importance of establishing a @sensory dietA for people with
special needs.
7 +nderstand that active treatment is an ongoing process which utili1es every moment of a
person%s day as a teachable moment and an opportunity to learn.
UNIT =OUR
PRESENTATION
OUTINE
O!"
E#T
I$E
T
I
%
E
#ONTE
NT
%E
&IA
NO
TE
S
7.4.
4
5
8
m
i
n
.
'iscussio
n about
the
importan
ce of
sensory
stimulatio
n of
children
and
adults
with
special
needs
7.5
4
5
o
m
i
n
.
Provide
the
definition
of sensory
integratio
n and
discuss
specific
sensory
disintegra
tive
disorders
and their
severity
levels.
7.6 H
8
m
i
n
.
Introduce
types of
sensory
defensive
ness and
discuss
sensory
treatment
ob=ectives
for people
with
special
needs
before
covering
the steps
involved
in
establishi
ng a
@sensory
diet.A
7.7
7
8
m
i
n
.
'iscussio
n about
active
treatment
as an on#
going
process
which
utili1es
every
moment
of a
person%s
day as a
teachable
moment.
)verh
ead
7.5.4
)$23CTI-3 ):3&
Participants will be able to understand that sensory and;or environmental stimulation is
essential for the growth and well#being of people with special needs
#ONTENT O$ER$IE'
'uring 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 sensor& integration.
Sensory Integration" The &once!t
All of the information we receive about the world comes to us through our sensory
systems. $ecause many sensory processes ta!e place within the nervous system at an
unconscious level, we are not always aware of them.
2ust as the eyes transmit visual information to the brain for interpretation, all sensory
systems have receptors that pic! up information to be processed by the brain. Cells within
the s!in send information about light, touch, pain, temperature and pressure. (tructures
within the inner ear detect movement and changes in the position of the head.
Components of muscles, =oints, 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. or
e0ample, the sense of touch Bthe tactile senseC ma!es 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. or e0ample, 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 loo! up and down
at something without losing one%s balance. It would be difficult to wal! along a roc!y
path without falling, or to stand on one foot long enough to !ic! 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 5ody $osition
Closely related to the vestibular sense is the sense of proprioception. which gives us the
awareness of body position. It is proprioception that ma!es it possible for a person to
s!illfully guide his arm or leg movements without having to observe every action. ?hen
proprioception is functioning efficiently, an individual%s body position is automatically
ad=usted to prevent falling out of a chair. Proprioception also allows ob=ects such as
pencils, buttons, spoons and combs to be s!illfully manipulated by the hand. $ecause of
proprioception we are able to synchroni1e our steps according to the ground.
)$23CTI-3 T?)&
Participants will be able to understand the concept of sensory integration and become
familiar with the signs and severity levels of sensory disintegrative disorders.
C):T3:T )-3R-I3?
'uring this portion of the discussion, participants will learn the definition of sensory
integration and e0plore specific sensory disintegrative disorders. ?e will discuss some
specific signs of these disorders, and cover the levels of severity that may be present.
*rganization 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 comple0, and is necessary in order for a person to interpret a
situation accurately and give an appropriate response. This organi1ation and utili1ation of
the senses is termed @sensory integration.A
Motor $lanning
(ensory 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 e0ecuting the action. ?hen motor
planning occurs, a person is able to deal with a completely new tas! by implementing
a new action. ?hen 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 tas!, while relying on stored information regarding
unconscious body sensation.
Sensory Integrative Disorders
or 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. $ut for some children, sensory
integration does not develop as efficiently as it should. ?hen the process of sensory
integration is disordered, a number of problems in learning, development, or behavior
may become evident.
Signs of Sensory Integrative Dysfunction
:ot 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.
*verly sensitive to touch, movement, sights, or sound
This may manifest in behaviors such as irritability or withdrawal when touched, avoidance
of certain te0tures of clothes or foods, distractibility, or a fearful reaction to ordinary
movement activities, such as those typically found on a play ground. "e;she
may manifest difficulty climbing in and out of cars, difficulty going up and down stairs.
"e;she may fall out of chairs or wal! into ob=ects.
*ther e)am!les"
a. 'ifficulty using @pull toysA
4 Problems using tricycles or bi!es
5 Continuing to have accidents after being fully potty trained
6 Approaching an activity each time as if it were the first time
7 'ifficulty doing pu11les G manipulating pieces or determining where pieces
belong
9 'ifficulty guiding food to mouth
g. Clothing strong clothing preferences disli!es sleeves
hitting wrists;only wears long or short sleeves sensitive to collars
hitting nec!
does not want to wear a belt or anything that ties around the
waist is bothered by seams in clothing e0periences difficulty
manipulating buttons, 1ippers, 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
food
sensitive to temperature
sensitive to te0ture
heightened awareness of flavor;lac! of awareness of flavor
difficulty manipulating eating utensils
fre<uently spills both food and drin!s
chews with mouth opened
bites fingers and tongue while eating
dribbles food and drin! down chin
drops food on the floor unintentionally
disli!es carbonated beverages

9nder:reactive to sensory stimulation
In contrast to the overly sensitive child, an under#responsive child may see! out intense
sensory e0periences such as body whirling or crashing into ob=ects. "e or she may seem
oblivious to pain or to body position. (ome children fluctuate between the e0tremes of
over# and under#responsiveness.
%ctivity level that is unusually high or unusually lo
The child may be constantly on the move or may be slow to activate and fatigue easily.
Again, some children may fluctuate from one e0treme to the other.
&oordination !roblems
This can be seen in gross or fine motor activities. (ome children may have unusually poor
balance, while others have great difficulty learning to do a new tas! that re<uires
motor coordination.
Delays in s!eech, language, motor s1ills, 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.
$oor organization of behavior
The child may be impulsive or distractible and show a lac! of planning in approach to
tas!s. (ome children have difficulty ad=usting to a new situation. )thers 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.
;(V(;S *4 S(V(<IT=
;evel I > Mild
Children with mild defensiveness might be described as @pic!y,A @over#sensitive,A @slightly
overactive,A @resistant to change,A or slightly @controlling.A They can act mildly irritated by
some sensations but not by others. They may be pic!y about clothes or food. ?hile 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. ?hen they can no longer
maintain the level of effort re<uired to do so, they may @fall apartA emotionally under
apparently little or no stress.
;evel 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 s!ills are disrupted,
such as dressing, bathing and eating. They may be having difficulty with attention and
behavior. 30ploration and play may be limited due to fearfulness of new situations and
resistance to change.
;evel 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 Bi.e. severe developmental
delay, autism, autistic#li!e behavior or emotionally disruptedC. (trong avoidance of
some !inds of sensations or the reverse, intense sensory#see!ing are common. (ensory
defensiveness may bloc! 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.
)$23CTI-3 T"R33&
Participants will be able to design interventions which address sensory needs and provide
environmental stimulation, and understand the importance of establishing a
@
sensory diet
A
for people with special needs.
#ONTENT O$ER$IE'
?e will introduce the types of sensory defensiveness and discuss sensory treatment
ob=ectives for people with special needs before covering the steps involved in establishing a
@sensory diet.A
I#T(<V(#TI*# %$$<*%&?(S
Treatment for sensory defensiveness falls into three categories& 4C Awareness* 5C
Planned and scheduled activity program called a sensory diet* 6C A professionally
guided treatment program.
%7%<(#(SS
)ne of the more important steps in treating sensory defensiveness is ac<uiring
awareness of the symptoms and behaviors associated with the problem. $y doing
that, we can see that most people are doing the best they can to feel safe and adapt to
their disorder. )nce we understand their behavior we can provide activities and
sensory input that can eliminate the defensiveness.
S(#S*<= DI(T > $;%##(D %#D S&?(D9;(D %&TIVIT= $<*'<%M
The @sensory dietA concept is based on the idea that each individual re<uires a
certain amount of activity and sensation to be the most alert, adaptable and s!illful.
This is much li!e a person%s nutritional re<uirements. Certain !inds 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.
or e0ample& activities which re<uire whole#body action and ma!e the muscles wor!
hard have a therapeutic effect which lasts for about two hours* the effect
of deep pressure on the s!in lasts up to two hours* the benefits of low rhythmic
movement can last from two to si0 hours. Activities planned for the purpose of
calming include slow, boring, rhythmic movement, pressure on the s!in, neutral
warmth, activities in upside down postures, =oint traction and compression, heel
to head roc!ing Bespecially when lying on stomachC, total body activities and those
that demand heavy wor! from the muscles. Through careful planning, we can use
sensory input to ma!e a child feel safe and organi1ed throughout the whole day.
or the @sensory dietA to be best effective it is important to use special activities
scheduled throughout the day to help the child feel calm, alert, and organi1ed most
of the time. ?hen 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 ma!ing activities available, setting up environments
and supervising safety.
