Supporting Individuals with Intellectual & Developmental Disabilities: Hill Country MHDD

1. Supporting individuals with idd Debbie Benavides – cis Hill country mhdd Serving the greater texas hill country

2. Points of discussion • Hill Country MHDD • What is IDD ? • Crisis • Vulnerabilities to crime • Supporting individuals who have been victimized • How to communicate with individuals who have IDD

3. Counties served Llano Mason Medina Menard Real Schleicher Sutton Uvalde Val Verde • Bandera • Blanco • Comal • Edwards • Gillespie • Hays • Kendall • Kerr • Kimble • Kinney Contact Us: 830.792.3300

4. Hill country mhdd Provides mental health, individual developmental disability and substance abuse services Mission: Promoting Independence, Community Integration and Recovery Intellectual & Developmental disabilities (IDD) Mental health Psychiatric Rehabilitation Self-Management Training Education Peer Support • Day Programs • Residential Services • Supported Home Living • Respite • Service Coordination • Community Supports • Vocational Services

5. MH services • Short term episodic treatment • Focus on psychiatric needs • Recovery model • Medication Treatment • Consumer/Client /Patient lDD services • Services/supports over lifetime • Emphasis on direct support • Self Determination • Behavioral Support (PBS) • Self – Advocate/ Consumer

6. Terminology / language • The DSM 5 changed from the term “mental retardation” to the term “intellectual disability” or “intellectual developmental disorder.” - IDD • This change better reflects terminology changes by medical, educational, service professionals and advocacy groups. • MHMR to MHDD DSM 5, 2013

7. Definition of a disability • ADA defines as an individual who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of impairment, or a person who is perceived by others as having such an impairment.

8. Prevalence • 1 in 5 people have some type physical, intellectual, developmental or psychiatric disability • The disability is unique to the individual • Can range dramatically in severity and how they affect their independence • Can be visible or obvious (blindness, Cerebral Palsy, Down Syndrome) • Can be invisible (ASD, hearing loss, DD, MH, TBI)

9. What is idd?

10. IDD • A neuro-developmental disorder characterized by deficits in general intellectual functioning such as reasoning, planning, judgment, abstract thinking, academic and experiential learning • Impairments in practical, social and academic functioning • Children with IDD learn more slowly than typically developing children • Children may learn to sit up, crawl, walk or talk later than other children Childmind.org

11. Idd • Most have difficulties developing communication skills as well as trouble interpreting and applying new information • Deficits in memory, social and problem-solving skills • Lack of social inhibitions • Difficulty with adaptive skills or tasks of daily living

12. 3 domains of idd • Impairments of general mental abilities that impact adaptive functioning in three domains, or areas. These domains determine how well an individual copes with everyday tasks: • The Conceptual Domain includes skills in language, reading, writing, math, reasoning, knowledge and memory. • The Social Domain refers to empathy, social judgment, interpersonal communication skills, the ability to make and maintain friendships, and similar capacities • The Practical Domain centers on self-management in areas such as personal care, job responsibilities, money management, recreation, and organizing school and work tasks. DSM 5, 2013

13. 4 levels of idd

14. Risk Factors • Genetic syndromes • Brain malformation • Environmental influences • Labor and delivery related issues • Traumatic brain injury • Infections • Seizure disorders • Social deprivation Childmind.org

15. Diagnosis & Treatment • Standardized test such as IQ tests are used to determine a child’s level of intellectual development • A score below 70 indicates they may have an intellectual development disorder • To be officially diagnosed, one must also exhibit deficiencies in two or more specific areas of adaptive behavior such as communication skills, interpersonal skills or daily living skills • IDD is a lifelong disorder and is treated through management and rehabilitation programs Child mind.org

16. Most common types of idd • Down syndrome • Fragile X • Autism Spectrum Disorders (ASD) • Fetal Alcohol Spectrum Disorder (FASD) DM-ID, 2007

17. Crisis intervention

18. Role of the CIS • To serve as a support to the community to assist in facilitating services to prevent crises • Provide information about IDD programs and services to individuals with IDD, their families and providers • Assist in obtaining resources and services once a crisis has occurred • Bridge the gap between MH and IDD • Training and Education • Consultation and Collaboration • Do not take the place of MCOT or emergency services • If an individual is presenting in a manner that would indicate the need to call 9-1-1 or MCOT, please do so.

19. What is a crisis • An individual presents an immediate danger to self or others • The individual’s mental or physical health is at risk of serious deterioration • The individual believes he or she presents an immediate danger to self or others or that his or her mental or physical health is at risk of serious deterioration

20. What is considered a crisis in IDD? According to Merriam-Webster, a crisis is defined as: an unstable or crucial time or state of affairs in which a decisive change is impending; especially:  one with the distinct possibility of a highly undesirable outcome

21. Psychiatric vs … Not • Safety is always the first priority, regardless of the origin of the crisis • Active S/H/I always take precedence • With IDD/Dual dx individuals, origin can be difficult to discern – often trauma based which can present in a variety of ways

22. Vulnerability

23. Stereotypes • Deemed less valuable or important • More vulnerable to abuse, neglect, discrimination and exploitation. • Stereotypes, misinformation and general lack of interest contribute to a culture of ignorance • Do not have feelings or emotions • Do not make worthwhile contributions to society • Incapable of making decisions for themselves

24. Discrimination • Finding jobs in the community that pay at least minimum wage, including benefits • Have opportunities for promotions and career advancement • Find appropriate, safe, accessible housing • Access to the health care system, receive adequate care or be allowed to make decisions about their health care • Get access to appropriate communications support • Access to a free and appropriate public education (FAPE) • Pursue post secondary education

