Category Archives: Residential Services

What is an ISP?

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People with disabilities that are eligible for community habilitation, day habilitation, supportive employment and support services will receive an Individual Service Plan (ISP).
What is an ISP?

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 are 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.

Updated 2/22/24.

Adult Provider Training Resources

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Abuse and Neglect

Sexual Abuse of People with Disabilities

Sexual Abuse Definition-The ARC

Preventing Abuse of Children with Cognitive, Intellectual and Developmental Disabilities

Abuse and Neglect: Individuals with Developmental Disabilities

Choking/ Aspiration

Teaching Material on Choking

Arizona Department of Economic Security

Eunice Kennedy Shriver-Dysphasia, Aspiration and Choking

Ohio Department of Developmental Disabilities

New York State Choking Prevention Resources

Washington State Department of Social and Health Services

State Agencies Choking Alerts

Georgia Department of Behavioral Health and Developmental Disabilities

Minnesota Mental Health and Developmental Disabilities 

New Jersey Health and Safety Alert Choking

CPR Training for Disabled Students

Fire Safety

Educational materials for people with disabilities

Fire safety and teaching people with intellectual disabilities

Fire Safety for Individuals with disabilities

Fire safety outreach materials for people with disabilities

Guide to teaching fire safety to students with disabilities

Incident Reporting

Incident/abuse, identification, reporting and processing 

Incident reporting for individuals with developmental disabilities

Incident response and reporting manual

Major unusual incidents and unusual incidents

Personal support worker incident report requirements

Overview of Developmental Disabilities

Introduction to developmental disabilities

Introduction to intellectual and developmental disabilities 

Introduction to developmental disabilities classroom participant guide

Orientation Manual for Direct Support Professionals

Van Safety

A guide for drivers of seniors and persons with disabilities

Oversight of Passenger Safety

Safe Transportation of People in Wheelchairs

Transportation Safety Awareness

Self- Injurious Behavior Resources

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Working with individuals- both children and adults diagnosed with self-injurious behaviors can be challenging at the very least. Some examples of self-injurious behaviors include head banging, handbiting, and excessive scratching. There are many reasons why a student or individual may cause self-injurious behaviors including the inability to communicate needs, the environment, sensory issues and physiological issues. The following are articles on identifying cause of self-injury and ways to prevent it.

Autism, head banging and other self-harming behaviors– Autism Parenting

3 techniques to stop self-injurious behavior of children with autism– Steinberg Behavior Solutions

6 Strategies for Addressing Self-Injurious Behaviors– Wonderbaby

Effective evidence-based strategies to minimize self-injurious behaviors in young children with autism- CSUSB Scholarworks

Essential guide to self-injurious behavior and autism– Research Autism

Head banging, self-injury and aggression in autism– Treat Autism

Self-injurious behavior in people with developmental disabilities-crisis prevention.com

Self-injury in patients with intellectual disabilities- Nursing2020

Understanding and treating self-injurious behavior– Autism Research Institute

Understanding self-injury among autistic individuals- Good Therapy

 

Understanding and Treating Self-Injurious Behavior

Understanding and Treating Self-Injurious Behavior

What You Should Know About GERD and Developmental Disabilities

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Feeding problems are common in people with an  intellectual/developmental disability. For example, it is reported that 37% of individuals with diplegia or hemiplegia and 86% of individuals with quadriplegia experience GERD. It is very common in people with cerebral palsy and can show up as anemia, failure to thrive and reoccurring infections.

It is usually missed by people who have been feeding and serving food to individuals with disability due to its subtle signs.

What is Gastroesophageal Reflux? (GERD)

GERD occurs when the muscle connecting  to the esophagus is weak and opens under pressure, allowing the stomach contents to flow back into the esophagus. It is the acid from the stomach to the esophagus. this will irritate the lining of the esophagus and causes heartburn. Without treatment, GERD can cause complications.

What causes GERD?

GERD is usually caused by inflammation from the exposure of the esophagus to the stomach acid. The following can cause GERD:

  • diet such as fatty foods, coffee, peppermint and chocolate
  • decreased muscle tone
  • overweight
  • backup in blockage of the intestinal tract.

There are many reasons for the high incidence of GERD in individuals with intellectual disability including immobility and positioning, abnormal postures, medication use and excessive drooling.

What is a developmental disability?

A developmental disability is described as an assortment of chronic conditions that are due to mental or physical impairments or both. For example, you may have a child or an adult with an intellectual disability or perhaps a person diagnosed with cerebral palsy and an intellectual disability. It is also considered a severe and chronic disability that can occur up to the age of 22, hence the word developmental. A developmental disability can occur before birth such as genetic disorders (i.e. cri du chat, fragile x syndrome,) or chromosomes ( i.e. Down syndrome, Edwards syndrome); during birth (lack of oxygen) or after birth up to the age of 22 (i.e. head injuries, child abuse or accidents).