(stablishing a sensory diet
Structuring the time
4 'etermine a predictable flow for the day
5 Incorporate times for sensory input
6 3stablish routines
7 Alternate passive and active ; sitting and moving activities
9 (tart activities with preparation time for getting calm, settled, and organi1ed
H Allow plenty of time and a method for transition
Structuring the s!ace
4 )rgani1e the space to be inviting, soothing, calming, and organi1ed. $eware of the
total environment
5 "ave a predictable, organi1ed space for sit#down activities, eating, <uiet 1one and
play 1one
6 Avoid multiple use of space
7 +se identifiable visual cues, colors, names, and dQcor for set spaces
9 Consider visual stimulation Bwalls, bright colorsC
H Consider lighting Bnatural as much as possible, lampsC
I Consider sounds Bvoices, bac!ground, time to process, bac!ground musicC
J Consider odors& as a rule do not wear perfumes
K "ave a <uiet, organi1ed place Bbeen bag, big pillow, chair, tentC
Structuring the activities
4 Provide heavy wor! opportunities that are calming for the child
5 Incorporate active participation of the child
6 Incorporate strong sensory elements
7 +se a main theme
9 Provide fre<uent movement brea!s with rhythmic BcalmingC movements Bslow body stretch,
carry;pull;push heavy ob=ects, wall pushups, s<uish ballC
H :ever impose sensory input. ?atch for signs of distress.
Structuring your interaction
4 Invite;offer;encourage. 'o not push, demand, or force sensory activities
5 Provide plenty of time, do not rush, move on too fast, or change activity too fast
6 Fimit verbali1ations, yet reinforce communication
7 Protect the child from stimulation they cannot handle
9 (tay rela0ed, use appropriate tone of voice Bsoft for rela0ing, happy for arousingC
H "ave interaction be pleasurable. Foo! for smiles.
I +se firm, constant pressure touch Blight touch is alerting, triggers protective systemC
J (top activity after 68 seconds at the most if you see an adverse or negative affect
Some basic !rinci!les to consider"
?hile remembering that everyone is different and that people%s responses will vary, we can
consider some general principles in promoting sensory integration&
<emember 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.
5e sensitive to the child3s reactions to activities
It is important to recogni1e and understand how each child perceives and is affected by
different e0periences. ?hile light touch may be pleasing to some, for others it may
be irritating and distracting. (imilarly, some people may react negatively to loud noises or
certain types of sounds, or may have trouble turning out bac!ground noises in order
to attend to specific sounds Bi.e. your voiceC. (ome may e0hibit negative responses to
heights and certain types of movement, while others may seem to see! e0cessive amounts of
movement. )nce 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. or e0ample, 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. )r for the person who has difficulty tuning out bac!ground noises to attend to
a tas!, a special <uiet place could be set up for that specific tas!.
;oo1 for clues from the !erson
People often see! the type of sensory e0perience their nervous systems need. If a person
appears to be loo!ing 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 see!s a great
deal of movement, touch, pressure, vibration, visual or auditory stimuli, try to provide some
of these sensations in normal play activities. or e0ample, if a person seems
to want a lot of hugging and firm pressure, a caregiver might try neighborhood hi!ing with
weighted bac! pac!s, rolling games, or hide#and#see! under large pillows G all activities that
provide deep proprioception.
<ecognize the !erson3s abilities
Consider the demand placed on a person to process and respond to activities. (omeone who
en=oys movement and who has a good balance may be able to interact with you while
swinging. (omeone who is fearful of movement, however, may need to concentrate intensely
=ust 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 !erson in activities
Active involvement depends on the person initiating, planning, e0ecuting, or dynamically
responding to an activity. A passive activity may provide sensation or movement that does
not necessarily re<uire a response. Active involvement provides the best opportunity for
changes in the brain that lead to growth, learning, and better organi1ation of behavior. ?hen
someone is actively involved, he or she has more control over the situation. Therefore, when
planning new sensory and movement e0periences, it is usually best to emphasi1e active
participation on the part of the person.
)$23CTI-3 )+R&
Participants will be able to understand that active treatment is an ongoing process which utili1es
every moment of a person
%
s day as a teachable moment and an opportunity to learn.
#ONTENT O$ER$IE'
This ob=ective will focus on the idea that children and adults with special needs re<uire
continuous, consistent de/elopment on an ongoing basis. (taff wor!ing with persons
with special needs should promote the personal growth of people with special needs and help
them increase s!ills development and lead functional independent lives.
1. Discuss the following areas of interest regarding people with special needs. independence,
inclusion, individuali0ation, and productivit&. Use Overhead ,.+.1.
IN&EPEN&EN#E
D Attainment of responsible behaviors
D Improving self#care s!ills
D Increasing involvement in the community
D Improving self#advocacy s!ills
D Improving eating s!ills
D (elf#administration of medication
IN#USION
D 'eveloping appropriate social behavior
D 'eveloping and maintaining a valued social role
D 'eveloping !nowledge and access to community resources
D Increasing community participation
IN&I$I&UAIHATION
D Improving self#e0pression
D Improving understanding of decision#ma!ing and conse<uences
D Increasing participation in choice ma!ing
PRO&U#TI$IT<
D Increasing recognition of own abilities
D Increasing ac<uisition of s!ills;desired behaviors
D Increasing problem solving and conflict resolution s!ills
D Increasing involvement in preferred recreational and vocational activities
+. Introduce participants to the (lements of %ctive Treatment.
4 Interests, strengths, and needs of the individual have been accurately assessed.
5 Priority needs are addressed formally through activities which are relevant and
responsive to individual interest, choice and need.
6 3ach person receives consistent development, treatment, and services by trained staff.
7 :ew s!ills and socially acceptable behaviors are encouraged and promoted.
9 3ach person has the adaptive e<uipment and assistive technology necessary to promote
increased independence.
H Routines and environments are organi1ed to facilitate ac<uisition of s!ills, choices and
socially acceptable behaviors.
I Individual performance is accurately measured and programs are modified
accordingly.
J Persons with degenerative conditions receive training and services to maintain s!ills
and prevent regression.
IN&EPEN&EN#E
D Attainment of responsible behaviors
D Improving self#care s!ills
D Increasing involvement in the community
D Improving self#advocacy s!ills
D Improving eating s!ills
D (elf#administration of medication
IN#USION
D 'eveloping appropriate social behavior
D 'eveloping and maintaining a valued social role
D 'eveloping !nowledge and access to community resources
D Increasing community participation
IN&I$I&UAIHATION
D Improving self e0pression
D Improving understanding of decision ma!ing and conse<uences
D Increasing participation in choice#ma!ing
PRO&U#TI$IT<
D Increasing recognition of own abilities
D Increasing ac<uisition of s!ills;desired behaviors
D Increasing problem#solving and conflict resolution s!ills
D Increasing involvement in preferred recreational and vocational activities
AcTIVE
cHAPTER ENd
cONTINUOU
S
)$23CTI-3(
+pon completion of this module, participants will be able to&
4 +nderstand the importance of providing positive behavior support for people with behavioral
challenges.
5 +nderstand and use pro#active strategies, rela0ation techni<ues, non#verbal and verbal
calming techni<ues to help people with special needs re#gain self#control..
6 'emonstrate Core Personal Interventions.
7 'emonstrate (peciali1ed Personal interventions.
UNIT =I$E
PRESENTATION OUTINE
O!"
E#T
I$E
T
I
%
E
#ONTE
NT
%E&
IA
NOTES
9.4.
H
8
m
i
n
.
'iscussio
n
regarding
the types
of
interventi
on
specific to
positive
behavior
support
that have
a
significan
t impact
on
challengi
ng
behaviors
)verh
ead
9.4.4
9.5
4
5
8
m
i
n
.
'iscussio
n
regarding
non#
verbal
and
verbal
calming
techni<ue
s.
)verh
ead
9.5.4
)verh
ead
9.5.5
)verh
ead
9.5.6
)verh
ead
9.5.7
"and
out
9.5.9
9.6
H
#
4
5
h
o
u
r
s
'emonstr
ate Core
Personal
Interventi
on
9.7
H
#
4
5
h
o
u
r
s
'emonstr
ate
(peciali1e
d
Personal
Interventi
on
)$23CTI-3 ):3&
Participants will be able to understand the importance of providing positive behavior
support for people with behavioral challenges.
#ONTENT O$ER$IE'
This ob=ective focuses on setting up individuali1ed positive behavior support plans.
Use lecture3discussion format to introduce five elements of supporting positive
!ehavior. Use Overhead 9.1.1 the !lan' /ehavior *upport lanning 4ool to show how
all five elements should !e incorporated into a treatment plan. Discuss the five
ma2or elements in the ta!le. Have participants identif& e%amples of intervention falling
within each t&pe.
ifest,le Enhancement
)ffering people with special needs a wide range of choices and opportunities will help
them develop a positive self#image and a sense of personal control.
En/ironmental #han-es
Removing any dysfunctional or non#supportive elements in the surrounding environment
may reduce the occurrence of challenging behavior in persons with special needs. This
would be similar to changing @AA in the A#$#C model. or e0ample, if a person often
e0hibits negative behaviors in noisy environments, the environment may be altered in a
variety of ways. Have participants give e%amples of wa&s to avoid noise and reduce
noise in the environment.
