Studies show that a small subgroup of individuals with visual impairments are also diagnosed with autism. The following articles are a great read in understanding visual impairments and autism.
Cerebral palsy is a condition caused by damage to the specific areas of the brain. Cerebral palsy refers to the brain and palsy to muscle weakness. Cerebral palsy is a syndrome of motor impairment with posture and movement disorder. It is a non-progressive disorder, however, as a person begins to age, muscle and skeletal problems begin to worsen resulting in more pain, discomfort and limited mobility. Due to muscle flexibility, strength and endurance issues, there is a greater risk of falls and injuries. The following articles includes information on understanding how aging and adulthood affect people with cerebral palsy.
5 common challenges for adults with cerebral palsy- Made For Movement Blog
Adults and cerebral palsy– Cerebral Palsy Organization
Adults with Cerebral Palsy- Cerebral Palsy Foundation
Aging with Cerebral Palsy and Chronic Pain– The Mighty
Care of adults with cerebral palsy-American Academy for Cerebral Palsy and Developmental Medicine
Cerebral Palsy and aging– Developmental Medicine and Child Neurology
Cerebral palsy and transitioning to adulthood-Cerebral Palsy Alliance
Cerebral Palsy effects through lifespan-Physiopedia
Cerebral Palsy in Adulthood– Everyday Health
Cerebral Palsy patients provide rare insight into aging– Cerebral Palsy News Today
Cerebral palsy symptoms in Adulthood- Healthfully
Living as an adult with cerebral palsy– Healthline
You are probably familiar with IEP’s if your child or family member attend a public school here in the United States. For some people with a developmental disability, the next step may be attending a day habilitation program where adults with developmental disabilities receive Medicaid Waiver Services and has what is called an Individualized Service Plan (ISP). If you are new the ISP process, the following terms that you will hear often before, during and after meetings.
Assessments. Serves to develop a body of information about an individual’s desires and goals his/her capabilities in areas in need of learning and skill development and the experiences or supports that will promote achievement of those goals.
Background/History. Provides an overview of the life experiences of the person and family.
Goals/Service. includes person-centered supports to enhance opportunities for individuals to make choices that increase their quality of life. An example would be a goal of increasing money or budgeting skills.
Interest and Activities. Describes personal preferences, gifts and interests, as well as conditions to avoid.
ISP Plan. A living document that provides details about what is important to an individual with developmental disabilities. It reflects a person-centered planning process.
Natural Supports. Personal associations and relationships developed in the community that enhance the quality and security of the life for people including family and friends.
Provider Program. The name of the voluntary agency delivering direct care to individuals with developmental disabilities. Providers may offer a variety of services and supports.
Habilitation Service. Services that help you keep, learn or improve skills and functioning for daily living skills
Individual Service Environment. Provides self-directed, individualized assistance and support to individuals living on their own, either alone or with roommates in their own home or apartment.
ISP Revision. Revisions and changes to the ISP can occur when an individual experiences a change in need throughout the year and must be reflected in the ISP. It is not necessary to wait annually to make the revisions. The date of the revisions should be reflected in the ISP.
HCBS Waiver Services. A Home and Community-Based Service (HCBS) Waiver is a Medicaid program designed to meet the needs of children and adults who prefer to get long-term care services in their home or community, rather than in an institutional setting.
Medicaid. is a jointly funded, Federal-State health insurance program for low-income and people in need including children and adults with disabilities. It is a government insurance for people whose income and resources are insufficient to pay for healthcare. A Medicaid number is needed for an ISP and is used to bill services.
Person-Centered Planning (PCP). An ongoing problem-solving process used to help people with disabilities plan for their future. It allows individuals to be engaged in the decision making process about their options, preferences and values.
Protective Oversight. is a documented and approved plan used for the sole purpose of enhancing individual safety. It list the key activities that affect health and wellness of an individual.
Safeguards. a measure taken to protect the individual from harm by providing information on how it will be addressed. An example is fire evacuation. If a person is not able to evacuate independently from a fire emergency, protections are put in place to ensure his or her safety.
Service Provider. The name of the voluntary agency delivering direct care to individuals with developmental disabilities. The provider may offer a variety of services and supports.
Value Outcome. Statements that represent what is important to the person. It may include what the individual needs, wants to change or would like to maintain in his/her life. Outcomes are developed through the ISP process.