For people with limited communication, the following are possible signs of gastroesophageal reflux:

If you suspect GERD, make arrangements for the person to be evaluated by a physician.

Aspiration Precautions

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Children and adults with developmental disabilities often face challenges with eating, drinking and swallowing disorders than the general population. It is estimated that adults with intellectual disabilities require support from caregivers during mealtime. It is common among people who have a diagnosis of cerebral palsy, intellectual disability, physical  disability and muscular dystrophy.

Dysphasia is a medical term used to describe any person having difficulty swallowing foods and liquids taking  more energy and time to move food from the mouth to the stomach. Signs of dysphasia may include:

  • Drooling
  • Food or liquid remaining in the oral cavity after swallowing
  • Complaints of pain when swallowing
  • Coughing during or right after eating or drinking
  • Extra time needed to chew or swallow
  • Reflux of food

Dysphasia can lead to aspiration. Aspiration is defined when food, fluid, or other foreign material gets into the trachea or lungs instead of going down the esophagus and into the stomach. when this occurs, the person is able to cough to get the food or fluid out of their lungs, in some cases especially with children and adults with disabilities may not be able to cough. This is known as Silent Aspiration.

A complication of aspiration is Pneumonia which is defined as inhaling food, saliva, and liquids into the lungs

According to the Office of People with Developmental Disabilities Health and safety Alert, factors that place people at risk for aspiration include:

  • Being fed by others
  • Weak or absent coughing, and/or gag reflexes, commonly seen in people with cerebral palsy.
  • food stuffing and rapid eating/drinking
  • Poor chewing or swallowing pills
  • GERD- the return of partially digested food or stomach contents to the esophagus
  • Providing liquids or food consistencies the person is not able to tolerate such as eating whole foods.
  • Seizures that may occur during eating and/or drinking.

How to recognize signs and symptoms of Aspiration:

  • Choking or coughing while eating or just after eating
  • Drooling while eating or just after eating
  • Eyes start to water
  • Shortness of breath
  • Fever 30 minutes after eating
Intervene immediate if there are signs of aspiration:
  • Stop feeding immediately
  • Keep the person in an upright position
  • Call 911 if the person has difficulty or stops breathing and no pulse
  • Start rescue breathing

Minimize aspiration from occurring by serving the appropriate food texture and liquid consistency. If you are not sure of the right consistency, check with your health care provider. The following are pictures of food consistencies.

Courtesy of OPWDD

Courtesy of OPWDD

Whole. Food is served as it is normally prepared; no changes are needed in
preparation or consistency

Courtesy of OPWDD

1 ” Pieces cut to size. Food is served as prepared and cut into 1-inch pieces
(about the width of a fork).

Courtesy of OPWDD

1/4 Pieces Cut to Size. Food is cut with a knife or a pizza cutter or placed in a food
processor and cut into ¼ -inch pieces (about the width of a #2 pencil)

Courtesy of OPWDD

Ground. Food must be prepared using a food processor or comparable equipment
until MOIST, COHESIVE AND NO LARGER THAN A GRAIN OF RICE, or relish
like pieces, similar to pickle relish. Ground food must always be moist. Ground meat
is moistened with a liquid either before or after being prepared in the food processor
and is ALWAYS served with a moistener such as broth, low fat sauce, gravy or
appropriate condiment. Hard, dry ground particles are easy to inhale and must be
avoided.

 

Courtesy of OPWDD

Pureed. Food must be prepared using a food processor or comparable equipment.
All foods are moistened and processed until smooth, achieving an applesauce-like or
pudding consistency. A spoon should NOT stand up in the food, but the consistency
should not be runny. Each food item is to be pureed separately, unless foods are
prepared in a mixture such as a soup, stew, casserole, or salad.

Aspiration Precautions

  • Make sure the person eats slowly and takes small bites of food
  •  Ensure the person takes small sips of liquids
  • Focus on the person’s swallowing
  • Make sure the person remains upright for a minimum of thirty minutes after eating

Cystic Fibrosis Awareness Month

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According to the Cystic Fibrosis Foundation, cystic fibrosis is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe overtime. It is a life-threatening disorder that damages the lungs and digestive system. A thick mucus can block the lungs and the pancreas.

In the United States, about 30,000 people are affected by the disease. It is estimated that more than 70,000 people worldwide are living with cystic fibrosis. 1 in every 20 Americans is an unaffected carrier of an abnormal CE gene.

