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Ray of Light Homes, llc.

• Overview of Company Policies
• Required Trainings

2
Hours of Operation

• Office Hours for ROLH are 
• Monday-Thursday
• 1000am-500pm
• Please call the office number below during
  regular office hours for regular business issues.
  
• If you should have an emergency outside of office
  hours, please call our on- call pager at the
  number below.
•  

3
Phone Numbers

• Office 683-7712 
• Dawns cell 768-2571 
• Claudias cell 713-4293
• Christinas cell 215-7767
• ROLH Beeper 285-3009
• Call During Off Hours when Emergency
• Must Hit  

4
Mission Statement (Purpose)

• Our mission is to serve developmentally disabled
  and dual diagnosed individuals with a high degree
  of staff competence, quality of care and
  accountability.

5
Role

• ROLH is a community service provider and
  placement agency that serves individuals with
  developmental disabilities. Ray of Light Homes,
  llc. contracts with Area Lead Management Entities
  throughout the Western North Carolina Region.
  Provider services include Alternative Family
  Living (AFL) funded by Residential Supports,
  Community Based Services (CBS), Home and
  Community Supports (HCS), Personal Care and
  Respite Services. ROLH specializes in the area
  of AFL and Respite services providing superior
  services and support to the communities we serve.
  It is also our responsibility to carry out the
  individuals outcomes as written in the Plan of
  Care and to provide feedback of that plan to
  facilitate the achievement of the individuals
  full potential.

6
Philosophy

• ROLH believes that all individuals should achieve
  their full potential and that all attempts should
  be made to maximize each individuals
  independence, productivity, talents and quality
  of life according to his/her preference as well
  as support each persons choice of living
  environment, learning techniques, play, work and
  retirement ROLH believes that each person should
  be empowered to make true choice in daily life by
  being informed of the consequences of the choices
  made and to afford the dignity of risk.

7
Ray of Light Homes, llc.AFL and Respite Providers

• For the Health and Safety of our clients the
  following information must be provided and will
  be kept confidential and enclosed in your
  personnel file.
• Employee Name
• List all individuals that are 16 years of age or
  older that reside in the home.
• Name SS
  DL
  Date of
  Birth
• By signing, I agree to give ROLH permission to
  obtain information about my background, which may
  include Criminal background check, Sex offender,
  and The Health Care Registry.
• Signature Date
• Signature Date

8

• Alternative Family Living pays on a semi-monthly
  basis.
• You will receive a pay schedule that will show
  when your data sheets and timesheets are due as
  well as the date you will receive payment for the
  services you render.
• If notes are not received on the due date by 2pm
  the services cant be billed and you will not
  receive payment until next billing cycle.
• If you dont submit you data and time sheets in a
  timely manner the first offense will be a written
  warning. The second offense you could be
  subjected to a pay rate decrease to 7.25 per
  hour.
• Make sure that the notes are correct and you have
  the appropriate signatures and dates.
• All employees will have to submit a time sheet
  along with your data sheets. AFL providers will
  submit a census sheet.
• You will be assigned a supervisor and must agree
  to see them on a monthly basis for AFL providers
  and on a quarterly basis for one on one services.
• You can choose to have your pay check mailed but
  please remember ROLH will not be held responsible
  if it is not received in a timely manner.
• ROLH will not accept hours called in, however you
  may fax your time sheet in but it is your
  responsibility to assure that it has been recd.
• ROLH has a web site you can utilize for most
  forms and time sheets, it also has the training
  schedule listed.
• http//www.rayoflighthomes.com/Home.html
• Any over time will have to have the directors
  approval. If you work over 40 hours without the
  approval you may be terminated.
• You cant work with a different client unless it
  has been approves and you have signed the client
  specifics

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Responsibility as Employee

• As an employee of ROLH Inc., you have agreed to
  provide the best quality of care for the person
  we are serving. I understand that my
  training/credentialing must be current in order
  to continue working for ROLH. It is a policy of
  ROLH Inc. that no individual will be left alone
  with another person unless that person has had
  the minimum training and has been approved by
  ROLH Inc. The minimum training requirements are
  Criminal background check, current CPR and 1ST
  Aid certification and Introduction to
  Developmental Disabilities (this may be waived if
  the person has verifiable experience in this
  field). There may be additional requirements
  based on the needs of the individual served. A
  close friend or a family member may provide care
  for a short period of time while the
  employee/Employee has an errand to do, but only
  if they meet the requirements listed above. I
  understand that ROLH is responsible for the
  safety and well being of the individual in my
  care. I agree to abide by all required State,
  Medicaid and CAP rules. I realize that if I
  wrongfully bill services to Medicaid, I may have
  to pay a fine and/or serve a prison sentence
  depending on the outcome of the court hearing. I
  also understand that if I am convicted of
  Medicaid fraud I will be ineligible to work in
  any industry where Medicaid is billed. Some
  examples of Medicaid fraud Double billing
  (example working with more that one individual
  at a time and creating paperwork to show
  different times, or working with more than one
  individual at a time and billing different
  agencies) Over billing (example turning in more
  hours for an individual that could possibly be
  done in one day, in most cases you are limited to
  16 hours or less per day) turning in time for
  someone else or turning in time that you did not
  actually do. These are just some examples, this
  is not a complete list. I understand that I
  cannot provide service to more than one
  individual at a time for a one to one service
  (examples Residential, CBS/Developmental
  Therapies, Personal Care, Respite). I understand
  the requirements of the services that I am to
  provide to the individual(s) that I serve. I
  agree to these terms and I understand that if I
  do not abide by these rules I will be terminated
  immediately. 

