Monday, May 09, 2016
Compliance
Looks like its been a while since I wrote anything, so here goes...
Compliance - sounds obvious, doesn't it? We of course, want our clients to comply with our directions. But is compliance always what we want?
I tell the story in my book "How to Teach Daily Living Skills to Adults with Developmental Disabilities about one of our clients who showed up one morning with a brand new lunch pail. He was VERY proud of this lunch pail. Staff said, "Yeah, yeah," and told him to put it in his locker because he was scheduled for a Nutrition Activity that day and the group would be making lunch there at our facility.
And they didn't just tell him once, they repeated the demand until he finally reached the assaultive stage of behavior. Then somehow, it was his fault that he hit a staff person. Seriously? What would it have hurt to let him take his lunch box into the kitchen during lunch time? Would it have interfered in his participation in the nutrition activity somehow? Staff agreed afterwards that no, it wouldn't have hurt a darned thing... but he's supposed to do what he's told!
Do you always do everything that you're told to do?
Don't get me wrong... when a safety issue is at hand, then yes, we want compliance! But use some common sense - if you can prevent someone from becoming assaultive by letting them carry a lunchbox around, then let them carry the danged lunchbox. If he's threatening others using the lunchbox as a weapon, that's another story. That's a safety issue.
I think one of our goals is to teach our clients to be independent thinkers. We can certainly talk to that client about why packing around a lunchbox when it isn't needed is unnecessary (why is it unnecessary - especially if its comforting to him?), and maybe talk to him about learning to make a schedule and follow it so he knows the days when he doesn't even need to bring a lunch, but just demanding that he 'follow directions' for no reason isn't a good idea.
You can tie that with using a Prompting Hierarchy to teach skills to clients, also. Using a criteria such as 'Bob will (do whatever) with no more than three verbal prompts' isn't necessarily a good one. Really? We want Bob to learn to do things with three prompts?
Bob, get out of the street, there's a truck coming. Bob, get out of the street, there's a truck coming. Bob, get out of... thump! There's an example of when we do want compliance! But teaching him to wait for a third prompt before getting out of the street is setting yourself up for disaster... and a LOT of paperwork!
Remember... we are supporting ADULTS here. Treat them as adults and explain rationally and calmly WHY you want them to do things a certain way and see if you don't get some results.
Compliance - sounds obvious, doesn't it? We of course, want our clients to comply with our directions. But is compliance always what we want?
I tell the story in my book "How to Teach Daily Living Skills to Adults with Developmental Disabilities about one of our clients who showed up one morning with a brand new lunch pail. He was VERY proud of this lunch pail. Staff said, "Yeah, yeah," and told him to put it in his locker because he was scheduled for a Nutrition Activity that day and the group would be making lunch there at our facility.
And they didn't just tell him once, they repeated the demand until he finally reached the assaultive stage of behavior. Then somehow, it was his fault that he hit a staff person. Seriously? What would it have hurt to let him take his lunch box into the kitchen during lunch time? Would it have interfered in his participation in the nutrition activity somehow? Staff agreed afterwards that no, it wouldn't have hurt a darned thing... but he's supposed to do what he's told!
Do you always do everything that you're told to do?
Don't get me wrong... when a safety issue is at hand, then yes, we want compliance! But use some common sense - if you can prevent someone from becoming assaultive by letting them carry a lunchbox around, then let them carry the danged lunchbox. If he's threatening others using the lunchbox as a weapon, that's another story. That's a safety issue.
I think one of our goals is to teach our clients to be independent thinkers. We can certainly talk to that client about why packing around a lunchbox when it isn't needed is unnecessary (why is it unnecessary - especially if its comforting to him?), and maybe talk to him about learning to make a schedule and follow it so he knows the days when he doesn't even need to bring a lunch, but just demanding that he 'follow directions' for no reason isn't a good idea.
You can tie that with using a Prompting Hierarchy to teach skills to clients, also. Using a criteria such as 'Bob will (do whatever) with no more than three verbal prompts' isn't necessarily a good one. Really? We want Bob to learn to do things with three prompts?
Bob, get out of the street, there's a truck coming. Bob, get out of the street, there's a truck coming. Bob, get out of... thump! There's an example of when we do want compliance! But teaching him to wait for a third prompt before getting out of the street is setting yourself up for disaster... and a LOT of paperwork!
Remember... we are supporting ADULTS here. Treat them as adults and explain rationally and calmly WHY you want them to do things a certain way and see if you don't get some results.
# posted by John @ 11:25 AM 
Comments:
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I am very saddened that you don't have more comments on your blog posts. They are wonderful. Thank you for posting.
