Thursday, June 27, 2013

Hands make good notepads

I was driving to Cortland this afternoon to pick up one of my residents from their day program and kept thinking about all the things left to do before I clocked out.  I began to write them down as I thought of them.  The red was to indicate the note was completed.  Ended up clocking out an hour and a half late.

BUT, I got to meet the occupational therapist who came to assess Flash's sensory needs and help him feel more comfortable and happy in his home.  She came after my scheduled shift so I wasn't too sad about all the extra work that had piled up which kept me there during the length of her visit.  It was fascinating discussing ideas with her.  I've already thought of studying occupational therapy either formally as a PhD after my Master's, or informally by reading lots of books and talking with OT's as I meet them.  She had some awesome ideas like lotions, massage, textures, a BIG exercise ball, a tricycle, and more.

Wednesday, June 26, 2013

What I do at work on a really good day:

A lot of people ask me what I do for my job.  In our parents' and grandparents' day, many individuals with developmental disabilities lived in large institutions and were kept, for the most part, away from mainstream community interactions.  Fortunately, the mental health department has made huge leaps in providing better lives and services for those who need various levels of assistance in everyday living and working.  But most people don't know what it is that I do exactly.  Basically, I am a direct support professional and work with the residents in a group home.  I transport them places, accompany them to their doctor appointments, take them on outings in the community, fill out LOTS of paperwork, support them in self-hygiene skills, and lots of other things.

Introduction to the basics of my job:

As I've mentioned in the past, I work in a group home with 5 individuals.  It is a basic one level house with 5 bedrooms, an open living room/kitchen when you first walk in, 2 bathrooms, and a second small living room area at the far side of the house.  They each have their own rooms and can decorate it as they choose.  Those who show no preference or interest in choosing decor get to have staff make those choices for them and try to match their rooms to their personalities.

4 out of 5 of my residents are diagnosed with Autism and Intellectual Disability (used to be mental retardation).  The 5th has Cerebral Palsy and Intellectual Disability.  To protect their privacy, I can't write their names or share pictures.  I've come to refer to them by superhero names.  They are the Hulk (early 30's), Thor (early 30's), Flash (early 20's), Loki (mid-twenties), and Spiderman (mid-twenties).

What I did today:

I clocked in around 12:45.  I did the quarterly emergency food supply inventory and made a list of things that need to be replaced.  I met with the other supervising shift coordinator (I recently got promoted, by the way.  Yay!) and caught up on what happened during his watch and made mental notes of things that needed to be done during my watch.  Then I headed to Spiderman's semi-annual ISP.

An ISP (Individual Support Plan) meeting consists of the house nurse, house behavior specialist, team director for the house, sometimes a regular staff from the house (me, in this case), those that oversee him at his day program, and his service coordinator (social worker).  We talked about where he is excelling and where we should focus his goals and any needed interventions.  Spiderman was present.  His verbal and communication skills are limited but he did help his main day hab worker to go through his weekly schedule (Monday: mail run, church to vacuum, lunch, shredding paper... something similar to that).  Mostly he sat next to me shredding paper in to small bits with his hands that I handed him to keep him occupied and content.  It worked.  :)  We do address him as much as possible and give him the opportunity to be involved even if he chooses not to answer.

We got back to the house.  Spiderman went to take a nap - his usual afternoon activity.  I did some office work and tried to find some activities for Flash to participate in during the upcoming months that he is home. Flash has graduated from high school but has not been fully accepted into a day hab program and it looks like it will be 6-12 months waiting period.  We are looking for volunteer activities that match his skill level that he can participate in during the days since he doesn't do well with unstructured days - Autistic trait.  I replaced some light bulbs, cleaned the grease off the ventilation fan above the stove (thank you magic erasers!), and prepped for a 20% chance of a State inspection (nothing big, just did some quick looks around to make sure things were in place and order).  The 80% chance of them not coming won and they went to a different house to inspect than ours.  They'll come by each house about once or twice every year or two.  It varies.

Spiderman came to inform me it was time for our outing around 5pm.  He grabbed my hand, pointed out the window with his towel and swimsuit in hand and said, "out."  We had already determined our outing schedule on the way home from his ISP.  "Nap, shopping, swimming, McDonalds - cheesburger, french fry, soda."  I quickly changed into my swimwear (hard to change in privacy while together in a family dressing room so I make it simpler by changing at the house before we leave in the privacy of the bathroom).

Our outing:

We first went to Kohl's to buy him 2 pairs of swim trunks.  He has lost some weight due to him increasing his physical activity and needed to replace them.  Yay for staff taking him out on so many hikes!  He chose 2 in his favorite color: red.  He was SUPER good.  Held my hand most of the time.  Patiently waited in line.  Didn't ask for anything extra.  And skipped back to the van holding my hand cause he was so happy about his new "red, red, red" swim trunks.