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Responsibilities of Residential Supports Providers

• Provides residential services to individuals in a
  home environment where the primary purpose of
  these services is the care, habilitation or
  rehabilitation of individuals who have a mental
  illness, developmental disability or substance
  abuse disorder and require supervision in the
  residence
• Complete documentation in a correct and timely
  manner Maintain privileging status Be on time
  participate in clinical reviews with Qualified
  Professional

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• Assistance with personal care needs, such as but
  not limited to bathing when necessary,
  toileting, tooth care, dressing, etc..
•  
• Management of clients recreational activities.
  The cost of said activities to be borne by the
  primary care provider of the client as agreed
  upon prior to activity(s).
• Provide habilitation training as outlined in the
  clients plan of care for specified services such
  as Home and Community supports, Developmental
  Therapy, Residential Supports, Personal Care.
•  
• Provide transportation of client to and from an
  agreed upon, specified location for transporting
  to and from client residence and direct care
  services. Cost of mileage to be borne by SERVICE
  PROVIDER.
• Continuous monitoring and assurance of clients
  well-being.
•  
•  Involvement in assigned clients team meetings
  with employee and other providers of said
  client.
•  
• Inform employee of any changes in client
  behavior, health, or damages to personal
  belongings. To fill out appropriate incident
  report form when necessary.
•  
• To complete required state documentation as
  specified by employee for designated direct care
  services (service note, medication administration
  documentation, incident reports, etc..)
•  
• To complete and assure that employee has a copy
  on file of all required training including
  recertification as required by the state rules
  for Medicaid and CAP funding.

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Required Paperwork

• Client Data Sheets
• Census Sheet
• Medication Administration Sheets and/or
  controlled Substance Form
• Monthly Reports
• Medication Log
• Self Inspection Forms
• Fire/Safety/etc. Drills
• Copies of Prescriptions
• Copy of Medicaid Card

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CAP Documentation Residential Supports North
Carolina Division of Mental Health/ Developmental
Disabilities/ Substance Abuse Services Consumer
Name Record Number
Month/Year____________________ Shift N/A Specific
Service Residential Support Level 2 T2014
Program/LME WHLME Service Provider/ Agency
ROLH
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(No Transcript)
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Key I Intervention
Key AReflects Assessment
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• Elements for Client Rights
• Foundations of Client Rights.
• Basic human rights are assured to each Consumer
  of an agency. These rights include the right to
  dignity, privacy, humane care, and freedom from
  mental and physical abuse, neglect, and
  exploitation. Each Consumer is assured the right
  to live as normally as possible while receiving
  care and age-appropriate treatment.
• Each Consumer has the right to an individualized
  written treatment or habilitation plan setting
  forth a program to ROLH the development of
  her/his capabilities.
• Each Consumer has the right to be free from
  unnecessary or excessive medication. Medication
  shall not be used for punishment, discipline, or
  staff convenience.
• Medication shall be administered in accordance
  with accepted medical standards and only upon the
  order of a physician as documented in the
  Consumers record. (Remember, if an individual
  refuses to take the medication, the provider may
  not force her/him to take the medication.)

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• Each Consumer or legally responsible person has
  the right to consent to or refuse any treatment
  offered. Consent may be withdrawn at any time by
  the person who gave consent. If treatment is
  refused, the qualified professional shall
  determine whether treatment in some other
  modality is possible.
• Unless the exercise of a civil right has been
  disallowed by an adjudication of incompetence,
  each Consumer keeps the same right (as age
  requirements permit) as any other citizen to
  exercise rights, including the right to
• dispose of property
• make purchases
• register and vote
• marry and get a divorce
• send and receive sealed mail
• make / receive confidential telephone calls
• make visits and receive visitors
• communicate with individuals of his own choice
• keep and use personal possessions
• keep and spend money
• execute instruments
• enter into contractual relationships
• bring civil actions
• contact and consult with legal counsel, private
  physicians, other professionals and Consumer
  advocates
• be out of doors daily and have access to physical
  exercise
• participate in religious worship

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• ROLH Client Rights Committee is a safeguard to
  protect participant rights. Quarterly, the Client
  Rights Committee will review any alleged
  violations of Consumer rights, incidents or
  accidents involving a Consumer, and other
  Consumer issues. The committee will make
  recommendations and the QP will follow-up with
  the individuals treatment team accordingly. The
  Client Rights Committee will review and amend as
  needed direct care treatment on Consumer rights
  issues.
•  
• It is important to the therapeutic relationship
  that we show the Consumers respect. Respect can
  be communicated through eye contact, attentive
  listening, body positioning (facing the
  Consumer), support and understanding. It can
  also be conveyed through providing services and
  supports in a safe and respectful environment
  most appropriate settings and methods promoting
  coping and engagement skills. Providing choices
  of activities meaningful to the individual
  served.
• ROLH is a non-restraint company and we do not
  place limitations or restrictions on a persons
  rights. Restrictive Interventions may only be
  utilized by qualified staff trained in NCI Core
  or Core Plus techniques. Restrictive
  Interventions will only be utilized in cases of
  emergency where the clients health and safety
  are in jeopardy and/or when an approved
  behavioral plan has been implemented. Each
  employee/staff receives training on alternatives
  to restrictive interventions.
• Whenever a Protective Device is utilized for a
  client, necessity for the device has been
  assessed and is only applied by a trained
  employee/staff that has demonstrated competence
  in the utilization of the protective device. The
  use of positive and less restrictive alternatives
  have been reviewed and documented and the
  protective device selected is the appropriate
  measure. While using the protective device the
  Consumer is frequently observed and provided
  opportunities for toileting exercise etc. as
  needed. When a protective device limits the
  clients freedom of movement, the client shall be
  observed at least every hour. The protective
  device is cleaned at regular intervals. The
  utilization of a protective device in the
  treatment/habilitation plan shall be subject to
  review by the Client Rights Committee

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Confidentiality

• Confidential information acquired in attending or
  treating a Consumer is not a public record. Each
  Consumer has the right that no individual having
  access to confidential information may share this
  information. We receive all of our confidential
  information from the Local Management Entitys
  network of providers. In each case, they have
  gained informed consent from the legally
  responsible party to share that information with
  representatives of ROLH. You, as a ROLH
  employee/staff, are privileged to obtain but not
  to share that confidential information.
• As a ROLH employee/staff, you will be held
  accountable for following laws, rules, policies
  and procedures governing confidentiality. In the
  event that there is a perceived need to share
  confidential information with other parties, it
  is your responsibility to bring this to the
  attention of your supervisor (QP). The
  supervisor (QP) will review the need and
  determine whether the confidential information is
  necessary in the situation. If necessary, the
  supervisor (QP) and/or outside entity will gain
  informed consent from the legally responsible
  party.

