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scssconsulting

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scssconsulting

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  1. www.scssconsulting.org

  2. Grandma Masse’s Rules for Success: “The smart guys are the guys who learn from the other guys. Don’t get all caught up in one thing; everyone believes their thing is the best thing and they’re usually wrong. So, shut-up and listen and learn and change.” In order to be successful you’ve got to be eclectic.

  3. More Grandma Masse “Models collect dust on shelves.” Don’t fall in love with a particular approach – ideally, you’ll/we’ll create a framework for intervention (a working theory) that will evolve with experience and evidence

  4. So, why is self-regulation so important?

  5. Socially Unacceptable Behavior

  6. Aggression

  7. Impulsive Behavior

  8. The Ultimate Result of Impaired Self-Regulation

  9. Context Relevancy: How does this stuff apply to the bigger world? adapted from Sailor, 1999 •Useful: Do the outcomes that we’re targeting produce something useful to the individual in long run? • Desirable: Does the individual choose the outcomes for him/herself when given the choice? Is the individual given thechoice of outcome? • Social: Do the outcomes result in behaviors that will increase interactions with persons other than paid staff? • Practical: Will the behavior be used in real contexts without staff support? • Adaptable: Is there a focus on developing skills that can/will be used in a number of situations and without staff?

  10. Most of the stuff that works is conceptually simple but procedurally difficult. In many ways good intervention is really about the systematic application of common-sense. Unfortunately, “common-sense is terribly uncommon.” – Mark Twain

  11. Three Beliefs That Will Affect the Likelihood That You’ll Be Successful • Optimism & Hope. Evident in the problems that are targeted and the language that is used when describing the individual and when interacting with the individual. • Appreciating the Influences of Contextual Factors on Behavior. Requiring an understanding of the setting events (the distant events on an individual’s behavior). • Applied Pragmatism. Recognizing that there is no single “right” solution; moving away from the notion of “consistent” use of a prescribed intervention strategy to “concordance” on the part of all involved.

  12. Introduction to Intervention Ideas: Conceptually Simple, Procedurally Difficult

  13. Why Do I Keep Making the Same Mistakes? Why doesn’t it Get Better?

  14. Communication Cognition Behavior

  15. COGNITION OrganizationMemory Info Processing Planning Procedural vs. Declarative Non-strategic Self Monitoring Implicit vs. Explicit Reviewing Self-evaluating BEHAVIOR Excesses Impulsiveness Aggressiveness Substance Abuse Deficits Initiation Impairments Insight Impairments COMMUNICATION Efficiency Fluency/Articulation Discourse Effectiveness Functional Apparent

  16. Success via Learning from Consequences Presupposes: Reasonable intactness of the neural networks responsible for connecting: Memory for the factual aspects of past behavior and/or Memory for the “Somatic Markers”, or the feeling states associated with the consequences of those behaviors Without these connections in memory, past rewards and punishments lack the power to drive future behavior

  17. An impulse is not a choice

  18. When choice is offered, of course, it is essential that the person being offered the choice have the information necessary for making a meaningful decision . . . without such information, being given a choice will feel more like a burden than a support for autonomy. • Edward Deci, 1995 Why We Do What We Do

  19. Each waking day is a stage dominated for the good or ill, in comedy, farce, or tragedy, by a dramatis persona, the “self”. And so it will be until the curtain drops . . . Although multiple aspects characterize the conscious self, this self is a unity.” - Charles Sherrington, 1946 The Integrative Action of the Nervous System

  20. Alliances are Critical to Success • When working with others in a concordant manner the intensity, consistency, and duration of services improves. • 2. There is an increase in the probability of generalization and maintenance of positive change (Brown’s Rule of Three: Three people, three places, three times.) • 3. There is a necessary infusion of reality, common-sense, and a functional focus of interventions. • 4. “All of us are smarter than any one of us.”

  21. Creating Alliances: • Three Rules of Thumb for Professionals • Demonstrate respect all the time, especially when interacting with someone that you don’t like (or who doesn’t like you!). • 2. Seek the insights of everyday people - find the hidden experts and use their expertise. • 3. Keep your hat in your hand; never forget you will always be a visitor in the life of the person with whom you are working.

  22. THAT’S WHAT I AM! THAT’S WHO I AM! RIGHT OR WRONG, I CAN’T CHANGE THAT CARLITO (AL PACINO), CARLITO’S WAY

  23. “I’ve lived a very dysfunctional life, and I know that that life has shaped and molded me into the person I am today. I want to reshape myself.” - Lloyd K.

  24. Choice (Noun) 1 The act of choosing; selection 2 the right, power, or chance to choose; option 3 a person or thing chosen 4 the best or most preferable part 5 a variety from which to choose 6 a supply that is well chosen 7 an alternative 8 purposive discernment.

  25. Impulse (Noun) 1a) an impelling or driving forward with sudden force b) an impelling force; sudden, driving force; push; thrust; impetus 2 a) incitement to action arising from a state of mind or external stimulus b) a sudden inclination to act, usually without premeditation 3 sudden involuntary inclination prompting action.

  26. Functional Conceptions of Choice: • Free choice • Fixed choice • Forced choice • Feeling the natural and logical results of actions in the environment

  27. For behavior-outcome linkages to serve as motivators, people must understand them, see them as relevant to their lives, and have the capabilities for utilizing them. • Edward Deci, 1995 Why We Do What We Do In other words: People need to have both thestrategies and capacities for attaining desired outcomes!

