Restrictiveness and Labels

As much as most people hate having labels attached to us they are important for to obtain services. The medical community has traditionally used diagnosis to determine what treatment is best for an individual. In large, people accept theses labels because they don’t generally determine what a person is but a condition they have. It gets far more complicated for those who have psychiatric diagnoses. Psychiatric labels become more complex when they describe persons behaviors and/or personality problems. Psychiatric labels can be damaging for a person’s self image and the way others look at them. Labels describing a person with developmental disabilities are also very difficult for individuals to deal with. No one wants to be called “stupid” or “slow” or worse yet retarded. However these kinds of labels like “level of Intellectually Disabilities” and “Autistic” are necessary to receive a variety of services from Regional Center. Services can include food and housing, education, and assistance in the workplace.

This is why many individuals who are diagnosed as mild or borderline MR elect to “pass” as normal and not receive those. And this is in my option, fine. There are risks however. There are many overcrowded prisons and jails housing people who did not have the ability to or did not fully understand the charges against them nor were they able to effectively help with their own defense. And when they get out, adhering to the rules of parole or probation, finding a job and a safe place to live quickly is hard to do with no involved family, friends or outside supports. In times of trouble, Regional Center can virtually save lives or prevent further problem with the law.

Appropriateness of a particular placement for any one individual takes specialized training and a complete understanding of what options are out there. Also matching the most appropriate living arrangements with the best facility in that area can be very complex. Fortunately most all Regional Centers have either a person or a particular team that specializes in placements.

For example it would not make sense to have a person who has mild MR and many social and daily living skills to be placed in a situation where they live with residents who have profound MR and who are non-verbal. It equally is not appropriate to place a quiet person with behavior with issues of self stimulation to the point of self injury with violent residents.

One key to different facilities are the level of restrictiveness. Restrictiveness of a facility (house rules etc...) vary depending on residents functioning level and special needs. I have seen over and over throughout the years that a person’s reason for placement in a current facility is “Least restrictive Environment”.This is why proper diagnosis is so important. I know, nobody likes “labels” and neither do I when I comes to a person’s limitations or possibilities. Labels can be limiting, However, when it comes to appropriate placement for people who may not be able choose their own places to live, work or go to school it can be necessary. Finding the best placement for a person (at that time in their life) is a difficult job at best. Regional Center has this daunting responsibility.

Also restrictiveness of a placement must be considered. The way it is expected to work is that residents only go to more involved facilities for as long as they need to. For example: A resident in an ICFDDN facility whose medical problems have resolved themselves should move to an ICFDDH or Community Care. A person who is in an ICF and has come the long way to socialization where they can now feed themselves or dress themselves with minimal assistance and most medical problems have resolved themselves should move to a Community care home. And a person in a Community Care home who can function almost independently should move to supportive living. This does not always happen. Well meaning individuals and families will often go with the safest placement. This again is ok. It is much worse to send someone into the next level of independence before they are ready and have them fail to thrive in the new setting. Also it can be a dangerous world out there and we all know it. Labels can keep our loved ones safe but they can also limit them from living a full and complete life.

Facilities are not conducive to having friends over, love interests, making what you want for dinner that night or just exploring life in general. Decisions over what choices a person can make for themselves are exceeding difficult and often there is no completely right answer. As professionals we all need to keep in mind that individuals are not labels and labels although sometimes very necessary never completely describe what a person is.