Understanding People with Developmental Disabilities, Mental Illness, and/or Special Health Care Needs

1. Understanding People with Developmental Disabilities, Mental Illness, and/or Special Health Care Needs Tri City Partnership for Special Children & Families First Responder Smart Card Program TM

2. Performance Objectives At the end of this course of instruction, through verbal response and use of notes and handouts provided, the student will: • Develop and describe practical skills that can be used when interacting and communicating with people who have mental illness, mental retardation or special needs. • Identify appropriate referral agencies for various situations involving individuals with MI/DD. • Demonstrate how to effectively handle situations involving people with MI/DD or special needs.

3. Performance Objectives • List several types of Disabilities that fall into the special needs category • Identify safety techniques to be considered when responding to calls for service involving individuals with MI/DD. • Identify verbal and non-verbal behaviors that are indicative of persons who are emotionally unstable and/or potentially hostile. • ID the following w/ respect to detaining persons w/ MI: Legal Basis; Notification Procedures; Procedures for Serving Court Order; Procedures for Restraining and transporting; Where to Transport.

4. What Can Cause A Disability? • Genetic (or inherited) conditions • Problems at birth • Problems after birth • Poverty and cultural deprivation • Problems during pregnancy • Accident or injury

5. Mental Retardation (MR) Autism Cerebral Palsy (CP) Epilepsy Traumatic Brain Injury (TBI) Developmental Disability (DD) Seizure Disorder Examples of Disabilities

6. Communication Self-care Home living Social skills Leisure Community use Health and safety Self-direction Functional academics Work Understanding Functional Limitations

7. Disability Definitions • AUTISM-A condition which may be characterized by severe disorders in communication and behavior, resulting in limited ability to communicate, understand, learn, and participate in social relationships.

8. Autism • Inability to relate to other people • Delayed communication skills • Language comprehension is impaired • Highly sensitive to sensory input, noise levels and touch • May react indifferently or with emotional outbursts • Difficulty in dealing with changes • Obsessive or compulsive behavior

9. BRAIN DAMAGE-Generally described as any defect of the brain specifically occurring from injury before, during or anytime after birth. It may affect any brain function, but is especially related to movement, thinking and learning. • CEREBRAL PALSY-A permanently disabling condition resulting from damage to the developing brain which may occur before, during, or after birth and results in loss or impairment of control over voluntary muscles.

10. Cerebral Palsy

11. EPILEPSY-A neurological condition characterized by abnormal electrical-chemical discharge in the brain. This discharge is manifested in various forms of physical activity called seizures. • SEIZURE DISORDER-The result of a disorder of the central nervous system causing loss of consciousness, muscle spasms, mental confusion or uncontrolled or aimless body movements.

12. Epilepsy

13. MENTAL RETARDATION-As defined in Arizona, a condition involving significantly sub average general intellectual functioning existing concurrently with significant deficits or impairments in adaptive behavior and manifested before the age of 18.

14. What is a Mental Disability? • IQ (Intelligence quotient) is below 70-75 • Mild - IQ 55 - 70 • Moderate - IQ between 40 - 55 • Severe - IQ between 25 - 40 • Profound - IQ is below 25 • Limitations in “Functional Limitations”

15. Most people are “mildly” affected All other forms of mental retardation 13% Mild mental retardation

16. Intelligence means… • Paying attention • Demonstrating good memory • Using abstract thinking • Using practical problem-solving skills • Generalizing knowledge

17. Problem Solving Ability 362,379 x 9,737 = ?

18. BENEFITS OF TRAINING • Effecting positive change in our communities.

19. Common Syndromes Associated With Mental Retardation

20. What Would You Do? • A suspect is read his Miranda rights by an officer who asks, “Do you waive these rights?” and the individual responds by smiling and waving his right hand. • A middle-aged woman sees a sign in the window of an empty parked car that says, “baby on board.” She spends a long time looking inside the window of the car searching intently for a baby.

21. Waiving Rights?

22. Traits to Consider • Communication • Limited vocabulary • Speech Impairment • Unable to read or write • Say what others want to hear • Have difficulty understanding directions or answering questions. • Takes things at face value

23. Traits to Consider • Behavior: • Be easily influenced and anxious to please others. • Easily victimized • Easily frustrated (not able to understand others) • Don’t want theirdisabilitytobenoticed • Have difficulty making changes, reading, using the telephone, telling time and giving accurate directions. • Unable to pick up on social cues. • Unable to relate socially to others

24. May Be Easily Led

25. Traits to Consider • First Responder (FR) contact: • Not able to understand Miranda rights or commands. • Overwhelmed by FR presence • May act upset and try and run away • Be over willing to please officer and admit to something they did not do. • Be less likely and less able to report criminal acts or victimization

26. Vulnerability of victims • Segregated from others • Heavy dependence on caregivers • Praised for compliance • Easily persuaded or led by others • Impaired judgment • Not trained on safety or basic legal rights

27. One Officer’s Personal Experience • “I’ve got an uncle. He has down syndrome. He is just slow. Like he has all the same feelings and emotions as anyone else but he’s just like a ten year old…often people with mental retardation won’t stand up for themselves, and when someone says to them, ‘you are wrong,’ well, they say, ‘OK’… they’d just rather agree with you.”

