Relationship building as a best practices approach in treatment planning.

Abstract

A subject that has been of significant importance to us in various combinations over the past decade is that of relationship building. In the past, it has been taught to staff in residential facilities for individuals with Mental Retardation that one ought not to become too involved with the patients who live there. As we have moved to a system of respecting individuals' rights to choice and freedoms, regardless of presumed disabilities, and a system of supports, we see the need to change our approach towards those we serve. A project that we began in our Devereux adult programs for individuals with mental retardation and developmental disabilities, referred to as Reality-Based Approaches, begins the treatment process by actually first training staff in becoming close companions to those whom they serve. We identify staff to work in the program who demonstrate nurturing skills and who have an interest in involved in the lives of these individuals. We then provide training and support to the staff to carry out this seemingly unusual approach in a residential program with cottages on a campus. As individuals are admitted to the facility, staff are encouraged to take an interest in the individual as a person, and are instructed to not look at the challenging behaviors first. Instead, the staff are encouraged to get the know the person as a human being with the same desires and need for attention and affection, and social contact, as anyone else. Through informal interactions in which staff become involved in various activities with the individuals, including going shopping, to restaurants, movies, and the like, the relationships are formed. It is important for staff to know and respect the person, and not to correct inappropriate behavior. This is the very essence and foundation of the approach. We have discovered over the past several years in looking at the data for individuals we accept in the program, that those staff who have developed a mutually respectful relationship with the individual has the best chance of getting and being successful with that person. By this, we mean that we see a dramatic effect with regard to stopping or preventing the challenging behaviors from occurring to begin with. In addition, we have found that over time, that even the most challenging and dangerous behaviors of an individual tends to cease through the establishing of durable relationships or attachments. Many of the individuals who are referred for such settings tend to have very extreme reputations for the most difficult behaviors to manage in prior settings over the years. These individuals were typically placed in a residential program, such as foster care or a congregate care setting since early childhood due to their parents' inability to care for them at home. As a result, we see the effects of this trauma in terms of the abandonment, and subsequent attachment disorders. Use of controlling or punitive methods tends, in our experience, to exacerbate the behavioral difficulties and is often counterproductive. Once the relationship has been established, stimulus control over behavior becomes easier based on our data and direct observations. The individual is more willing to cooperate with someone whom the person simply likes and respects, and who they know respects and likes them in turn. This is a rather simplistic recipe, but one which is very humane, effective, and long overdue in human services settings, whether it is with individuals with mental health concerns, or mental retardation. …