After much deliberation and thought into this assignment, I have chosen to work with Bill for the purposes of this assignment. He is a 65 year old male who has been living in a group home setting for the last five years. Preceding his move into one of our higher functioning group homes, he lived with his parents his whole life. To my understanding, he has one brother who also suffers from an undiagnosed disability. Both his parents passed away from cardiac related illnesses. Bill suffers from bipolar disorder, paranoid schizophrenia and mild retardation. As previously mentioned, he is very high functioning as he attends workshop daily and is capable of carrying out many household responsibilities. There are several reasons I chose to work with Bill, the first and most important being that he has a clear understanding of what is expected of him and the goals that have been personally formatted for him. He also wants to achieve these goals, and shows pride and satisfaction when they are accomplished.
I approached Bill explaining that I have an assignment for school that I would like for him to participate in. I explained that I have to pick one person to closely work with and try to help them achieve a goal they ultimately would like to accomplish. He was very flattered that I had chosen him for this assignment. I asked him to explain to me some of the goals he is currently working on, and his answers were such; taking out the garbage, cooking or baking every week, and to try and be more understanding of others. I am already aware of these goals, but had a different one of his goals in mind that he failed to mention. I reminded him of his concern and desire to be more sociable at home and outside the home. Currently, Bill only leaves his room at home when it is time to eat a meal with his peers or take medication, otherwise he remains in his room upon his arrival from workshop. He verified that this topic is still a goal of his. He also relayed his concern that he would be unsuccessful and was afraid of failing. Part of my job and also by ethical standards, I need to be aware of issues and situations that will set my client up for failure. I must tread very carefully and not push or pose anything that may cause harm to my client or myself. For this reason, I chose to carry out this study in the privacy of his own home where he is comfortable with his peers. I will not force him in any way to participate in the activities that I have planned, but will offer him a reminder that not only would we love for him to participate, he will be accomplishing his goal for that day.
I have been in constant contact with my field instructor and Bill's house manager regarding this process to formulate a goal for me to accomplish through this assignment. It has been extremely difficult in constructing a feasible goal that is not only realistic but significant in his lifestyle due to the fact that Bill has been having an extremely difficult time dealing with his life due to his bipolar and schizophrenic tendencies the last few weeks. He has been unable to concentrate or cope with stress in any environment, making his temper short and fierce. A portion of his disability is that he has no self confidence and truly believes that he will not succeed and that no one can help him accomplish this goal. We have discussed making his goal for the purpose of this assignment something easier, along the lines of baking, but thought that this is too simple. As per my supervisor's and the house manager's suggestions, Bill would benefit the most from me if I could enable him to participate more in the house activities. Even though this poses a greater challenge, if we could show him that he can accomplish even a small portion of this, he might be able to internalize that feeling and ultimately have more confidence at least in his home. This will hopefully encourage him to be more sociable in his home setting.
I have chosen to modify Bill's behavior and show him through positive reinforcement and encouragement that he can be sociable. The definition of sociability in direct relation to Bill means that he will initiate a conversation with someone he is unfamiliar with and/or participate in a social style activity either in his own home or outside the home. If this occurs outside his home, he must be familiar with the area and settings. His unsociability is an overt behavior as it can be directly seen by others. For example, the staff or anyone around him will witness that he withdraws and will avoid a social interaction. I will observe and record his behavior both at home, once a week, and at a nursing home that we volunteer at together once a week. I will record the amount of times he participates in a social opportunity and will further record the duration of the successful behavior. I will also record how many times he has denied the opportunity to partake in a social activity and will the ask Bill to record how he was feeling. There is a possibility I will be able to question him about his success or lack thereof if I am present. I will record the results through sampling, which involves observing the target behavior during specific times. For the purpose of observing the target behavior necessary in this assignment I chose to observe his social skills in both his home setting and the nursing home every Tuesday between 10:00 and 12:00 and then again every Thursday between the hours of 3:30 and 4:30. There may be random checks throughout the upcoming weeks if the opportunity arises and Bill self reports on a failure or accomplishment towards his goal. One component of recognizing the behavior is to make sure there is a clear beginning and end to the behavior so that we can properly monitor the outcome, intensity, frequency and duration. This will also serve as a guide for Bill as to how to initiate a social interaction.