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• The following are examples of breach of
  confidentiality followed by the correct manner of
  how to respect the rights of individuals served
  and maintain confidentiality.
• When at Susies house providing direct care,
  Susies mother vents to you all of the familys
  difficulties, stresses, and upcoming events.
  This information may weigh heavy on you. What do
  you do with the information?
• CONFIDENTIALITY BREACH When out with your friend
  for coffee, tell her all about it. Susies mom
  told me.
• CORRECT MANNER Contact supervisor (QP) at ROLH,
  Susies mom told me What should I do with this
  information? How should I handle this situation
  should it arise again?
• You and Susie are out in the community and you
  run into a friend of yours. Your friend wants to
  meet Susie and know all about her.
• CONFIDENTIALITY BREACH This is the girl I work
  with, Susie Jones. She has CP and is mentally
  retarded. She goes to Joe School and is friends
  with the boy Jenny works with from that other
  agency.
• CORRECT MANNER This is my friend Susie. We are
  going to ride the carousel. Your friend asks
  you, How old is Susie? You can ask her
  yourself. Your friend questions you further.
  Were having a great time, it was good to see
  you.
•  

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• HIPAA See the specific HIPAA training
• Failure to maintain and protect confidentiality
  will result in disciplinary action up to and/or
  including termination per ROLHs Employee/staff
  Handbook. Disclosure of confidential information
  is a class 3 misdemeanor and is punishable by a
  fine not to exceed 500. (As found in the N.C.
  General Statutes)
• Abuse and Neglect
• Abuse means the infliction of mental or
  physical pain or injury by other than accidental
  means, or unreasonable confinement, or the
  deprivation by an employee/staff of services
  which are necessary to the mental or physical
  health of the client. Temporary discomfort that
  is part of an approved and documented treatment
  plan or use of a documented emergency procedure
  shall not be considered abuse.
• Neglect means the failure to provide care or
  services necessary to maintain the mental or
  physical health and well-being of the client.
• Exploitation means the use of a clients person
  or property for anothers profit or advantage or
  breech of a fiduciary relationship through
  improper use of a clients person or property
  including situations where an individual obtains
  money, property or services from a client from
  undue influence, harassment, deception or fraud.
• As an employee/staff you are responsible to
  prevent or intervene if possible if observing
  abuse, neglect or exploitation.
• An employee/staff of an agency who knowingly
  causes pain or injury to a Consumer or borrows or
  takes personal property from a Consumer is guilty
  of a class 1 misdemeanor.

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• As a health care provider you are obligated to
  report any SUSPECTED abuse, neglect, or
  mistreatment to your supervisor, office or the
  local department of social services. Telephone
  number Adult abuse/neglect reports-(800)-
  677-1116 and Child abuse/neglect
  reports-(800)-4-A-CHILD
•  
• If in the event you are unsure if the situation
  calls for reporting or you would like to discuss
  these issues further, contact your supervisor
  (QP) immediately. PLEASE help us stop fraud,
  neglect and abuse by reporting any type of
  unusual occurrences to the ROLH office.
•  
• All employees shall protect individuals served
  from harm, abuse and exploitation in accordance
  to the G.S. 122C-66.
• Employee/staffs shall not subject a client
  to any sort of abuse or neglect as defined in 10A
  
• NCAC 27C .0102. Any violation by
  employee/staff shall be grounds for dismissal.
• Please refer to ROLHs Abuse, Neglect,
  Exploitation Policy.

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Decision Making and Making Choices

• Decisions and choices are made for all
  individuals under the age of 18 by their parent
  or legally responsible person. Individuals age
  18 and over are responsible for making their own
  decisions and choices unless she/he is under the
  guardianship of a court appointed legally
  responsible person. With permission or request
  from the parent or legal guardian, individuals
  may make decisions and choices within their lives
  and experience shared control over decisions
  made.
• Examples may include but are not limited to
• Susie would you like to take your bath first or
  brush your hair first?
• Offer choices of where to go or what to do during
  leisure time. Choices could include going to the
  park, swimming, or out to the library or putting
  a puzzle together, drawing, or playing a game.

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• Remember to only give choices when the individual
  has the authority to make that choice.
•  
• There are different types of guardianship with
  different corresponding responsibilities. The
  type of guardianship appropriate for an adult
  depends on the nature of her/his needs and
  resources. The scope of the guardians authority
  is established to best meet the persons needs
  without assuming any more control than necessary.
  For example, the person may be able to make
  decisions about daily living needs, but not about
  medical care and treatment.
• There are three types of guardians
• A guardian of the person is appointed solely for
  the purpose of performing duties related to the
  care, custody, and control of a ward. A
  guardian of the person is appointed for an
  incompetent adult who needs someone to make
  decisions about such issues as living
  arrangements, professional care and treatment,
  and other services which may be needed for the
  adults welfare.

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• A guardian of the estate is appointed solely for
  the purpose of managing the property, estate and
  business affairs of the ward. A guardian of the
  estate is appointed when an adult needs someone
  to manage property and income.
• General guardian means a guardian of both the
  estate and the person. A general guardian has
  the authority to make decisions in both realms.
•  
• You will be informed of the individuals status
  as it relates to guardianship. Guardianship
  documents will be obtained and kept on file by
  ROLH.
•  
• Information will be provided regarding the
  persons mode of communication, likes, and
  dislikes enabling you to communicate appropriate
  choices to/for that individual. Communication
  techniques will be reviewed during Consumer
  specific competencies. If a situation arises in
  which you question what choices may be
  appropriate or how to convey appropriate choices,
  immediately report for supervision.