3lements A. and $. relate directly to the previous discussion of @Positive and (upportive
3nvironmentsA in the @Multi#disciplinaryA chapter, and typically involve changing antecedents.
#onse3uences to !eha/ior
ocus on the use of positive reinforcers, and natural, as opposed to artificial,
conse<uences. The @Interrupt G Ignore G Redirect G RewardA se<uence is an e0ample of
the use of conse<uences contained in the Pro#Active Approach section of the @Person#
CenteredA chapter.
Teachin- Substitute S7ills
'oing a functional analysis will give insights into the functionBsC of challenging
behavior. Bunctional analysis is previously discussed in the @Multi#'isciplinaryA
chapter.C ?ith @Pro#Active Approaches,A the idea is to teach the person positive s!ills
that will have the same or a similar function or outcome for the person as the problem
behavior. or e0ample, if a person is stealing another%s property, s!ills may be taught to
help the person get what he or she wants in a more socially acceptable fashion. Have
participants give suggestions.
Teachin- (eneral Alternati/es
,eneral Alternatives include communication s!ills, social s!ills, rela0ation
training, self confidence, problem solving and coping s!ills. (uch s!ills 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.
*ummari0e the material in this o!2ective !& 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.
?hen appropriate positive behavior supports are integrated into a person%s life, incidents
of crisis intervention are often reduced to 1ero or near 1ero.
)$23CTI-3 T?)
& Participants will be able to understand and use pro#active strategies, rela0ation techni<ues, non#
verbal and verbal calming techni<ues to help people with special needs re#gain self#control.
:on#-erbal Calming Techni<ues
Redirect to Another Acti/it, G 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. @
E,e #ontact G ma!ing eye contact often helps people to regain control by reminding them of
their personal relationship with staff. :ote that many people with special needs, especially
people with autism, may become more agitated in response to attempted eye contact. N:)?
T"3 P3R():.
#lose ProGimit, G standing close to people may ma!e them feel more secure, but it may also
be seen as threatening. N:)? T"3 P3R():.
Touch G some people may find light physical contact reassuring and supportive. N:)?
T"3 P3R():.
Effecti/e Use of Space G try to position yourself and the individual so as to ensure safety and
relieve tension.
!od, Posture G try to convey a calm, in#control mood by adopting a rela0ed, non#threatening
stance and gestures.
Planned I-norin- G this is used to @e0tinguishA negative attention#see!ing behavior and
should be used only as part of a treatment plan. It involves not giving people attention for mildly
disruptive behavior.
=acial EGpression G as with body posture, rela0ed and friendly facial e0pressions tend to be
calming.
Pro/ide access to preferred ob@ects and en/ironments+
(er!al 4echni:ues. present these using the same instructional strategies descri!ed
a!ove. 4he& are listed on Overhead 9.+.1.
$entilation G listening to a person%s concerns in a non#=udgmental way may help the person to
regain control.
Use acti/e listenin-+
&istraction G as!ing <uestions related to people%s interests may serve to distract them from the
situation. /ou might also ma!e a @help meA re<uest. Reassurance G let people !now that you
are there to help them to deal with problems. Understandin- G ac!nowledge that the person is
angry or upset without =udging the
individual or the reason why the person is angry. %odelin- G control your tone of voice,
spea!ing softly in short, simple sentences. ;umor G the use of positive, good natured humor
can alleviate tension in some cases. :ever
use sarcasm or ridicule. N:)? /)+R P3R():.
One5to5one G tal!ing in private may help by providing people with needed attention and
removing them from the source of tension. Ma!e sure that other staff are available if needed.
Encoura-e alternati/e copin- strate-ies that the individual has or is wor!ing on.
Remind people of the s!ills they already have to deal with difficult situations. 'o not, however,
try to teach new s!ills when a person is upset.
Remind the person of the natural conse3uences of their beha/ior+ Try to do this in a
positive, non#threatening way, focusing on people%s positive motivations and your concern for
them.
Use Positi/e an-ua-e G 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.
=acilitate relaGation G move to a <uiet place.
Escalators. discuss the t&pes of responses that might ma'e a situation worse.
3scalators are the opposite of calming techni<ues in that they typically increase tension and the potential
for crisis. (taff should therefore be able to identify @escalatorsA 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. ?hen using verbal calming, staff should be aware of the potential
negative impact of the following types of statements.
'on%t plant the suggestion of misbehavior.
Tendency is to say @now don%t bite anyonePA or @don%t brea! a windowPA planting a suggestion that a
person might act on. 'on%t threaten the conse<uences of misbehavior which could serve as a dare to the
person. 'on%t present commands in the form of a <uestion. This often confuses the person by allowing
the person to thin! that they have a choice when they do not.
'on%t restart the confrontation by immediately demanding emotionally difficult actions.
'on%t rehash the incident in front of the person. 'on%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. 'on%t ignore attempts at communication. Ignoring is in this case a ma=or escalator.
resent the *i%=*tep Calming rocess found on Handout 9.+.9.
Identif, G be sure to correctly identify how the person is feeling.
Reflect G reflect your understanding of the emotion bac! to the person.
Reassure G give a concrete e0ample that shows you understand how the person is feeling.
Redirect G assist the person in transferring their energy to another tas! or ob=ect. Praise G
respond positively to any steps the person ma!es to regain control. =ollow up G use teachable
moments to wor! on relevant s!ills.
P;ASE * : SETTIN( E$ENTS
P;ASE . : EAR< 'ARNIN(S
P;ASE 0 : #RISIS
P;ASE 1 : RE#O$ER<
NON5$ER!A TE#;NIIUES
Redirect to Another Activity 3ye
Contact Close Pro0imity Touch
3ffective +se of (pace $ody Posture
Planned Ignoring acial 30pression
Provide Access to Preferred )b=ects
and3nvironments
$ER!A TE#;NIIUES
-entilation Active listening
'istraction Reassurance
+nderstanding Modeling "umor
)ne#to#one Coping strategies
#atural conse/uences of
behavior Positive Fanguage acilitate
rela0ation
Escalators
4. Planting the suggestion of misbehavior.
e.g.. #Don)t hit me A$
5. Threatening the conse<uences of a behavior.
e.g.. #if &ou throw that to& I)ll ta'e it awa&.$
6. Presenting commands in the form of a <uestion.
e.g.. #-re &ou read& to get in the van nowB$
7. Restarting confrontation by immediately demanding
emotionally difficult actions.
e.g.. #You hit 5aria, now apologi0e to her.$
9. Rehashing the incident within hearing range of the
individual.
e.g.. #Did &ou hear what Olga did last nightB$
Handout 9.+.9
The following is a si0#step se<uence that can be used by staff to help individuals to calm themselves
and deal more effectively with challenging situations.
(tep )ne G I&ENTI=<
3valuate the situation and the person%s emotional reaction to it. Try to correctly
identify the person%s feelings and the cause. As! more <uestions if you are not sure
what the person is feeling. If you are uncertain, don%t guess at emotions and causes.
"owever in such situations it may be effective to use more general emotional terms
li!e @upsetA or @uncomfortableA.
(tep Two G RE=E#T
If you feel reasonably confident that you have accurately assessed the situation, reflect
this to the person. or e0ample @/ou loo! upset that you can%t find your glasses.A or
@I%ll bet you%re angry that 2ohn too! your wor!.A This type of reflection serves two
purposes. irst, it helps the person to define his;her emotional reaction and may
facilitate independent identification of emotions. (econd, it lets the person
!now 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 li!elihood that he;she will be willing
to participate in a socially acceptable solution.
:)T3& (howing that you understand does not mean that you condone inappropriate
behavior. Fimits should be set on behavior while ac!nowledging the validity of the person%s
emotional response. Be.g., I !now that you are angry that 2oan teased you but hitting is not
allowedAC.
(tep Three G REASSURE
Fet the person !now 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. "aving people participate in the
solution gives the situation a positive twist that serves to enhance self#image and to
increase behavioral;emotional self control.
:)T3& +nder no circumstances should you ma!e promises that you may not be able to !eep.
Handout 1.1.
+
6cont.7
(tep our G RE&IRE#T
,et the person moving Bphysically involvedC in a different direction so he;
she can%t sul!, 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.
(tep ive G PRAISE
$e 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.
(tep (i0 G =OO' UP
)nce the individual has regained sufficient self#control, it may beneficial to
use the @teachable momentA to wor! on relevant s!ills.
If you create a plan with the person as part of the resolution of the problem, you need to ta!e
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.
)$23CTI-3 T"R33&
Participants will be able to perform Core Personal Interventions
REcOmmENdEd TImE FRAmE: 6-12 HOuRs
#ONTENT O$ER$IE'
Participants will review and practice Personal Intervention Techni<ues, BPITC, which will vary based
on number of trainees and number of interventions taught. The interventions are organi1ed into
Core, (peciali1ed and Restrictive. The core interventions are to be the only ones to be taught to all
trainees. The others may be taught based on person#specific needs.
/efore demonstrating and practicing intervention techni:ues, lead the group through 9 minutes
of gentle stretching as a warm=up to prepare for session.
