One Treatment Option Does Not Fit All. Ruth M. Wiseman Chileda La Crosse, WI

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1 One Treatment Option Does Not Fit All Ruth M. Wiseman Chileda La Crosse, WI

about Chileda residential program day school summer school program dual diagnosed autism spectrum disorders attachment disorders seizure,

2 about Chileda residential program day school summer school program dual diagnosed autism spectrum disorders attachment disorders seizure, physical, bi-polar, traumatic brain injury, attention deficit hyperactivity disorder, obsessive compulsive disorder and other disabilities & disorders 2

3 Characteristics of autism: detail focused on specific interests fact based logical black & white (concrete) thinking straightforward - say what they are thinking repetitive & ritualistic visual thinkers and learners nonverbal or limited verbal abilities

4 Chileda Culture communication (supports) social skills (what to say, do and why) daily living skills (personal care, cooking, money skills, etc.) sensory profile (hyper and hypo) leisure skills (how to play, relax, hang out) control over own behaviors (internal controls) specially designed environments empathy compassion modeling 4

5 Approaches include: Crisis Prevention Institute s (CPI) Non-violent Crisis Intervention TEACCH Love and Logic Trauma Informed Care Positive Behavior Supports Augmentative communication Social Learning Hidden Curriculum - Power Cards - Social Stories - 5 Point scale - Comic strip conversations

CPI CRISIS PREVENTION INSTITUTE Nonviolent Crisis Intervention A program focusing on the safe management of disruptive and assaultive behavior.

6 CPI CRISIS PREVENTION INSTITUTE Nonviolent Crisis Intervention A program focusing on the safe management of disruptive and assaultive behavior. CPI purposes of Nonviolent Crisis Intervention: understand how crisis develops and escalates awareness of behaviors associated with crisis utilize consistent and supportive responses to developing crisis maintain a safe environment communicate tips and techniques individual and team interventions benefits of using CPI s Nonviolent Crisis Intervention at Chileda: maintaining a safe environment providing consistent management of challenging behaviors

7 CPI continued

8 Trauma-Informed Care Trauma-informed care is an approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. NCTIC facilitates the adoption of trauma-informed environments in the delivery of a broad range of services including mental health, substance use, housing, vocational or employment support, domestic violence and victim assistance, and peer support. In all of these environments, NCTIC seeks to change the paradigm from one that asks, "What's wrong with you?" to one that asks, "What has happened to you? National Center for Trauma Informed Care

Three Pillars of Trauma Informed Care SAFETY CONNECTIONS EMOTIONAL/IMPULSE CONTROL Praise safe behavior Be empathetic Help remind what has worked in the past Give time and space Validate feelings

9 Three Pillars of Trauma Informed Care SAFETY CONNECTIONS EMOTIONAL/IMPULSE CONTROL Praise safe behavior Be empathetic Help remind what has worked in the past Give time and space Validate feelings Offer choices Use a team approach Be predictable Use inclusive language... Let s go for a walk - We can... Use a calm, interested Ask questions Plant seeds/ideas on how to and concerned voice about safety be successful in similar and comfort situation in the future

10 Single-Event vs. Complex Trauma Single-Event Trauma: An isolated event that may occur within the context of both emotional and physical safety. Complex Trauma: Relates to toxic stress or ongoing negative experiences that provide no emotional or physical relief Ex) Generational poverty, mother/infant attachment style Center for Early Childhood Mental Health Consultation, Georgetown University Center for Child and Human Development

11 Developmental Complex Trauma Early age chronic stress due to violence, abuse, neglect, abandonment or changes in primary caregiver Safety threat Occurs early in life when child does not have a base of coping skills Toxic Stress: videos/three_core_concepts/toxic_stress/

12 Attachment Disorganized attachment patterns Is a trauma in itself Traumas that tend to go hand in hand Neglect Abuse (emotional, mental, physical, sexual) Attachment Challenges VS. the School Mission A school s mission is to teach, but the concerns of a child with attachment challenges include safety, security and trust. Schwartz & Davis, 2006

