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Helping People Without Making Them Helpless: Fun, Functional, and Other “F” Words. Tim Feeney, Ph.D. Project Director New York Neurobehavioral Resource Project Binghamton, NY Clinical Director School and Community Support Services 600 Franklin Street Suite 110

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slide1

Helping People Without

Making Them Helpless:

Fun, Functional, and Other “F” Words

Tim Feeney, Ph.D.

Project Director

New York Neurobehavioral Resource Project

Binghamton, NY

Clinical Director

School and Community Support Services

600 Franklin Street

Suite 110

Schenectady, New York USA 12305

tfeeney@scssconsulting.com

518-372-2026

slide2

“I’m a person, not a patient;

and I’m not ‘yours’!”

slide3

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; moreover,

we need to learn from other literatures

from other populations

more grandma masse
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

slide5

You can make people

do things that they

just don’t want to do

but the price for doing

so will be high

slide7

FUNCTIONAL

does not equal

Increased/Improved

performance on

standardized tests

slide8

FUNCTIONAL

does not equal

Bowling

or the

The Friday Outing

or the

The really neat,

really expensive,

simulated. . .

slide9

FUNCTIONAL

equals

Creating stable routines of life that

enable me to do what I need to do

when I need to do it.

slide10

“ A coach gets guys to do the things

they don’t want to do so they

can become the players that

they want to be.”

- Walt Harris

“We’re all coaches”

A good coach:

• Alters his/her coaching to

reflect the needs of the player

and conditions of the context.

• Never tries to play the game

him or herself.

slide11

The glass ain’t half empty,

it’s half full!

and

You can teach 1/2 empty

people to become 1/2 full people

(it’s hard to teach 1/2 empties to

become 1/2 fulls)

slide12

PERSON

Language

Emotion

Volition

Behavior

Motor SKills

Cognition

Human beings are a collection of

relatively independent structures,

processes, and systems

slide13

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
slide14

John’s Language

Phonology

Syntax

Morphology

Semantics

Pragmatics

Receptive vs.

Expressive

Phrase Structure

Rules

Etc.

Receptive vs.

Expressive

Lexicon

Semantic

Relations

Discourse

Structures

Receptive vs.

Expressive

Speech-act

Competence

Conversational

Competence

Socio-linguistic

Competence

  • Goals for John: John will
  • Decrease mean naming latencies from 3 to 2 seconds
  • Include 5 basic story grammar elements in retellings
  • Use politeness markers in greeting people: 90%
slide15

John’s Behavior

John is the totality of his behaviors and

the systematic relationships among them

John

b1b3b12b4 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
slide16

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

intervention goals
Intervention Goals

Sarah will successfully complete ___meaningful task,with ___supports, possibly using ___“tools/strategies”,in ___ context (setting, people, activities), in order to achieve ___goal.

Possibly focusing intervention attention on some specific aspects of cognition, communication, social skills, behavioral self-regulation, or educational/vocational skills – aspects that are either particularly weak or particularly important for Sarah.

slide18
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Fluctuating Attention

Strategy:Appropriate Pacing

Delivering material in small increments and requiring responses at a rate consistent with the individual’s processing speed increases the acquisition of new materials.

slide19
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Memory Impairment

Strategy:Errorless learning and high rates of success in interactions

Acquisition and retention of new information tends to increase with high rates of success (and error frequency increases with frequent errors and error correction).

slide20
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Organizational Impairment and Inefficient Learning

Strategy:Task analysis of activities and advance organizational support

Careful organization of learning and tasks including systematic sequencing of intervention targets and advanced organizational supports increases success.

slide21
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Inefficient Learning and Inconsistency in Performance

Strategy:Massed practice and review including frequent cumulative review

Acquisition and retention of new information and consolidation of old information in memory is increased with frequent, routine-based review.

slide22
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Inefficient Feedback Loops and Implicit Learning of Errors

Strategy:Errorless learning combined with corrective (and brief) feedback when errors occur.

Many individuals with severe memory and learning problems benefit from errorless learning. When errors occur, learning is enhanced when those errors are followed by non-judgmental corrective feedback.

slide23
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Frequent Failure of Transfer/Concrete Thinking and Learning

Strategy:Facilitation of transfer, generalization, and maintenance via contextual teaching.

Generalization is more likely when skills are taught in the context in which they will be used (context is encoded with information). In addition, using a general case approach (wide range of examples and settings) increases generalization.

slide24
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Unpredictable Recovery, Unusual Profiles, and Inconsistency in Behavior

Strategy:Ongoing assessment and flexibility in curricular modification.

Adjustment of interaction based on ongoing assessment of the individual’s progress facilitates learning and allows for curricular modifications “on the fly”.

slide25
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Impaired Strategic Behavior/ Impaired Organizational Functioning

Strategy:Strategy-based intervention.

