Pennsylvanians have been very successfully learning positive, new ways to help people overcome their challenging behaviors. We are still struggling, however, to find ways to help everyone in the Commonwealth understand and apply the principles and practices behind Positive Approaches.
In essence, Positive Approaches is a worldview, in which all individuals are treated with dignity and respect, in which all are entitled to "Everyday Lives." This journal focuses on how this principle plays out in working with individuals who have developmental disabilities and who present challenging behaviors. In coming issues we will present philosophies, practice techniques, tools and case studies that mesh well with the Positive Approaches paradigm. The case studies and most of the articles will be presented by Pennsylvanians. The effort is to build a resource network across the state and to build the expectation that "YES! We can do it here!"
In recent years we have been trying to conceptualize the Positive Approaches paradigm in terms that are relevant to all of us who interact directly with the people we serve. Many of us have found it helpful to think about Positive Approaches in terms of four major areas: Environment, Communication, Assessment, and Hanging in There.
ENVIRONMENT
Most of the time, when people exhibit challenging behaviors [Note #1], we discovor that a close look at that person's environment shows us why the person is having difficulty. In roughly three quarters of the situations in which we have been asked to consult, a person's behaviors change for the better when they are helped to live in a manner that better meets their needs. Rather than using interventions and sedating medications to "control" the person's behavior and cause them to behave as if adapting to an environment that causes distress, we advocate altering the environment to meet the person's needs. In many cases, the distress and the related "maladaptive" behavior are alleviated.
For example, many people in group homes and institutions don't get along with their roommates. People with very different biorhythms, interests, and needs are often required to live together. The daily irritation, sleep problems, and experiences of personal space being violated will often lead to aggressive or self-abusive behavior, sleeping problems, and general irritability. Changing roommates or arranging for individuals to have their own rooms are appropriate solutions rather than trying to force incompatible roommates to coexist.
The environment creates challenging behaviors:
Many environmental based areas of conflict begin as a small issue which grows into a relationship destroying juggernaut.
I once worked with a young man, Mark, who wanted to take his shower in the morning. He would say, "That is when grown men take their showers, and I am a man."
The staff found it more convenient to have him take his shower in the evening. Fights over the shower occurred every evening as a result. When asked why they wouldn't modify theit schedule to accommodate Mark, the staff explained that they didn't want to give in to him. They said that they were afraid that if they changed their practices, he would think that it was his fighting that got them to change their minds. They were afraid that they would set a precedent that would guarantee that he would fight for everything. So they refused to change the shower time and continued the nightly fights.
The fights continued into the daytime hours due to the breakdown in the relationship between Mark and the staff. Eventually the house felt like a warzone. Mark felt a need to prove that he was a man, and the staff felt a need to prove that they were in control of the situation. Mark would hit, bite, scream, and kick. Thc staff would take away Mark's privileges and physically restrain him. They said that he was irrationally explosive.
Eventually, in desperation, and on the advice of a consultant, the staff allowed Mark to shower in the morning. The evening fights stopped. Staff could focus on bulding a positive relationship with Mark rather than on defending themselves against him. As the staff started seeing Mark as a man with needs and images of how he wanted his world to be, they were able to make small alterations in their schedule and in their style of interacting that made for a rewarding relationship. A complete change in relationships occurred, and no additional expense was incurred as a result of using a Positive Approach.
COMMUNICATION
In this case all involved were fortunate that Mark possessed communication skills so he could let the staff know what he wanted. The people working with Mark just had to develop the capacity to hear what he was saying.
Often the person challenging us to understand cannot articulate wants and needs. Positive Approaches obliges supporters of a person with challenging behavior to do whatever is possible to enable the individual to communicate. Communication, then, is the second major area of concern when we are working with a person with challenging behaviors. We must continually ask ourselves how we know what a person is communicating. Those with difficulty expressing themselves must be offered any tool available that might enable communication: tools such as language boards, liberators, and Facilitated Communication should be tried. The people closest to the person we are trying to serve must b)e consulted with, since these individuals are the ones who can most often read the person's body language enough to tell us what the person is trying to say. This is especially important when all other attempts to augment communication have been unsuccessful.
ASSESSMENT
It is now comrnon knowledge that when a person cannot communicate, frustration becomes part of every interaction. When a person can communicate, the frustration disappears, and often, so does the problematic behavior.
Here in Pennsylvania, we are finding more and more places where Positive Approaches to challenges are commonplace, and indeed, ftar more people are living happier lives as a result. However, even after environmental and communication needs have been addressed, some individuals still evince challenging behaviors. The search for ways to help these folks must never cease. And, in fact, we are Iearning more each day about ways to help people with extraordinary challenges. We are learning more, for instance, about the high frequency of mental illnesses among individuals with developmental disabilities. These illnesses must be accurately diagnosed and treated in order for other Positive Approaches pertaining to environment and communication to be fully successful. Prompt assessment, diagnosis, and syndrome related trearment are vital tools in the Positive Approaches repertoire. (But using medication simply to control symptoms and to sedate is not a Positive Approach.)
Every concern that is relevant to typical citizens is also relevant to people with developmenltal disabilities. Problems such as trauma, loss, sexuality issues and abuse, loneliness, powerlessness, and addiction should be assessed. Relevant interventions should be offered.
Positive Approaches practitioners take advantage of the ever-widening repertoire of tools becoming available to help individuals in distress. Accounts of such interventions and their results will be highlighted each month in this journal.
HANGING IN THERE
Even with all of the needed supports, opportunities, and conditions in place, a person who has lived a life full of hardship, isolation, stigma, and sorrow may have problems that continue for a long time. The person we are trying to help needs to have the opportunity to develop trust, often for the first time, needs to learn new ways of being in the world that can meet her/his needs, needs to experience over and over the goodwill and positive regard of others. For those with the most serious challenges, finding someone to persevere with them has proven difficult. Once found, that person often has more impact on their lives than any thing, or any one, else. This journal will relate in depth stories about people who have hung inÑin order to inspire hope in the rest of us as we each sign up for the long haul.
Beth Barol is the Clinical Training Director of the OMR Statewide Training Initiative, Harrisburg, PA.
The Pennsylvania Journal on Positive Approaches is published by the Pennsylvania Office of Mental Retardation (OMR) Statewide Training Initiative through Temple University, Institute on Disabilities, University Affiliated Program and Contract Consultants, Inc., 105 Old York Road, New Cumberland, PA 17070. For subscription information, please contact Contract Consultants, Inc. at [717] 774 - 5455. Copyright © 1996 OMR/CCI. All rights reserved.
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