After the behavior is observed or missed, the client will be asked to rate the experience in terms of anxiety level and satisfaction. This will be completed by both a self anchoring scale through a questionnaire, possibly an anxiety scale. I believe that the scale will be similar to a 1-10 self anchoring scale, where 1 is the lowest amount of anxiety and 10 being the highest or most intense form of anxiety during the target behavior. I look forward to the results!
Monday, February 21, 2011
Saturday, February 5, 2011
Shapiro Assignment 1
I am currently working at J-ADD, which is short for The Jewish Association for Developmental Disabilities, located in Hackensack, NJ for my field placement this year. So far it has been a wonderful experience that I look forward to sharing with you. The population that I work with involve those who suffer from a developmental disability and are over the age of 18. In our agency, we currently have nine group homes sporadically located in Bergen County. I have been assigned to four of the homes, where I visit with the consumers on a weekly basis.
J-ADD is a small but efficient agency providing an essential service to those who need extra help. The consumers are usually referred to us, but some are placed in our agency by their families or removed from the street when conditions are unsafe. J-ADD provides a safe shelter, food, clothing and any other essentials that our consumers need. The staff at J-ADD work hard to place every person in the home that best meets their needs. Each home is distinguished by the abilities of those who live in it. For example, some of the homes occupy people who are immobile or unable to speak, while others are extremely high functioning. J-ADD also has several apartments for those who are able to care for themselves but need a little supervision and guidance.
The staff in the J-ADD office are highly trained and well prepared for the unexpected types of situations. Every staff is licensed in CPR and first aid and have attended classes in abuse and neglect, medication, and overview of mental illnesses. Most of the staff that work in the "office" have PHDs and at the very least a MSW and LSW degree. Those who provide the direct care for the consumers do not need any special degree but do undergo training.
I meet with a variety of consumers weekly. In one home, which only has 6 men residing there and is considered one of the higher functioning homes, I visit with one specific client twice every week. For confidentiality purposes, I will refer to this client as Bill. I do carry out activities with all who live in that house, such as cooking and arts and crafts. I recently made home made pizza with this home, which was a great activity to get everyone to spend time together and share what they are going through each day. In the second home I visit, there are 5 consumers living together, 3 men and 2 women. In this home, there is only one person who is verbal, but her needs are very complex since suffers from paranoid schizophrenia and an intellectual disability. I meet with her once a week as well where we always do an activity such as coloring or go out shopping. For confidentiality purposes I will refer to this person as Amy since I will be discussing her again soon. The third house I visit is one where 4 consumers live. All but one are non verbal making discussions extremely difficult. For this purpose I am constantly baking and doing puzzles with them to engage them. The one consumer who is able to speak has conversations with me very frequently.
During the initial phase of this assignment I wanted to focus on Amy, who has many identifiable behavior patterns that need attention. Amy is a 55 year old female who has been living with her step mother for as long as she can remember. She suffers from paranoid schizophrenia and an intellectual disability. She is accustomed to spending her entire social security check on scratch offs and Dunkin Donuts. Her and her mother were forced to sleep in chairs because their apartment was infested with bed bugs. Amy was removed from her home by social services, where the placed her with our organization. She is very resistant to being in her new group home and is constantly causing arguments because she wants to return to her home with her step mother.
Amy craves attention, and will do or say almost anything if she is being ignored. It has come to my attention that Amy can remain calm until someone new arrives and then she likes to "put on a show". Similar behavior occurs when she arrives at a new place, for example, when Amy comes home from her workshop, she always has a meltdown. She will enter the house screaming and yelling, throwing her stuff and anything that is around her on the floor while cursing at whom ever is closest to her. Despite that she actually had a decent day, has positive things to say about it later while in a calm state of mind, and stayed out of trouble, this is part of her disability.