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ELEMENTS FOR INTERACTION AND COMMUNICATION
COMPETENCIES

• Effective Communication
•  
• Communication between individuals occurs both
  verbally and nonverbally.
• Verbal communication is expressed through spoken
  language or vocalizations.
• Nonverbal communication can be expressed in a
  variety of ways including gestures, pictures,
  body language, facial expressions, and physical
  contact (touching, hitting, biting, hugging,
  pulling, pushing, etc).
• When dealing with individuals with developmental
  disabilities, pairing these two forms of
  communication is often helpful. This helps to
  increase effective communication and
  understanding by providing multiple types of
  information input. The pairing of a variety of
  communication techniques can also aid an
  individual in learning. For example if you tell
  an individual, Get the bowl, and at the same
  time point to the bowl, the individual begins to
  associate the word bowl with the object bowl.
• Some important aspects in communicating with
  individuals with developmental disabilities are
  to use simple, clear, concise, consistent
  language. The provider should also remember to
  use language (vocabulary) that is appropriate to
  the individual Consumers level of understanding.
  In some cases, it may be necessary to simplify a
  statement by cutting out parts of speech, such as
  the object of the sentence, in order for the
  Consumer to understand. For example, when
  instructing the Consumer to Put the bowl away,
  the provider may need to shorten to Put away
  paired with a gesture to the bowl. When working
  with some individuals consistent word choice may
  be very important in communicating. For example,
  a person who knows to wash his stomach with
  verbal prompting may be confused by your request
  if you ask him to wash his tummy or wash his
  belly. Again, the use of simple, concise,
  consistent statements helps the Consumer
  understand directly what is being asked, while
  the pairing of verbal and nonverbal communication
  allows multiple modes of communication to be
  targeted to Realize understanding.

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• Use an even, neutral tone of voice when speaking.
  At times, it may also be helpful to slow your
  speech, or to break it down into parts. This is
  especially true if you notice that the Consumer
  is having difficulty understanding the
  information being presented. Repetition may also
  be necessary and helpful. This does not mean
  repeating the exact same sentence over and over
  again, but adapting the sentence in appropriate
  ways such as shortening, rewording, slowing
  presentation, etc. to help the Consumer
  understand. Remember the ultimate goal is for
  the Consumer to learn and develop, and this will
  often mean you must adapt to aid this process.
• A final way to help ensure that the Consumer has
  understood what you have presented to them is to
  ask them to paraphrase. This means that the
  Consumer repeats back to you in his/her own words
  what you have said. Paraphrasing is, of course
  only applicable for verbal Consumers, but it is a
  helpful tool. It allows you to check if what you
  communicated was correctly interpreted and make
  adjustments where needed so as to eliminate
  confusion.
•  
• Remember to allow for sufficient reaction or
  response time. Many individuals with
  developmental disabilities have delayed
  processing time. It takes them longer to
  interpret and respond to information. You may
  need to give a person up to 30 seconds to respond
  to a simple request. Pick up the block. An
  individual may require several seconds to hear
  the request, process the incoming information,
  and be able to coordinate muscle movements to
  pick up the block.
• Listening is a task that requires many skills as
  well. An effective listener gives the other
  person full attention. This includes waiting to
  formulate a response until the communicator has
  finished speaking. Paraphrasing now becomes
  important for you, the provider. It is an
  important tool to help reduce frustration for
  both the Consumer and the provider. Again, it
  helps to ensure that the Consumer is understood,
  and if they were not, opens up the opportunity
  for you to help the Consumer structure his or her
  thoughts in a way that is clearer. Some other
  helpful hints for listening are to give eye
  contact and face the person that is communicating
  to you. This helps you to listen to other
  communications like body language and facial
  expressions and shows the speaker that you are
  interested in them and that what they have to say
  is important.
• Many things affect communication. Internal
  feelings and thoughts may impact both expressive
  language (output / that which is communicated)
  and receptive language (input / that which is
  received or understood). Feelings that you are
  unaware of may affect your tone, facial
  expression, body language, etc. This may, in
  turn, cause the person to feel defensive,
  unimportant, or criticized. Being aware of your
  personal feelings going into a situation is
  crucial and may help prevent unintentional
  problems in communication. Feelings that your
  Consumer is having may also impact on two-way
  communication.
•  
•  

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• Interpersonal dynamics also impact communication.
  How your Consumer feels you come across, as well
  as how you feel he or she comes across to you,
  can strongly influence communication. Your
  interpretations and the Consumers
  interpretations will influence the communication
  dynamic. Again, being aware of your feelings and
  attitudes about the relationship is important.
  Further, open communication about how you feel
  the Consumer is coming across to you may help
  eliminate misunderstanding. For example, if your
  Consumer says something to you with crossed arms,
  an irritated expression, and quick speech, it may
  seem that he or she is upset or angry. Asking if
  something is wrong, rather than just assuming and
  reacting, will keep the intentions of the
  situation clear. It could be that the individual
  is simply unaware of how they are coming across
  and can adjust now that you have brought it to
  his or her attention. It could also be that the
  Consumer is legitimately upset and didnt know
  how to appropriately address it. By asking, you
  have opened up lines of communication for the
  issues to be discussed and hopefully resolved.
  For nonverbal Consumers, finding ways other than
  asking, whats wrong may be helpful. For
  example, using pictures or objects, as aids to
  assess the Consumers problem may be more
  effective.
•  
• Finally, familial and cultural dynamics can
  affect communication. Some families or cultures
  may be more likely to be engaged in continuous
  conversation, while others may tend to keep
  speech limited to the necessary. Some cultures
  and families may also tend to speak faster or
  louder than others. Learning to adapt to a
  particular environment is important. You as a
  provider will need to adapt to the setting in
  which you work.
• Some helpful hints in trying to foster
  communication with individuals with developmental
  disabilities include being willing to share the
  same type of information that you are requesting,
  respecting boundaries of what they are willing to
  share, adapting your communication style to meet
  the individuals need, and reading the non-verbal
  cues of the individual for guidelines on how to
  proceed.
• You will be able to learn about the individual
  you serve by listening to, watching and observing
  that individual. As others can give input and
  thoughts regarding the individual, remember that
  the individual served knows him/herself BEST.
•  