This is an introduction to identifying street signs for children and young adults learning how to cross the street safely. The worksheet includes signs needed in teaching street crossing safety.
- Will match the traffic sign correctly
- Will identify the traffic sign correctly
- Will name the traffic sign correctly
Traffic sign worksheet
- Once you have printed the worksheet, cut the individual traffic signs and laminate.
- Explain each traffic sign and have the individual repeat.
- Once the signs are separated, mix them up and have the individual point to the correct ones.
- Have the individual state the traffic signs correctly and match
An Individual Support Plan (ISP) is an ongoing process of establishing goals for individuals and identifies supports and strategies that reflect the person’s strength and abilities and details all of the services and supports needed in order to keep the person in their community. The ISP should reflect an opportunity for the person to live in the least restrictive home setting and to have the opportunity to engage in activities and styles of living which encourage and maintain the integration of the individual in the community through individualized social and physical environments.
Who should be included in the development of the ISP?
- The person receiving services
- family members, caregiver, or designated representative
The ISP Planning Process
The ISP should be developed with participation from the following people:
- The individual
- Members of the individual’s family
- A guardian, if any
- The individual’s Service Coordinator
When is an ISP meeting held?
The meeting is held when it is desired or needed. Some State require meetings every 6 months while others every 2 years, so check with your state regulations.
What is discussed at ISP meetings?
The meeting should focus on 5 areas:
- Review and gathering information including any new changes or discoveries. Has the person’s health status changed?
- The person’s goals and desires
- Review or identify personal value outcomes
- Recent events that may affect the person’s health, safety and goals
- Review and develop next-step strategies and resources
What must the ISP include?
The ISP should include:
- Specific goals
- The supports the individual needs to reach those goals without regard to the availability of those goals.
- Who is responsible for providing those supports
- How often and how much support is needed
- The criteria foe evaluating the effectiveness of the supports
- Team members responsibilities for monitoring the ISP implementation
- The date of the next ISP review.
For many years, most people with developmental disability had only the option of living at home with family or become institutionalized. Today, people are given many more housing options. Although there is still a challenge in finding the right fit, home opportunities are more available. The following are housing options for adults with special needs.
Living with parents or family
Adults with special needs may choose to live at home with their families as long as they can. In some cases, adults with developmental disabilities continue to live at home after their parent’s death by hiring a Personal care Attendant (PCA). A PCA is hired by a person with a disability to assist with his or her personal care routine. People are eligible for this service is they qualify for Medicaid if they have a severe, chronic disability and requires physical assistance for personal care.
The Section 811 program allows persons with disabilities to live as independently as possible in the community by subsidizing rental housing opportunities which provide access to appropriate supportive services. Serves extremely low-income individuals with serious and long-term disabilities, including physical or developmental disabilities as well as mental illness.
- Is designed to accommodate the special needs of such persons;
- Makes available supportive services that address the individual health, mental health and other needs of such persons; and
- Promotes and facilitates community integration for people with significant and long-term disabilities.”
Residential home which provides 24-hour support services in a group setting. Oversight, training and supervision are provided by staff employed by a provider agency. This type of facility is provided to those with significant health and/or safety needs.
Are limited to 3 or fewer individuals and provide need-based support and services for those living in their own homes or apartments, but do not require 24-hour staff support and supervision.
Assisted living communities,
- also referred to as supported care facilities, provide care to older adults who are unable to live independently, often needing assistance with ADLs. Most offer private and semi-private apartment-style living often containing a living area and kitchenette.
When an individual with a developmental disability becomes an adult, Guardianship is something you should consider. In many States, the law will see the individual as an adult able to make decisions on their own. If you have a child with a disability who many never have the ability to make legal decisions on their own, the following information are links on guardianship and what you need to know about them.
Does my child need a guardianship?– Special Needs Alliance
Guardianship– Cincinnati Children’s
Guardianship: A basic understanding for parents– Parenting Special Needs
Legal guardianship and your adult child with disabilities– A day in our shoes
My child with a disability is an adult- Now what? – Parenting NH
Special needs children turning 18 years old– Today’s Caregiver
Understanding guardianship for adults with special needs– Protected Tomorrows
When your child turns 18: A guide to special needs guardianship– Friendship Circle
Guardianship- State Specific Requirements
Each State has it own requirements for Guardianship, click on your State below to find more information:
Studies show that most accidents occur in the home. There are a number of factors that increases this number in a residential setting. For example, Staff are responsible for providing care to more than one person and the may also be responsible for a number of other duties including, preparing dinner, giving out medication and working on performance goals. Given these factors, it is vital that attention and skill is given during bathing time. One minute away, could lead to a disastrous event.
