Post on 17-Jan-2018
description
A Working Alliance: Person-Centred Planning and
Employment
Brian McCleanBrothers Of Charity Roscommon
Social Role Valorisation
• Raise consciousness• Challenge perceptions• Provide valued social roles• Promote social inclusion
Wolf Wolfensburger 1934 - 2011
From the bedroom door…• Mild intellectual disability• Autism• Schizophrenia• Attended specialised treatment service till 18.• Home for four years behind the bedroom door• Suicidality• Assaulted his mother• Coercion and physically assaulted • 4 month stay in acute psychiatric hospital
…To the Factory Floor
• Rapport• Shaping• Diary• Treatment of intractable
medical conditions• Mental Health Review• Individualised costing• Low arousal Residential• Job• Car Maintenance Class
FIVE STEPS IN BEHAVIOUR SUPPORTLow ArousalRapport BuildingPredictabilityCommunicationIncentives
Aidan
Brendan
Cormac
Darragh
Num
ber o
f Inc
iden
ts
0
2
4
6
8
10
12
14
16
18
20
1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156
AggressionSIB
A B
0
5
10
15
20
25
30
35
1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156
AggressionGrabs
0
5
10
15
20
25
30
35
40
45
1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156
AggressionSIB
B+C
B+
C +
D +E
B+C+D
B+C +D +E+F
0
5
10
15
20
25
30
35
1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156
AggressionHandbiting
A = Baseline B = Low ArousalC = Rapport BuildingD = Visual SequencingE = Escape Communication TrainingF = Differential Reinforcement
Weeks
An Evaluation of an Intervention Sequence Outline in Positive Behaviour Support for People with Autism and Severe Escape-Motivated Challenging Behaviour
McClean and Grey, 2012 Journal of Intellectual and Developmental Disabilities
Readiness for Work
• Safety• Exchange• Heart• Purpose• Identity• Engagement• Paradise
Behaviour Support Plan
Rapid effects Generalisation Maintenance Quality of lifeNo side effects
Proactive Strategies Reactive Strategy
Vision based planning
Every person should have a vision statement of what is
Important to him or her…Important for him or her…And a circle of support
able to speak from a position of love and concern
Paradise
• Positive Emotion• Flow• Meaning
To be seen and met as a fellow human being with the capacity to discover one’s personal vision is to be encouraged determine for oneself, the things that happen in one’s own life. If, as staff, our actions inspire others to dream more, to learn more, to do more and to become more, we are working as effective skilled helpers.
Not All Services Are Effective
Mover (N = 20)
Mean
Non Mover (N = 22)Mean
F df1 df2 Sig
Adaptive Behaviour Scales – Support Needs
132.5 94.0 21.6 1 40 .000
Autonomy 9.6 5.2 10.5 1 40 .002
Mental Health (HONOS) 8.5 15.5 10.1 1 40 .003
Adaptive Behaviour Scales – Challenging Behaviour
44.6 38.3 4.8 1 40 .034
Year of Birth 1973 1970 1.0 1 40 N.S.
Acceptability of the Vision Statement
57.7 53.5 7.7 1 40 .008
Working Alliance Inventory 66.6 58.5 26.4 1 40 .000
Acceptance of Risk -Taking 15.2 13.3 5.5 1 40 .024
Additional Cost Of Vision (€56) €10,813 3.6 1 40 N.S.
Empowerment Instrument 95.5 92.4 2.8 1 40 N.S.
Role Clarity 87.1 85.5 0.4 1 40 N.S.
Standards 21.4 20.2 2.5 1 40 N.S.
Structure 31.2 29.0 4.9 1 40 N.S.
Conflict 13.5 12.7 2.4 1 40 N.S.
Responsibility 25.6 24.9 0.6 1 40 N.S.
Warmth 19.4 18.5 1.4 1 40 N.S.
Ability to express 3.8 4.2 0.1 1 40 N.S.
79% of the variance is explained
Adaptive Behaviour Scale -Support NeedsWorking Alliance
Unexplained
Variable Entered into the Equation -2 Log likelihood
Cox & Snell R2
Nagelkerke R2
Adaptive Behaviour Scales – Support Needs 39.33 .361 .48
Working Alliance Inventory 20.28 .594 .79
The Working Alliance
The extent to which frontline staff and family members – agree about the goals– share a mutual respect and
trust – have a common
appreciation of the person