Developmental Disability Etiquette

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Developmental Disability Etiquette

• Patti Higgins, RN
• CCBDD
• [phone]
• higgins.patricia_at_cuyahogabdd.org

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DISABILITY ETIQUETTE

• Presentation Objectives
• Identify the different modes of communication
  that individuals with DD utilize
• Discuss general communication strategies when
  working with individuals with DD
• Identify actions to take when individuals
  with DD have behavioral issues.

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Communicating with Individuals with Developmental
Disabilities

• MYTH 1
• People with DD cannot
• understand speech, let
• alone medical
• information

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Premise 1

• Many people with DD can effectively communicate
  their needs
• People with DD have a wide variety of
  communication skills and abilities

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Premise 1 (continued)
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Premise 1

• Individuals who are non-verbal can communicate
  with gestures and / or body language.

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Premise 1 Medical Info

• Many people with DD are very involved with their
  healthcare.
• Healthcare providers may have to adapt their
  physical environment and interaction techniques.

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MYTH 2

• People with DD cannot make decisions

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Premise 2

• People with developmental disabilities
  participate in decision making in a variety of
  ways.

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PREMISE 2 (contd)

• Many individuals with DD are their own guardians
• Many individuals with DD are capable of informed
  consent for medical procedures / treatment.

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MYTH 3

• People with DD are sick.
• People with DD are dependent on others to meet
  many / all of their needs.

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Premise 3

• Many people with DD are not sick, incompetent,
  dependent, unintelligent or contagious. They are
  like the typical population, i.e. healthy,
  chronic medical conditions, mental health
  diagnoses and acute care issues

• People with DD have masters degrees, work
  full-time, drive, own businesses, participate on
  committees, are married and have children.
• They are individuals and you use the same
  assessment skills as with typical population.

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Premise 3 (contd)

• Triage
• Communication issues
• Baseline health
• Mirrors other individuals that may be in
  shelters, with mental health issues, alzheimers,
  elderly, typical population.
• Cooperative, communcative and compliant

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MYTH 4

• People with disabilities can
• access health care easily.

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Premise 4

• Healthcare providers
• may have to adapt
• their physical
• environment and
• interaction techniques.

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Premise 4

• Talk to the person, rather than through their
  caregiver or sign language interpreter.
• If the caregiver needs to be involved in their
  healthcare conversation, ask the individuals
  permission.
• Listen patiently. Dont complete sentences for
  the person unless he/she looks to you for help.

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Premise 4

• Allow extra time for the visit and give specific
  directions.
• Dont pretend you understand a person with a
  speech disability just to be polite.
• Be prepared for various devices or techniques
  used to enhance or augment speech.

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General Communication Strategies

• N
• O
• U
• S
• S
• R (adapted from
  Seigel-Causey and Guess, 1989)

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Nurture

• Develop a trusting and supportive environment
• Show real interest in communicating
• Act and speak naturally

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Opportunity

• Communicate about what is happening now
• Provide choices

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U

• You always play a key role in assuring
  effective communication
• Talk to the person
• Ask permission to talk with whoever is assisting
  them
• Listen
• Clarify
• Restate

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Sensitivity

• Recognize an individuals readiness to
  communicate
• Respond at the persons level
• Recognize the communication modes of the
  individual
• Respond appropriately to all communicative
  attempts

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Sender

• Get the persons attention
• Present info using persons receptive mode
• Repeat the message once, then restate
• Rephrase using different words or modes
• Recognize all attempts to respond

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Sender

• Treat Adults as Adults
• Do not shout at the person with DD

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Receiver

• Pay attention and be aware
• Ask for clarification when needed
• Be honest
• Encourage individual to use many modes

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Cognitive Disability

• Use very clear, specific language
• Be patient. Allow the person time to tell or
  show you what he or she wants.
• Condense lengthy directions into steps
• Use short, concise instructions
• (Commission for
  People with Disabilities, November 2007)

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Cognitive Disability

• Present verbal information at a relatively slow
  pace, with appropriate pauses for processing time
  and with repetition if necessary, e.g. In five
  minutes, well be going to lunch.

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Cognitive Disabilities

• Reinforce information with pictures or other
  visual images
• Use modeling, rehearsing and role playing
• Use concrete rather than abstract language
• Limit the use of sarcasm or subtle humor

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Cognitive Disabilities

• If you are not sure what to say or do, just ask
  the person what he/she needs.

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Dealing with Behavioral Issues

• Dual Diagnosis
• Individuals who have
• both a mental illness
• and a developmental
• or intellectual
• disability.
• Increase incidence of
• mental health issues with
• in people with DD may
• be due to brain pathology.

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Behavioral Issues

• Unlike the general population, individuals with
  a dual diagnosis may be more likely to exhibit
  sign and symptoms of their disorders in the form
  of behavioral outbursts including verbal or
  physical aggression, self-injury, property
  destruction, impulsive behaviors and/or elopement
  .
  
• 
  (Family Crisis Handbook, Donna Icovino
  Lucille Esralew, Ph.D.
• 
  July, 2009)

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Behavioral Issues

• Not uncommon for people with Pervasive
  Developmental Disorder (PDD) or Autism to display
  aggressive
• behavior.
• May be a response to frustration, pain and
  limited communication skills.

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Behavioral Issues

• For individuals who are non-verbal, behaviors may
  be their way of expressing frustration and/ or
  pain.

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How to Cope with Behaviors During a Disaster

• Stay calm
• Use verbal and non-verbal techniques including
  relaxed body position
• Limiting space by directing the person to another
  room or area away from others
• Soothing tone of voice
• Avoid giving commands

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How to Cope with Behaviors During a Disaster

• Identify feelings (if able)
• Ask Caregiver for assistance with behavior (may
  be aware of behavior plan to de-escalate
  aggressive behaviors)
• Redirect to a different activity, preferably
  something soothing

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Self-Injurious Behavior

• For some individuals, i.e, people with autism and
  those who are non-verbal, aggression may be
  expressed by self-injurious behavior.
• Head banging, hitting themselves, biting
  themselves.
• Interventions are the same as previously
  discussed.

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A FINAL WORD

• People with DD are individuals with families,
  jobs, hobbies, likes and dislikes, problems and
  joys. While the disability is an integral part
  of who they are, it alone does not define them.
  Dont make them into disability heroes or
  victims.
• Treat them as individuals.

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RESOURCES

• www.disabilityisnatural.com
• Commission for People with Disabilities
• (November, 2007)
• The Ten Commandments of Communicating with People
  with Disabilities www.ucp.org
• www.peoplefirstohio.org
• Ohio Developmental Disabilities Council
• Self Advocates Being Empowered