Wikipedia

Common symptoms of cystic fibrosis include:

  • Salty-tasting skin
  • Persistent coughing
  • Shortness of breath
  • Wheezing
  • Poor weight gain in spite of excessive appetite
  • Greasy, bulky stools
  • Repeated lung infections
  • Muscle and joint pain
  • Sinus infections.

Cystic Fibrosis does not affect any cognitive or learning abilities. However, the student may need modifications and supports due to the disease. Teachers with students with cystic fibrosis should be knowledgeable about the disease.

Spring Fine Motor Activities

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Spring has finally arrived! birds are signing, trees are budding and flowers are blooming. There is no better tome to strengthen fine motor skills for children and adults with developmental disabilities. Fine motor activities improve independent living skills including feeding, dressing and writing. The links below provide spring-themed activities providing opportunities to improve the child or adult’s pincer grasp by using scissors and pencils.

5 Spring inspired fine motor activities– Brain Balance

10 fine motor activities for spring- You Aut- Aknow

10 flower fine motor skills activities- Harry Brown House

40 fine motor skills activities– The Imagination Tree

Fine motor and color matching Flowers– The Kindergarten Connection

Fine motor and sensory play for spring using a sand-tray– Buggy and Buddy

Spring crafts for preschool fine motor skills– Lalymom

Spring fine motor and executive function skills freebie- Your Therapy Source

Spring fine motor activity tray– Little Bins Little Hands

Spring themed fine motor sensory activity– Hands On As We Grow

Spring-themed fine motor activities– Pink Oatmeal

Adults with Special Needs and Housing Options

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Click here to download PDF article

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.

Section 811

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.”

Group Homes

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.

Individual Supports

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.

 

Bathing Training Curriculum For Direct Support Professionals

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Click here to print PDF version of article
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

Description 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.

Learning Objective(s):

  • 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.

Blooms Taxonomy:

  • Remember
  • Understand
  • Apply

Required Employees: Direct Support Professionals

Materials:

  • Handout
  • Handout
  • Competency test
  • Competency
Training:  1 Hour
Objective 1: The participants will be able to explain bathing risk for people with disabilities

Lecture:

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.

Scalding

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

Characteristics;

  • Minor damage to the skin
  • Color- pink to red
  • Painful
  • 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
  • Towel
  • Body wash/soap
  • Body lotion
  • Toothbrush
  • Toothpaste
  • Mouthwash
  • 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:

COMPETENCY DEMONSTRATION CHECKLIST

Click on the link below to download the training in Word format

bathing module

 

 

10 Easy Steps of Audit and Survey Readiness

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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.

Audit Preparation

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:

  1. Knowledge of Individuals. know each person’s plan including person-centered planning plan, medical needs, preferences and habilitation plan.
  2. Cleanliness. Make sure the environment is neat and orderly.
  3. Privacy. Remember to give the person privacy when needed.
  4. Choice. Offer choices throughout activities whenever possible. The auditors may ask you how do you teach choice-making.
  5. Tone. Always speak in a positive and appropriate tone of voice.
  6. Small groups. Work in small groups whenever possible. Incorporate variety  of choice during activities.
  7. Community activities. Ensure individuals are able to make choices in activities in the community and community inclusion opportunities are available.
  8. Universal Precaution Guidelines. Know the precautions and follow them. Remember to change gloves when moving from one individual to the next.
  9. Active Programming. The auditors may ask questions related to what they have read in the individuals ISP or CFA (Comprehensive Functional Assessment).
  10. 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!

Election Lesson Plan and Activities for Day Hab

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Since President Trump’s, election, there has been a vigorous interest in politics not only in the United States but also in other countries as well. The upcoming mid-term elections provides an opportunity for adults with developmental disabilities to participate through a lesson plan created not only on the upcoming election, but also ways to get individuals more involved on topics and platforms that impact their lives.

Sadly, I have heard very little from politicians on issues concerning people with disabilities and the impact it will have on people with disabilities and their families. This affords an opportunity to have real discussion with people on issues that are important to them through a series of multisensory activities.

  1. Who doesn’t like a game of bingo? Download the bingo template, make as many copies as you wish and set up an activity playing Bingo. Once you call out a name. use it as an opportunity to have discussion i.e. How would you describe a conservative? When is the election held? Below, click on the template


Bingo.download

2. The second activity includes a week-long lesson plan on election and representative in office using a multisensory approach.  The first day is set up for making an apple smoothie and a trip preparation activities allowing individuals to work on their social and money management skills. I left the lesson plan editable so that you can move activities around as you wish.


election.dayhab

Materials Needed for the lesson plan activities

Mock Voter Registration

mock voter registration

Apple Smoothie Recipe

Apple Smoothie Recipe

Caramel Apple Smoothie

Patriotic Printable Paper Chain

Free patriotic printable chain

Patriotic paper chain with needed supplies

Oh, this is also a great activity to use a home or school for students at the high school level.