I recently was hired as the director to an adult day program that started out just a few months ago. The problem is that the day program has been running unlicensed for years, and the previous way of doing things had nothing to do with treating participants as adults, customizing the program to meet different needs, building life skills, or anything at all. So we're rebuilding from the bottom up, brick by brick so to speak. The most difficult part is re-orienting the staff's perception to understand what a day program should actually be, and how we should treat the participants, in light of doing things differently for so long. It's very difficult to change the direction of any program after it has operated in one way for so long.
Reading your blog is very encouraging. Several of your blog posts reflect the new ideology I am trying to get to stick at this new program. I have doubted many times, since I keep facing resistance and excuses (e.g. the compliance issue you brought up, my staff hate that wholeheartedly. They expect immediate and uncompromising obedience from the participants, often for the silliest things). But your post gives me confidence and reinvigorates me to keep on pushing.
I originally found your blog because I was using Google to search for a good independent living skills curriculum. I am seriously considering your products.
Thanks again for your blog posts, and hope you are enjoying retirement.
I recently was hired as the director to an adult day program that started out just a few months ago. The problem is that the day program has been running unlicensed for years, and the previous way of doing things had nothing to do with treating participants as adults, customizing the program to meet different needs, building life skills, or anything at all. So we're rebuilding from the bottom up, brick by brick so to speak. The most difficult part is re-orienting the staff's perception to understand what a day program should actually be, and how we should treat the participants, in light of doing things differently for so long. It's very difficult to change the direction of any program after it has operated in one way for so long.
Reading your blog is very encouraging. Several of your blog posts reflect the new ideology I am trying to get to stick at this new program. I have doubted many times, since I keep facing resistance and excuses (e.g. the compliance issue you brought up, my staff hate that wholeheartedly. They expect immediate and uncompromising obedience from the participants, often for the silliest things). But your post gives me confidence and reinvigorates me to keep on pushing.
I originally found your blog because I was using Google to search for a good independent living skills curriculum. I am seriously considering your products.
Thanks again for your blog posts, and hope you are enjoying retirement.
# posted by 
: 8:59 AM
: 8:59 AM
William,
I am not saddened, but surprised at the lack of comments. Thanks for yours! I don't know about your agency, but the one I used to work for regularly hired high school graduates with no work experience, and certainly no experience with people with disabilities. Then we let 'experienced staff' train them. That's fine, except that the 'experienced staff' never had any training either.
Put those staff people in a situation where you are dealing with clients with behavioral issues and we end up with a bunch of babysitters who are doing heir best to just get through the day, never mind doing any actual beneficial skills training. I started writing my materials for my own staff since our agency declined to provide any sort of training.
You are so right about changing staff behavior once they have been taught that 'this is the way we do it." And I wish I had a good answer... except start doing some trainings in the basics and let staff figure out that knowing how to do their jobs is easier with basic knowledge, and that we really can make a difference in our clients lives if we approach it with an new attitude. I truly think staff are afraid to try anything when they have seen that babysitting gets them through the day.
Using a prompting hierarchy isn't that hard! Tracking when behaviors occur, for how long, and what is/was going on just prior, who was around, and what happened when the behavior stopped doesn't take a great deal of time and effort, but that's how we figure out what causes behaviors. Once we know why the behavior occurs, then we can start figuring out a way for the client to express the same need in a new way.
And let's make some attempt to figure out how each individual client learns things and quit trying to teach them the way we want them to learn them. It's not rocket surgery!
Anyway, good luck and thank goodness for people like you who want to do the right thing for the clients!
I am not saddened, but surprised at the lack of comments. Thanks for yours! I don't know about your agency, but the one I used to work for regularly hired high school graduates with no work experience, and certainly no experience with people with disabilities. Then we let 'experienced staff' train them. That's fine, except that the 'experienced staff' never had any training either.
Put those staff people in a situation where you are dealing with clients with behavioral issues and we end up with a bunch of babysitters who are doing heir best to just get through the day, never mind doing any actual beneficial skills training. I started writing my materials for my own staff since our agency declined to provide any sort of training.
You are so right about changing staff behavior once they have been taught that 'this is the way we do it." And I wish I had a good answer... except start doing some trainings in the basics and let staff figure out that knowing how to do their jobs is easier with basic knowledge, and that we really can make a difference in our clients lives if we approach it with an new attitude. I truly think staff are afraid to try anything when they have seen that babysitting gets them through the day.
Using a prompting hierarchy isn't that hard! Tracking when behaviors occur, for how long, and what is/was going on just prior, who was around, and what happened when the behavior stopped doesn't take a great deal of time and effort, but that's how we figure out what causes behaviors. Once we know why the behavior occurs, then we can start figuring out a way for the client to express the same need in a new way.
And let's make some attempt to figure out how each individual client learns things and quit trying to teach them the way we want them to learn them. It's not rocket surgery!
Anyway, good luck and thank goodness for people like you who want to do the right thing for the clients!
Thanks again for your blog posts, and hope you are enjoying retirement.
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# posted by : 2:35 PM
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