4eaching intervention s'ills should !e !ased on positive learning. 4he supportive aspects of the
techni:ues should !e stressed whenever possi!le. articipants are guided in a step=!&=step fashion
through the appropriate techni:ues. articipants will re:uire a significant degree of ver!al and
ph&sical assistance as the& first learn the techni:ues. articipants should not move on to the ne%t
step of techni:ue until having properl& completed the previous step. 4he person !eing held should
offer no resistance until the trainee can correctl& appl& the techni:ueC graded levels of resistance
can !e then !e allowed in a #controlled$ fashion. 4his approach has !een more effective in !oth
increasing correct performance and reducing the potential for in2ur&. 4he instructor should
structure the s'ill training so that correct responses are the norm.
Each participant goes through all steps until no errors are present. 4he instructor ma& initiall&
give ver!al and ph&sical help. Competenc& in the techni:ues must !e evaluated !& the instructor.
Each participant must demonstrate the core techni:ues independentl& to the instructor)s
satisfaction.
*4O OID4 is used at various places with the techni:ues. 4hese are places where a trainee can
stop and go no further with a techni:ue.
>hen teaching interventions, instructor to participant ratio must never e%ceed 1 to 1E. It is
recommended that teaching teams should !e used for this section. 4he time needed to allow
participants to master the core techni:ues is ;=1+ hours. 4his will depend on the si0e and proficienc&
of the group. -dditional time must !e added when optional and3or restrictive techni:ues are
taught.
Instructors should caution participants to pass if the& feel that the& are unsure or una!le to
perform the techni:ue !ecause of ph&sical limitations or medical pro!lems. articipants
should also !e cautioned a!out the importance of practicing with partners of appro%imatel&
the same si0e and weight to promote safet& during the training.
-s an initial approach to an& intervention, the following is to !e considered.
A-)I' G the preferred method of avoiding in=ury is to avoid any physical contact entirely. "ere are
the basic principles of avoidance. eet G should be spread about shoulder#width apart with one foot
somewhat in front of the other. $ody weight G should be centered between the feet and rotated
slightly upward on the balls of the feet.
Nnees should be slightly fle0ed to allow for smooth and rapid movement of the body weight.
Movements G should be made in circular patterns so that the energy of an attac! is deflected off the
edge of a moving circle rather than absorbed by a stationary target. The feet are moved in
coordination with the hands in a manner similar to a tennis player preparing to receive the ball.
'3F3CT G when deflecting blows, physical contact is only momentary, there is no attempt to hold
or control the attac!er.
The goal of deflection is to use the force of the attac! to provide part of the necessary momentum in
moving away. (pring bac! on to the side to allow contact to pass by.
PR)T3CT G when a physical confrontation cannot be avoided or deflected, the defender attempts to
cover everything that won%t heal <uic!ly while at the same time moving away.
?hile turning front away from the person, cover ear with fist so that forearm covers side of face to
protect eyes, nose and mouth area. "ead is
tuc!ed so elbow reaches chest;rib area
)pposite arm wraps around ribs and fisted hand Bthumb over fingersC.
Crouch body to decrease e0posed, and therefore vulnerable, areas.
(TA$IFIR3 G when a challenging behavior results in a capture such as hair#pulling, biting,
scratching, pinching and cho!ing, the defender moves his;her body weight <uic!ly toward the point
of capture to minimi1e the ris! of in=ury prior to attempting an escape.
Application of Techni<ue
The techni<ues are selected to allow a ma0imum of use of strength of many body parts. All
available strength is concentrated in applying a specific techni<ue. An important aspect of
this principle is the efficient use of energy. This allows a person who is physically wea!er
to hold a person physically stronger. (trength can be ma0imi1ed by using good body
mechanics and leverage.
(peed and Control
)ne of the most important aspects of performing a techni<ue is the use of speed. (peed is
important but ineffective without good control. It is therefore important to !eep the
various muscles loose and rela0ed 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 techni<ues. If timing is faulty, the
techni<ue will fail. A move too soon or late is often fruitless. The start of the techni<ue is of
first importance in any consideration of timing.
2udgment
2udgment implies careful consideration of the situation and choosing wisely between several
possible responses. It mar!s the difference between using one%s head and acting blindly* between
intelligent and unintelligent choice.
+se of intervention should be done with a high degree of rationality and low degree of emotionality.
Any time personal intervention is re<uired, it should begin with the least amount of force needed
to help the person gain control. If more support becomes necessary, then more restrictive
techni<ues should be applied. Techni<ues should be presented in terms of the amount of support
offered to a person through the application of the techni<ue.
"andout 9.6.4 contains general information that should be used to summari1e this discussion
&OES &ONETS
Nnow the people you
are wor!ing with&
typical behavioral
responses in various
situations, physical
conditions;medical
problems, significant
reinforcers, overall
program goals or
ongoing services
pertaining to
maladaptive behavior.
+se less intrusive
interventions Be.g.
verbal calming,
humor, redirectionC
whenever possible.
&O NOT overreact to
behavior problems. &O
NOT ta!e a person%s
behavior personally.
&O NOT feel it is your
responsibility to control
another person%s
behavior. Instead,
figure out what will
enable that person to
regain self#control.
,et out of the way.
?hen a personal
intervention needs to
be used to help a
person regain self#
control, try to lessen
the potential for
in=ury. 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.
&O NOT continue to
progress to a @holdA if
the person becomes
calm. Thin! about
(T)P P)I:T(.
'uring
implementation of
personal
interventions, monitor
the person%s
respiration and
general physical well#
being at all times
Bremember $A:CSC.
Release the person
from the restrictive
hold if he;she
becomes calm.
Neep calm. The intent
of PIT is to reduce the
potential for in=ury
and to help the person
regain control of
his;her behavior.
&O NOT personali1e
the intervention. &O
NOT get involved in a
@power play.A &O NOT
ta!e a person%s behavior
personally.
Handout 9.1.1
(ENERA TIPS for Personal Inter/ention Techni3ues >PIT?
As the person
gradually regains
his;her
composure, gradually
fade the amount of
&O NOT use personal
intervention
restriction placed on
him;her. Reinforce
calm,
to @punishA person who
misbehaves.
controlled behavior.
Chec! for in=uries.
After a behavioral
incident re<uiring
implementation of
personal intervention,
fully document use of
PIT, noting
antecedents, any
in=uries or suspected
in=uries and ultimate
result;outcomes.
F/-DC G /reathing, -!ilit& to move, Doise3sound, Color of facial s'in
PERSONA INTER$ENTION TE#;NIIUES >PIT
?
#ORE : To be taught to all certified staff
Touch )ne#Person 3scort )ne#Person 3scort G
(eated -ariation Two#Person 3scort G (eated
-ariation Arm Control by )ne Person or ?ith
Assistance (tanding ?rap
ront 'eflect
$ite Release )ne#Arm Release Two#Arm Release
ront Cho!e ?indmill Release $ac! Cho!e Release
ront "air Pull (tabili1ation;Release $ac! "air Pull
(tabili1ation;Release $ac! "air Pull
(tabili1ation;Release ?ith Assistance
SPE#IAIHE& : To be taught based on program needs
$loc!ing Punches
(eated ?rap
"ead (upport
Approach Prevention
ront Arm Catch
$ite Prevention ront "old
ront Cho!e Release
"ead Foc! Prevention
"ead Foc! Release
(lip Punch to ?rap
ront Nic! Avoidance;'eflection
$ac! Cho!e Arm Catch to ?rap
$ac! "old +nder Arm Release $ac!
"old Fow )ver Arms $ac! "old
"igh )ver Arms to ?rap
Chair 'eflection
Protection from a Chair as a ?eapon
Protection from Thrown )b=ects )ne
Person ?rap;Removal Two#Person
Removal
RESTRI#TI$E To be taught on an as needed basis only
Two#Person Ta!e 'own Two# or Three#
Person (upine Control )ne#Person Ta!e
'own )ne#Person Ta!e 'own to (ide
Control )ne#Person Ta!e 'own to (eated
Control (eated Control to (upine Control
#ore Techni3ue
s
Techni3ues in this section are
re3uired for certification in I%PA#T
Touch
&escription of the techni3ue:
Touch is a proactive intervention used as a support techni<ue, a calming techni<ue 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 techni<ue.
Reasons for usin- techni3ue:
To encourage verbal e0change. 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 !now you are aware of a situation
and willing to help resolve it. To be in a good position to step bac! and reassess. To be in a good position
to offer support.
Reasons not to use this techni3ue:
Person does not li!e to be touched.
+se 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.
?hen 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.
'o !now the individual.
'o use touch along with other verbal and;or non verbal calming techni<ues.
'on%t use on someone who does not li!e to be touched.
Dotes. This is often a very effective intervention to let the person !now you are aware of the situation.
One5Person Escor
t
(taff 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 Bi.e.&
when a participant is wea!, wobbly or unsteady for whatever reasonC.
To assist person in moving from place to place if unsteady.
To prevent a possible in=ury BfallC 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. Foo!s
appropriate in the community.
Reasons for not usin- this techni3ue:
If person is physically out of control.
If person is much larger than you Brecommend 5 person escortC.