Organized intervention designed to facilitate a strategic approach to difficult tasks, including organizational strategies.

slide26
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Decreased Self-Awareness/ Denial of Deficits

Strategy:Self-awareness/attribution training

Facilitation of individual’s understanding of his/her role in learning

slide27
Research-Based Intervention Strategies Related to Common Characteristics of Individuals with Brain Injury

Characteristic:Behavioral Difficulties

Strategy:Positive behavior supports

Using an approach to behavior intervention that focuses primarily on the antecedents of behavior in the broadest sense (including setting events and establishing operations), environmental management, and role improvement.

fun as an important element of rehabilitation
Fun as an Important Element of Rehabilitation

Therapeutic: Serving to sure or heal

Fun: Lively, joyous, playful

Do you ever ask yourself:

“Where is the fun?”

rather than

“Are we having fun yet?”

fun is not
FUN IS NOT:

 Worrying about being politically correct

 Going to “therapy”

 Doing a workbook activity

 Working on fricatives in the speech closet

  • Working to meet some fricking criterion on

some fricking test before I can get out of

this fricking place

  • Being told to “be realistic”
  • Being told to “be realistic” by some snot-

nosed twenty-something who hasn’t lived life

like I have

fun is
FUN IS:
  • The 1st time  Kids
  • Play  Joking
  • Friends  SpongeBob Squarepants
  • Laughter  Hope
  • Feeling connected  Feeling useful
  • Viagara  Being naughty
  • Love  Pure joy
  • Doing something you really like with someone

you really like

 Accomplishing something meaningful

slide31

It’s important to have fun

with and create opportunities

for fun and to laugh a lot

even in the face of

significant challenges

mindsets not conducive to fun
MINDSETS NOT CONDUCIVE TO FUN:
  • The Oprah Type - victim/tragedy/altruist

Typical utterances:

“Suffers from . . .”

“Victim of . . .”

  • The Dr. Kildare Type - medical orientation

Typical utterances:

“The patient . . .”

  • The Dr. Phil Type - control/territorial

Typical utterances:

“You gotta . . .”

“We tried that before, it’ll never work”

“Because I’m the expert”

“This is my area, don’t mess with me!”

mindsets conducive to fun
MINDSETS CONDUCIVE TO FUN:
  • Flexible

Typical utterances:

“Yeah, we can do that.”

“That looks interesting, different than I thought

but it’s worth a try.”

  • Collaborative

Typical utterances:

“Whaddaya think?”

“Geez, that’s a good idea, let’s give it a shot.”

  • Mature

Typical utterances:

“You’re right!”

“Some things I can’t change.”

mindsets conducive to fun34
MINDSETS CONDUCIVE TO FUN:

•Risk taking

Typical utterances:

“Well, I don’t know what might happen . . .”

“What’s the worst that could happen?”

“What’s the benefit?”

“Sometimes it’s easier to ask for forgiveness

than for permission”

• Hopeful

Typical utterances:

“Hey, we’re onto something here!”

“Let’s give it a shot.”

“Sure, we can do that.”

• Self-Effacing

Typical utterances:

“I don’t think I could think like that.”

“I couldn’t ever.”

slide35
Friendly

(adj.) 1 like, characteristic of, or suitable for a friend, friends, or friendship; kindly 2 not hostile; amicable 3 supporting; helping; favorable

slide36
Fellowship

(n.) 1 a mutual sharing, as of experience, activity, interest, etc. 2 a group of people with the same interests; company; brotherhood

slide37
Frequent

(adj.) 1 occurring often; happening repeatedly at brief intervals 2 constant; habitual.

slide38
Faithful

(adj.) marked by or showing a strong sense of duty or responsibility

slide39
Feeling

(v.) to be moved by or very sensitive to

slide40
Fair

(adj.) just and honest

slide41
Fabulous

(adj.) very good; wonderful

slide42
Fantastic

(adj.) seemingly impossible; incredible

slide43
Folly

(n.) 1 a lack of understanding, sense, or rational conduct; foolishness 2 any foolish action or belief 3 any foolish and useless but expensive undertaking.

slide44
Foolhardy

(adj.) bold or daring in a foolish way; rash; reckless

slide45
Fiasco

(n.) a complete failure.

slide46
Fail

(v.) to be deficient or negligent in an obligation or duty

slide47
Fecal

(adj.) of or consisting of feces

slide48

Four Lessons to Live by:

• Hope is an essential part of

any successful plan of support.

• Form follows function. Think

about what the individual needs

and then create a way for that

to happen in a flexible manner.

• The more you try to force something

or someone to change, the more

it (or he or she) changes you.

• When all else fails, a sense of joy

and a sense of humor can get you

through a whole lot!

slide49
Finished

(adj.) 1 ended; concluded 2 completed 3 highly skilled or polished; perfected; accomplished 4 given a certain kind of finish or surface, as of paint, wax, etc. 5 defeated, ruined, dying, etc. 6 no longer dealing with or concerned with.