 

15 Halloween Fine Motor Skill Activities

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Candy is not the only great thing about Halloween. It is a chance to work on fine motor skills and eye-hand coordination while having fun at the same time. From ghosts to witches, there are a number of activities you child or student can do that will help increase fine motor skills. For some children and adults with disabilities, struggle with fine motor skills. These activities are a chance to improve the coordination between the brain and the muscles including dexterity and motor control. Click on the links below.

Easy Halloween fine motor activity

Eyeball sensory bag

Feed the spider

Frankenstein monster pumpkin

Halloween fine motor: Giant lacing spiderweb

Halloween fine motor activities for preschool

Halloween fine motor activities that promote cutting practice

Halloween mask to print and color

Halloween Necklaces

Halloween Play Dough

Halloween themed cutting tray

Scissor skill pumpkins

Spider web yarn

Witchy fingers

Yarn wrapped spider craft for halloween

15 Visual Schedule Resources

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Imagine during the course of the day you have no idea what is expected of you. Moving from one activity to the next depending on others to inform you of your daily plans. there are many benefits to using visual schedules especially for autistic children and adults. Studies show that many people diagnosed with autism experience high levels of anxiety often caused by unstructured activities.

Visual schedules are a way to communicate an activity through the use of images, symbols, photos, words, numbers and drawings that will help a child or adult follow rules and guidelines and understand what is expected during the course of the day.

Th following are resources containing information on creating visual schedules and free printables:

8 types of visual student schedules

Building a daily schedule

Daily visual schedule for kids free printable

Examples of classroom and individual schedule and activity cards

Free picture schedule

Free visual schedule printables to help kids with daily routines

Free visual school schedules

How to templates- visual schedules

How to use visuals purposefully and effectively

Time to eat visual schedules

Using visual schedules: A guide for parents

Visual schedule for toddlers

Visual schedule resources

Visual supports and autism spectrum disorders

What is visual scheduling?

What is Prader Willi Syndrome?

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May is Prader Willi Syndrome Awareness Month

Click here to download PDF version

What Exactly is Prader Willi Syndrome?

Prader Will Syndrome is a genetic disorder resulting from an abnormality of chromosome 15 such as a loss of active genes. In most cases (70%) the paternal copy is missing and in some cases (25%), will exhibit two maternal copies of Chromosome 15. The genetic disorder was initially described by John Langdon Down and was named after Drs. Andrea Prader, Heimrich Willi and Alexis Labhart in 1956 and is found in 1 in 20,000 births affecting both sexes. It is also the most common recognized genetic form of obesity.

During childhood, individuals diagnosed with Prader-Willi Syndrome tend to eat constantly leading to obesity and for some, type 2 diabetes will develop. This complex disorder affects appetite,growth, metabolism, cognitive functioning and behavior.

Signs and Symptoms

People with Prader-Willi Syndrome (PWS) tend to never feel full (hyperphagia) which leads to constant eating. Signs in infants include, problems with strength, coordination and balance. Often there are feeding problems at birth, delayed speech and gross motor development. Children may be born with almond-shaped eyes and undeveloped sexual organs. Cognitive disabilities and developmental delays may also be present.

As children began to grow, constant craving for food often leads to behavior challenges including hoarding food, eating frozen food and food left in the garbage causing controlling or manipulative behavior.

Medical Issues

Medical concerns may include the following:

  • Sleep Apnea
  • Respiratory/Breathing
  • High pain tolerance
  • Severe stomach illness
  • Difficulty with vomiting reflex
  • Excessive appetite
  • Binge eating
  • Eye problems
  • Choking
  • Hypothermia
  • Leg Swelling
  • Consuming unsafe items
  • Negative reactions to medications
Teaching Strategies

Most people diagnosed with Prader Willi Syndrome fall between the moderate and mild levels of an intellectual disability meaning there may be challenges in the area of reasoning, problem-solving, planning, judgment, abstract thinking and learning.  A child or student functioning at the moderate level may lag behind their peers in the area of language and pre-academic skills. Adults may function at an elementary school level and will require support in both work and daily living skills. For children and students functioning at the mild level, there may be difficulties in the area of reading, writing, math and money management. as children grow into adults, there may be a need for support in abstract thinking, executive functioning (planning, prioritizing and flexibility) as well as short-term memory and money management.  Teaching strategies should focus on the following:

  • Aggression management
  • Anger management skills
  • Anxiety management
  • Emotional regulation
  • Personal safety
  • Social skills

Keep in mind that many children and adults diagnosed with Prader-Willi Syndrome may have additional challenges in learning due to medication. Some people take medication such as a growth hormone therapy which can cause fatigue.  The following teaching strategies may also be useful when teaching a student diagnosed with Prader Willi Syndrome:

