IAN Topic on Bullying of ASD children

As I have mentioned in a previous posting, IAN, is a helpful website and here is an article relating to IAN on the topic of Bullying at school for ASD kids.

Find the article by copying and pasting this URL;
http://www.crestonnewsadvertiser.com/articles/ara/2010/09/16/8049210103/index.xml

More information on this topic can be found on the IAN website

Emergency Resources in the Community

Yesterday, I held a training on behavior management and safe strategies for V's personal support staff. We have some new staff who have been trained by a local agency and their strategies and responses were not exactly on the same page with the staff who have been with us longer. My hope was to get them all using the same strategies and working well together with each other when they take V into the community. Although V has 2:1 staffing for community time, one of the staff mentioned during the training that she thought there may be circumstances where she would call the police for assistance. This has never happened in all of V's life and I have never had to give consideration as to what consequences such a action might have for all parties involved.

The trainer informed the staff that they had more and better training on how to manage V than the police have, and that such an action would probably result in V being placed in handcuffs and taken somewhere in a police car, and this would not be the best solution to the problem.

The fact that someone on staff was even thinking of this as a possibility concerned me enough to follow up on this topic with a personal friend who is the captain of the local police station. I asked him what would happen if my staff called the police while out in the community with V in a situation they did not feel they could safely handle. He confirmed what the trainer had told my staff, that they would probably put her in cuffs and take her to the emergency room in the police car. He was unfamiliar with the basket hold or other safe restraints and escorts that my staff have been trained in, and so this is probably the case with the officers on the city force.

He suggested that I call the community services division of his city and speak to Crystal,the director for guidance. I called her right away and spoke to her at length about my issue. She was not sure about the best recourse in such a situation, but suggested that I contact the Mobile Crisis team at the Crisis Center for the county department of health and hygiene.

I followed this advice and explained my situation to Beth at the Crisis Center. She explained to me that the people at the Mobile crisis Team were trained to talk to Verbal individuals who were in a mental health crisis, and that the team had a hands-off policy. When they respond to a crisis they bring police with them. She thought that a better resource, although not a perfect option, was to call the police non-emergency number and request a CIT officer, who is someone who has been through a 40-hour advanced mental health training and who she thought may be more likely to listen to the recommendations of the support staff.

Basically, my conversations made the Mobile Crisis Team aware that there is a population of people in the community that they are not prepared to serve. I wonder if an awareness of a gap in services might lead to some action to fill that gap.

My friend, the police captain, sent a follow up message to see if his referral had been helpful, and I filled him in, at the same time providing the contact information for our trainer in case he ever feels it would be appropriate to provide training to his officers for how to best manage citizens with autism or developmental disabilities in the community who are agitated and not necessarily able to talk it through.

I learned a lot through the question raised by my staff about using emergency resources in the community, and I have a lot more to learn to feel that I have a good solution for my staff in these situation. I need to provide them with guidelines and emergency contacts for exactly this kind of scenario, although, to date, they have never been unable to resolve a problem in community without additional help.

They have the contact information for my husband and I, doctors, therapists, etc... but what I think they actually want is just an extra strong body to assist in the moment. Since my husband and I are not always close by, I could give permission for them to call an off-duty staff member for assistance, since those people would have the necessary training and experience. I can provide the non-emergency police number for a CIT officer, although I don't know if that would be more helpful or harmful, and usually V calms down before anyone else can actually get to the location she is at anyway.

If anyone knows of any better solutions to these situations, please post your comments.

Learn a Little Bit About Human Resources

No matter how well you screen and train your employees, performance issues are bound to occur from time to time. Some will be minor and some serious. While the care of the disabled person is the first consideration, some knowledge about correct HR procedures can protect you from a possible law suit for wrongful termination, and can protect you from unemployment claims that can raise your unemployment insurance premiums on your other staff.
Maryland DDA provides New Directions Waiver Support Brokers with a manual that includes a disciplinary form and some guidelines. It is your judgement, however, that will determine when to merely provide a verbal reminder about your procedures to a staff member, and when to put it in writing and impose a suspension or to terminate employment. I had a lengthy conversation with the Human Resources specialist at the ARC and learned a lot from her. Some of what she had to say was surprising to me. Unless V's safety has been deliberately put at risk, I try to use mistakes as teaching opportunities,starting with a mild verbal reminder, or a refresher training on the issue at hand. I keep a record of these issues/incidents somewhere so that they can be mentioned in the next performance review, and so that I have a record if the same problem occurs again. If the problem continues, then a written warning is presented, signed by all parties, and goes into the employee file. If the issue is serious enough, I may skip the simple written warning and write up the incident, imposing a suspension for a day or longer, without pay.
Your chances of winning an in an unemployment claim if termination becomes necessary, are better if you can show a written record of performance issues, especially a pattern of behavior that has not responded to counseling.
Even if all you want is to have good care for yourself or a loved one, having employees makes you an employer and that brings all of the legal responsibilities that go along with that job, whether it is a paid job or not. It can be unpleasant, frustrating and stressful at times and it is one price paid for having to depend on others for care.
Good luck to all of you out there who are managing these responsibilities.

