icf/mr focused training

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ICF/MR FOCUSED TRAINING

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Henry

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MAJOR MOVEMENT DISORDERS

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BAD REPUTATIONS

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CREATIVE COMMUNICATION STYLES

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MEDICALLY FRAGILE

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TRADITIONAL PERSPECTIVES

This person is disabledThe disability is a problemThis problem needs to be fixedSpecial people are needed to fix it It can only be fixed in special places It needs to go to one of those special places

to be fixed It can only come back when it is fixed

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FORM VS. FUNCTION

Function = the purpose of the behavior, service, objective, etc.

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FORM VS. FUNCTION

Form = the way we do it

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“The most critical deficiency in typical assessment is the emphasis on teaching skills of a specific form

rather than focusing on training relevant behavior.”

(Campbell and Bricker)

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MORE HELPFUL ASSUMPTIONS

Autonomy and Independences Individuality Love and Acceptance Stability and Continuity Continuous Growth and Learning Community Status Protection of Rights and Personal Interests

ALL PEOPLE SHARE THE SAME BASIC NEEDS:

People with disabilities do not have qualitatively different needs.

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“The description of the disability is relevant only to the extent that the condition complicates the fulfillment of the above-mentioned needs. What people with disabilities do not have in common is the independent ability and means to create conditions, situations and experiences to meet all of their basic needs.”

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FOCUSING ON WHAT THE PERSON CANNOT DO

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Assuming Unlimited Time For Learning

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Eradicating Functional Behavior (Functional Communication)

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Too sick Too retarded

Labeling the person as Incapable of Change, e.g. Too crazy Too worthless

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CRITICAL DIMENSION OF ASSESSMENT

Underlying functions critical to performance of more complex forms of behavior

Useful in analyzing obstacles to development

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Thriving

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Motor Quantitave—how much does the

person move?

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Motor Qualitative—How well does the

person move?

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Oral Motor FunctionEating

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Oral Motor FunctionVocalizing

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MobilityHow does person get

from one place to

another?

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Sensory Status

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Visual StatusWhat can this guy see?

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Auditory Status

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Muscle tone & movement affect smell & taste

Taste requires smell Open mouth affects

both

Smell/Taste

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Joint sense Place in space Righting reactions Movement causes

pain

Tactile/Proprioceptive

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How the person uses hands Hand development takes many months Sensory preparation

Manipulative

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Response to possible enforcers

Consequence Preference

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Primary circular reactive Object permanence

Use of Objects

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Willingness to cooperate

Creative communication used so you will “buzz off”

Compliance

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Knowing things continue to exist Indicates “readiness” for symbols

Object Permanence

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Seeking interaction with others Range of behaviors used to control social

environment

Social Responsiveness

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Imitates movement sequence modeled by others

Motor Imitation

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Imitates sounds or parts ofsounds initiated by others

Vocal Imitation

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Top Ten Approaches for Functional Assessment

1. Discover the Person

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2. Evaluate from more than one point of view.

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3. Are skills present in different places (Grandma’s Law).

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4. What supports are needed to do valued things?

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5. Make sure they don’t already have it.

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6. Identify splinter skills and fill in the blanks.

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7. Discover how (not if) the person controls environment.

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8. Identify developmental obstacles.

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9. Find the passionate relationship in the person’s life.

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10. Ask: If the person can’t do it, will we have to hire someone todo it for him/her?

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Basic Guides for Helping

1. Pass the Dead Person’s Test, e.g. “If a dead person can do it, it’s not an objective!” e.g. tolerating side lying.

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2. Real Life, e.g. What would an able-bodied person of the same age and sex be doing?

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3. Pay attention to the antecedents in the A-B-C (antecedent-behavior-consequence).

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4. Demystify Clinical Skills-a person who implements clinical interventions must be directly trained, and supervised. And clinician must be accessible for change.

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5. Make everyday activities therapeutic rather than doses of treatment, e.g. 15 seconds X 10 X per day.

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6. If immediate results not apparent, problem is probably with the program and not the person.

“It’s difficult to give a person a choice of what she wants for breakfast if the

only word she knows is eggs!”

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Activity: Some of JJ’s Goals @ 40

1. Given a well aligned left sidelying position JJ ill breathe deeply for 60-90 seconds X 4 times per day.

2. JJ will eat a full meal in 30 minutes or less using active lip closure to pull food from a spoon.

3. JJ will consume 240 cc of thickened fluid X 5 times per day in 30 minutes or less using an independent consecutive swallow.

4. JJ will indicate choices of food, clothing, activities using a yes/no response 5 X/day.

5. JJ will participate in 2 off site activities of his choice per week.

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Activity: Some of JJ’s Goals @ 60

1. JJ will use a motorized chair to participate in a senior program.

2. JJ will use an augmentative communication device to participate in recreation programs at the senior center.

3. JJ will make personal functional choices during 3 community outings per week—(e.g. food, brands of personal products.

4. JJ will choose from a range of menu items for 3 meals a day.

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Activity: Goals for JJ

Using JJ’s goals @ 40, determine when, where, and how you might implement each goal.

Using each of JJ’s goals @ 60, write objectives and/or strategies for either a money management program, or a self-administration of drugs program.

icf/mr focused training

Documents

iticfmr focused trainingthe

basic needs

different needs

abovementioned needs

fixedspecial people

training relevant behavior

personal interestsall

disabledthe disability