  • Use a multi-sensory approach. This involves a teaching style that includes auditory, visual, tactile, spatial, and kinesthetic (hands on activities)
  • Break learning into small steps. Check for understanding by asking the student to repeat back to you.
  • Teach a skill at least 2-3 times a day. This will help the student retain information.
  • Managing perseveration. Set up a rule where the student can a question no more than 3 times. After the third answer. Ask the student to repeat the response back to you.
Adult Day Program/Residential Setting

Most people with Prader Willi Syndrome due to their cognitive level, will be provided services in either a day habilitation program or live in a community providing residential services. Once a person becomes an adult, it becomes a little bit more tricky on maintaining issues especially behavioral. For instance, while living at home, a parent has the right to lock the refrigerator which is often suggested by experts. However, this becomes a violations of a person’s rights once they reach adulthood. Typically, committees meet to help make the right decisions along with family members and the adult diagnosed with Prader Willi Syndrome. Here are some suggestions.

  • Allow the person to have control of what is important to them. Have discussions on nutrition and staying healthy. Check to see if this may be an appropriate topic the person may want to improve by adding to their person-centered plan. Hold discussion groups in both day programs as well as in residential to discuss various topics on health and nutrition including holding classes on mindfulness and meditation.
  • Trips to shopping malls can be very tricky. Try to avoid mall’s eatery and plan if it is a group trip to have people bring their own lunches.
  • When teaching, allow time before giving additional prompts
  • Give praise as much as you can when it is appropriate.
  • Use visuals as much as you can including graphics and pictures.
Staff Training

Staff training on Prader-Willi Syndrome should include the following topics:

  • Overview of Prader-Willi Syndrome including, causes, symptoms, characteristics, nutrition, and self-regulation.
  • Impact on the family including the stresses families experience.
  • Teaching techniques including problem-solving, forward shaping and role-modeling.
  • Individual rights
  • Managing behavior and crisis intervention
  • Community inclusion trips and activities
Resources

Foundation for Prader-Willi Research

Prader-Willi Syndrome Association (USA)

Prader-Willi Syndrome (Mayo Clinic)

Reference

Prader-Willi Syndrome Association

 

Speech-language Pathology and Adult Services

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Guest Blogger, Anne Marie Pineiro, M.A. CCC-SLP, 

Speech-language Pathologists serve individuals, families, and groups from diverse

linguistic and cultural backgrounds. Services are provided based on applying the

best available research evidence, using expert clinical judgments, and considering

clients’ individual preferences and values. Speech-language pathologists address

typical and atypical communication and swallowing in the following areas:

–pragmatics (language use, social aspects of communication)

-literacy (reading, writing, spelling)

– prelinguistic communication (e.g., joint attention, intentionality, communicative signaling)

–paralinguistic communication

  • cognition- attention,  memory,  sequencing,  problem solving,  executive functioning
  • feeding and swallowing- 4 phases of swallowing

-oral, pharyngeal, laryngeal, esophageal

–orofacial myology (including tongue thrust)

-oral-motor functions

Source:   http://www.asha.org/uploadedFiles/SP2007-00283.pdf

In providing services to those Adults diagnosed with a variety of Developmental Disabilities, the SLP’s role may become much more defined, focusing on what is most functional to an individual in the areas of speech, receptive and expressive language (verbal or non-verbal communication) and feeding/ swallowing.  Very often we are attempting to assess and/or maintain an individual’s current level of functioning in the above areas and to train all those involved in the care of that individual in the strategies and implementation of them to achieve that goal.  In our Agency, for example, we break the assessment down into the following areas in order to develop functional and measurable outcomes:

Speech

  1. Does the individual use speech functionally to communicate wants/needs in a variety of settings?
  2. If so, is their speech understood by all, some, few communicative partners?  Are there any strategies a person might use to increase his/her intelligibility- modifying volume, rate, resonance, increasing fluency, etc.?  Does the person use Augmentative Communication to supplement speech when he/she cannot be understood e.g. low/high tech communication device, writing, American Sign Language, Picture Language Board, etc.

Language

  1. Receptive language (Language comprehension) including attention to objects, using objects functionally, identification of objects and/or pictures, comprehending one, two or three-step oral directives, vocabulary, comprehension of attributes and spatial relationships, or auditory comprehension on the word, sentence and paragraph levels.  Is comprehension on the literal or inferential levels?
  2. Expressive language- (Language expression)- for those who are verbal, the MLU (mean length of utterance) is assessed.  For non-verbal individuals, language expression can be in the form of pointing to one or two picture symbols consecutively on a picture language communication board or AAC device, writing or typing single words, phrases, sentences or paragraphs on paper, computer or AAC device.

