Offering choices and creating independence for people with developmental disabilities is an important area of active treatment.
With each choice we offer an individual, there is an amount of risk that prevents us from granting too much freedom. The idea is to create an environment that allows for "dignity" without substantial risk.
Offering choices is something that should be incorporated into client IPPs on all levels. Choices can be given to those clients whose capabilities are limited to simple activities as well as those clients who are capable of many independent activities. Teaching staff to offer choices should be emphasized at all opportunities including: orientation as well as ongoing throughout staff training programs.
Several examples of offering choices are listed below
During meals or snacks are staff offering a choice between different cereals or how they like their eggs done in the mornings, juices, milk, water, sodas with snacks and meals, offering condiments at meals. When a resident does not eat all or part of a meal served is another item offered. What do you do when a resident does not like an item that is served often, like milk or certain vegetables. Does the staff let the QIDP or dietitian know. Are they then offered an appropriate substitute%26 What if they will only eat mashed potatoes or insist on hot sauce with breakfast (usually because of a past history). When a resident gobbles down an item served, are they offered more%26 And when a resident asks for special item or meals (possibly expensive items like sodas, alcohol, Mc Donald's, going to a restaurant for dinner. What about smoothies, cake, orange chicken, or steaks). Are arrangements made to accommodate their wants as well as their nutritional needs.
Choices offered can be easy to comply with and they can be difficult.
Choices need to allow for dignity.
Offer a choice between 2 appropriate items to wear that day. Both choices should be appropriate for the weather, time of day, and where they are going. Both need to be stylish to the current times with no holes, stains etc. Even the lowest residents can make simple choices from 2 appropriate items. Example Staff will hold up 2 choices (2 outfits one blue, one green) one in one hand and one in the other hand The staff will then hold up one then the other and ask them which they would like to wear today. If the resident evens looks at one choice over the other, that is the outfit that staff will hand them to put on.
Encouraging choice includes allowing the client to choose when he would like to work on a particular skill at the time (i.e. exercise, room cleaning, etc).
Like choosing the type of music or TV program they would like to hear\watch (if applicable) participation in recreational opportunities in the community, going to the store to purchase new clothing. The choice of being indoors or outdoors, choosing the activity to participate in during leisure or hobby training.
Allowing the client to choose their bedtime if it does not interfere with his ability to wake for work in the morning; allow the client to sleep in on weekends.
Choosing pictures or other decorations for their bedroom or other areas of the house.
Going to the store to purchase the items that they stop and look at.
Have them try on clothes in the store, do they smile when the item is on them%26 Do they fit well, with no tugging or pulling on them. Or are residents stuck wearing whatever the staff selects from the store and brings back to the facility.
Choices encourage communication skills and are often employed as Speech therapy and Recreational therapy goals. If not the QIDP can pick it up as one of their goals.
If left alone many resident will choose to do nothing except self stimulation (appropriate or not), particularly lower level residents. Often there are problems with residents resisting to shower, brush their teeth or shave. They may not understand the need to be clean and well groomed.
Generally there are automatic choices that are intentionally not exposed to residents for their own protection. We either automatically don't give or offer choices that are illegal. Staff does not usually encourage smoking or drinking. Yes, there are residents who smoke and drink. However note, that residents who smoke or drink may require a doctor's order on their chart to show that the Doctor is aware of this activity can may be detrimental to their optimum health. Also note that residents on anticonvulsant medications and psychotropic medications may have a reaction with their medication and alcohol. And we all know about the health concerns of cigarettes. It is the responsibility of the facility to teach the individual of the risks (as best they can) and document the training and counseling. House rule can be made for the safety and comfort of the other residents. Example: smoking may be designated to the outside patio. So residents may also need supervision or assistance.
The choices that a resident makes on their own may be morally wrong or distasteful to the staff. This can be an area of concern. It is not so much as to draw the line, but who has the right to draw that line for another person. Do we have the right to limit choices is a whole issue itself. These areas need to be looked at carefully. For instance there is a male resident to likes to look at pornographic pictures. They have requested that posters be put up in their bedroom (maybe, even over their bed). They also might like to look at magazines but need someone to hold open the magazine for them. Perhaps they are only female staff who are on duty and they feel that this is morally wrong and do not want to assist him. Maybe the roommate is opposed to the posters or keeping the magazines out where others can see them.
There are residents who are actively dating, having sex, marrying others etc. Sexual education is an important option for those who either are sexually active or wish to be. Sex education can be customized to meet their individual's needs. Perhaps areas of intervention may be appropriateness of touching others in public or masturbation. Social skills training can enhance choices and control over their own bodies and environment. Note rights of others must also be taken under consideration.
Self-management is another personal goal that many of us have a tendency to overlook when dealing with individuals that have the capacity to learn many self-management skills. Whenever possible, the ID Team should be anticipating areas of self-management that can be developed and discussing these at the ID Team meetings. Empowering an individual to make self-management choices with the initial supervision of professionals should be a goal for all of us in this field.
Self management of private funds or income from work can range from making small purchases in the community with staff assistance to development of a budget to getting a bank account. Purchases are a very good area in developing choices as well as money management, community integration, and communication.
Self administration of medication can be offered at all levels from hand washing to identifying the time of day to take meds to what meds they are taking to side effects to able to punch out meds or give themselves a shot. There is an easy assessment to determine a resident's ability and understanding of medication passing. From that it provides where a resident should start on the road to independent medication passing.
Taking college community courses of choice at local colleges, arranging vacation or special trips, the purchase of special equipment that may provide increased independence or personal privacy in completing self-help tasks
So often outside relationships are discouraged because of time or transportation restraints by the staff or facility. Selecting friends out side the facility can be extremely frustrating for residents. When a new person is met at a dance or a friendship is developed at day program, or another facility, does staff arrange for other opportunities for the resident to meet up with them again%3F Is the other person made welcome to visit%3f
What about church activities%3f Does the facility just pack up everyone to go to the church chosen by the staff, or are individual religions taken into consideration. What about the resident who always falls asleep at service should they be forced to go just because everyone else is going%3f Do they have the option to stay at home or go to a local fare instead%3f
From going back to a place that they enjoyed, to incorporate selecting an item from a store to pay for. (Money management skills) Independently arranging trips in the community (via taxi, dial-a-ride, etc.), walking or riding a bike to a store.
With lower level clients we are trying to expand their world to give the control and confidence in their own lives. To get them to come out of them selves and join this world that we all live in.