Steps to appl, the techni3ue:
,rasp person%s nearest arm =ust above the wrist Boverhand graspC with your outside hand.
Reminder& loose clothing G ie., the strings on a sweatshirt are a ha1ard. Tuc! 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. /our arm should be between the person%s arm and body.
Pull person close to your body Bhip to hipC. This prevents any unnecessary bac! strain. (lowly
proceed forward maintaining a Ttight pac!age% 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. 3ventually, you may regrasp the person%s inside
arm above the elbow with your inside hand. If person drops to the floor G &O NOT try to hold
him;her up. (taff should carefully lower
themselves with the person to the floor to avoid bac! in=ury. Re#evaluate the situation.
&O NOT try to prevent someone from dropping to the floor. &O continually evaluate
the person%s need for support.
*+ .+
1+
2+
One5Person Escort
F
Seated $ariatio
n
This techni<ue uses the same physical steps as an escort in a seated position.
Reasons for usin- the techni3ues:
+seful in transportation situations. It also might be useful in community settings to help a person regain
self#control.
To !eep the vehicle safe.
Reasons for not usin- techni3ue:
If you cannot safely provide support on your own, the two#person escort is recommended.
ollow the steps for one#person escort. /ou may move from standing to seated. Maintain your grasp and
hip to hip position as you move. 5a. If techni<ue started from a seated position, maintain the same escort
grasp and position. If more support of the legs is re<uired, you may put your leg over the person%s inside
leg.
&O continually evaluate the person%s need for support.
*+
.+
0+
Two5Person Escor
t
This techni<ue 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 techni<ue may also be used when a
participant is wea!, unsteady, sleepy, etc.
Reasons for usin- the techni3ue:
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 usin- the techni3ue:
If person is in need of greater support than this techni<ue provides.
If the techni<ue cannot be applied correctly for the situation.
If the person is !nown to drop to the floor.
(taff member 4 implements a one#person escort as previously instructed. If staff feels he;she needs
assistance he;she as!s for it. (taff first on the scene maintains rapport with the individual and directs the
implementation of the techni<ue. (taff 5 grasps person%s nearest wrist with an underhand grip using
staff%s outside hand. (taff 5 tuc!s person%s elbow between his hip and person%s hip. (taff 5 reaches
behind person with other hand and grasps his;her forearm with an overhand grip. (taff 5 G arm may be
over or under staff 4 arm. (taff 4 changes the grip at the wrist to an underhand grip.
(taff 5 G pull person Band staff 4C close to body Bhip to hipC to create a @tight pac!age.A
(taff 4 and staff 5 must !eep 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 bac! in=ury.
&O remember head position Bboth staffC to avoid possible @head buttA situation.
&O communicate with your partner* it is vital to the success of the techni<ue.
&ONET use with potentially aggressive individuals. &O use to move the person
to a safe place. &ONET use on stairs.
&O !now where you are going.
Two5Person Escort: Seated $ariatio
n
A two#person escort in a seated position.
Reasons to use the techni3ue:
Provides more support than a one#person seated escort.
?or!s well in transportation situations.
Reasons not to use the techni3ue:
The person does not need this level of support.
/ou may move from standing to seated as with one#person escort, seated variation. If starting
from a seated position, maintain the two#person escort grasp and hip#to#hip position.
*
+
.+
Arm #ontrol b, One Person or 'ith Assistanc
e
The techni<ue involves holding the person%s arm while the person is seated, without restricting the
movement of their arms. May be used to protect the person from in=ury i.e.& self#abusive gestures.
To prevent participant from engaging
in self#in=urious behavior B(I$C.
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.
Reasons for not usin- techni3ue:
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.
(tand beside the person, facing the same direction.
?ith your outer arm, gently but firmly grasp the person%s wrist overhand.
?ith 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. Fean 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 techni<ue until the
person is calm.
&O use an overhand grasp.
&O use this techni<ue with persons who e0hibit self#in=urious behavior, but are not assaultive
toward others.
&O communicate with staff partners.
&O maintain good body alignment.
&ONET use this techni<ue with a highly aggressive individual.
&ONET put pressure on shoulder =oints G the person%s shoulders should be level.
*+ .+
0+
2+
Standin- 'ra
p
Reasons for usin-
techni3ue:
Reasons for not
usin- techni3ue:
Person is out of
control and
endangering self,
?hen other
techni<ues that are
less intrusive
others or the
environment.
will wor!.
To
impede
self#
in=urious
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 in=ury to self or others by wrapping your arms
around the person in a standing position.
Approach the person from the side. BThere may be times when it is possible to approach from
behind.C "ug the person over their arms. Neep your head low on the person%s bac!.
(lide around the person%s bac! G maintaining hug and crouched position. Neep head low. Ma!e a
@pair of feetA with your inside foot ne0t to the person%s foot. ?hen you are hugging from behind, slide
down to =ust 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 =ust above the wrist.
Move the arm across the person%s body ma!ing an @UA with their arms. Neep your hands in the
vicinity of the person%s front pants poc!ets.
Remain in crouch;front to bac! position. Maintain balanced stance. Neep your shoulder touching the
person%s bac! and !eep your head down.
STOP POINT
Maintain a wide stance, lean bac! on your outside leg supporting the person%s weight against your
body. ?ait for the person to regain control.
&O continually monitor your stance. It is critical to this techni<ue. &O !eep head down when doing
techni<ue. &O !eep full grip on the arms. &O be aware of furniture, surroundings and e0its. &O !eep
your arms below the individual%s arms Bwhich are being held at the hip levelC to avoid being
bitten. &O continually evaluate the person%s level of self#
control.
137
*+
.+
0+
2+ 1+
=ront &eflectio
n
If someone is coming towards you with their arms up to grab you,
it may be possible to deflect them away.
Reasons to use techni3ue:
If you feel threatened.
Reasons not to use:
If you can move out of the way.
Steps to appl, techni3ue:
?hen a person comes towards you with their arms out to grab you, raise your arms.
(tep to one side and deflect the person%s outstretched arms awayP
?hile moving away into the proper stance.
&O determine what the person wants from you.
!ite Releas
e
&escription of techni3ue:
To be used when a person bites and does not let go.
To minimi1e the possibility of in=uries when a person is bitten.
Reasons not to use techni3ue:
May compromise the individual%s breathing.
Push the area being bitten against the person%s mouth using =ust enough pressure to seal that area.
Many people who bite will release voluntarily. ?ait a few seconds before going to (tep 5. ,ently
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.
&O !now the individual who bites and employ preventive measures. &ONET pull the bitten part of
your body away while the person is still biting. &ONET push <uic!ly or roughly against the person%s
mouth when attempting to seal the area. &ONET continue to pinch the person%s nose shut if signs of
distress from having the airway closed
are present.
*
+
.+
One5Arm Releas
e
This techni<ue 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 techni3ue:
The person may be trying to communicate with you. 'o not assume that physical contact is
aggressive.
It may be safer to remain in a @grabbedA position until the person is calm.
If a person grabs your arm and they don%t let go and you feel threatened,
Ma!e a fist, rotate your arm towards the persons thumb and pull away <uic!ly.
&O try a verbal re<uest or as! the person what they want before moving. &O pull in the
direction of the wea!est part of the grasp G usually in the direction of the thumb. &O thin!
what the person is trying to communicate to you. &ONET abandon the person after he;she has
let go.
*
+
.+
One5Arm Release, $ariation
*
If you are grasped and verbal techni<ues are unsuccessful,
Ma!e a fist. $end your arm, !eeping your upper arm close to your side.
Rotate your arm in the direction of the person%s thumb and <uic!ly pull
through the person%s grasp.
.
irst stabili1e the person%s arm with your free hand either overhandP )r
thumb down so you can easily move the person%s side. L Rotate and pull
your arm <uic!ly. rom this point, you can decide whether
or not to maintain support with your hand.
0
If a person grasp your arm with two hands,
Ma!e a fist.
,rab your own hand with your free hand. And pull up across
your body to avoid hitting yourself in the chin.
*+ .+
1+
Two5Arm Releas
e
This techni<ue may be used when grasped by both arms.
If a person grasps both your arms with their hands and verbal techni<ues are not
successful in getting them to release the graspP
Ma!e fists, and
Pull up towards your body.
&O try verbal re<uest first. &O try a verbal re<uest or as! the person what they want
before moving. &O pull in the direction of the wea!est part of the grasp G usually in the
direction of the
thumb. &O thin! what the person is trying to communicate
to you. &ONET abandon the person after they let go.
=ront #ho7e 'indmill Releas
e
To be used if being cho!ed from the front.
If you are cho!ed from the front and the person does not let go when you as! themP Raise your right
arm up. Rotate your body to the left. Ta!e a short step forward and to the left with your right foot.
$ring your arm down over the
person%s arms to release the grasp from your throat.
'eflect the person%s arms away from you with your arm.
&O !eep your arms straight and be aware of the person%s head position to avoid butts.
&O find out why the person wanted your attention.
0+ 1+
4+
!ac7 #ho7e Releas
e
A means of releasing a cho!ing grasp applied form behind.