13 Executive Functioning Skills In the brain, the ability to hold onto the work with information, focus thinking, filter distractions, and switch gears is like an airport having a highly effective air traffic control system to manage the arrivals and departures of dozens of planes on multiple runways. INBRIEF: Executive Function: Skills for Life and Learning

14 Executive Functioning Continued Includes the areas of: Attention, focus and memory Organization Time management and planning Poor sequential and cause and effect thinking Task initiation and execution Behavior and response inhibition Social and emotional control Self-regulation and monitoring Video:

15 Theory of Mind Theory of Mind (TOM) Theory of mind is the capacity we have to understand mental states such as: believes, feelings, desires, hope and intentions. It s the way we imagine other people s feelings or thoughts. We can create a mental picture of our own emotions or other people s feelings. This theory of mind enables us to understand the behavior people display is caused by their inner feelings, believes or intensions. We can predict some of those behaviors and anticipate on them. Whatever goes on in the mind of other people is not visible so it will remain a theory we create for ourselves.

TEACCH University of North Carolina purpose of TEACCH strategies: to build independence through structured environments structured activities visual schedules how to begin: assess student s

16 TEACCH University of North Carolina purpose of TEACCH strategies: to build independence through structured environments structured activities visual schedules how to begin: assess student s strengths, abilities and needs assess environmental needs create individual visual schedules based on cognitive fit real object specific photograph generic photograph line drawing written word First-Then, 2 to 3 items, half day, full day include special interest picture check off or Velcro?

17 TEACCH continued benefits of using TEACCH at Chileda: decreases anxiety (fear of the unknown) puts one in a learning state of mind expectations are known predictability increases feeling of safety and comfort increases focus creates routine focuses on strengths preferred or reinforcement activities are known schedule gets to be the bad guy systemizes change

18 Examples of TEACCH

19 Love and Logic by Jim Fay, Foster W. Cline, M.D. and Charles Fay, Ph.D. Love and Logic is a philosophy of raising and teaching children which allows adults to be happier, empowered, and more skilled in the interactions with children. Love allows children to grow through their mistakes. Logic allows children to live with the consequences of their choices. Love and Logic is a way of working with children that puts parents and teachers back in control, teaches children to be responsible, and prepares young people to live in the real world, with its many choices and consequences. some benefits of using Love and Logic at Chileda: empathy natural consequences

20 Ziggurat Model Designed to address true needs or underlying deficits that result in social, emotional, and behavioral concerns. The Ziggurate Model by Ruth Aspy, Ph.D and Barry Grossman, Ph.D., Autism Asperger Publishing Co five levels sensory and biological reinforcement structure and visual/tactile supports task demands skills to teach

21 Ziggurat Model continued Benefits of using Ziggurats at Chileda: identifies strengths classic and high functioning autism gets team on same page provides focus to most significant area(s) of need staff understand reasons for behavior and goals builds into behavior program use with CAPS Comprehensive Autism Planning System - use with FBAs Functional Behavior Assessments

22 Positive Behavior Supports examples of positive behavior supports: making changes to the environment visuals social skills learning benefits of using PBS at Chileda: environment assessments- incremental changes providing enriched environments proactively addresses underlying cause for the behavior sensory diet communication systems

23 Social Learning Techniques "Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behavior is learned observationally through modeling: from observing others one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action." -Albert Bandura, Social Learning Theory, 1977 Benefits of using Social Learning techniques at Chileda: model: every moment is a teachable moment.

24 Social Stories A Social Story describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. The goal of a Social Story is to share accurate social information in a patient and reassuring manner that is easily understood by its audience. Benefit of using Social Stories and Power Cards at Chileda decreases anxiety of social situations by planning and seeing ahead

25 Social Stories continued Descriptive sentences describe social settings and what people do in particular social situations. I get to school by riding the bus each day.. Sometimes another kid sits next to me and starts talking to me. Directive sentences move a person toward a desired, appropriate social response. They state in positive terms what the desired behavior is. Directive sentences are used in conjunction with descriptive sentences eg. I will try to sit and listen when another kid is talking even if I really want to just turn away.

