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Category Archives: safety skills

Flooded with support when a steady stream is required

08 Friday Sep 2017

Posted by kolubcbad in adults, children, Community, flood, hurricane, resources, safety skills, Uncategorized

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disasters, hurricane, special needs, trauma

From Oregon to Florida, and Texas to India, people face terrible disasters.

There is trauma born of unpredictable and uncontrollable loss, and unwanted dependency on others for homes or meals after floods or tornadoes or fires devastate their neighborhoods. These events force capable people to rely on others, living out of hospitals or shelters.

And more people, including friends, families and people you don’t know, will suffer medical tragedies and unexpected losses.

There are similarities between these experiences and those of a foster kid moving into her 5th home in as many months. There are similarities between the needs of her foster parent, and those of the natural disaster victims who received initial support and are forgotten, alone, and still in a shelter.

While we were still thinking about Harvey and cleaning up homes, another round of disasters struck all around the world. Today Mexico’s most powerful earthquake in a century was devastating. And it will keep happening, although in between there will be periods of silence.

At the end of this article you can download some resources including visuals for caregivers of people with special needs facing disasters. But first, thoughts about the strange, sustained, nonlinear nature of recovery after tragedy or life after disruption.

A few months ago I attended a series of permanency roundtables. (Permanency… this is something those in flood zones or fire-ripe mountains – or foster homes – might never have.)

These roundtables were events to listen to hundreds of family members attempting permanent adoptions with children who had tragic stories of abuse, neglect, and repeated failed placements.

At these meetings, I heard a repeated chorus:

“We need long-lasting, repeated support.”

“We are grateful for what we’ve been given and still we work hard every day and night with no rest.”

“Our adoption workers mean well and yet are often quick to remove the supports that were so helpful for the 6 weeks of “honeymoon” after the paperwork was finalized.”

“It’s been months (or years) and the struggles are still there.”

“The kids seem to be really impacted by what they went through, and it’s showing up in difficult educational challenges which are hard to address.”

“The behavior challenges are still just as dire.”

“The wounds to our adult family members who tried to restrain the child in the middle of a furious display of emotion and behavior (whether these “come out of the blue” or after he spotted his biological aunt in Wal-Mart) are still healing and there are more coming.”

“The police are getting tired of the calls and the hospital we reached out to for help has started to blame us.”

“We look more normal now. But we actually have less support than ever before- and we still need help.”

Today, as we watch another storm about to hit, I think of a story I read last week, in which former flood victims shared their thoughts on how to help others.

When we want to help someone who will need help long-term, it suggested, we embrace the regular pace of helping a little at a time.

We say what we are doing and ask if there’s anything else. We mention when we’ll be back and we put it on our calendars, or set a reminder on our phone. We come back soon.

This approach reminds us a little of the preventative schedule… of using repeated orienting statements and offers of help and kindness… on a regular schedule, even when someone looks like they don’t need it. We have written about how it can be helpful for adult and child survivors of sexual abuse and dementia, Alzheimers, and those in mental health facilities. It’s helpful in schools. But it’s also important, useful, and do-able—to provide small, regular doses of whatever is helpful, to victims of disasters, and to keep doing this for a while after the visible evidence goes away.

Maybe the hard part is not what to give. Sure, we can give money. And at first, cash is more helpful than supplies because transportation is expensive and slow. But people rebuilding their lives need someone to show up after the show is over.

It might be as simple as dropping off fast food, working a shift piling up ruined household items, bringing hot coffee, or washing clothes and bringing them back clean. The hard part is to keep doing it regularly as long as it is needed.

What if I ask and they don’t tell me how to help?

If you leave near someone affected, but you were not, maybe you are thinking of asking them if they need something.

When someone has been through something very hard, they don’t respond well to questions.

“What do you need?” may produce a blank stare (from new moms with colicky babies after long hospital stays, or foster children or parents who clearly need support but can’t request it, to disaster victims who could really benefit from someone dropping by.

So should we shrug when we get that blank stare? After all, we asked and they said no, right?

Again, sometimes the most supportive thing to do is say how you’re addressing a need and when you’ll be back. “Hello. I’m here with food and next week I’ll be back with diapers. Let me know if there’s anything else you need.”

After the storm is gone but evidence is still there underneath brave faces, people won’t need a flood of support. Instead, try contributing in a steady stream… or even a slow trickle.