If you are cho!ed from behind, as! the person to let go. If verbal intervention is unsuccessful,
Raise your right arm.
Turn in the same direction. +se your raised arm to release the cho!e. Maintain a firm, balanced stance.
&O as! the person what they want.
&O follow up with support
=ront ;air Pull, StabiliAation and Releas
e
To be used when hair is being grasped from the front.
If a participant pulls your hair form the front.
Reasons for not usin- this techni3ue:
If you feel you cannot free yourself without assistance, use version of this techni<ue with
assistance.
If a person grabs your hair from the front, <uic!ly secure his;her hand with both your hands, Bto
stabili1e him;her from pulling your hair outC, by pushing the person%s hand towards your head.
(tabili1e the person%s hand on your head by placing both your hands over his;her fist. ?ait and
see if the person will let go voluntarily.
STOP POINT
)nce you have person%s hand stabili1ed* form a @+A grip Bwith handC and slide to participant%s
wrist maintaining stabili1ation with other hand. If you feel you are able to remove the person%s
hand from your hair, push up on the person%s wrist
with your @+A grip and down on the person%s hand thereby causing the person%s fingers to rela0.
After bac!ing away, maintain an appropriate stance to prepare yourself for the person%s response.
&O this maneuver <uic!ly. &O (TA$IFIR3 before you attempt release. &O !now the
person. &O wear lon- hair in a pon,tail or wear a cap+ A/oid lea/in- an open
tar-et+ &ONET allow a person who has tendencies to pull hair that close to you. &O
find out what the person wanted.
*+
.+
1+
2+
!ac7 ;air Pull StabiliAation)Releas
e
+sed if a person grabs your hair from behind.
If a person grabs your hair from behind G <uic!ly secure his;her hand with both your hands Bto
stabili1e him;her from pulling hair outC by pushing the person%s hand towards your head.
)ne you have person%s hand stabili1ed, bend forward at the waist Bthis causes the person to be
thrown slightly off balanceC. Place your thumbs on the person%s wrist. ?ait 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 bac! of your head and move away.
&O this maneuver <uic!ly. &O remember to (TA$IFIR3 before trying to free yourself to
prevent any unnecessary hair loss. &O as! the person to let go. &O wear long hair in a pony tail
or wear a cap. Try not to leave an open target. &O try not to have your bac! to a person who you
!now pulls hair.
*+ .+
0+
1+2
+
!ac7 ;air Pull StabiliAation)Release >Pon,Tail?
*+ .+0+
!ac7 ;air Pull StabiliAation)Releas
e
with Assistanc
e
To be used if you are unable to free yourself from a person who pulls your hair from behind.
/ou are unable to free yourself when a person pulls your hair from behind.
Implement bac! hair pull stabili1ation release as previously taught. If you feel you are
unable to free yourself, call for assistance, while maintaining stabili1ation
Bbend sharply at waist with person%s waist with person%s hand secured with your 5 handsC.
(taff 5 should implement touch to person%s @free handA.
(taff 5%s other hand should cover person%s eyes ma!ing sure thumb is tuc!ed close to hand.
?hen 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.
&O stabili1e before release. &O !now your own person. &ONET try to free
yourself if you don%t thin! you can. &ONET have your bac! turned to a
person who has a tendency to pull hair. &ONET bend down in front of the
person.
&O try to avoid
a punch.
&O try to bloc!
punches with arm
rather
&O use
calming
techni<ues.
than hands to
avoid in=ury to
fingers.
&O use
redirection.
163 &O follow up with
support.
SpecialiAed Techni3ues
Techni3ues in this section are to be
tau-ht based on pro-ram needs
!loc7in- Punches
This techni<ue is a way to use your body in ways which protect you from being hit by a punch.
Reasons to use this techni3ue: Reasons not to use this techni3ue:
To avoid being struc!. If you can move out of the way.
Steps to usin- the techni3ue:
Maintain a balanced stance with a wide base of support.
Present the smallest area of your body Buse a @side facingA positionC
Put your arms up to protect your face and head.
Ma!e sure you thin! more about avoiding than bloc!ing.
If a person attempts to stri!e you with an over hand blow, raise your forearm close to your forehead
in a hori1ontal position and rotate your forearm thumb side down, bloc!ing the blow with the arm
nearest the stri!ing blow.
or 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 stri!e 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+
Seated 'rap
This techni<ue can be applied from the two#person arm control while person is still in a chair.
Reasons to appl, the techni3ue:
To offer more support to a person who may be struggling to self#abuse, until the person regains
self#control.
?hen other techni<ues of redirection or environmental change would help the person re#gain self#
control.
rom the two#person arm position, one person drops to one !nee, !eeping head tuc!ed below the
person%s shoulder. Move the person%s wrist across his torso. ace to the rear.
Move behind the chair and grasp the person%s arm =ust above the wrist with your other hand. (lide
your hand to the person%s elbow and signal your partner to send the other wrist across the torso.
/our partner mirrors your move, completing the wrap. $oth should maintain a firm, balanced
position. The partner may leave unless needed for head support. (upport person in this
position !eeping your head low and your shoulder against the chair.
&O tal! to your partner. &O hold your arms below the person%s
arms to avoid being bitten. &O !neel low behind the person to
avoid head butts. &O pass the arm @low across the bodyA to avoid
staff being bitten. &O be aware of the chair G can it support the
personL &O !eep arms low to avoid pressure on the abdomen.
*+ .+
1+
;ead Suppor
t
A person%s head may be supported while in a seated wrap#up.
Reason for usin- the techni3ue:
To support a person%s head if they are struggling and trying to stri!e with their head.
Place your hand on the person%s shoulder while cradling his head with your other arm.
Place the inde0 finger of the arm cradling the head beneath the lower lip above the =aw with
your thumb tuc!ed down. Place your remaining three fingers under the =aw.
If necessary, move your hand at the shoulder to the person%s forehead for more support.
&O maintain proper hand position !eeping your fingers away from the person%s mouth.
&O gently cradle the person%s head holding it close to your body to reduce head butting.
&ONET pull or twist the person%s head or nec!. &O be careful not to po!e the person%s
eyes.
Approach Pre/entio
n
This techni<ue is a means to !eep someone from grabbing you as they approach from the front.
Reasons to use the techni3ue:
If deflection and avoidance did not wor!.
'epending on the person, may prevent from assaulting you.
If the person attempts to hold from the front.
>uic!ly straighten your outstretched arms and step bac! into a firm, balanced stance.
&O use this techni<ue to maintain appropriate distance between yourself and others. &O NOT
use with a highly aggressive person. &O NOT use with a person whose arms are much longer than
your own, should that person become
aggressive.
&O find out what the person wants.
=ront Arm #atc
h
&escription of the techni3ues:
This techni<ue is a means of containing a person%s arms to prevent possible cho!e.
?hen a person approaches you from the front to grab or cho!e 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 =ust above the wrist. Crisscross the arms
using their momentum. (traighten your arms and bring the person%s wrists together and down.
(tep bac! and maintain a
firm balance.
&O !eep your arms outstretched and straight to avoid head butts.
&O teach alternative communication s!ills.
!ite Pre/ention =ront ;ol
d
+se this techni<ue as a means of preventing a person from biting from the front.
If a person reaches and grabs you from the
frontP $ring your arms up close to your chestP
orm a -#shape under the person%s chin.
&O !now your person and ta!e steps to avoid being bitten.
=ront #ho7e Releas
e
?hen being cho!ed from the front, this is a method to release the grasp.
If you are being cho!ed from the front P
>uic!ly grasp both the person%s arms =ust above the wrists and use a circular motion to push up
on one wrist and pull down on the other... (traighten your arms and crisscross the person%s
armsP $ringing the person%s arms together and down.
(tep bac! and maintain a firm, balanced stance.
&O follow up with support. &O teach alternative
methods of communication.
*+
.
+
1+ 2+
;eadloc7 Pre/entio
n
If a person attempts to place you in a headloc!, this is a way to prevent it.
If a person attempts to place you in a headloc!P Immediately tuc! your chin into
your shoulder, and P $end sharply forward at the waist, stepping out and bac! to
the side of the person.
&O avoid facing away from a person who uses this behavior.
*+
.
+
;eadloc7 Releas
e
/ou can use this techni<ue to release yourself from a headloc!.
If you are grabbed from behind in a headloc!, immediately grasp the arm of the person who is holding
you near their wrist and elbow. Tuc! your chin into their elbow. $end forward and step bac! 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 =ust above the wrist. Push down on the person%s arm, andP (tep bac! and out of the
headloc!.
&O ma!e space with your chin at the person%s elbow. &O
protect your nec!. &O follow up with support. &ONET face
away from a person who e0hibits this behavior.
*+
.
+
0+
1+ 2+
Slip Punch to 'ra
p
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.
?hen the person needs this level of support after you have avoided a punch.
If a person swings at you, lean bac! and push the person%s arm in the direction of the swing. Fet
the person%s momentum turn them. )nce they are turned, place your arms over theirs and push
them forward. ,rasp their top arm =ust above the wrist with your hand, !eeping your head behind
their shoulder.
