Studies show that both children and adults with developmental disabilities are vulnerable to incidents of abuse and injuries. Personal safety includes learning about being safe and dangerous environments. The following articles focus on teaching tips in both the community and in the home.
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
- 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.
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:
- 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.
Whole. Food is served as it is normally prepared; no changes are needed in
preparation or consistency
1 ” Pieces cut to size. Food is served as prepared and cut into 1-inch pieces
(about the width of a fork).
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)
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
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.
- 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
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.
Common symptoms of cystic fibrosis include:
- Salty-tasting skin
- Persistent coughing
- Shortness of breath
- 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.
May is Williams Syndrome Awareness Month. It is a rare genetic condition that affects over 1 in 10,000 people worldwide. If you teach in a special needs classroom or work in an adult day habilitation program, it is likely you have experienced working and teaching a student or individual diagnosed with Williams Syndrome. Below you will find some interesting facts and statistics on the disorder:
- It is a genetic condition that is present a birth.
- It is a developmental disorder
- Tend to have a mild or moderate intellectual disability.
- It is also known as Beuren Syndrome and Williams-Beuren Syndrome.
- The symptoms were first described by John C.P. Williams in 1961.
- A year later, German Physician, A.J. Beuren described three new incidents of patients with similar facial features.
- It is caused by the spontaneous deletion of 26-28 genes on Chromosome #7
- The deletion is caused by either the sperm or the egg.
- The deletion is present at the time of conception
- The most common symptoms of Williams Syndrome includes unusual facial features and heart defects.
- The diagnosis is typically confirmed after identifying facial features and genetic testing.
- An individual with Williams Syndrome has a 50% chance of passing the disorder on to their children.
- Williams Syndrome affects 1 in 10,000 people worldwide.
- An estimated 20,000 to 30,000 people in the United States are affected.
- It occurs in both males and females equally
- It is found in every culture
- Individuals with Williams Syndrome tend to be overly friendly.
- People with Williams Syndrome often have difficulty with visual-spatial tasks
- Congenital heart defects (CHD) occur in approximately 75 percent of children
- By the age of 30, the majority of individuals with Williams Syndrome have pre-diabetes or diabetes.
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 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
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.
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
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!