25. Stereotypes Discrimination VIOLENCE

26. Vulnerabilities • May not be able to recognize and avoid danger • May not be able to protect themselves or escape harm which makes them vulnerable to victimization • Less able to contact law enforcement and will not receive accommodations for their disability

27. Vulnerabilities • Easily victimized and targeted • Easily influenced by and eager to please other • Normalization of victimization • Think perpetrator is a “friend” • Not considered a credible witness • Have few ways to get help, get to a safe place or obtain victim services

28. Statistics • Age group with highest victimization is 16 – 19 years old, followed by 12 – 15 years old • Age group with lowest victimization is 65 and older • Individuals with cognitive disabilities have the highest rate of total violent crime • 40% of individuals with disabilities was committed by someone the victim knew

29. victimization • May experience victimization at the hands of family caregivers, intimate partners or personal assistance service professionals. • More than half of all abuse of people with disabilities is estimated to be perpetrated by family members and peers. • Service providers (paid or unpaid) are estimated to be responsible for the other half

30. Reasons they don’t report • Fear • Getting offender in trouble • Jeopardizing living arrangements/support • Belief that the police would not or could not help • Assume the crime wasn’t important enough to report • Perception that they would not be believed

31. If they are accused of a crime • Not want their disability to be recognized (try to cover it up) • Not understand their rights but pretend to understand • Not understand commands or instructions • Be overwhelmed by police presence • Try to runaway • Say what they think officers want to hear • Have difficulty describing facts or details of offense • Be the first to leave the scene and the first to get caught • Be confused about who is responsible for the crime and “confess” even though innocent

32. Victim rights • Education and training is needed for those with disabilities to have equal justice • Individuals with IDD must learn the possibility of meeting a police officer and how to protect their rights during encounters with police (BE SAFE) • Cross training among all professionals • Community alliances

33. Disability justice • People with disabilities are often denied access to the justice system • Justice system can reflect outdated stereotypes that impact access • Assume incompetence and unable to participate in the justice system in a meaningful way • Victims often treated as children who are incapable of assisting in their case and must be protected

34. Supporting individuals with idd • It can be assumed that a person with IDD can communicate appropriately, understand and can respond accurately • It is important to be patient - makes the individual feel secure • Pay close attention to signals the person is making such as their actions to determine what they are trying to say • All behavior has meaning • Give thought to understanding the reason behavior a particular behavior • The same behavior can mean more than one thing • Build positive and meaningful relationships to notice changes other people may not

35. Effective Praise and Encouragement • Use Labeled/Descriptive Praise – Avoid generic cheers • Use Progressive Praise – Avoid waiting for perfection • Use Immediate Praise – 5-10 seconds • Let Praise stand alone – avoid combining praise with commands

36. Social, Emotional and Persistence Coaching • Lead by Example - Model and Extinguish • Help them Expand their Emotional Vocabulary • Try, try and try again!! • Use descriptive coaching

37. Non-threatening Communication • Tone • Rate • Volume

38. Communication tips Do Be careful Do not ask the person to justify or explain their behavior Watch your body language Do not compare the person’s life/experience with your own experiences from their age Do not trivialize their feelings Be careful about using slang • Be genuine • Allow for silence • Try different settings • Provide positive feedback • Acknowledge their strength • Help them find the language they are looking for

39. Clear and Respectful Limit Setting • Use Clear and Descriptive Statements – Avoid vague, unclear, disguised and negative statements • Use Concise Statements and Give Time to Respond – Avoid using unnecessary/repetitive statements and/or chain commands • The Translation Phenomenon • Prioritize what instructions are truly needed • Use Positive Commands rather than “No/Stop/Quit/Don’t” Commands

40. How to de-escalate a situation • Speak slowly and confidently with a gentle, caring tone of voice • Avoid raising your voice or talking too fast • Don’t respond in a hostile, disciplinary or challenging manner • Don’t argue with or threaten the person – can increase fear or prompt aggression • Use positive words (stay calm) • Ask what happened rather than what’s wrong with them

41. How to de-escalate a situation • Avoid nervous behavior • Don’t restrict the person’s movement • Keep your distance (cultural comfort) • Consider taking a break from the conversation to allow the person a chance to calm down • Invite the young person to sit down if they are standing

42. reminders • How you react during a challenging situation is important in de-escalating the behavior • You are modeling the emotions and behaviors you want them to show • Keep your composure • Keep your body language relaxed

43. First person language • Recognize that people with disabilities are ordinary people with common goals for a home, job and family • Never equate a person with a disability • Use first person language to tell what a person HAS, not what a person IS • Emphasize abilities not limitations

44. First person language • A disability is not a challenge to overcome • Ordinary things and accomplishments do not become extraordinary because a person has a disability • Avoid negative words that imply tragedy • Afflicted with / Suffers from / victim / prisoner / unfortunate • Promote understanding, respect, dignity and positive outlooks

45. You should say… • People with disabilities • Person who has (or has been diagnosed with) • Person who has Down Syndrome • Person who has autism • Person with quadriplegia • Person with a physical disability • Person of short stature, little person • People who are blind / visually impaired • Person diagnosed with a MH condition • Student who receives special education services

46. You shouldn’t say… • Handicapped, the disabled • Person afflicted with, suffers from, a victim of • Downs person • The autistic • The quadriplegic • A cripple • Dwarf, midget • The blind • Crazy, insane, psycho, mentally ill • Special Ed student

48. 24/7 crisis hotline 1-877-466-0660

49. Your turn!

50. Crisis intervention specialist Debbie Benavides, MA, LPC Intern, PsyD Doctoral Candidate Crisis Intervention Specialist Dbenavides@hillcountry.org 830.426.4362 ext. 2643