Resources and links

Boardmaker downloads for hurricanes and emergencies, including core words

http://boardmakeronline.com/hurricaneharvey

Social stories about hurricanes and tragedies

http://fhautism.com/hurricane-harvey-helpful-social-stories-for-children-and-people-with-autism-and-special-needs-by-carol-gray.html

Emergency preparedness for special needs, and Florida resources:

http://www.coj.net/departments/parks-and-recreation/disabled-services/resources/emergency-preparedness-for-special-needs

Oregon fire victims

https://www.bizjournals.com/portland/news/2017/09/07/how-oregons-businesses-are-helping-fire-and.html

Examples of special needs groups helping each other after Harvey

https://www.facebook.com/HarveySNH/?ref=br_rs

http://www.littlelobbyists.org/harvey/

https://www.facebook.com/Hurricane-Harvey-Autism-Relief-Group-832143870293854/

Ethical Friday presents: The power of a Worst Case Scenario

04 Friday Aug 2017

Posted by kolubcbad in adults, Behavior Analysis, Community, ethics, job aids, risk assessment, safety skills, supervision, teaching behavior analysis, teaching ethics, Uncategorized

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Picture the worst that could happen.

Can you even imagine it?

And if you’re a seasoned therapist or behavior analyst, how do you communicate about this with your students and supervisees, who almost certainly can’t really go there?

If you’re like many of us, you don’t know what you don’t know. Suppose a client wants to gift your staff a gourmet coffee gift card, or a mother wants to step out quickly to get her dry cleaning. “It’s a five minute drive, I’ll just be a second”, she calls, as you work with her child in an upstairs therapy room. “No problem”, you start to call… but your ethics bone starts to tingle. Surely you’re over-reacting. What, if  anything, could go wrong?

When the worst case scenario relates to our vulnerable clients affected by trauma, the consequences may be even more dire– and yet, those who haven’t faced the possibilities may not recognize the dangers.

Should I accept this client in foster care with severe challenging behavior and a history of abuse although I have never treated similar cases? Should my agency supervise our new BCBA to take on a new trauma case (we have funding, after all) when we haven’t experienced this situation?Danger sign

For those of us tasked with supervising and teaching others, or working with families, we can help students, supervisors or parents picture the worst case scenarios so they can better prepare for, predict, and prevent dangerous outcomes. The Compliance code helps give guidance and rules that we follow, but for those of us who have NOT encountered situations that make us keenly aware of the reasons for these, some of the code items may seem “nit-picky” or unreasonable, and may be disregarded in a dangerous way.

To support our own cases and our supervisees where it counts, we must have a wealth of experience, stellar training that exposed us to a variety of worst case outcomes and possibilities and some solutions, or a great imagination- and a few good teaching and documentation tools.

I get a new wake up call every semester I teach ethics students about the origins of Behavior Analysis’ Ethics Code, which was spurred in part by atrocious, life changing and widespread abuses by those doing “behavior modification” in recent decades.

When I ask “what do you think? Could those things ever happen here?”, Continue reading →

Do you wonder why they wander?

09 Thursday May 2013

Posted by kolubcbad in Autism, Behavior Analysis, Community, elopement, safety skills, Uncategorized

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autistic elopement, bolting, community safety, elopement, running away, safety skills, wandering in children with autism

Image

Recently Brenda, a mom and autism social media specialist, posted a story to her website http://autismbeacon.com/, originally shared by a news organization. The story led with a terrifying statistic: according to the National Academy of Pediatrics, nearly half of children with autism will run away before their 17th birthday. However, according to AWAARE, or the Autism and Wandering Elopement Initiative, a poll conducted 5 years ago found 92% of parents reporting “a tendency to wander” in their children with autism.

Parents of children with autism have had to create their own networks, do their own research, gather their own information, be their own advocates, lobby organizations for the similarly needed but unfunded support as persons with other challenges receive. Simply put, these families have had to be the change they desperately needed, which Brenda’s website (and her activity in additional social networks) illustrates. Many of Brenda’s followers have responded to her article post by sharing their suggestions, tips, and resources for elopement. I appreciate all of them, and have integrated many into my own practice or conversations with families.

So here are mine.