26 Social Stories continued Perspective sentences present others reactions to a situation so that the individual can learn how others perceive various events. eg. Listening to others can help me make friends Control sentences identify strategies the person can use to facilitate memory and comprehension of the social story e.g. "I remember that when the kid is done talking it is my turn to talk and I can say cool or ask him a question about what he talked about. These four sentences are to follow a ratio of 2 to 5 descriptive, perspective, and/or affirmative sentences for every 1 directive sentence. 2012) Constructing a social story (Edelson,

27 The Alert Program Therapy Works, Inc. Book: How Does Your Engine Run? By Therapy Works. guide to self-regulation Benefits of using Engine Rooms at Chileda: provides quiet place opportunity to increase activity opportunity to calm down

28 Other Supports and Reminders Sensory Diets PECS- Picture Exchange Communication System Me Moves Visuals Visuals Visuals

29 Preferred Directives 29 Avoid giving directions telling Students what they cannot/should not do. Examples: stop/no running stop/no yelling don't/no hit Give directions informing the Student of what you want them to do. Examples: walk please, walking feet, please walk indoor voice nice hands, hands in your pockets

30 Preferred Responses 30 First/Then Statements First we need to finish our math and then we can play on the computer. Say Yes And Keep them Thinking Sally Ogden, Love & Logic Yes we can play on the computer as soon as we finish our math.

31 Auditory Processing Delays and Disorders Wait time: 5-40 seconds or more between question or statement. Are you ready for the Skype call to your dad? Are you hungry? Do you want to go outside? Can you wait?

32 Sensory Dysfunction Sensory Integration Sensory system is constantly, efficiently processing information from our environment and our body Takes place at an unconscious level in which our brain is able to modulate sensory input during an activity Hypersensitivity/Overresponsive o The brain has difficulty filtering out excessive stimuli o Sensory overload causes a fight, or flight reaction Hyposensitivity/Underresponsive o Craves intense sensory input

33 Vestibular Input Structures in inner ear detect movement and changes in head position. Hypersensitivity Fear of heights Motion sickness Hyposensitivity Craves spinning, swinging, and riding Has difficulty sitting still

34 Proprioceptive Input receptors in our joints, muscles and tendons perceive contraction, stretching and compression 34

35 Tactile Input cells in skin give us information about touch, pain, temperature and deep pressure touch 35

36 Visual Systems includes acuity, ocular motor, visual motor and visual perception 36

37 Auditory Systems Involves hearing, interpreting sounds, localizing sounds, filtering out sounds and attending to a specific sound(s). Hypersensitivity Sensitive to loud or sudden sounds Distracted by and cannot filter out background noises 37

38 Social Story example Special Fester s Day! Today is Tuesday September 27 th.

39 Today we are going to Special Fester s Day! After we eat our sack lunches we will go in the van.

40 When we get to Special Fester s Day it is important that we stay with our staff. There will be a lot of rides that we can go on at Special Fester s Day.

41 We might have to wait in line for our turn, this is okay. It is important that I have nice hands and feet when I wait in line. Some rides might be closed, this is okay.

42 If rides are closed we can go on a different ride. There will be food at Special Fester s Day.

43 We will be able to get 1 treat at Special Fester s Day. After we eat our 1 (one) snack we can go on rides again, walk around, or sit on the bench and wait for our group.

44 Our staff will let us know when it is time to go back to the van. When our staff says it is time to go back to the van, we will walk nicely with our staff to the van.

45 When we get back to Chileda we will go back to class and talk about the fun we had at Special Fester s Day.

46 As an organization, we remember Safety First Treat everyone like a VIP (Very Individualized Person) Use Person First Language Person with. David has an autism spectrum disorder. Rather than: David is autistic. Once you ve met one person with autism, you ve met one person with autism. Always be a Role Model Every Moment is a Teachable Moment!

Inclusive Education. De-mystifying Intellectual Disabilities and investigating best practice.

Inclusive Education. De-mystifying Intellectual Disabilities and investigating best practice. Inclusive Education De-mystifying Intellectual Disabilities and investigating best practice. Aims for this session: To understand what the term Intellectual Defiency means To understand the broad spectrum