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Building Supportive/Therapeutic Relationships

• Relationship building takes time, and with
  developmentally disabled persons it may take
  extra time. Listening, watching and observing the
  individual being served is the best tool to learn
  all about the individual being served. Patience
  and consistency are key elements in developing a
  relationship. This allows the individual to gain
  trust in you because they know what to expect.
  Treating the individual with respect and
  nurturing are also crucial in building a
  relationship.
•  
• Helping a person learn to make decisions and take
  responsibility for their actions is an important
  process that can be broken down into steps. The
  first step in making a decision is identifying
  the goal. Step two involves brainstorming the
  different options available. The next step
  includes weighing the pros and cons, feasibility,
  and consequences of each option to see which best
  fit the goal. Once a decision has been made,
  holding the individual accountable for following
  through and accepting the consequences, good or
  bad, is important. The level of discussion and
  input needed throughout this process will vary
  from Consumer to Consumer.
• Appropriate boundaries should be established with
  the individual at the onset of the relationship.
  This includes physical, emotional, and role
  boundaries.

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• Physical boundaries differ from Consumer to
  Consumer. Some Consumers may not like to be
  touched at all and, therefore, touching may be
  limited. Other Consumers may be highly
  affectionate. Helping a person learn to
  establish appropriate boundaries is important and
  will affect many of their daily interactions with
  others. Knowing what you are comfortable with and
  assessing what the Consumers needs and comforts
  are will help you in establishing boundaries.
• Emotional boundaries deal with how involved you
  become with a Consumer. While it is appropriate
  to be friends with the person, it is not
  necessarily appropriate to treat your Consumers
  the way you would treat your other friends. For
  instance, it is not appropriate to divulge all
  the intimate details of your life with your
  Consumer. This may confuse the Consumer as to
  the nature of your role, which first and foremost
  is the therapeutic role of provider. The social
  role is important in that it models appropriate
  behavior to the Consumer, but this is a secondary
  role. If the Consumer sees you primarily as a
  friend, this could interfere with your
  effectiveness in helping and teaching the person.
  As you get to know the individual and family, it
  is imperative to maintain clear professional
  boundaries. Your role is of a supportive nature
  versus that of a social one. Sharing of personal
  information crosses the boundary, which may
  damage or impede on the relationships developed.
• It should further be clear to your Consumer that
  you are not his or her chauffeur,
  psychotherapist, bank, maid, etc. This is not
  say that you will never take your Consumer
  places, help him or her clean up, etc., however,
  it means that these things should occur as they
  appropriately relate to the goals of that
  Consumer.
•  

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Understanding and Interpreting Human
Behavior

• There are many environmental and personal factors
  that influence a persons behavior. One
  environmental factor that shapes behavior is the
  family dynamic. Just as each family differs in
  communication style, it also differs in dynamics.
  Some families may be faster paced with multiple
  activities going on at any given time, while
  other families may be more single task oriented.
  Some families will be more highly structured and
  organized in how they divide their time and
  attention, where as other families will be less
  likely to follow any particular routine. The
  individual family dynamic will greatly influence
  the Consumers behavior, because it will be the
  general pattern that he or she has adapted to.
  For example, a Consumer coming from a highly
  structured family household will most likely need
  high structure outside of the home as well in
  order to feel safe and comfortable. In a
  situation of low structure, this Consumer might
  become agitated not knowing what is expected
  next.
• Another major environmental factor affecting
  behavior is the present circumstance and
  surroundings that the Consumer is in. A Consumer
  who continually tries to go to sleep during a
  session may simply be reacting to the low light
  intensity, or high heat in a room. Factors such
  as temperature, lighting, and outside distraction
  or stimulation can have a strong impact on a
  Consumers behavior. Learning what environmental
  settings your Consumer functions best in, and
  then finding ways to help the Consumer adapt to
  settings outside of his or her comfort zone is
  important for success.

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• Just as there are environmental factors that
  influence behavior, there are also personal
  factors that influence behavior. A Consumers
  level of motivation, cognitive and physical
  functioning, tolerance for change and
  frustration, and ability to adapt will all
  greatly affect his or her behavior in any given
  situation. Finding ways to help a Consumer
  improve or cope with these personal issues can be
  a difficult, but crucial task.
• Many Consumers may experience feelings of
  powerlessness or lack of control as a result of
  their disability. This could be physical or
  psychological in nature. Consumers may feel
  angry, frustrated, or apathetic from time to time
  because of their deficits either mentally or
  physically or both. These feelings may be
  translated into behaviors that are less than
  desirable. Learning to focus on the Consumers
  abilities and provide encouragement without
  discrediting his or her feelings and disability
  will help the Consumer deal with issues more
  appropriately. There are some issues that will
  be lifelong for Consumers remember to remain
  consistent, patient, supportive, providing
  instruction without criticism.

33
Early Crisis Intervention

• Understanding risk and protective factors that
  may affect a persons behavior comes with knowing
  your Consumer. Having a knowledge base of your
  Consumers specific needs, abilities, and triggers
  will help you to assess particular situations for
  risk factors and provide appropriate intervention
  as necessary.
• When dealing with behavior, preventative measures
  are always preferred over reactive measures. The
  first step in prevention involves identifying
  cues indicating that the individual may be in
  distress. As mentioned previously, body language
  can be an early communication. Behavior that is
  out of the ordinary for that particular person,
  or inappropriate to the situation may also
  indicate distress. Some other general indicators
  of distress or possible loss of control are a
  snappy or short tone, crying, overly loud or soft
  tone of voice, abuse to others or self, etc.
• Learning what factors cause distress is another
  helpful step in prevention of unwanted or out of
  control behavior. While stressors are specific
  to each individual some possible stressors
  include the inability to understand or complete
  a task, too much or not enough stimulation or
  structure, unfamiliar situations or people,
  transitioning, inability to effectively
  communicate needs or wants.