  1. At any level of your involvement, know what YOU can do to prevent and respond to elopement. Families can teach safety skills and do preventative training with all family members and the community. Community leaders can advocate for mandatory training in nonviolent crisis intervention, responding to community safety alerts, warning signs in neighborhoods, fences on playgrounds at churches or schools, and awareness campaigns and meetings. School professionals can learn to not take it personally when a child’s parent demands in his IEP meeting that we need a fence around his playground because paraprofessionals might not be fast enough to prevent his running into the street.
  2. Understand reasons individuals might run away, elope, or bolt. As with any behavior used by an individual with autism, elopement often occurs to get away from a situation that is challenging, aversive, or overstimulating. Elopement also occurs to go toward a situation that is more pleasant, familiar, calm, or interesting. Does your student have a way to request visiting his favorite spot or a way to communicate that he needs to leave? Do others recognize her signs of distress that we might consider “precursors” to elopement? Do others in the family and community recognize how to interrupt a possible elopement and redirect to safety? Is everyone trained in nonviolent crisis intervention so that the child is not handled in a way that makes a dangerous situation even worse?
  3. Know which behaviors you need to teach. Teach family members to reinforce these behaviors often enough for the learner to master them.
  • Responding to safety questions: When the child is very young, we can begin by teaching children to respond to the sound of our voice. At first, it’s a safety skill to look when a parent calls our name, or to come nearer when our name is called. If your child is vocal, we can teach vocal responses to social safety questions. When mom calls “Danny!”, does Danny call back “I’m over here”? There are different levels of each of these skills, and as a student learns more sophisticated ways of answering questions, we should continue to practice safety questions. Can the child answer what’s mom’s name?  Can he answer where he lives?
  • Learn who the community helpers are in our environments, and where they are located: We can teach children to recognize community helpers, and later, what to do if they see unsafe situations.
  • Teach safe behavior: Does the child consistently look for an adult and ask prior to leaving the house? Does the child request a parent or sibling when he wants to take a walk, or go play outside? Beginning when the child is very young, we can teach him to look around and see an adult’s face before starting to do an activity where supervision is required. When one child was very young, his team placed a picture of his face on every door in the house- EXCEPT the back and front doors, and the door to the basement. On THOSE doors, we put a picture of the child with his mom. Every time we went out that door, we tapped the picture and said “We always go out THIS door TOGETHER. Where’s mom?” and we taught the child to go get mom’s attention. After that, they went outside together.  Does the student stay close when out with others? Does the student seek an adult if he gets separated from the group? Just like the research suggests, students CAN learn to do this- but they need serious practice under conditions very similar to the real thing (see this blog for an example)
  • 4. Prevent, prevent, prevent.
                      • Not once, but THREE times in the past year, I have heard a family say something like this: “I didn’t think he would leave, but after we found him down the street in a neighbor’s yard, we installed fingerprint locks on all the doors.” Listen: If we know 92% of parents report their child with autism occasionally wanders, it’s just a matter of time. If your child hasn’t run away yet, fantastic! Order locks today. There are many varieties of locking mechanisms that prevent leaving without someone else in the house hearing it. Consider whether your family needs bolts that prevent doors or windows from being opened, or other mechanisms that alert you or the police when a door is opened when  the security system is armed.

5. Research what other parents have done to prevent. Consider make an outing plan, including having a package of materials ready. If your child goes into the community, which adult is responsible for monitoring his location? Where are the safety phone numbers? Does he have activities with him that he can use to calm down if he becomes distressed or if he is in a situation he finds overwhelming or overstimulating? Where will he go if he needs a break? How will he find the needed information if he forgets your phone number? Does your community participate in Project Lifesaver? http://www.projectlifesaver.org/

6. Understand there may be help waiting for you. If your loved one is on one of the waivers supporting children or adults with special needs, they may be able to get locks or security systems funded. There are programs out there waiting to donate a fence, a lock, or even money for training.

7. Tell someone you’re concerned. Many families report they never received advice from a professional, or never discussed with their pediatrician that elopement was a concern. We need to educate pediatricians and other providers to ask about this. Primary care providers can collaborate with specialists to prevent dangerous behaviors, but this can only occur if both parties know they need to talk to each other.

8. Be aware of organizations that can help. Here is the Frequently Asked Questions page for AWAARE. You can also check out what other agencies have compiled to support families.

http://card-usf.fmhi.usf.edu/cardpubs/PLS_WanderingPreventStrat.pdf

http://nationalautismassociation.org/resources/autism-safety-facts/

http://www.projectlifesaver.org/

9. Know the research and understand that there ARE evidence based ways to teach safety skills. This article is a great example. This article shows the effectiveness of Behavioral Skills Training to teach abduction prevention skills in children with autism, and the results of teaching were maintained at follow up checks after the training had been completed. This was published in the Journal of Applied Behavior Analysis by leaders in the field of behavior analysis and used instructions, roleplay, modeling and feedback to teach a skill all children need, especially children with increased risk of running away.

 Thanks for reading. We’d love to hear your own tips and stories.

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