-AAC device assessments for nonverbal individuals take into account the individual’s cognitive skills, physical abilities in order to access the device (direct selection with hand or finger, eye gaze, head pointer, switch/scanning, etc.), receptive and expressive language skills, communicative intent and pragmatic language abilities, and literacy.  All those involved in the individual’s care play an extremely important role in whether or not someone may receive an AAC device since they will be the ones to set up/take down the device and provide basic maintenance for the device, including programming, charging, etc.

Feeding and Swallowing:

Many people wonder why an SLP would be the one to review an individual’s mealtime plan or protocol.  ASHA guidelines state it best: “The speech-language pathologist is a primary professional involved in assessment and management of individuals with swallowing and feeding disorders. These areas include:

  • Performing clinical swallowing and feeding evaluation;
  • Performing instrumental assessment of swallowing function with medical professionals as appropriate;
  • Identifying normal and abnormal swallowing anatomy and physiology;
  • Identifying signs of possible or potential disorders in upper aerodigestive tract swallowing and making referrals to appropriate medical personnel;
  • Making decisions about management of swallowing and feeding disorders;
  • Developing treatment plans;
  • Providing treatment for swallowing and feeding disorders, documenting progress, and determining appropriate dismissal criteria;
  • Providing teaching and counseling to individuals and their families;
  • Educating other professionals on the needs of individuals with swallowing and feeding disorders and the speech-language pathologists’ role in the diagnosis and management of swallowing and feeding disorders;
  • Serving as an integral part of a team as appropriate;
  • Advocating for services for individuals with swallowing and feeding disorders;
  • Advancing the knowledge base through research activities.

In addition, Speech-language pathologists have extensive knowledge of anatomy, physiology, and functional aspects of the upper aerodigestive tract for swallowing and speech across the age spectrum including infants, children, and adults (including geriatrics). The upper aerodigestive tract includes oral, pharyngeal, and cervical esophageal anatomic regions. Speech-language pathologists also have extensive knowledge of the underlying medical and behavioral etiologies of swallowing and feeding disorders. In addition, they have expertise in all aspects of communication disorders that include cognition, language, and behavioral interactions, many of which may affect the diagnosis and management of swallowing and feeding disorders.”

Source: http://www.asha.org/policy/TR2001-00150/#sec1.3

The dysphagia and feeding disorders that are seen in adults with developmental disability include poorly developed and absent feeding and oral preparation skills and competencies, physiological and anatomical impairments that degrade oral-pharyngeal and esophageal bolus motility, and disruptive or maladaptive mealtime behaviors. Nutrition, hydration, saliva management, ingestion of medications, and management of the oral hygiene bolus may be involved. Upper airway obstruction (choking), aspiration, malnutrition, and dehydration may result from the disorder (Rogers et al., 1994, Sheppard et al., 1988).  Source: http://www.asha.org/policy/TR2001-00150/#sec1.3

Therefore, in our Agency that serves Adults with Developmental Disabilities, the SLP works as one member of the Team, including the Occupational Therapist, Physical Therapist, Nurse, Residential Team and Family Members to create a mealtime protocol or plan which simply states the best way to maximize nutrition while at the same time attempting to decrease incidents of choking (partial or complete blockage of the airway) or aspiration (food or liquid making its way into the lungs which can lead to aspiration pneumonia).  These plans are developed so that all involved in the individual’s care may be informed of the best feeding practices for that individual which include: adaptive mealtime equipment (any cup spoon, plate, straw, etc. used for an individual to improve ability to eat independently and to improve oral-motor control), positioning in chair or wheelchair, degrees of assistance needed for self-feeding, food and liquid consistencies, food allergies and intolerances, the presence of any mealtime behaviors, including rapid pace of eating which may increase risk of choking or aspiration, and any specific instructions the caregiver would find useful in feeding the individual or maximizing the individual’s ability to feed themselves.

I hope you find this information helpful in identifying the SLP’s role in providing services to adults with Developmental Disabilities.

This information is in no way intended to serve as a complete guide in this area, but is meant to simply assist in identifying ways the SLP works as part of the Interdisciplinary Team in serving adults with developmental disabilities in a day habilitation setting

Lesson Plan: Sensory Activities for Children and Adults

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Orange is a color that is associated with the fall months of October and November. It can also be used as a training activity for people with developmental disabilities.

Click here to download a printed version

Facts about the color orange:

  • Orange is the color between red and yellow
  • It is associated with amusement, extroverts, warmth, fire ,energy, danger taste, aroma and autumn
  • It is the national color of Netherlands
  • It is the symbolic color of Buddhism and Hinduism.

