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 Volume 6 Issue 2 - Fall 1999 A Publication of the TRIC/PLUK Library Editor: LeeAnn Logan llogan@pluk.org Librarian: Janice Sand jsand@pluk.org |
TRIC/PLUK Library 516 N 32nd St Billings, MT 59101-6003 1-800-222-7585 in MT 406-255-0540 (voice/TT) FAX: 406-255-0523 E-mail: triclibrary@pluk.org URL: http://www.pluk.org |
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POISE UNDER PRESSURE--(Part Three)
ORGANIZATIONAL DIMENSIONS OF ABUSE
--by Novelene Martin and Lori Wertz - Abuse Prevention Specialists
Human Services is unique in one regard: behavior that would normally be regarded as offensive or as a violation of our individual and civil rights can be a daily occurrence at work. We are told that we WILL provide good care, we WILL NOT lose our tempers, we WILL NOT react to insults, non-compliance, or personal attacks. Why? Because it is policy, it is law. In the end, we will be Sainted, or at least we hope so, because we certainly aren't doing all of this for the millions of dollars in our paychecks!
Is there a different set of rules for the men and women in our care? Does it feel like they don't have consequences to their behavior, and staff are held to a higher standard? What is emotionally responsible caregiving and how do I get some? How can I make the leap from caretaker to caregiver?
Through the course of history, caretaking seems to have evolved as an accepted method of caring for large groups of people in unnatural environments. Early on, our service delivery systems set a precedent for too few staff and responsibility for too many people. The best we could hope for was that no one got hurt, no one died and no one got lost while we were on shift. The result has been a system of command, control, and meeting people's needs in a custodial manner&emdash;feed "them", water "them", keep "them" safe. Faces blur, names become unimportant and care becomes automatic and mechanical. Inherent to this custodial role is punishment&emdash;the belief that there must be a consequence to every behavior that we determine to be inappropriate. Not only should there be a consequence, but we will make sure someone is there to ensure that consequence is meted out. The resultant punishment mentality inevitably leads to subtle if not obvious abuse. Yet, historically, punishment has been shown to be ineffective in preventing or making lasting change in behavior. Think about the application of punishment in our own lives and through history. Does receipt of a speeding ticket guarantee that you will never speed again? Did the Salem witch hunts eradicate witchcraft any more than the heresy trials eradicated Christianity? Certainly not. But in a custodial role, punishment and all powerful consequences remain a central theme.
In order to move beyond custodial care and into modern caregiving, one must explore his/her philosophy of care. If you were to be admitted to a nursing home today, what information would you want the staff to have about you? Would you want them to know your favorite food? Your allergies? To please keep the door closed and not rush you when you are in the shower? To not rush you out of bed early in the morning? To not speak to you before you've had your coffee?? Likely these would all be considerations. Yet, if we look at the information traditionally given to staff about the people we serve, the picture is much different and centers around a person's "behaviors", necessary medications, social histories, professional evaluations. How does this information impact both staff and consumers in the care environment? The simple answer is that the it often puts us at odds almost immediately. Would people look at us differently if the majority of information about us was someone else's written opinion of our life? Is there any wonder that our consumers might be frustrated, angry or combative at our seemingly incessant urging to hurry to that dining room (to eat something you hate), or to get busy on that shower (the only time you have alone all day, or worst yet, the time of day when everyone and their brother is "helping" you)? The first key to master caregiving is to recognize and focus on the individual as a real and vital person. Caregiving should be personal, not mechanical. It should be thoughtful, not automatic. Incidents of non-compliance, aggression, resistance, etc...are not personal affronts against us as staff. We do not have the power to control when someone else's "behaviors" will occur. We do not have the authority to command another's persons thoughts or feelings. We can however, be analytical in our approach: what is this person telling me through this behavior? We can stop, step back and think&emdash;"What does this person need?" "Is this person uncomfortable, embarrassed, angry, grieving, cold, hot, tired, ill?" To be emotionally responsible caregivers, we must know ourselves, guard against our anger impulses, and know how challenging people affect us. We cannot meet emotion with emotion. By maintaining our composure and offering analysis instead of judgement, and by seeing the real person, not the incident, we take a giant step toward caregiving mastery.