Trust, But Verify

There is a reason they say, "Trust, but verify." When you have others paid to care for a disabled loved one, there is always the fear that someone will take advantage of the vulnerability of the individual they are caring for. It has happened to me more than once with V.
Yesterday was a sad day. I learned that my trust had been betrayed and I had to release a long-term employee and discipline two others who remain employed.
If you allow others to take your disabled family member out into the community and they use your vehicle, invest in a GPS tracking device as soon as possible and install it on the vehicle. A verbal or written report is not sufficient to know the truth about where your loved one has been if they are not able to tell you themselves. If you care where your loved one is spending their time and can't be there personally, then you need to KNOW, not think you know based on the word, written or verbal, of your employees.
It is worth the cost. New Directions won't cover this precautionary expense, so it will be out of pocket for you.

Want to see videos of V's daily activities?

V has a youtube channel. Search "ValerieinBoyds" on youtube to see short video clips of some of her activities. Many of these were filmed using a small flip video camera by the personal support staff.

Documentation is Important

I have to admit that I was nervous about whether or not Fitness for Health would be approved in this new year's Plan of Care and Budget. I submitted about 10 pages of documentation to support the need for the services that Fitness for Health can provide. Well, it worked and the request was approved. Fitness Centers and personal trainers are on the list of items that will not be approved by medicaid, so documentation is critical to get an exception made in this case. I included a letter from V's occupational therapist that explained how the center could address V's O.T. needs, among the documents that I submitted.
Art supplies, which are used every day with V to manage anxiety and reduce agitation, were not approved this year. I did not submit supporting documentation, but my resource coordinator wondered if it would have made a difference if I had. She is checking and I will try again, with documentation and see if it helps. The art activities also work on some of V's O.T. goals, so there is an opportunity for supporting documentation from the O.T. as well as from the behavior analyst.
So, our lesson this year when it comes to developing a good plan of care is to include as much supporting documentation to support the need for the services that you are requesting as you can.

Getting the Hang of Medical Appointments

This week it was time for the dreaded visit to the doctor so that V could be cleared for anesthesia. Next week she has a dental cleaning scheduled at Shady Grove Hospital, and any necessary scaling or restoration work that they find necessary. Last year, this medical appointment was a disaster because her new doctor and his staff did not understand how badly things can go when V has to wait in an office for a long time.

This year, I called the doctor's office before leaving our house for the appointment, to make sure that the doctor was running on schedule. Good thing that I called. He was not even in the office at 15 minutes prior to our appointment and still had 2 patients waiting ahead of us to see him. The nurse agreed to call me when he finished with the first patient, and we agreed that we would wait at home for that call, and only leave home after we heard from her. An hour later she called us, we left home, and when we arrived at the office the doctor was ready to see us immediately. V was reasonably cooperative during the exam and transitions in and out of the office. I had time to talk with the doctor about her health and to get a blood work order as part of an annual physical exam. This was a dramatic improvement over our experience last year.

We have started calling the psychiatrist office ahead of the appointment to determine if she is running on time as well, and then adjusting our arrival at the office accordingly to avoid the wait in the office or sitting in the car for a lengthy period of time. This is reducing the stress and anxiety related to these appointments for us all.

Yesterday, I spoke to the nurse at the hospital regarding the procedure that is scheduled for Monday morning. She was very understanding about the difficulty of waiting in a waiting room, and suggested that we arrive an hour before the procedure instead of the standard 2 hours. Then, I will go inside and register her while she waits in the car with my husband. When they are ready to take her back to a room, then we will bring her inside the hospital and avoid time sitting in the waiting area.

As the Beatles sing, "It's getting better all the time." So true.