Activity: What’s in the Box

Learning Objective: to identify various items using a multi-sensory approach

Activity Area:

  • Visual
  • Tactile
  • Olfactory
  • Kinesthetic

Materials needed:

  • shoe box
  • candy corn
  • carrot
  • orange
  • circus peanuts
  • crayon
  • cheeze-it
  • balloon
  • pumpkin
  • leaf

Instructions: Place all items into an empty container such as a shoe box. Once completed, have participants sit in a circle and pass around the box. Give each person an opportunity to touch the object and to guess the name of the object. For people with a severe cognitive level or multi-disabilities, provide hand over hand guidance.

Prompting:

Discuss with the group or class the various sizes, the aroma, etc.

Alternative Activity:

  1. You can also do a compare and contrast activity by adding items into the box of different colors and having the group choose the orange items.
  2. Have the group create a collage by cutting out items in a magazine that are orange. This will help with improving fine motor skills.

 

 

Understanding Medicaid Waiver Services

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Medicaid.gov - Keeping America Healthy

Home and Community-Based services Waiver allows people with long-term such as disabilities to receive services in a home or community setting. The goal of the waiver program is to enable States to tailor services to meet the needs of a particular group. Standard services can include case management, home health aide, adult day habilitation and respite care. The Federal and State Governments jointly fund and administers the program. At the Federal level, the Centers for Medicare and Medicaid Services (CMS) administers the program. Each State administer its Medicaid program in accordance with CMS approved State plan. Each State is allowed a great amount of flexibility in designing and operation it its Medicaid program as long as it complies with the Federal requirements.

 

Activity Ideas for Developmental Disabled Adults

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Board games.
Source: E-How

When it comes to activities, disabled adults have distinctive needs. Unlike average adults, disabled people may require the help of respite workers to do certain activities. However, the needs of disabled adults are not always comparable to those of disabled children because many disabled adults are sexually mature and socially competent. Many activities meet the needs of developmentally disabled adults. Click here to read the rest of the story

Developmental Disability Acronyms You Should Know

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Similar to special education, adult programs are full of acronyms that are used during meetings and in general conversation. Whether you are new to the field or a parent or caregiver with a child entering adult services, you will find this page useful as you navigate your way through adult services and programs.

Click here for a printed version

acronyms

 

Active Treatment (AT). A continuous, aggressive, and consistent implementation of a program of specialized training, treatment and related services that helps people function as independent as possible.

American Disabilities Act (ADA)- A civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life.

Assessment– A way of diagnosing and planning treatment for individuals with disabilities as part of their individual plan of service.

Autism Spectrum Disorder (ASD)- A group of development disorders that can cause significant social, communication and behavioral challenges.

Cerebral Palsy– A disorder that affects muscle tone, movement and motor skills.

Commission on the Accreditation of Rehabilitation Facilities (CARF)- An independent, non-profit accreditor of health and human service organizations.

Council on Developmental Disabilities-State Councils on Developmental Disabilities (Councils) are federally funded, self-governing organizations charged with identifying the most pressing needs of people with developmental disabilities in their state or territory. Councils are committed to advancing public policy and systems change that help these individuals gain more control over their lives.

Day Program– A day program to assist individuals in acquiring, retaining, and improving skills necessary to successfully reside in a community setting. Services may include assistance with acquisition, retention, or improvement in self-help, socialization, and adaptive skills; provision of social, recreational, and therapeutic activities to maintain physical, recreational, personal care, and community integration skills; and development of non-job task-oriented prevocational skills such as compliance, attendance, task completion, problem solving, and safety; and supervision for health and safety.

Developmental Disability– A group of conditions due to an impairment in physical, learning, language or behavior areas.

Developmental Center– residential facility serving individuals with developmental disabilities owned and operated by the State.

Habilitation– Service that help you keep, learn, or improve skills and functioning for daily living.

Human and Community Based Services (HCBS Waive)- Provides opportunities beneficiaries  for Medicaid beneficiaries to receive services  in their own home or community.

Health Insurance Portability and Accountability Act (HIPPA) – Protects individuals records and other personal information.

Intermediate Care Facilities (ICF/ID)- Medicaid benefit that enables states to provide comprehensive and individualized healthcare and rehabilitation services to individuals to promote their independence.

Independent Living Center (ILC)- Community-based resource, advocacy and training center dedicated to improving the quality of life for people with disabilities.

Individualized Service Plan (ISP)- Written details of the supports, activities and resources required for the individual to achieve personal goals.

Individual supported employment-  Competitive employment in the community in integrated business settings for comparable wages.  Paid support staff provides training on the job site as well as follow along services and supports to the individual and business as needed.
Job Coach– An individual employed to help people with disabilities learn, accommodate and perform their work duties including interpersonal skills.