The essential foundations of emotionally responsible caregiving center on the following:
Abuse has a look, a taste, a feel and a sound. It is sometimes more subtle than bruises or screams. It is often more insidious than blatant, reportable acts of aggression. Often, as staff persons, we can become desensitized to it. Emotionally responsible caregivers are ever vigilant to their own stress points and to the stress levels of those around them. We know that we do not have to solve problems alone and that we can avoid power struggles by creatively diffusing situations. We refuse to revert to a parenting role. We are not behavioral cops, needing control, but rather we are teachers, companions and advocates. We are not judgmental. We can orchestrate outcomes by leading, anticipating and diverting actions. We are unflappable and imperturbable. We must believe that we are a member of a proud profession whose honor and integrity we will protect. Caregiving excellence means knowing that in a difficult situation, the only buffer between an abusive, punishing act, and one of compassion and understanding is what I choose to do. •••
TWENTIETH ANNUAL MONTANA CONFERENCE ON DEVELOPMENTAL DISABILITIES
This year's conference will be held October 27--29, 1999 at the Sheraton Billings and the Radisson Northern Hotels. Registration for the conference is open to all persons interested in issues concerning individuals with developmental disabilities. Hotel and motel rooms in Billings are available at state rates for the conference. This year's keynote speakers include Dr. Leslie Rubin from the Marcus Institute of the Emory University School of Medicine in Atlanta; David Hingsburger, from Eastman, Quebec; and Thomas Nerney, Co-Director on the National Program on Self-Determination from New Fairfield, Connecticut. More than 100 presentations are scheduled on topics such as new service options, assistive technology, advocacy, traditional and alternative medical/health options and best practices in the provision of services to persons with developmental disabilities. In addition, a trade show, art exhibit/silent auction, service provider information fair and a service awards ceremony will be offered.•••
New Library Materials
The TRIC/PLUK Library has recently purchased the following materials. Call Janice at 1-800-222-7585 or (406) 255-0540 or e-mail her at jsand@pluk.org for more information or to check out these items. Also, remember to visit the library and PLUK Computer Lab during the DD Conference and sign up to win $25.00! We will be holding a drawing of all DD conference participants who visit us anytime during the conference. It is within walking distance of the Sheraton and Raddison Northern Hotels.
QUALITY CORNER
DD Case Managers: If you have things to add to this section, please send them to me. I will compile, edit, and send articles and information on to Lee Ann. Contact: James Driggers at (406) 444-2995.
Community Supports
The Developmental Disabilities Program (DDP) has completed statewide training to case managers, provider/contractor staff, and DDP staff on a new way of providing services, called Community Supports. Community Supports is based on the ideal that everyone waiting for DDP services should receive some support, and that the support should be flexible and individualized.
Everyone on the waiting list for adult services as of April 1999, and who were receiving no other services, were selected to receive a modest allocation for services which are designed to be flexible and ensure consumer choice. This is a very different way of doing business for all of us, and will hopefully allow creativity in developing some unique and individual supports, where and when people want them. This will require a lot of hard work on the part of everyone in the system, but we hope that the results will be worth the effort. For more information on Community Supports, please call a DD Case manager, contact a DD Program staff person, or call (406) 444-2995.
Dual Case Management and Mental Health
We have some recent discussions about providing DD Case Management to people who are also receiving services from mental health case management. This discussion has been the result of mental health case management being provided through the Targeted Case Management system now, rather than through the managed care organization, Montana Community Partners (MCP). The Department's position on dual case management has not changed, and we would expect that the Department guidelines developed in 1996 will continue to be met. However, billing for dual case management was not an issue for the State or for Medicaid when MCP provided the case management. Now it is.
As stated in the DPHHS Protocol for Case Management Coordination, " . . . the Department will allow only one case management provider to bill Medicaid for case management services for Medicaid recipients in any given month." Since both providers are Medicaid case management providers, there would have to be agreement as to which agency will bill for the service each month.•••
Copyright © 1999 Parents, Let's Unite for Kids, all rights reserved.