,rasp the other arm near the wrist with your free hand and maintain a firm, balanced stance.
&O !eep the person%s arms low at their hips. &O !eep your head behind
their shoulder. &O maintain a firm balanced stance. &O communicate
with the person. &ONET try to duc! under a punch. &O bloc! with your
arm rather than with your hand to avoid finger in=ury.
=ront Cic7 A/oidance)&eflectio
n
+se this techni<ue to avoid or deflect a !ic! from a person who is facing you.
If a person !ic!s you and you are unable to step bac! to avoid it, bring one foot bac!, use the arm
of the same side of your forward leg to reach down, andP
,ently deflect the !ic! across the person%s body.
&O step bac! and avoid a !ic! if possible.
&ONET grab or hold the person%s leg.
!ac7 #ho7e Arm #atch to 'ra
p
+se this techni<ue to move from a $ac! Cho!e Arm Catch to a ?rap.
Reason for usin- techni3ue:
If you are being cho!ed from behind, this is a way to release that cho!e and provide additional
support.
If you are being cho!ed from behind and you
need to release itP
>uic!ly 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 cho!e
while wrapping their arms with your arm.
$egin to move around the person while holding
their arms. STOP POINT: decide at this
time if the person re<uires the support of a
wrap. If so,
As you move behind themP
$egin to apply the wrap.
3nd with the wrap, maintaining a firm,
balanced stance.
&O continually evaluate the level of support that the person needs to be safe.
&O allow the person to regain self#control.
*+ .+0+
1+
2
+
4+ 6+
!ac7 ;old Under Arm Releas
e
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, as! them to let go. STOP
POINT& wait to see if the person will let go voluntarily. If not, go to (tep 5. >uic!ly raise
your arms and grasp the person%s arms =ust 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. )nce the grasp is bro!en,
push the person%s wrists tightly to your legs. Move away and reassess
the situation.
&O determine what the person wants.
&O as! the person to let go.
*+
.+0
+
1+ 2+
!ac7 ;old ow O/er Arm
s
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 G begin by
re<uesting 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 ma!e space and pull one arm free.
Pull your arm out, andP
,rasp the person%s arm =ust above the wrist on the
same side.
Fean the other way and pull your other arm free.
?ith that arm, grasp the person%s other arm near
the wrist.
(traighten your arms and push down on the
person%s arms. Push the person%s wrist onto
your legs. (tep away and reassess.
&O remember that si1e and strength differences ma!e this a very difficult techni<ue to
perform. &O try as!ing the person to let go. &O put your thumb between the person%s arm and
your body. &O teach the person another means of getting your attention.
*+.+ 0+
1+
2+4
+
6+ 8+9+
!ac7 ;old >;i-h? O/er Arms to 'ra
p
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
!nees.
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.
(tep to the other side while holding on to the
person%s wrist and slide your head down and out.
(tep 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.
&O continually evaluate the person%s need for support.
&O reali1e that you are doing the same thing to the person that was done to you.
This may be a bad message.
&O find out what the person wants.
*+.+ 0+
1+2+
4
+
6+ 8+
#hair &eflectio
n
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 closeP >uic!ly approach the
person from the side, grasp the chair, and <uic!ly pull it forward and down.
&O use verbal calming techni<ues.
&ONET sit in the chair to hold it down.
&ONET hesitate.
*
+
.+
Protection from a #hair as a 'eapo
n
?hen 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 weaponP >uic!ly
grab a chair. +se it to shield yourself from the person%s
chair, whileP
orcing the chair to the floor if possible.
&O remember to use calming techni<ues
*+
.
+
0+
1+
Protection from Thrown Ob@ect
s
To avoid or deflect ob=ects thrown as weapons.
Pic! up an ob=ect to use as a shield Bcouch cushion, pillow, blan!et, =ac!et, etc.C
'eflect ob=ect down and away.
&O be aware of ob=ects that are potential
pro=ectiles. &O use verbal calming techni<ues.
&ONET deflect ob=ects at people, windows, T-, etc.
*
+
One5Person 'rap Remo/a
l
(taff stands behind the person, reaching around his;her waist and placing downwards pressure on the
arms. (taff !eeps his;her head low and stance from front to bac!.
(taff stands behind the person, reaching around his;her waist and placing downwards pressure on the
arms. (taff !eeps his;her head low and stance from front to bac!. Initially, step bac! maintaining a
wide stance. Pull the person into your base of support. (lide the foot closest to the person bac! to you.
Continue to move out of the area in this fashion.
&O use the @step and slideA method. &O !eep your head at, or below the shoulder, to avoid head butts.
&O !eep a full grip on the wrists and !eep your arms below the individual%s arms to avoid being bitten.
&O support the individual%s weight against your hip to protect your bac!. &O plan where you are
going.
*+ .+
1+
Two5Person Remo/a
l
Reason for usin-
the techni3ue:
Reasons for not
usin- the
techni3ue:
Person is out of
control, endangering
self and;or
If other less
intrusive techni<ue
will wor!,
others, and cannot be
assisted by one
person.
i.e., Two#person
escort.
A means to move a person bac!wards while supported on either side by staff.
?hen a two#person removal is needed, two staff approach the person from the side. )ne staff attracts the
person%s attention, possibly through a touch on the shoulder. (taff 4 then grasps the person%s wrist with their
outside arm. Immediately after, (taff 5 then grasps the person%s other wrist with their outside hand. $oth
staff members now <uic!ly loc! their arms under the person%s arms grasping the shoulders and
securing the person%s upper arms in their arms. ?al! the person bac!wards while !eeping staff%s hips
close to the person%s hips, and the person%s shoulders supported.
&O communicate with your partner. &O !eep the
person%s hips close to your hips. &O maintain proper
arm position to avoid being bitten. &O !now where you
are going.
0+ 1+
2+
6+
Restricti/
e
Two5Person Ta7e &own
If a person is to be ta!en to the floor, it can be done with two people from the two#person removal
position.
rom the two person removal position, both staff place inside legs and hips behind the person
with their heels behind the person%s heels.
?hile supporting under the shoulders with upper arms, staff ta!e one step forward with their
outside legs.
(taff !neel on their inside !nees and carefully lower person to floor while !eeping hips close. (lide
arms out at the same time as the person slides down. (lide your arms out from under the person%s
shoulders once the person is on the floor.
*+
.+
Two5 or Three5Person Supine #ontro
l
)nce on the floor, after a two#person ta!e down, it is possible to maintain control using two or
three people.
rom the two person ta!e down on the floor, hold the wrist and the shoulder while !eeping your
hips in close to avoid !ic!s. It is possible to stop here. STOP POINT& wait a moment for the
person to calmP 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. )ne staff moves over the person%s head, and P Ta!es 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 legsP
+ntil they are able to wrap their arms around the person%s thighs =ust above the !nees. 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 =ust above the wrists and elbows with their !nees =ust below the
shoulders. The third person controls movement of the person%s legs by wrapping his;her arms
around the person%s thighs =ust above the !nees.
&O communicate with each other. &O
monitor vital signs. &O stop and release
if the person calms.
*+
.
+
0+ 1+
One5Person Ta7e &ow
n
If you are unable to support a person in a wrap position and assistance is not available, a one#person
ta!e down is possible.
rom a standing wrap positionP (tep outside the person%s foot and bend your
!nees. 'rop to your !nees gently while !eeping the person close in a balanced
position. Carefully set person down on their side using your leg as a cushion if
necessary.
&O provide support throughout the techni<ue. &O be aware of
vital signs. &O always release if possible to move to a less
restrictive position. &ONET allow the person to fall to the floor or
hit their face or nec!. &ONET do this techni<ue with a person with
'own (yndrome.
*+
.+
1+
One5Person Ta7e &own to Side #ontro
l
A restrictive techni<ue used only to interrupt a truly dangerous situation where a person is
threatening to in=ury self, staff or others.
Reasons for usin- this techni3ue:
To interrupt a truly dangerous situation when a person is threatening to be a danger to self, staff
or others.
rom one person wrap, ta!e the person down to a !neeling position.
After the person has been ta!en down to a !neeling position, the staff then pulls the person across
their lap and lowers the person to their side.
?hile maintaining the person on their side, staff lowers themselves to the side, behind the person,
!eeping their head tuc!ed into the person%s bac!, facing towards the floor and !nees drawn up.
This is the side control position. The staff can raise their upper leg as protection against !ic!ing. A
second staff can assist by approaching from front and wrapping the person%s legs above the !nees.
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. (taff should roll bac!ward 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 58 minutes.
&O utili1e the stopping points whenever possible. &O !eep your head tuc!ed into the person%s bac! or to
the side. &O get into a tight position to avoid in=ury. &O release the person if they are attempting to roll
over onto their stomach. &O monitor vital signs at all times. &O roll in the opposite direction of the person
when releasing. &ONET ever roll the person over onto their stomach or place any pressure on the person%s
bac!. &ONET use this techni<ue if two staff are available to intervene. Must release after 58 minutes. &O
avoid pressure against the diaphragm. If the person%s upper shoulder moves forward to touch
the floor, release the grasp.