The following is a training curriculum that serves to train staff (Direct care Professionals) on bath safety. I have included the lesson plan also in a PDF format and a demonstrative checklist. Once completed, staff should be able to show their competency level in bathing an individual safely. This training also satisfies and supports Core Competency 5 (safety) and Core Competency 6(Having a home).
Title: Bath Safety Training
This module is intended to provide direct support professionals with principles and strategies which will assist them in the preparation, supervision and assistance necessary to ensure the safety of people with developmental disabilities. The first section focuses on identifying and evaluating required staff supervision. Section 2 includes the responsibilities of staff during bathing time.
- Demonstrates steps to ensure all necessary bathing items are in the bathroom before preparing for bathing time.
- Evaluate the level of supervision needed
- Define the characteristics of a burn
- Distinguish temperature for bathing vs. showering
- Identifying the process of bathing residents to ensure the process is safely carried out.
- Explain the risk for people with disabilities
Maximum Group Size:
Training segment 10- competency portion should be conducted one person at a time.
Required Employees: Direct Support Professionals
- Competency test
Training: 1 Hour
|Objective 1: The participants will be able to explain bathing risk for people with disabilities|
The trainer will begin this session with a brief introduction on the magnitude of the problem regarding accidental deaths, bathing injuries including scalding. In your own words, please say the following:
Studies show that after the swimming pool, the bathtub is the second major site of drowning in the home including residential settings with seizures accounting for most of the common causes of bathtub drowning.
The National Safety Council reported that one person dies everyday from using bathtub in the United States. That more people have died from bathtub accidents than all forms of road vehicle accidents.
Injuries from the bathroom included slipping and falling when entering or exiting the bathtub or shower.
A study concluded by the State University of New York State found bathing difficulties included maintaining balance when bathing and making transfers.
Inform participants the following:
Near-drowning happens very quickly. Within three minutes of submersion, most people are unconscious, and within five minutes the brain begins to suffer from lack of oxygen. Abnormal heart rhythms (cardiac dysrhythmias) often occur in near-drowning cases, and the heart may stop pumping (cardiac arrest). The blood may increase in acidity (acidosis) and, under some circumstances, near drowning can cause a substantial increase or decrease in the volume of circulating blood. If not rapidly reversed, these events cause permanent damage to the brain
Ask – How much water does it take to drown?
Answer- inches of water in the bathtub. Any amount of water that covers the mouth and nose.
Who is at -risk?
Tell the participants the following people are considered high risk for accidents and drowning in the bathtub or shower:
- Older people
- Residence with a history of seizures
- Residents diagnosed with dementia or Alzheimer
- Residents who require assistance or supervision for mobility, transfer or ambulation.
- Lack of understanding of one’s own physical and cognitive limitations.
The trainer will introduce the segment on scald burns. Tell participants that individuals with physical, cognitive and emotional challenges are at high risk for burn injuries due to mobility impairments, muscle weakness and slower reflexes. Further explain that, sensory impairments can result in decrease sensation in the hands and feet with the resident not realizing the water is too hot.
The instructor will discuss the following handout:
Time and Temperature relationship to Severe Burns
|Water Temperature||Time for a third degree burn to occur|
|155° F||1 second|
|148° F||2 seconds|
|140° F||5 seconds|
|133° F||15 seconds|
|127° F||1 minute|
|124° F||3 minute|
|120° F||5 minutes|
|100° F||Safe temperature for bathing|
|Objective 2: Define the Characteristics of a Burn|
In this section, the trainer will give the definition of a burn, Explain to participants that a burn is damage to the skin and underlying tissue caused by heat chemicals or electricity.
Further explain, Burns range is severity from minor injuries that require no medical treatment to serious, life-threatening and fatal injuries. Further explain that burns are categorized by degrees. Have participants turn to the handout on burns.
