This behaviorally-oriented rehabilitation manual provides a down-to-earth, easy to implement model that is designed to teach, strengthen, and evaluate desired skills in human service interactions.
The Helping Exchange is based on the following principles...
Positive- defines and invites positive interactions.
Early- stresses importance of interacting early by providing help or problem solving and not waiting until a risky situation develops.
All- shows how to use all components with all people in all settings all of the time.
Reinforce- shows how to interact in ways that acknowledge more independent behavior and encourage future use of the behavior.
Look- identifies opportunities to teach and encourages greater participation in the community.
Examples illustrate how to apply the P.E.A.R.L. to clients with behavioral, emotional and cognitive disorders. A score sheet provides a rating scale to observe interactions and rate performance.
|Pages||48 pages, 7 x 8½, softcover|
Just in my human service lifetime (which has been just a bit more than three decades), we have had the opportunity to witness remarkable advances in the medical, educational, and behavioral treatment of individuals who have been considered disabled. In fact, somewhere in the professional literature related to these areas of inquiry, there is probably an intervention that has been designed to address virtually any problem that an individual in need of assistance might have. With all the information that is available, one could easily get the impression that human service providers have it pretty well covered in terms of providing assistance to those who need our help. There are times that I feel that way.
However, there are other times when I am disappointed by what I view as the "gap" between what I know exists in terms of a "technology" of human service and the actual "practice" or application of human service at the person-to-person level. At these times, I am struck by what appears to be a lack of interest or preparation on the part of caregivers to treat the persons they help with even basic dignity and respect. At these times, I am surprised that people who probably ought to know better, simply don’t. At these times, I find myself wondering whether anything important has really changed in to our treatment of persons who are considered disabled.
I absolutely respect human service technology and those who have contributed to it. In fact, I spent nearly eight years working in a very special behavioral research setting with two of the more influential behavioral psychologists of our time.1 I have seen the remarkable results that behavioral technology can produce, in both individual and group situations, with a variety of human problems including depression, self-injury, sprawling, pica, echolalia, stereotopy, aggression, marital discord, social skills and language development…just to name just a few.
Yet, I question the practical value of human service technology when: (a) it is so complicated that it can only be used by specialists; (b) it promotes professional or social distinctions between the people who create it and the people who might use it; (c) some of its most basic premises continue to be misunderstood (or not understood at all) by human service providers, and (d) it fails to reach the persons for whom it was designed.
Let me give two vivid examples of what I view as the gap between technology and practice in human service. In 1986, I was consulting with a group of human service professionals in a specialized treatment setting for a group of individuals who were considered chronically mentally ill. The elderly man who was the focus of attention on this day had a longstanding and troubling problem of pilfering or taking items from others with whom he lived. As a result, his room had been totally striped of small items, including clothing, so that the staff could more easily determine if he had taken anything from anyone else on the unit.
Not knowing a great deal about the situation, I just surmised that this man probably liked to have a few things in his possession. Acting on this bit of seemingly common sense, I suggested that one way staff could encourage the absence of pilfering was by providing little things at key times when they noticed that he did not have things that belonged to someone else. We set up what I viewed as a simple, and very applicable, behavioral intervention.
To make a long story short…the staff loved this idea and there was great enthusiasm that this simple plan would actually work. At the end of our very productive meeting, I suggested for the record that our plan actually had a technical name (i.e., differential reinforcement), but we didn’t need to worry about that as long as everyone knew what to do. It was an amazing meeting, thoroughly welcomed by all in attendance. However, the most amazing thing to me was that the setting in which I was consulting with these human service professionals was, in fact, the site where one of the first behavioral token economies in the country had been designed and extensively researched nearly 15 years earlier. Where were the benefits of that work?
The second example is even more straightforward. Very recently, I was providing an all day training workshop for approximately 50 human service professionals from almost as many different organizations in a large urban community. These were individuals who administered, coordinated, and directly served many individuals who were considered developmentally disabled and brain injured on a daily basis…most of whom had been doing so for years. Sometime after lunch while I was momentarily tired, I found myself sort of challenging the group. I asked, "How many of you have heard the term positive reinforcement?" All 50 people raised their hands. Then I asked, "Which one of you would like to tell the group what it means?" Only two hands were raised. The first person’s description was well off the mark, whereas the second individual came very close to an accurate definition using everyday language. We applauded his effort. Yet I was amazed that, after more than 30 years of broadly disseminating information and research related to behavioral clinical interventions, only 2-4% of this sample of human service professionals could accurately describe one of its most fundamental premises.
To me, these are just two of many examples of how the technology that is available for human service providers often does not appear to be practiced or applied in situations where it is most needed. Clearly, this is not a new problem for researchers or practicioners and I do not view it as anyone’s fault. However, with the change in the locus of service delivery for many people who are considered disabled (e.g., from specialized treatment settings or institutions to the community and home), it may have become more evident than at any point in our human service history.
So, what are we to do? There are many possible ways that we could begin to close the "gap" between available technology and the application of evidence-based human service practices. For example, perhaps more human service professionals, who are technically trained, could be recruited to the field. Or, maybe there are ways to increase the number of skilled or certified trainers of the technology. Perhaps we could encourage allocation of more funds specifically directed toward influencing the quality and availability of training for persons who are most involved with the individuals in need of assistance. Or, maybe additional laws or regulations are needed to enforce implementation of the tools that we have.
While these and other approaches may be useful, I am not sure that any of them would actually make much of a difference in the lives of those persons in need of assistance or those who assist them. For starters, I am not sure that there is enough consensus on what technology ought to be trained. And, even if there was agreement on this important issue, I am not at all sure that there would ever be enough funds, human resources, or oversight available to help insure that it would actually have a lasting impact on how people are treated. In fact, in this day of increased community care, increased inclusion in broader (e.g., non-specialized, less consistent) social contexts, and decreased participation of professional people in the lives of many persons who are considered to be disabled, I am often not even sure if any of this is on the right track.
A general purpose of this work is to encourage a somewhat different approach to influencing the lives of persons who are considered disabled, one that emphasizes interaction between people as the basis of all human assistance. In my opinion, if we are to have a marked influence on the way that persons who are considered to be disabled are treated, then we are going to need to find more ways to promote the personal and social value of the relationships that can develop as a result of those interactions.
A more specific purpose is to continue the work of translating complex behavioral principles and concepts into language that is understandable and actions that are relevant to those who are most closely involved in the everyday lives of others in need of our help.