&O not place leg over the person%s nec!.
&O
maintain support by using your grasp on the upper hand
G
not by hugging more tightly.
&O
turn your head toward the floor when using side control, to protect your nec!.
=ollow up
Chec! the individual when calm for in=uries.
'ocument intervention.
Repeat steps *51 from One Person Ta7e &own
2+
4+
6+
One5Person Ta7e &own to Seated #ontrol to Side #ontrol
A restrictive techni<ue used to interrupt a truly dangerous situation where a person is threatening in=ury
to self, staff or others. (eated control and side control are stop points to the )ne#Person Ta!e 'own.
To interrupt a truly dangerous situation where a person is threatening in=ury to self, staff or others.
Reason for not usin- the techni3ue:
If two people are available, use two#person supine control.
+sing the one#person ta!e down, ta!e the person to a !neeling position.
After the person has been ta!en down to a !neeling 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 buttoc! with !nees bent. (taff should !eep head low and tuc!ed into the person%s bac! to the
level of the person%s armpit. This seated control position is a stable position and considered a (T)P
P)I:T to end the one#person ta!e 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 tuc!ed into the person%s bac!, and facing towards the floor with !nees drawn up. This is the side
control position and is the final stopping point to the one#person ta!e down. 'o not maintain this
position for more than 58 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 bac!ward in the opposite direction, moving to a position from which they may re#engage the
person if necessary.
&O utili1e the stopping points whenever possible.
&O !eep your head tuc!ed into the person%s bac! or to the side.
&O get into a tight fetal position to avoid in=ury.
&O release the person if they succeed in rolling over on to their stomach.
&O monitor vital signs at all times.
&O roll in the opposite direction of the person when releasing.
&ON
E
T
use this techni<ue if two staff are available. +se two#person ta!e down to supine control
instead.
&ONET E$ER roll a person over onto their stomach or place any pressure on the person%s
bac!. Must release after 58 minutes.
=ollow up
Chec! the person when calm for in=uries. 'ocument intervention.
'ecide what can be done to avoid this level of intervention in the
future.
Repeat steps *51 from One Person Ta7e &own
2+ 4+
6+ 8+9+
Seated #ontrol >one5person
?
to Two5Person Supine #ontro
l
To be utili1ed when in the seated control position Bafter a one#person ta!e downC and another staff
becomes available to assist. The second staff person assists in transitioning from seated control to
two#person control.
Reasons for usin- the techni3ue:
To interrupt a truly dangerous situation when a person is threatening to be a danger to self, staff or others.
?hen assistance is available after utili1ing the seated control techni<ue, staff may transition to a
two#person supine control techni<ue if additional control is needed.
Person has stopped struggling and no longer needs this level of support.
rom 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.
(upporting the person%s bac!, both staff members move the person bac!ward so that the person%s legs are
now in front of their body. (taff then lower the person%s upper torso.
?hile 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
techni<ue.
The other staff member then moves the hand from the person%s shoulder to the opposite BbottomC wrist,
then the hand from the person%s near BtopC wrist to the person%s near shoulder.
&O practice hand placements. &O NOT apply any pressure to the
person%s abdomen or diaphragm.
=ollow up
Chec! the person when calm for in=uries. 'ocument intervention.
'etermine what changes could be made to avoid the situation in the future.
213
*+ .+
1+
2+ 4+
Seated #ontrol >one5person?to
Two5Person Supine #ontrol
>cont+?
6+
8+
*:+
**+
cONTINUOUS
cHAPTER ENd
TRANSFORmATIO
N
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 ali!e. Transformation is not e0clusively a goal or destination, but rather a
=ourney* along the way caregivers have an opportunity to create e0citing 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. /ou 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 wor!, to reach
the highest standards of e0cellence as a (upport Professional. 3ngage in creative problem#solving
together with colleagues. Attend yearly training updates to reinforce your !nowledge and stay
current with the latest information. $ecome mentors, model the IMPACT philosophy to others
where you live, and ta!e part in transforming the community at large.
)$23CTI-3 ):3&
Participants will be able to use all they have learned from the IMPACT curriculum to design
person#centered, proactive approaches and provide high <uality support to people with special
needs.
#ONTENT O$ER$IE'
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 thin! about ways they may utili1e these concepts.
?ead participants in a discussion a!out the importance of person centered, proactive
approaches, which are at the foundation of the I5-C4 curriculum. Invite them to share
e%amples of person=centered approaches the& have designed or anticipate using for those
the& support.
Transformation is not e0clusively a goal or destination, but rather a =ourney* along the way
caregivers have an opportunity to create e0citing 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. /ou will discover much about
those you support, and a great deal about yourself.
)$23CTI-3 T?)&
Participants will understand that they can positively transform the <uality of life for those with
special needs, reach new standards of e0cellence as (upport Professionals, and ta!e part in
transformation that also e0tends to the community at large.
#ONTENT O$ER$IE'
The purpose of this ob=ective 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 ali!e.
Invite participants to share the wa&s in which I5-C4 has changed the wa& the& view their
role as *upport rofessionals. Invite participants to envision wa&s 4ransformation ma&
e%tend to all communit& mem!ers.
The education and awareness gained from IMPACT training provides the tools necessary to
develop and grow in your wor!, to reach the highest standards of e0cellence as a (upport
Professional. 3ngage in creative problem#solving together with colleagues. Attend yearly
training updates to reinforce your !nowledge and stay current with the latest information.
$ecome mentors, model the IMPACT philosophy to others where you live, and ta!e part in
transforming the community at large.
)$23CTI-3 T"R33&
Participants will understand 3ssential 3lements of Transformation
#ONTENT O$ER$IE'
Introduce the 3ssential 3lements of Transformation and provide details which e0pand
on the meaning of each.
rovide the following list as a handout or use as an overhead.
Essential Elements of Transformation
Obser/ation: Allow time to slow down and get to !now the person you support on
their terms, through observation. Fet them e0press their individuality first, without
attempting to change who they are. Foo! for clues to hidden strengths and abilities.
Intention: Much of what we communicate is non#verbal. People with special needs,
li!e 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 re<uires people who are committed to providing genuine care,
understanding, and continuity for people with special needs. ?ith social contact,
community involvement, and public awareness, people with special needs can flourish.
This encompasses family members, friends, neighbors, employers, and e0tends to all
members of the community.
En/ironment: Provide environments for people to safely test their capabilities.
3ncourage them to e0pand their e0periences with new activities and materials.
Providing this !ind of stimulation helps bring out hidden abilities and interests.
Increase your e0pectations G you won%t !now unless you e0plore it. This is especially
true of activities that are intrinsically motivating to the person.
Perse/erance: Results can occur une0pectedly or can sometimes ta!e a great deal of
time. Providing choices in a rela0ed environment will often bring about positive
behavioral changes. $e open to the possibility that positive change may be ta!ing place
in small increments very gradually, over a long period of time.
)$23CTI-3 )+R&
Participants will share their own Transformative e0periences in an effort to model creative
problem#solving s!ills they have learned to one another.
rovide the following two 4ransformation stories to participants in a handout and3or
read aloud. -s' the group to !rea' into #teams.$ He:uest that each team present their own
4ransformation stor& to the whole group, !ased on their e%periences, utili0ing the elements of
4ransformation.
TRANS=OR%ATION STORIES
The Stor, of %att: Matthew and his brother attend a (upplemental 'ay "ab program.
)n the first day, while Matt%s brother wal!ed directly into the building to the correct
room, Matt was outside, running into neighboring properties, with his mother chasing
close behind. 3ventually 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
ob=ects 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. "is 4&4 staff provided visual support in the
form of picture symbol cards, which Matt could use to communicate re<uests. 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 stor, of Ric7,: Ric!y is non#verbal and deaf. "is family struggled with Ric!y%s
out of control behavior throughout his young adulthood. ?hen first attending 'ay "ab,
Ric!y sat at a des! writing his name over and over again. "e was given the opportunity
to attend art classes but did not even enter the room for over a year. "owever, provided
with an enriching environment and the ability to ma!e choices, Ric!y was able to
e0pand on one of his special interests G his collection of small plastic animals G and
create photographs of his animals in his own hand drawn color field environments. Today
Ric!y is an award#winning, widely e0hibited artist. More importantly, Ric!y has a new
awareness of his identity as a creative person and a calmness within himself.
#ON#USIOND
?hat stories can you share about transformation since using
IMPACTL ?ith each e0perience your understanding will grow,
as you witness those you support reach unforeseen milestones.
This is =ust the beginning of many new stories to be toldP
TRANSFORmATION
cHAPTER ENd
Reference
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IMPACT is respectfully dedicated to the beautiful children of Romania, who accepted and

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

insists on wearing T#shirts in spite of cold weather

heightened awareness of flavor;lac! of awareness of flavor

difficulty manipulating eating utensils

fre<uently spills both food and drin!s

chews with mouth opened

bites fingers and tongue while eating

dribbles food and drin! down chin

drops food on the floor unintentionally

disli!es carbonated beverages

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