34

• Once the distressing factor has been identified,
  work to relieve distress in the least intrusive
  manner. Try to give the individual options for
  coping with the problem as it is. Discuss the
  real versus imagined harm of the distressing
  factor, give examples of similar situations where
  the outcome has been positive, and provide
  examples of appropriate responses to distress,
  and model appropriate behavior for the Consumer.
  If this is not possible, work with the individual
  to reduce the factor, provide a time of reprieve,
  or where necessary, eliminate the distressing
  factor.
• Finally, prevention of crisis or distress is
  aided by the safety assessment of every
  situation. Safety needs will vary from Consumer
  to Consumer depending on age and level of
  functioning. General assessment of a situation
  should be done. Observe for possible objects or
  obstacles that could present a problem for the
  Consumer, as well as the structure of the
  environment, and the others present in the
  environment.
• There are some situations in which Consumers may
  exhibit potentially dangerous behavior such as
  running into the street, touching a hot surface,
  self-injurious behavior, etc. In these
  instances, you may have to intervene and model or
  teach appropriate alternatives. For example,
  with a Consumer who is prone to running into the
  street, you may have to intervene by holding
  hands and teaching the Consumer to stop and look
  for oncoming traffic. Other ways to intervene
  and teach appropriate alternatives could include
  positioning yourself between the Consumer and the
  potential danger, using body language or gestures
  (such as holding up hand to say stop), or using
  verbal communication.
•  
• When working with Consumers in the community,
  there may be instances where other individuals
  may trigger or escalate a person with
  disabilities level of emotional distress. In
  these instances, it will again be important for
  you to have established a working relationship
  and knowledge of your Consumer. As mentioned
  previously intervention on your part may be
  necessary and this could include placing your
  self between the Consumer and outside individual,
  using positioning, body language, or gestures, or
  using verbal communication to de-escalate the
  situation.

35
Factors that influence behavior  

• Mental illness, developmental disabilities, and
  substance abuse issues can all affect an
  individuals behavior. Individuals experiencing
  these issues may exhibit slowed reactions or
  processing of information, disruptive or
  disoriented behaviors. Interactions with
  individuals with these issues may at times be
  stifled or inappropriate. Additional help may be
  needed at work, school, and social activities.
  This could include increased time and support for
  the completion of tasks. Modeling and discussing
  appropriate behavior in a given situation can
  further be helpful to Consumers.
• Emotions such as anger and fear can often
  escalate a situation. When an individual is
  experiencing these emotions, he or she may
  respond in a more extreme fashion than what is
  reasonable for the situation. Recognizing the
  emotions involved and looking for ways to
  alleviate the Consumer stress level can help
  deescalate the situation. If an individual is
  feeling angry or afraid, for example, identifying
  the agitating factor(s) is the first step.
  Looking to resolve, or at a minimum provide
  reprieve from the factor in order to calm the
  individual is the next appropriate step. Once
  the individual has been reassured, discussing or
  modeling appropriate ways to handle the situation
  will be beneficial. Finally, reinforcing or
  rewarding appropriate behavior helps to teach the
  Consumer for future situations. Other emotions
  such as excitement can also escalate behavior. A
  person who is excited may respond to a situation
  with extreme behaviors that one would not
  normally expect to the given situation. Again,
  calming the person and addressing the actual
  issue will help balance the behavior being
  exhibited.
• Health issues are another factor that can affect
  behavior. Pain or discomfort may cause a person
  to react to a situation in a more extreme fashion
  than would be anticipated. Medications that an
  individual is taking may have behavioral side
  effects such as irritability, hyperactivity,
  sleepiness, slowed reaction time, etc.
  Recognizing that these issues are present and
  looking for ways to provide appropriate responses
  to the given health issue will be necessary in
  serving these individuals. Further, being
  supportive of the individual and responding to
  limitations will help accomplish more activities
  as well as enhance the therapeutic relationship.

36

• There are a variety of ways that people can
  communicate their wants and needs. Verbal
  communication is one way, however, there are many
  nonverbal means of communication also. Behaviors
  such as crying, smiling, hitting, pulling,
  pushing, pointing, signing, pictures, etc. are
  other common ways of communicating. As you get
  to know your Consumer, you will become more aware
  of his or her particular mode of communication.
• There are some behaviors and attitudes that can
  create barriers to positive interaction.
  Behaviors can include a variety of body language
  signals such as facing away from the individual
  you are dealing with, having a closed off stance
  (such as crossed arms), lack of eye contact, etc.
  More overt actions might include raising your
  tone of voice, doing other activities while your
  Consumer is trying to interact with you, etc.
  Attitudes that create barriers to positive
  interaction include indifference towards the
  Consumer, irritability or impatience, looking
  down on your Consumer, etc. Remember that your
  job is to support and help teach your Consumer,
  so having patience and persevering is crucial.

37
Dealing with loss of control in the Consumers
life

• Many individuals with mental illness,
  developmental disabilities, or substance abuse
  issues face a loss of control in their lives.
  This may be physical loss of control, such as
  difficulty with movement or motor control. This
  could also be mental or emotional loss of
  control, such as the inability to control
  impulses or outburst of feelings. Furthermore,
  in many of these individuals lives, the right or
  ability to make decisions on many levels is not
  present. This can result in feelings of
  frustration, anger, powerlessness, depression,
  etc. for the individual.
• Helping the individual feel in charge of what
  is happening in his or her life is an important
  task for you as the provider. This can be done
  even in situations where Consumers have rigid
  schedules to be followed. For example, a
  Consumer who has a set schedule of activities can
  still be given the opportunity to choose his or
  her reinforcement or leisure activities for
  appropriate completion. A Consumer with a less
  strict schedule can choose the order of the
  activities to be completed. Allowing the
  Consumer adequate time to process information
  before providing assistance is another way of
  increasing his or her level of control.
  Remember, the ultimate goal is to help the
  Consumer achieve his or her level of productivity
  and independence, so you want the Consumer to do
  as much for his or herself as possible, even is
  this takes more time and patience.
• Always try to empower and encourage Consumers
  with disabilities. As previously mentioned, be
  patient, allow for ample processing time, and
  provide reinforcement for correct and appropriate
  decisions. Another way to help Consumers with
  decision making is to model appropriate decision
  making. For example, if a Consumer with issues
  relating to healthy eating wants to go out to
  eat, you can model appropriate decisions by
  choosing healthy items on the menu yourself. You
  can also help your Consumer make good decisions,
  while still encouraging independence by offering
  multiple choices and discussing the pros and cons
  of each. Finally, it may be helpful to break the
  decision making process down into parts.
  Remember that this is often a complex and
  confusing task for individuals with disabilities.
  The individual may not be able to assess all
  aspects of the process at once and may need your
  assistance to see all the steps involved in
  making a decision.