  28. The Three Big Things

  29. “When we think of your future – the next 10 years – we need to think about the 3 most important things to work on; the things that, if you achieve, you’ll have a meaningful life.” The 3 Things tend to cluster around these areas: • Behavioral regulation/self-regulation • Friendships/social-interaction • Vocational skills/meaningful engagement • Self-help skills

  30. Being intrinsically motivated has to do with being wholly involved in the activity itself and not with reaching a goal. -Edward Deci, 1995 Why We Do What We Do

  31. Making the “Big Things” Real • Creating personal maps or steps to attaining the personally meaningful goals. • Articulated by the individual (with some help from staff, friends, family) • Organized in a visual manner to assure clarity

  32. Step 55. Me the: _______ I’m good at: I need to: Step 3. Step 2. Step 1. Me Now I’m good at: I need to:

  33. KEEPING A HOTTIE BOYFRIEND EULA’S STEPS TO SUCCESS BEING A GOOD PERSON WITHOUT THINKING ABOUT IT HANDLING MYSELF OUT OF CLASSES DEALING WITH PROBLEMS /BEING IN CONTROL HANDLING MYSELF IN CLASSES LISTENING TO GOOD ADVICE/IGNORING BAD IN THE RESOURCE ROOM

  34. HAVING A JOB, LIVING IN MY APARTMENT PETER’S STEPS TO SUCCESS DON’T FORCE IT GET OUT OF IT BEFORE I GET INTO IT FOLLOW MY PLAN WHEN I’M OUT IN THEWORLD People, Places, Things MAKING PLANS BEFORE GOING OUT IN THE WORLD DEALING WITH ASSHOLES POSITIVELY MAKING MEETINGS & PARTICIPATING IN THEM MAKING MY PLAN TO STAY CLEAN EVERYDAY & LETTING PEOPLE KNOW IN A TREATMENT PROGRAM

  35. A doctor Tom’s Plan & Tom’s Reality An EMT Be a helping person In rehab

  36. More Intervention Ideas: Conceptually Simple, Procedurally Difficult

  37. PERSON Language Emotion Volition Behavior MentalHealth Cognition Human beings are a collection of relatively independent structures, processes, and systems

  38. John’s Cognition Attention Perception Memory Organization Reasoning EF Sequence Categorize Associate Analyze Synthesize Arousal Select Direct/ Filter Maintain Divide Shift Encode/Store/Retrieve Episodic/Semantic Explicit/Implicit Declarative/Procedural Involuntary/Strategic Working Memory/ Knowledge Base Remote/Recent Pro/retrospective Iconic Inductive Deductive Analogical Divergent Convergent • Goals for John - John will: • Increase duration of maintained attention • Increase prospective memory from 3 to 5 minutes • Increase category naming from 3 to 5 members per category

  39. John’s Mental Health Axis I Axis II Axis III Axis IV Axis V Clinical Disorders Other Conditions Personality Disorders Mental Retardation General Medical Conditions Psychosocial And Environmental Problems Global Assessment of Functioning • Goals for John: John will • Participate in psychotherapy sessions without falling asleep • Comply with his medication regimen as directed • Follow the recommendations of the clinical staff to assure his safety • Seek community services for his disorder and for his living • arrangements

  40. John’s Behavior John is the totality of his behaviors and the systematic relationships among them John b1b3 b12b4 b1 b7 b62b17 b17 b17b4 b6 b9b17b12 b3b8 b8 b5 b6b17 • Goals for John: John will • Increase frequency of b3 and b12 • Decrease frequency of b17

  41. Alternative Understanding of Human Beings Sarah Pursuing personally meaningful goals While participating in culturally valued activities In social, cultural, and historical contexts Mediated as necessary by individuals with greater expertise in that domain Using cultural tools, such as language, category schemes, mathematics, organizational supports, domain-specific strategies In the presence of varied context facilitators and barriers

  42. Goal Plan Predict Do Review

  43. Constructing an identity that is meaningful and sustainable is a primary goal of intervention

  44. “The self is not something ready made but something in continuous formation through choice of action.” - John Dewey

  45. SENSE OF SELF FOR INDIVIDUALS WITH CO-EXISTING DISABILITIES • Perplexity • Unawareness or denial: Retention of preinjury self-concept • Fragmentation • “I am a victim” (passivity; depression) • “I refuse to be a victim” (anger; aggression) • “I’ve changed; I’ve got my work cut out for me” (resolve)

  46. “IDENTITY MAPPING” • Identification of goals • Identification of image, hero, metaphor • Organization of identity description • [Creation of “identity map”] • Supported practice • Modification of others’ support behavior • Possibly meaningful project

  47. Reconstructing/Constructing Identity An Identity Map FEELINGS How does this person feel? FACTS APPEARANCE What has this person done? What does this person look like? POSITIVE IDENTITY METAPHOR GOALS PROCEDURES What am I trying to accomplish? What will I need to do?

  48. IDENTITY CONSTRUCTION Helping individuals with disability construct a sense of personal identity that is: • Satisfying/compelling • Organized • Adequately realistic AND that includes the hard strategic effort needed to be successful with a disability

  49. “IDENTITY MAPPING” • Identification of goals • Identification of image, hero, metaphor • Organization of identity description • [Creation of “identity map”] • Supported practice • Modification of others’ support behavior • Possibly meaningful project