Helping People Without Making Them Helpless: Fun, Functional, and Other “F” Words

1. Helping People Without Making Them Helpless: Fun, Functional, and Other “F” Words Tim Feeney, Ph.D. Project Director New York Neurobehavioral Resource Project Binghamton, NY Clinical Director School and Community Support Services 600 Franklin Street Suite 110 Schenectady, New York USA 12305 tfeeney@scssconsulting.com 518-372-2026

2. “I’m a person, not a patient; and I’m not ‘yours’!”

3. Grandma Masse’s Rules for Success: “The smart guys are the guys who learn from the other guys. Don’t get all caught up in one thing; everyone believes their thing is the best thing and they’re usually wrong. So, shut-up and listen and learn and change.” In order to be successful you’ve got to be eclectic; moreover, we need to learn from other literatures from other populations

4. More Grandma Masse “Models collect dust on shelves.” Don’t fall in love with a particular approach – ideally, you’ll/we’ll create a framework for intervention (a working theory) that will evolve with experience and evidence

5. You can make people do things that they just don’t want to do but the price for doing so will be high

6. Poodle

7. FUNCTIONAL does not equal Increased/Improved performance on standardized tests

8. FUNCTIONAL does not equal Bowling or the The Friday Outing or the The really neat, really expensive, simulated. . .

9. FUNCTIONAL equals Creating stable routines of life that enable me to do what I need to do when I need to do it.

10. “ A coach gets guys to do the things they don’t want to do so they can become the players that they want to be.” - Walt Harris “We’re all coaches” A good coach: • Alters his/her coaching to reflect the needs of the player and conditions of the context. • Never tries to play the game him or herself.

11. The glass ain’t half empty, it’s half full! and You can teach 1/2 empty people to become 1/2 full people (it’s hard to teach 1/2 empties to become 1/2 fulls)

12. PERSON Language Emotion Volition Behavior Motor SKills Cognition Human beings are a collection of relatively independent structures, processes, and systems

13. John’s Cognition Attention Perception Memory Organization Reasoning EF Sequence Categorize Associate Analyze Synthesize Arousal Select Direct/ Filter Maintain Divide Shift Encode/Store/Retrieve Episodic/Semantic Explicit/Implicit Declarative/Procedural Involuntary/Strategic Working Memory/ Knowledge Base Remote/Recent Pro/retrospective Iconic Inductive Deductive Analogical Divergent Convergent • Goals for John - John will: • Increase duration of maintained attention • Increase prospective memory from 3 to 5 minutes • Increase category naming from 3 to 5 members per category

14. John’s Language Phonology Syntax Morphology Semantics Pragmatics Receptive vs. Expressive Phrase Structure Rules Etc. Receptive vs. Expressive Lexicon Semantic Relations Discourse Structures Receptive vs. Expressive Speech-act Competence Conversational Competence Socio-linguistic Competence • Goals for John: John will • Decrease mean naming latencies from 3 to 2 seconds • Include 5 basic story grammar elements in retellings • Use politeness markers in greeting people: 90%

15. John’s Behavior John is the totality of his behaviors and the systematic relationships among them John b1b3b12b4 b1 b7 b62b17 b17 b17b4 b6 b9b17b12 b3b8 b8 b5 b6b17 • Goals for John: John will • Increase frequency of b3 and b12 • Decrease frequency of b17

16. Alternative Understanding of Human Beings Sarah Pursuing personally meaningful goals While participating in culturally valued activities In social, cultural, and historical contexts Mediated as necessary by individuals with greater expertise in that domain Using cultural tools, such as language, category schemes, mathematics, organizational supports, domain-specific strategies In the presence of varied context facilitators and barriers

17. Intervention Goals Sarah will successfully complete ___meaningful task,with ___supports, possibly using ___“tools/strategies”,in ___ context (setting, people, activities), in order to achieve ___goal. Possibly focusing intervention attention on some specific aspects of cognition, communication, social skills, behavioral self-regulation, or educational/vocational skills – aspects that are either particularly weak or particularly important for Sarah.

18. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Fluctuating Attention Strategy:Appropriate Pacing Delivering material in small increments and requiring responses at a rate consistent with the individual’s processing speed increases the acquisition of new materials.

19. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Memory Impairment Strategy:Errorless learning and high rates of success in interactions Acquisition and retention of new information tends to increase with high rates of success (and error frequency increases with frequent errors and error correction).

20. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Organizational Impairment and Inefficient Learning Strategy:Task analysis of activities and advance organizational support Careful organization of learning and tasks including systematic sequencing of intervention targets and advanced organizational supports increases success.

21. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Inefficient Learning and Inconsistency in Performance Strategy:Massed practice and review including frequent cumulative review Acquisition and retention of new information and consolidation of old information in memory is increased with frequent, routine-based review.

22. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Inefficient Feedback Loops and Implicit Learning of Errors Strategy:Errorless learning combined with corrective (and brief) feedback when errors occur. Many individuals with severe memory and learning problems benefit from errorless learning. When errors occur, learning is enhanced when those errors are followed by non-judgmental corrective feedback.

23. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Frequent Failure of Transfer/Concrete Thinking and Learning Strategy:Facilitation of transfer, generalization, and maintenance via contextual teaching. Generalization is more likely when skills are taught in the context in which they will be used (context is encoded with information). In addition, using a general case approach (wide range of examples and settings) increases generalization.

24. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Unpredictable Recovery, Unusual Profiles, and Inconsistency in Behavior Strategy:Ongoing assessment and flexibility in curricular modification. Adjustment of interaction based on ongoing assessment of the individual’s progress facilitates learning and allows for curricular modifications “on the fly”.

25. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Impaired Strategic Behavior/ Impaired Organizational Functioning Strategy:Strategy-based intervention. Organized intervention designed to facilitate a strategic approach to difficult tasks, including organizational strategies.

26. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Decreased Self-Awareness/ Denial of Deficits Strategy:Self-awareness/attribution training Facilitation of individual’s understanding of his/her role in learning

27. Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury Characteristic:Behavioral Difficulties Strategy:Positive behavior supports Using an approach to behavior intervention that focuses primarily on the antecedents of behavior in the broadest sense (including setting events and establishing operations), environmental management, and role improvement.

28. Fun as an Important Element of Rehabilitation Therapeutic: Serving to sure or heal Fun: Lively, joyous, playful Do you ever ask yourself: “Where is the fun?” rather than “Are we having fun yet?”

29. FUN IS NOT:  Worrying about being politically correct  Going to “therapy”  Doing a workbook activity  Working on fricatives in the speech closet • Working to meet some fricking criterion on some fricking test before I can get out of this fricking place • Being told to “be realistic” • Being told to “be realistic” by some snot- nosed twenty-something who hasn’t lived life like I have

30. FUN IS: • The 1st time  Kids • Play  Joking • Friends  SpongeBob Squarepants • Laughter  Hope • Feeling connected  Feeling useful • Viagara  Being naughty • Love  Pure joy • Doing something you really like with someone you really like  Accomplishing something meaningful

31. It’s important to have fun with and create opportunities for fun and to laugh a lot even in the face of significant challenges

32. MINDSETS NOT CONDUCIVE TO FUN: • The Oprah Type - victim/tragedy/altruist Typical utterances: “Suffers from . . .” “Victim of . . .” • The Dr. Kildare Type - medical orientation Typical utterances: “The patient . . .” • The Dr. Phil Type - control/territorial Typical utterances: “You gotta . . .” “We tried that before, it’ll never work” “Because I’m the expert” “This is my area, don’t mess with me!”

33. MINDSETS CONDUCIVE TO FUN: • Flexible Typical utterances: “Yeah, we can do that.” “That looks interesting, different than I thought but it’s worth a try.” • Collaborative Typical utterances: “Whaddaya think?” “Geez, that’s a good idea, let’s give it a shot.” • Mature Typical utterances: “You’re right!” “Some things I can’t change.”

34. MINDSETS CONDUCIVE TO FUN: •Risk taking Typical utterances: “Well, I don’t know what might happen . . .” “What’s the worst that could happen?” “What’s the benefit?” “Sometimes it’s easier to ask for forgiveness than for permission” • Hopeful Typical utterances: “Hey, we’re onto something here!” “Let’s give it a shot.” “Sure, we can do that.” • Self-Effacing Typical utterances: “I don’t think I could think like that.” “I couldn’t ever.”

35. Friendly (adj.) 1 like, characteristic of, or suitable for a friend, friends, or friendship; kindly 2 not hostile; amicable 3 supporting; helping; favorable

36. Fellowship (n.) 1 a mutual sharing, as of experience, activity, interest, etc. 2 a group of people with the same interests; company; brotherhood

37. Frequent (adj.) 1 occurring often; happening repeatedly at brief intervals 2 constant; habitual.

38. Faithful (adj.) marked by or showing a strong sense of duty or responsibility

39. Feeling (v.) to be moved by or very sensitive to

40. Fair (adj.) just and honest

41. Fabulous (adj.) very good; wonderful

42. Fantastic (adj.) seemingly impossible; incredible

43. Folly (n.) 1 a lack of understanding, sense, or rational conduct; foolishness 2 any foolish action or belief 3 any foolish and useless but expensive undertaking.

44. Foolhardy (adj.) bold or daring in a foolish way; rash; reckless

45. Fiasco (n.) a complete failure.

46. Fail (v.) to be deficient or negligent in an obligation or duty

47. Fecal (adj.) of or consisting of feces

48. Four Lessons to Live by: • Hope is an essential part of any successful plan of support. • Form follows function. Think about what the individual needs and then create a way for that to happen in a flexible manner. • The more you try to force something or someone to change, the more it (or he or she) changes you. • When all else fails, a sense of joy and a sense of humor can get you through a whole lot!

49. Finished (adj.) 1 ended; concluded 2 completed 3 highly skilled or polished; perfected; accomplished 4 given a certain kind of finish or surface, as of paint, wax, etc. 5 defeated, ruined, dying, etc. 6 no longer dealing with or concerned with.