38
Assessing risk for escalating behavior

• There are many reasons why people might engage in
  challenging behavior. Some of these reasons
  include frustration, anger, irritability,
  exhaustion, pain, hunger, etc. Engaging in
  challenging behavior is most likely a way to get
  needs or wants met when the individual can not
  think of any other way to get these things to
  happen. Behavior may be escalated by how the
  individual is feeling (such as tired, hungry, in
  pain, etc.). Escalation of behavior can also
  occur if the person feels that he or she is being
  given unfair treatment, ignored or taunted in a
  given situation.
• Environmental factors contributing to distress of
  either staff or the Consumer could be a chaotic
  environment (loud, busy, cluttered, etc.) or
  weather (hot, cold, rain, snow, etc.). Internal
  factors contributing to distress might include
  confusion, frustration, distraction,
  disappointment, etc. Recognizing these factors
  and determining how they affect the circumstances
  is an important skill learning to manage distress
  for both you and the Consumer.
•  
•  

39
Defusing and de-escalating potentially dangerous
behavior

• Many different techniques are available to calm
  an individual who is in distress. A person can
  be verbally reassured that a situation is under
  control and that he or she is safe. Listening to
  an individual and allowing time to discuss what
  is bothering him or her is another way to help
  calm an individual. Other ways to verbally
  de-escalate a situation include softening your
  tone of voice, and slowing the speed of your
  speech. There are many nonverbal ways to assist
  in calming a distressed individual also. First,
  try to keep a calm and relaxed body stance and
  facial expression. Seeing that you are not
  distressed may aid in calming the individual.
  For some people, a light touch on the arm or
  shoulder may help to reassure them that the
  situation is safe and under control. Other
  people may prefer to have some space and quiet.
  For these individuals, removing them from the
  present situation into a calmer atmosphere (ie.
  Moving outside into another room, etc.) for a
  moment can be helpful. Assessing your Consumers
  particular needs when distressed will come by
  getting to know your Consumer.
• Ways to help a person manage stress include
  providing appropriate options for ways to behave
  or respond to the situation, as well as modeling
  appropriate behavior and responses. Again,
  remaining calm, using an even or neutral tone of
  voice and speed of speech is helpful. Remember
  that individuals with disabilities may not know
  how to respond to a situation and will look to
  you for guidance modeling is a key tool for
  stress management.
•  

40
Positive behavioral supports

• Teaching appropriate interpersonal, social,
  coping and self-management skills is an important
  aspect to working with individuals with
  disabilities. Individuals with disabilities may
  not learn these behaviors through general
  inference as others do. Extra support and
  guidance is often needed to help teach these
  skills in the areas of thinking, behaving, and
  feeling. Furthermore, just as reinforcement is
  appropriate in teaching specific skills,
  reinforcement for abstract concepts such as
  socialization and coping or self-management
  skills is also crucial.
• Helping a person identify alternatives to unsafe
  behavior will partially depend on the
  individuals specific needs, abilities, and level
  of understanding and functioning. However, there
  are some general techniques for providing
  assistance in finding appropriate alternatives.
  You can start by helping an individual identify
  the pros and cons of the unsafe behavior,
  followed by prompting the individual to
  brainstorm for more appropriate alternatives. If
  the individual is unable to come up with
  alternatives, you can provide some possible
  alternatives and ask him or her to compare which
  behavior would be the most appropriate and safe.
  
•  
• The employee/staff will be provided with
  additional information or resources based on the
  individual served. Take time to assess the
  Consumers strengths and weaknesses. Look for and
  note their natural tendencies and their
  personality. This is best accomplished by
  watching carefully and actively listening to your
  Consumer. This population may communicate much
  differently than you are accustomed to. Because
  the individuals we serve tend to have
  difficulties with receptive and expressive
  language, their thoughts, wants, and needs may be
  communicated through their actions, behaviors,
  and/or body language. Once you have developed a
  good sense of who your Consumer is, you will also
  be more successful with relating to your Consumer
  and with getting your Consumer to learn. You will
  also be more readily able to foresee
  difficulties, head off problems, and be flexible
  in your method of presentation. All of this will
  ensure a rewarding and productive experience for
  both the Consumer and you. By getting to know
  your Consumer, you will learn what works well as
  rewards, incentives to encourage him/her to keep
  trying and to try harder. With new skills,
  tangible rewards tend to work better, such as
  special foods, drinks, choosing a preferred
  activity, down time, verbal approval. Skills
  being worked on that are closer to being mastered
  should be rewarded more intrinsically by their
  own feelings of pride in their hard work and
  verbal praise from you. The focus should always
  be to focus on rewarding the positive and
  overlooking the negative when possible.