After speaking with my supervisor, I was persuaded to stray away from my original plan to change or interfere with Amy's behavior patterns, because it would be better to focus on someone who has a goal they want to change. I agree with this due to the fact that it is a great deal harder to make someone participate in a change that involves them self when they don't want this change. In Amy's case, she doesn't understand what I want from her either. After much collaboration with my supervisor and staff from another house, I have decided to focus on Bill for this assignment.
Bill is in his late fifties. He too suffers from paranoid schizophrenia and very mild retardation. He is physically fit and healthy otherwise, who understands what is expected of him and is willing to help others. To briefly mention his history, he lived with his family up until approximately five or six years ago when his father passed away. His mother had passed away when he was much younger. I believe that both parents died from a cardiac related illness. He has a brother who does not visit often. He misses his parents greatly and is able to express his emotions clearly. In relation to his disability he has constant thoughts that people around him don't like him or are not his friends. He sometimes has trouble internalizing an idea, for example, if the staff gives him advice (that can be very useful to him) he won't be able to apply it to himself. He can repeat back to you what they said, but does not realize this information can be useful to help him. Bill does not like to socialize with the others from his house and can not take the initiative. Although this is rare, Bill is sometimes able to initiate a difficult conversation with heavy prompting and guidance, or be present in a common room with others in his house. Some of his goals included becoming more sociable, since this is an area he lacks in. His feelings are easily hurt and his rage can easily get out of control. He has never expressed will to harm others, but has mentioned ideas of hurting himself.
After speaking with the manager from his home and my supervisor, we all agreed that it would be most beneficial not only to me, but a great deal to him as well to focus on his desire to socialize more for this assignment. The main factor for this decision is due to the fact that this is something he wants to accomplish, and we are not asking for an unreasonable demand. I still need to sit with the manager a bit more to discuss what will be the best way to carry out this task, but we have thought of a few simple changes in my routine. From now on, when I visit weekly, we will all do an activity together, rather than me spending time with him for part of my stay and then with the rest of the residents for the remaining portion of the time. I will attempt to organize a group activity involving cooking, a discussion, and arts and crafts in order to include everyone. In addition, when I take Bill to our weekly volunteer program, which I am the leader of, I will guide him in initiating conversation with others. I will formulate a way to keep track of his accomplishments, such as a chart, with the help of the staff in the home during times that I am not present. In addition, I will discus with his every week how he feels about what he has accomplished, or lack thereof to make him aware of his current progress. Any mention of progress will act as a motivator for him and will help with this process and change. I will monitor his progress over the next three weeks and will keep you posted as to my progress in addition to periodic updates.
J-ADD is a small but efficient agency providing an essential service to those who need extra help. The consumers are usually referred to us, but some are placed in our agency by their families or removed from the street when conditions are unsafe. J-ADD provides a safe shelter, food, clothing and any other essentials that our consumers need. The staff at J-ADD work hard to place every person in the home that best meets their needs. Each home is distinguished by the abilities of those who live in it. For example, some of the homes occupy people who are immobile or unable to speak, while others are extremely high functioning. J-ADD also has several apartments for those who are able to care for themselves but need a little supervision and guidance.
The staff in the J-ADD office are highly trained and well prepared for the unexpected types of situations. Every staff is licensed in CPR and first aid and have attended classes in abuse and neglect, medication, and overview of mental illnesses. Most of the staff that work in the "office" have PHDs and at the very least a MSW and LSW degree. Those who provide the direct care for the consumers do not need any special degree but do undergo training.
I meet with a variety of consumers weekly. In one home, which only has 6 men residing there and is considered one of the higher functioning homes, I visit with one specific client twice every week. For confidentiality purposes, I will refer to this client as Bill. I do carry out activities with all who live in that house, such as cooking and arts and crafts. I recently made home made pizza with this home, which was a great activity to get everyone to spend time together and share what they are going through each day. In the second home I visit, there are 5 consumers living together, 3 men and 2 women. In this home, there is only one person who is verbal, but her needs are very complex since suffers from paranoid schizophrenia and an intellectual disability. I meet with her once a week as well where we always do an activity such as coloring or go out shopping. For confidentiality purposes I will refer to this person as Amy since I will be discussing her again soon. The third house I visit is one where 4 consumers live. All but one are non verbal making discussions extremely difficult. For this purpose I am constantly baking and doing puzzles with them to engage them. The one consumer who is able to speak has conversations with me very frequently.