Superficial (first degree burns)
- Causes : sunburn, minor scalds
- Generally heal in 3-5 days with no scarring
- Minor damage to the skin
- Color- pink to red
- Skin is dry without blisters
Partial thickness (second degree) burns
- Damages, but does not destroy top two layers of the skin
- Generally heal in 10-21 days
- Does not require skin graft*
- Skin is moist, wet and weepy
- Blisters are present • Color – bright pink to cherry red
- Lots of edema (swelling)
- Very painful
Full thickness (third degree) burns
- Destroys all layers of the skin
- May involve fat, muscle and bone
- Will require skin graft for healing*
- Skin may be very bright red or dry and leathery, charred, waxy white, tan or brown
- Charred veins may be visible
- Area is insensate – the person is unable to feel touch in areas of full thickness injury
*Except for very small (about the size of a quarter) full thickness burns will require a skin graft to heal. The patient is taken to the operating room where all the dead tissue is surgically removed. Skin is taken or harvested off an unburned or healed part of that person’s body and grafted or transplanted to the clean burn area. In seven to 14 days, this grafted skin “takes” or adheres to the area and becomes the person’s permanent skin. The donor site (where the skin was harvested from) is treated like a partial thickness burn and heals within 1- to 14 days.
|Objective 3: Identify the process of bathing residents to ensure the process is safely carried out|
The trainer will discuss the importance of following the appropriate steps when giving a resident a shower:
When escorting a resident to the bathroom, the following items should be gathered and taken to the bathroom:
- Washcloth/bath sponge
- Body wash/soap
- Body lotion
- Hair shampoo
- Hair conditioner
The trainer will remind participants not to leave the participants in the bathroom alone under any circumstances for those requiring supervision.
Ask- What circumstance might a person leave the person alone.
The participant should respond- none.
Click on the link below to download the competency checklist:
Click on the link below to download the training in Word format
Individuals with developmental disabilities have a greater chance of being impacted by the cold weather. for example people with disabilities are at a higher risk for hypothermia. Hypothermia is defines as a condition in which the body core temperature drops below the required temperature for bodily functions. Here are 5 tips on winter safety:
- Register with the Special Needs Registry for Disaster. This allows residents with disabilities and their families and caregivers an opportunity to provide information to emergency response agencies so emergency responders can better serve people during a disaster. The information is shared with local, state and federal agencies.
- For people using a wheelchair, make sure to wrap a small blanket around your legs by tucking it underneath the chair. This will help to maintain body heat.
- Wear multiple layers of clothing including a scarf around your neck, a winter hat and two pairs of socks.
- In the event of a winter storm, make sure your home is stocked with flashlights/batteries, non-electric can opener, bottled water, extra blankets and a first aid kit.
Annual audits and surveys can be very intimidating. A group of state surveyors showing up at the residence or day program to review services given to individuals with developmental disabilities.
What is the purpose of the audit?
In each state, Immediate Care Facilities (ICF), Immediate Residential Alternatives (IRAs), Waiver services or privately operated programs are funded through Medicaid Assistance Annually State agencies. Annual surveys serve the purpose of recertifying facilities and to make any further recommendations. Overall, the goal is to ensure the quality of for the individuals receiving services.
What are surveyors looking for?
In recent years, the focus is more on ensuring facilities that provide services and supports to individuals with intellectual and developmental disabilities are providing opportunities for individual choices including person-centered planning, community inclusion and choice-making. Typically, State auditors will review the Individualized service Plan (ISP) document to determine it the ISP is both current and accurate.
State Auditors generally spend some time talking to staff. They may ask you questions relating to the person’s plan. The questions are often generated after they have read the individual’s ISP plan. The questions that are asked are more than likely things that you do well everyday. here are 10 easy steps as you prepare for the auditing process:
- Knowledge of Individuals. know each person’s plan including person-centered planning plan, medical needs, preferences and habilitation plan.
- Cleanliness. Make sure the environment is neat and orderly.
- Privacy. Remember to give the person privacy when needed.
- Choice. Offer choices throughout activities whenever possible. The auditors may ask you how do you teach choice-making.
- Tone. Always speak in a positive and appropriate tone of voice.
- Small groups. Work in small groups whenever possible. Incorporate variety of choice during activities.
- Community activities. Ensure individuals are able to make choices in activities in the community and community inclusion opportunities are available.
- Universal Precaution Guidelines. Know the precautions and follow them. Remember to change gloves when moving from one individual to the next.
- Active Programming. The auditors may ask questions related to what they have read in the individuals ISP or CFA (Comprehensive Functional Assessment).
- Safeguards. make sure you are able to describe the individual’s supervision needs.
Remember: Demonstrate your self-confidence, because you are good at what you do!