28. Developmental DisabilityA First Responder Approach • Speak directly to the person • Keep sentences short • Use simple language • Speak slowly and clearly • Ask for concrete descriptions • Break complicated instructions down into smaller parts • Use pictures, symbols and actions to convey meaning

29. Individuals w/ DD as Witnesses

30. Developmental DisabilityA First Responder Approach • Take time giving or asking for information • Repeat questions more than once • Avoid confusing questions about reasons for behavior • Don’t speak louder in an effort to increase the person’s understanding. • Use firm and calm persistence if the person is non-compliant. • Avoid “yes” or “no” answers

31. Keep an Open Mind • Don’t assume he or she can’t understand or communicate • Be genuine in your desire to understand him or her • Demonstrate the same respect given to others without a disability

32. Victim case scenario • While on patrol you get a call from across town about a sexual assault that has just occurred. You arrive on the scene to find two middle-aged women talking. One woman, Mary, has a mental disability and is alleging sexual assault by the driver of the bus she just exited. She says it happened many times, but she has been too afraid to tell anyone until now. The other woman is Mary’s caseworker who sees Mary on a weekly basis. She works at the local mental health center. Mary’s case worker called the police immediately after the allegation was made.

33. BENEFITS OF TRAINING • Effecting positive change in our communities. • Increased safety for first responders, consumers and the public.

34. Mental Illness

35. Mental Illness • A disorder causing severe disturbances in thinking, feeling and relating. The result is a diminished ability to function or cope with ordinary demands of life. • Characteristics are abnormalities in perception, thought and mood. • Usually triggered when an individual experiences distress. • Observe duration and frequency of cognitive, emotional and behavioral impairment.

36. Mental Retardation Decreased ability to learn Low IQ Before the age of 18 Disability usually noticeable Mental Retardation & Mental Illness are NOT the same thing • Mental Illness • Impacts moods and emotions • Low or high IQ • Occurs at any time • Disability may be noticeable

37. Dually Diagnosed • Term used to describe a condition where a single person has more than one major clinical psychological/ psychiatric diagnosis. (mental retardation/mental illness, mental illness/poly-substance abuse)

38. Mental Illnesses Are: • Biological brain disorders that interfere with normal brain chemistry • Very common • Equal opportunity diseases • Devastating to ill persons and their families • Treatable

39. Mental Illnesses Are Not: • Anybody’s Fault • Preventable or curable at this time • Hopeless

40. Contributing factors • Biological factors - inherited genetic factors influence person’s present functioning. • Social influences - environmental norms of person’s support system. • Emotional influences - general temperament of the person. • Developmental influences - current developmental stage and tasks.

41. Seriously Mentally Ill • SMI is a legal term not a diagnosis • SMI is a term for people who are eligible to receive publicly funded services in Arizona.

42. 3 Basic Types of Illness • Psychosis/ Thought Disorder • Mood Disorder • Anxiety Disorder

43. Psychosis / Biochemical • A symptom or feature of mental illness typically characterized by radical changes in personality, impaired functioning, and a distorted or non-existent sense of objective reality.

44. Schizophrenia • Schizophrenia will impact: • Way a person sees the world • Their thought patterns • Speech • Movement • Almost all aspects of daily living

45. Schizophrenia - WDC Shooting

46. Delusion • A delusion is a persistent belief that something is true when there is no evidence suggesting that this is the case. The delusional person cannot be dissuaded from the delusion by force of logical argument.

47. Hallucination • Seeing, hearing, smelling, tasting, or feeling things that aren’t there. • Disorganized speech-symptom can be observed if the person discusses issues illogically, jumps from topic to topic or uses unintelligible words.

48. Schizophrenia • Common Medications • Haldol • Zyprexa • Risperdal • Side Effects: blurred vision, tremors, stiffness, drowsiness, muscle spasms, uncontrolled muscle movements, jerking, and twisting movements.

49. Hallucinations – Norman / Part 1

50. SchizophreniaA First Responder Approach • Recognize and acknowledge that their delusions or hallucinations are real to them. • Don’t tell them there is no one there • Don’t tell them you see or hear something that you don’t • Consider asking what the voices are saying to get an idea of what the person is going through