Next, we went to the YMCA to swim.  They are super awesome and let us in for free.  I think maybe FRC (the agency I work for) has a membership or agreement or something cause they always let any of our residents in for free.  We got him changed in his new swim trunks then headed out to the pool.  Spiderman went straight to the kiddy pool.  There were some kids already there, maybe 5 or 6.  He was very mindful of them and while they got splashed as he ran back and forth slamming his hands in the water, he always ran or walked around them and never bumped them.  15 minutes into swimming (running back and forth from one end to the other), Spiderman noticed that my hair wasn't wet yet.  He cupped his hands and began pouring water over my head handful by handful and then clapped when I was thoroughly wet.  His method of play splashing was cupping his hands and tossing it over my way.  I was impressed that water rarely hit me above my neck.  Never in my face.  He saved that for his running back and forth slapping the water or when he poured water over my head.  :)  After a half hour, the big pool opened up so we moved over there to deeper water.  He does not know how to swim so we stayed at a maximum depth of 4 feet but Spiderman enjoyed being deeper in the water than the kiddy pool.  He held to the ledge as I held his hips and would kick his legs while I counted to 10.  At the count of 3, we would both go under and pop back up.  Mostly, he ran from one end to the arbitrary 4 foot depth marker and back again.  After 50 minutes total, we decided we were exhausted and got out.  Spiderman was extremely generous and actually put his towel on my head and started trying to dry my hair and my arms.  It was really funny.

Wednesday's are Spiderman's McDonalds night.  He does a physical activity - hiking, swimming, or playing at a park - and then gets "cheeseburger, french fry, soda."  He startled some people cause he was so happy and was galloping in place and flapping/waving his arms and hands.  They smiled once I praised Spiderman for being so happy.  (A subtle way to assure people unfamiliar with Spiderman that this behavior is positive and that he most likely has a developmental disability and is not someone on drugs.)  Unfortunately, we get that impression a lot since visually, most of our residents look neurotypical.  We ate inside then got back to the house.

Wrapping up to go home:

Once back at the house, I called TC3 in Cortland to look into swim lessons for Spiderman.  They apparently do swim lessons for individuals with special needs.  I called his step-mom last week to get her approval.  She was enthusiastic about the idea.  I filled out receipt ledgers and had Spiderman sign them.  I helped make lunches for the 4 who are currently enrolled in day hab.  Individuals with Autism are VERY particular about their food and their lunches are individual and very different from each other.  I checked up on a staff member who had been shoved by Flash into a counter's edge.  She'll have a respectable bruise on her hip bone but no other harm.  Made copies of some forms to restock some of their service binders that we document daily.  And clocked out only 30 minutes past my scheduled shift of 1pm - 8pm.

Not everyday at work is that good.  Spiderman was so affectionate, playful, and cooperative today.  It made it an awesome day.  I like to collect these days so that I can try to recall them when I want to quit and never come back on the really tough days.  My job can be rather rough, emotionally stressful, and physical.  These are grown men who are mostly non-verbal and have few communicative outlets.  They express their likes, dislikes, pleasure, and displeasure through behaviors.  It can get violent.  I have been very lucky.  (Knocking on wood).  The worst physical injury I've gotten is a fat lip on my first outing by myself with Spiderman 2 years ago.  He wasn't even trying to hit me.  He was trying to get away (shoplifting at Best Buy) and his flaying arms and hand holding a Coke bottle just happened to make friends with my face.  He apologized later after he had some time to calm down.  Other than that, its mostly been scratches and small bruises.

What's on the menu for tomorrow?

I work the morning shift for the next 2 days which means I'll have lots of quality time with Flash after we transport the other 4 residents to day hab.  Depending on Flash's mood and cooperation level, I would like to take him on a short house shopping trip (some groceries and household needs), take the recycling to the recycling center, and have a picnic at a park.  If he is having a rough day, I might encourage a nap and work on writing various protocols to help train staff and increase the consistency in the house.  And then, try for a picnic at a park.

Well, I hope you enjoyed this series of what I do at work, particularly on a REALLY good day.  I love sharing what I do because I love each one of my residents.  I've been with them for over 2 years.  I've seen them cycle through many different phases, nursed them when sick, comforted them when upset or frightened, and fought for them as their advocate.  I constantly am researching intervention methods, outings they would enjoy, or things to get for them at the house to increase their individual quality of life.  I love what I do and am so excited about my studies and making this into a career.