Indeed, it is the only thing that ever has.
It is now eight years since a small group of dedicated people came together to discuss what has come to be known as Positive Approaches.
This group of fifteen or so people from across the state met to explore how people with challenging behaviors were being supported. Some were agency administrators, some psychologists, and some residential workers. Some had been exposed to new ideas from national experts and some had developed the same ideas from their own experiences and struggles. Each was feeling a little isolated. Many had few words to describe what they were doing.
What was it they all had in common that brought them together? It was the realization that challenging behavior was not something to simply be stopped or redirected, but something that must first be understood. They had all concluded that behavior is communication; it tells us, albeit in a way we sometimes cannot at first discern, what people are feeling and what they need.
Because they recognized the power of behavior to communicate, they had all begun to look at the lives of people-in-service differently. They realized that the people "with Behavior" lead lives lacking privacy, meaningful activity, respect, and sometimes love, but overflowing with boredom.
Challenging behavior is often a rational response to life's circumstances. Hitting the person who makes you go to the center you do not want to go to every day may be the only way you make your feelings known - especially if you cannot use words or any other form of communication.
This group of fifteen people started to share their stories. They quickly concluded that there was a lot to learn and a lot of work to do to spread what they had and would learn. The group struggled to name "it." What do you call a new way of looking at people and a new way of helping them? What name would not offend but would encourage others? What name would be accessible but not trivialize the message? But most importantly, the group struggled to find a name that would inspire people to accept a new way of thinking without demeaning their past efforts to help.
"Positive Approaches" was born. The name communicates a stance, an attitude, a set of values that directs what approaches we take in supporting people. The approaches themselves are many.
When meeting someone who has challenging behavior, it is necessary to listen to the person first. Can we discern what he or she is telling us? Listening may take many forms, such as asking the people closest to the person what they understand, and introducing alternate communication systems such as language boards or facilitated communication. It may mean getting a medical evaluation to find pain that the person cannot tell us about.
What we hear and learn will dictate our support strategies. We may need to accommodate the person's need by changing the living situation or housemates or by simply eliminating some annoyance such as noise or light in their lives which may seem trivial to us but is terrible for him or her. Daily routines, opportunities for privacy, and daily menus may have to change. Doing something every day which is a meaningful activity to the person can dramatically improve life.
The group learned that control is a key factor. Each and every one of us wants to control not only our destiny, but our daily existence. Denied that control, each of us would "act out." How simple!
So much of the struggle is over control. "Who is in control?" Roland Johnson* used to say, "Are you in control or is the staff in control?" Roland understood the issue very well. Wrestling over control is futile and a waste of human energy. Caregivers can balance their responsibility to support and protect people with the right of each person to have as much control over their life as possible. The best support and protection support self-determination by giving good information and assistance in the decision-making process.
Above all, the need to be loved and valued is essential to all people. "To be helpless is not necessarily to be in jeopardy. To be helpless and unloved is the matrix of disaster," wrote Dr. Williard Gaylin. Recognizing this undeniable truth, our task becomes then not only to advocate for and provide appropriate services but to facilitate opportunities for people to have valued roles in our communities and, as unorthodox as it may seem, find love.
I admire the work of that original Positive Approaches Committee: their caring and commitment; their thoughtfulness and wisdom. The committee has grown and spawned Positive Approaches committees all over the Commonwealth. It has now expanded to include the efforts to address the needs of people with the dual diagnosis of mental retardation and mental illness. Those many regional, county, and agency committees have demonstrated the same eagerness to find new ways to support people and the same commitment to carry out what they learn.
"Positive Approaches" has gone on to be adopted by many others nationally. It best describes what we all mean to do for people with challenging behaviors.
* Roland Johnson was a nationally recognized advocate for people with disabilities. He experienced the struggles of institutional living while he spent many years of his young life at Pennhurst Center.
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  774 - 5455. Copyright © 1996 OMR/CCI. All rights reserved.
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