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:
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:
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
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.
A generalized seizure, formally known as a gran mal seizure affects both sides of the brain, and starts in all parts of the brain at the same time. About 25 percent of people with epilepsy have generalized seizures. It affects all ages, socioeconomic and racial groups.
There are 4 phases of a generalized seizure:
Prodromal. This is the first phase where an early sign may include a group of symptoms hours or days before the seizure including depression, difficulty concentrating, headaches, insomnia and mood changes.
Aura. Typically, an aura occurs from a few seconds to a few minutes before the arrival of the seizure. Signs may include blurry vision, buzzing, ringing or an abdominal sensation.
Tonic-Clonic. This is the phase where the whole body is affected. The body begins to stiffen and the person loses consciousness and falls. This is followed by a violent uncontrollable shaking. During this phase, the person may have difficulty breathing, an inability to swallow, may drool and begin to sweat.
Postictal. Occurs at the end of the seizure, common signs include confusion, anxiety, depression, embarrassment, fear, memory loss, upset stomach and sleepiness.
There are 6 types of generalized seizures:
Absence (Petit Mal). It occurs throughout the entire brain beginning and ending very quickly. The person becomes unconscious with a blank stare. It may appear the person is day dreaming.
Tonic-Clonic. When the body stiffens and shakes. usually last 1 to 3 minutes.
Clonic. When a person has a muscle spasm in the face, neck and arms may last several minutes.
Tonic. The muscles in the arms, legs and trunk are affected. Usually last less than 20 seconds.
Atonic. the muscles go limp and can cause a person to fall or head his or her head if they are standing.
Myoclonic. Muscles suddenly jerk. The electrical impulses are strong enough to throw a person to the ground.
What Causes Epilepsy with Generalized Seizures?
Possible causes of epilepsy and seizures include:
a change in the structure of your brain
an infections of the brain, such as meningitis or encephalitis
a brain tumor
a stroke, or a loss of blood flow to the brain resulting in brain cell death
congenital conditions, including Down syndrome or tuberous sclerosis
First Aid For Tonic Clonic Seizures:
Call 911 if:
The person has never had a seizure before.
the person has difficulty breathing or waking after the seizure.
The seizure lasts longer than 5 minutes.
The person has a seizure back-to back.
The person is injured during the seizure.
The person has an additional condition like diabetes, or heart disease.
Ease the person to the floor.
Turn the person gently onto the side (this will help the person breathe).
Clear the area around the person of anything hard or sharp
Put something soft and flat, like a folded jacket, under his or her head.
Loosen ties or anything around the neck including button on a shirt.
Time the seizure.
Familiarize Yourself With The Warning Signs
Each person is different. Typically warning signs of a seizure may include:
Loss of consciousness
Stiffening of the body
Jerking of limbs
A loss of awareness
Do not hold the person down or try to stop his or her movements.
Do not put anything in the person’s mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue.
Do not try to give mouth-to-mouth breaths (CPR). People usually start breathing again on their own after a seizure.
Do not offer the person water or food until he or she is fully alert.
After the seizure:
After the seizure ends, the person will probably be groggy and tired. He or she also may have a headache and be confused or embarrassed. Try to help the person find a place to rest. If necessary, offer to call a taxi, a friend, or a relative to help the person get home safely.
Don’t try to stop the person from wandering unless he or she is in danger.
Don’t shake the person or shout.
Stay with the person until he or she is completely alert.
Annual awareness observances are sponsored by federal, health and non-profit organizations. Awareness campaigns serve the purpose of informing and educating people on a certain causes. Each year, the number of special needs organizations bringing awareness to specific disabilities and disorders seem to grow. Awareness activities range from one day to a month. Here is a calendar of major special needs awareness months, weeks, and days. Most websites include awareness toolkits, promotional materials and fact sheets. Since it is still early in the year, some of the campaigns still have 2018 campaigns on their websites. I will add new information once the changes are up on the websites.
Fine motor skill activities should include skill development in using the small muscles in the hand. Most activities focus on using pencils, scissors and tongs. This holiday season, why not engage your special needs child in a fun, engaging activity that will help to improve the pincer grasp and hand manipulation? The following links include fine motor activities with many items you can find around your home.
Sequence is defined as a set of related events, movements, or things that follow each other in a particular order. For many children and adults with developmental delays and disabilities, the ability to arrange thoughts, information and language may be a challenge due to issues with their executive function capabilities. The following resources, tips and strategies will help you teach sequencing skills.
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!
Nonverbal Learning Disorder is a disorder you may or nay not heard of. It shares similar characteristics to autism such as the challenge in reading body language but is also quite different. By learning the signs and symptoms of nonverbal learning disorder, the better chance you have in using effective teaching strategies.
Nonverbal learning disorder is defines as a person who has difficulty in interpreting and understanding non verbal cues in the environment If 93% of how we communicate is nonverbal, a person with nonverbal learning disorder is only getting 7% of daily communication.
Dr. Byron P. Rouke of the University of Windsor developed the following criteria to assess nonverbal learning disorder:
Perceptual deficits usually on the left side of the body. The child has difficulty understanding or perceiving information through the skin of both hands but the left hand has more difficulty than the right.
Tends to be clumsy
Difficulty with visual-spatial organizational skills. Finds it difficult to organize notes.
Difficulty when encountering new information.
Difficulty in knowing what is expected of you and hard to see the bigger picture
Distort sense of time. Time is abstract and non-linear
Well-developed, rote and verbal capacity
Repetitive way of speaking
Signs and Symptoms
Excellent vocabulary and verbal expression
Excellent memory skills
unable to see the bigger picture
Poor motor and coordination skills
Difficulty with reading
Difficulty with math reading problems
Fear of new situations
May have symptoms of anxiety, depression
Misreads body language
Better auditory processing skills than visual processing skills
Focus on details
Teaching Strategies For Parents and Teachers
Give assignments in chunks
Give constructive feedback
Create a daily class routine and stick to them
Write the class schedule on the board
Provide several verbal cues before transition
Give the student time to preview and prepare for new activities such as group projects
Offer added verbal explanations when the student or child seems confused
Teach in sequential steps
Rondalyn Varney Whitney/OTR, Nonverbal learning disorder: Understanding and coping with NLD and Aspergers: What parents and teachers need to know (2008)
Woliver, Robbie (2008) Alphabet Kids: From ADD to Zellwer Syndrome.