During the initial phase of this assignment I wanted to focus on Amy, who has many identifiable behavior patterns that need attention. Amy is a 55 year old female who has been living with her step mother for as long as she can remember. She suffers from paranoid schizophrenia and an intellectual disability. She is accustomed to spending her entire social security check on scratch offs and Dunkin Donuts. Her and her mother were forced to sleep in chairs because their apartment was infested with bed bugs. Amy was removed from her home by social services, where the placed her with our organization. She is very resistant to being in her new group home and is constantly causing arguments because she wants to return to her home with her step mother.
Amy craves attention, and will do or say almost anything if she is being ignored. It has come to my attention that Amy can remain calm until someone new arrives and then she likes to "put on a show". Similar behavior occurs when she arrives at a new place, for example, when Amy comes home from her workshop, she always has a meltdown. She will enter the house screaming and yelling, throwing her stuff and anything that is around her on the floor while cursing at whom ever is closest to her. Despite that she actually had a decent day, has positive things to say about it later while in a calm state of mind, and stayed out of trouble, this is part of her disability.
After speaking with my supervisor, I was persuaded to stray away from my original plan to change or interfere with Amy's behavior patterns, because it would be better to focus on someone who has a goal they want to change. I agree with this due to the fact that it is a great deal harder to make someone participate in a change that involves them self when they don't want this change. In Amy's case, she doesn't understand what I want from her either. After much collaboration with my supervisor and staff from another house, I have decided to focus on Bill for this assignment.
Bill is in his late fifties. He too suffers from paranoid schizophrenia and very mild retardation. He is physically fit and healthy otherwise, who understands what is expected of him and is willing to help others. To briefly mention his history, he lived with his family up until approximately five or six years ago when his father passed away. His mother had passed away when he was much younger. I believe that both parents died from a cardiac related illness. He has a brother who does not visit often. He misses his parents greatly and is able to express his emotions clearly. In relation to his disability he has constant thoughts that people around him don't like him or are not his friends. He sometimes has trouble internalizing an idea, for example, if the staff gives him advice (that can be very useful to him) he won't be able to apply it to himself. He can repeat back to you what they said, but does not realize this information can be useful to help him. Bill does not like to socialize with the others from his house and can not take the initiative. Although this is rare, Bill is sometimes able to initiate a difficult conversation with heavy prompting and guidance, or be present in a common room with others in his house. Some of his goals included becoming more sociable, since this is an area he lacks in. His feelings are easily hurt and his rage can easily get out of control. He has never expressed will to harm others, but has mentioned ideas of hurting himself.
After speaking with the manager from his home and my supervisor, we all agreed that it would be most beneficial not only to me, but a great deal to him as well to focus on his desire to socialize more for this assignment. The main factor for this decision is due to the fact that this is something he wants to accomplish, and we are not asking for an unreasonable demand. I still need to sit with the manager a bit more to discuss what will be the best way to carry out this task, but we have thought of a few simple changes in my routine. From now on, when I visit weekly, we will all do an activity together, rather than me spending time with him for part of my stay and then with the rest of the residents for the remaining portion of the time. I will attempt to organize a group activity involving cooking, a discussion, and arts and crafts in order to include everyone. In addition, when I take Bill to our weekly volunteer program, which I am the leader of, I will guide him in initiating conversation with others. I will formulate a way to keep track of his accomplishments, such as a chart, with the help of the staff in the home during times that I am not present. In addition, I will discus with his every week how he feels about what he has accomplished, or lack thereof to make him aware of his current progress. Any mention of progress will act as a motivator for him and will help with this process and change. I will monitor his progress over the next three weeks and will keep you posted as to my progress in addition to periodic updates.
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