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Careers in Special Education
Working with Special Needs Adults in Residences

By Skip Holiday

Autism is a perplexing neurodevelopmental disorder that has befuddled the medical community for many years. It is a disorder that surfaces before a child turns three years old and is more prevalent among males than females. It is a disorder that can affect anybody regardless of race, social class or gender. What makes autism so complex is that the medical community still can’t pinpoint the causes and while there are various methods to treat autism, there is still no cure for it.

I have been working with the autistic population for over three years in a residential setting. I work as a direct care counselor for a mental health/social services agency in New York City in what is called an IRA (Individualized Residential Alternative). An IRA is similar to a group home but there are differences between an IRA and a traditional group home such an ICF (Intermediate Care Facilities). In an IRA you typically work with a small number of consumers compared to an ICF. Also, an IRA is designed for high functioning consumers who can complete their ADL skills (Activities of Daily Living) independently. An ICF tends to be for low functioning consumers who need assistance in completing tasks of daily living that we take for granted such as showering, tooth brushing, shaving, eating and toileting to name a few. These consumers work “one on one” with a staff that works with them to complete their ADL skills with verbal, gestural and physical hand on hand prompting. These are tasks that we tend to take for granted but for the autistic population it takes years of treatment plans to learn how to master these tasks and as direct care staff we help and guide these consumers to master these tasks.

In the residence where I work, two staff members are assigned to a house with four consumers. We rotate depending on the shift that consists of evening and overnights during the week. The consumers we work with range from medium to high functioning and each of them have their own behaviors, peeves and disorders. Some of them only have autism but others have autism along with other mental disorders such as schizophrenia, psychosis and mental retardation. We work withseveral consumers who have Asperger’s syndrome, which is an autism spectrum disorder common in high functioning consumers. These consumers are allowed to travel on their own. We also work with non-verbal consumers who despite the fact they can’t communicate verbally, can read and write and understand every word that is spoken to them.

Our work in the IRA is fairly simple because most of the consumers can do things on their own such as washing and drying their own laundry, cleaning their homes, cooking their breakfast, ironing their clothes and so on. We are also responsible for tasks such as maintaining a personal log of their behavior and daily activities as well as administering their medications.

Their autism is treated primarily with ABA (Applied Behavior Analysis) therapy. Since their functioning and behaviors vary their treatment as well as their behavior and goal plans are different. We have consumers that have tooth brushing and showering goal plans because their functioning is behind some of the high functioning consumers. We also have high functioning consumers who are on community awareness and socialization goal plans so they can learn to socialize and integrate themselves in a community setting. We have consumers who are on money management goal plans to learn how to manage their money effectively.

With ABA, a team of QMRP (Qualified Mental Retardation Professionals) implement the behavior plans and methodologies with the hope of get ting all of these consumers functioning at an independent level where they can maintain a job and live on their own instead of a group home setting.

Our consumers are also treated with medication therapy such as Risperdal, Zyprexa and Prozac. Unfortunately these medications are designed to control and modify behaviors and peeves. There is no magic pill that can stop these consumers from behaving violently when they are upset or stop making them behave hyperactively when they are in a community. There is no miracle surgical procedure that can cure autism and for me that is the saddest part about working with these consumers. This disorder doesn’t go away.

Through all my years working with this population, ABA therapy is probably the best way to treat this disorder. The goal is to have these consumers functioning at a level where they can behave and socialize appropriately without the use of medications that can have adverse long term side effects such as dementia. But I have found that if the methodology of ABA isn’t executed properly than it can be useless. That is one of the criticisms that I have about this field and the agencies that are entrusted to treat the autistic population. In the agency in which I work, we are trained to administer medications and learn how to appropriately handle situations of crisis but we have no training in ABA therapy and how to execute these behavior and goal plans properly and that is a problem if we are the ones that work with them in a residential and community setting.

When implemented and executed properly ABA therapy can be a wonderful method to treat autism; when not executed properly, the results can be mediocre. These consumers didn’t have a choice in being afflicted with this disorder so the least the hierarchy of these mental health and social services agencies can do is provide these consumers with the best chance to succeed and part of that starts with integrating direct care counselors in the implementation of these treatment plans and methodologies that fall under ABA therapy.#

Skip Holiday is a pseudonym for an employee that has worked with autistic individuals for many years.



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