Individualized Supported Living Arrangement (ISLA) – This residential service is provided to people with developmental disabilities and/or intellectual disabilities in their own homes or apartments.  The level of support provided is individualized to the person’s need for training and assistance with personal care, laundry, money management, etc.  Individuals who receive ISLA typically need a higher level of support than people in a Supported Living Arrangement (SLA).

Intellectual Disability–  a disability characterized by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills. This disability originates before the age of 18.

Least Restrictive Environment (LRE)- Individuals with disabilities should live in the community of their choice and receive the necessary services that will help them maintain their independence.

Level of Care- ICF eligibility determination

Person Centered Planning (PCP)- A set of approaches designed to assist someone to plan their life and supports. Used as an ongoing problem-solving process uses to help people with disabilities plan for their future.

Plan of Care– A document developed after the assessment that identifies the nursing diagnoses to be addressed in the hospital or clinic. The plan of care includes the objectives, nursing interventions and time frame for accomplishments and evaluation.

Provider-Typically private non-profit community organizations that provide vocational (and other types) of services to adults with disabilities.  These services are usually paid by state agencies.

Qualified Intellectual Disability Professional (QIDP) -Ensures individuals with Developmental and Intellectual disabilities receive continuous active treatment in accordance with Individual Support Plans (ISPs). Provide counseling, case management, and structured behavior programming to people with disabilities receiving Residential Services.  Responsible for the implementation of rules and regulations as required by licensing entities. Qualified Developmental Disability Professional (QDDP): Individual qualified to work as an expert with persons with developmental disabilities. The QDDP has a four-year college degree in an area related to developmental disabilities and a minimum of one-year experience working in that field.

Quality Assurance/Improvement (QA/QI)- Facilitate quality improvement activities to ensure compliance with accreditation standards regulations, funding source requirements, agency standards and assurance that all required manuals and procedures are maintained and implemented

Residential Care – Services provided in a facility in which at least five unrelated adults reside, and in which personal care, therapeutic, social, and recreational programming are provided in conjunction with shelter.  This service includes 24-hour on-site response staff to meet scheduled and unpredictable needs and to provide supervision, safety, and security.

Respite Care – Temporary relief to a primary caregiver for a specified period of time.  The  caregiver is relieved of the stress and demands associated with continuous daily care.
Self-Advocacy: an individual with disabilities speaking up and making their own decisions.

Self-Determination- Individuals have control over those aspects of life that are important to them, such as the services they receive, their career choices and goals, where they live, and which community activities they are involved in.

Service Coordination- Assists individuals with developmental disabilities and their families in gaining access to services and supports appropriate to their needs.

Supported Employment- Community based employment for individuals with disabilities in integrated work settings with ongoing training and support typically provided by paid job coaches.
Supported

Transition Services – Services provided to assist students with disabilities as they move from school to adult services and/or employment.

Transition Planning

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IDEA Regulations and Transition Services

The term “transition services” means a coordinated set of activities for a child with a disability that:

  • Is designed to be within a results-oriented process, that is focused on improving the academic and functional achievement of the child with the disability to facilitate the child’s movement from school to post-school activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation
  • Is based on the individual child’s needs, taking into account the child’s strengths, preferences, and interest.
  • Includes instruction , related services, community experiences, the development of employment and other post-school adult living objectives, and if appropriate, acquisition of daily living skills and functional vocational evaluations.
What is the Transition Process?

The transition process is designed to help students with disabilities move smoothly from school to adult life.

Resources on Transition Planning

Center for Parent Information and Resources– Webpage includes information on IDEA’s requirement on transition and how to include the student in the transition process.

Disability’s.gov’s Guide to Student Transition Planning– Topical links on secondary education and transition, transitioning to adult health care and options for life after high school.

National Association of Special Education Teachers– Great webpage on a variety of topics relating to transition planning including, overview of transition services, types of services covered, recordkeeping, employment planning, travel training, assistive technology and residential placement options.

National Parent Center on Transition and Employment– Website includes information on middle and high school transitioning planning including, IDEA, IEP, college planning and several worksheets on preparing for employment and transition planning.

Understood– article on understanding the transition process.

WrightsLaw– This page contains loads of information on transitioning planning including articles on IEP and transition planning, legal requirement for transition components of the IEP and IDEA 2004.

Happy Holidays!

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HAPPY HOLIDAYS2015

Special Needs Resource Blog will take a break during the holidays and will return Monday, January 4, 2016 with new information, tools and resources to post including more downloadable free tools and templates Monday thru Thursday. I am excited and look forward to sharing more resources with you in the new year.
Thanks to all of you for following my blog this year. Wishing you and your families joy and peace all through the holidays and throughout the new year. May the spirit of the holidays be with you throughout the new year.  🙂   🙂

 

HAPPY THANKSGIVING!

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