41

• When giving instruction to the Consumer that you
  serve, make sure that you keep your directions
  simple and very clear. Give adequate time for
  the Consumer to process the information given to
  them, as well as, to determine his/her response
  and respond. Give immediate feedback, especially
  positive reinforcement, to the Consumer following
  his/her response to help in the acquisition of
  the new skill.
• In summary
• Know your Consumer.
• Be consistent.
• Reinforce wanted behaviors.
• Give opportunities for communication.
• Use varied strategies over a period of time.
• Use more praise, less criticism.
•  
• It is important to remember that a person with MR
  or DD has many CAPABILITIES. When working with a
  Consumer, you want to use the Consumers
  capabilities to enhance the development of new
  skills. This is called habilitation.
  Habilitation is often confused with
  rehabilitation, which is the relearning of a lost
  skill. You will be doing habilitation. As human
  beings, we tend to take care of or care for other
  people. The focus with habilitative care is
  shifted towards helping people to develop and
  acquire skills for themselves. Instead of doing
  the task yourself, you will be teaching, role
  modeling, and encouraging the Consumer to achieve
  the skill so that the Consumer can do it on their
  own. These newly acquired skills will ultimately
  help the Consumer to become more effective and
  independent within the community. Instead of
  taking care of, you will be caring about the
  Consumer. You will care about the Consumer as a
  person with great capabilities who has the
  potential to learn and grow. You will afford the
  individual the dignity of risk.

42

• For example, when you were a child and you wanted
  to learn how to ride a bike, someone told you
  that they would teach you. They got on the bike
  and modeled for you how to ride but they never
  held you up on the bike while you learned to
  pedal, nor did they guide your steering. You
  were just left to figure it out on your own from
  the example given to you. Most likely, you would
  not have learned how to ride a bike. Another
  example would be learning the simple task of
  eating. If someone always fed you and you were
  never given the opportunity to hold the fork or
  spoon and guide its way to your mouth, you
  probably still wouldnt use utensils when eating.
  People learn by doing as well as watching, and
  so it is with habilitation.
•  
• Some Consumers will need more structure, while
  others will need less. Some Consumers will need
  shorter intervals of work time than others. In
  light of this it is always important to plan
  ahead for breaks (i.e. transition time). This is
  because the passage of down time (i.e.
  preparing during the session instead of ahead of
  time) as well as transition time is the most
  likely time for problem behavior to occur. When
  problem behaviors are exhibited, it is important
  to identify what is going on for the Consumer.
  Ask yourself a few questions. Is the Consumer
  becoming bored and impatient? Is the Consumer
  seeking my attention? Is the Consumer becoming
  frustrated? Am I assuming the Consumer already
  knows something that he/she does not? Am I
  rewarding the Consumer frequently enough? Is
  what I am using as a reinforcer truly rewarding
  to my Consumer? These are all relevant
  questions to constantly be asking yourself as you
  work with persons with MR and DD. In addition,
  here are a few things to remember
• When Consumers are engaged in positive
  interactions, negative or problem behaviors are
  less likely to occur.
• If you see a problem developing, redirect the
  Consumer.
• Know what your expectations are so that you can
  replace unwanted or problem behaviors with
  acceptable alternatives.

43

• Integration and inclusion refer to the
  opportunity for all individuals with disabilities
  to live, learn, work, and enjoy life in regular
  contact with citizens without disabilities in
  their home communities. This could involve using
  the same community resources, participating in
  the same activities and employment, living in
  neighborhoods with persons without disabilities,
  and developing friendships and relationships with
  persons without disabilities. People with mental
  retardation need the opportunity to participate
  in, benefit from, and enrich the daily life of
  their communities. Inclusion brings people with
  and without disabilities together throughout
  their lives. Supports and services needed by
  people with MR should be given to them in their
  home communities as they live, learn, work and
  play with non-disabled peers.
• Children with MR should live in a family grow
  up enjoying nurturing adult relationships both
  inside and outside a family learn in their
  neighborhood school in a regular classroom that
  contains children without disabilities play and
  participate with children with and without
  disabilities, in community recreation and other
  leisure activities.
• Adults with MR should have the opportunity to
  have personal control over their own lives have
  adult relationships ranging from acquaintances to
  friends to life partners live in a home engage
  in meaningful work and be paid fairly for it
  enjoy recreation and other leisure activities
  practice spiritual life.

44

• Disability (1) A particular act that someone
  has problems performing, like reading a book,
  running, or dressing, because of an impairment.
  (2) The result of any physical or mental
  condition that affects or prevents ones ability
  to develop, achieve, and/or function in
  educational and social settings within the
  typical rate of growth and development.
• Mental Retardation Having significantly sub
  average general intellectual functioning (refers
  to scores obtained on intelligence (IQ) tests)
  existing concurrently with deficits in adaptive
  behavior (refers to a persons adjustment to
  everyday life) and manifested during the
  development period, which adversely affects a
  childs educational performance.
•  Developmental Disability (1) A handicap or
  impairment originating before the age of 18 which
  may be expected to continue indefinitely and
  which constitutes a substantial impairment. (2)

45
Elements for Incident / Accident Reporting

• The following incidents / accidents must be
  reported to ROLH within 24 hours of the incident
  / accident.
• Death of a Consumer
• Injury to or caused by a Consumer
• Property damage caused by a Consumer
• Alleged abuse, neglect or exploitation of a
  Consumer
• Alleged criminal act by a Consumer
• Alleged criminal act by others, having an impact
  on the Consumer
• Elopement or wandering of a Consumer
• Violation of the rights of a Consumer
• Accidental injury
• Adverse reactions to medication(s)
• Medication errors
• Emergency or unauthorized restraint or seclusion
• Violation of the confidentiality of a Consumer
• Unknown bruises
• Client theft
• Medical crisis
• Threats of suicide
• Threats towards others

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• ROLH is responsible for reporting ALL incidents
  and/or accidents to the local area program in
  writing within 24 hours.
•  
• ROLHs Policies and Procedures regarding incident
  reporting state all injuries and/or accidents are
  to be reported to the ROLH office. An incident
  report (attached) shall be completed immediately
  and submitted no later than 24 hours following
  the occurrence of any Consumer injury.
• A full narrative description of events relating
  to the occurrence must be written and signed by
  the employee/staff involved on a communication
  note form (attached).
• Review attached incident report-complete for
  competen