DDD

If you suspect abuse of neglect, call

1-800-832-9173.

Correctly document a PRN

1. Add it to the MAR if it is not already there. 2. Sign initials in the first box available in that section of the MAR, on the date you are giving the medication. 3. Document the time and reason the medication was given. Track details on the effects of the medications. (Did it work, or not? Were there side effects or problems?)

Parts of Health and Medication History

1. Basic information about the person 2. medication history that includes: A list of all current prescription medications and when they are used. Information about other medications and preparations and when they are used. A list regarding problems or sensitivities to medications the person has experienced. 3. Health History: Physical conditions and a history of surgeries, medical events, and hospitalizations. Family health history. Summary of lifestyle factors that influence medications. 4. A list of all the health care practitioners that work with this person.

Regarding Medication, A DDD can...

1. Call for more information about the side effects of a medication 2. Pick up a prescription for a person receiving supports 3. Take a person to an appointment with a practitioner 4. Assist a person in taking medications as prescribed 5. Discuss with the person the reasons for not taking medications as recommended

our exceptions that need to be recorded on the MAR

1. Errors. A medication error occurs when one of the five rights of medication is missed. A very common error is when a medication is forgotten. Another is when the wrong dosage is taken. It is very important to keep track of errors. Sometimes errors can have serious effects on a person's health. 2. Refusals. A medication refusal happens when a person refuses to take a recommended medication. People have a right to refuse medications; however, this must be tracked. Missing recommended medications for any reason can have harmful effects. 3. Holds. A hold on a medication is when the prescribing practitioner has decided to temporarily stop a medication for a specific purpose. Only a health care practitioner can make this decision. Otherwise the missed medication is either an error or a refusal. 4. Leaves. In certain types of support settings (especially licensed settings), when medications are given away from the person's home or by people who are not trained in medication supports, it must be noted. This is often referred to as a "leave." In these types of situations, the DSP may be asked to prepare the medications and document that they were sent with the person. The leave must be recorded on the MAR.

Types of restrictive programming and aversive or deprivation procedures that may be in place

1. Manual restraints (physically holding or blocking a person) 2. Mechanical restraints (items that can be used to restrain a person without another person being present) 3. Time out rooms or other forms of isolation (procedures that remove a person from contact with others) 4. Presentation of unpleasant events or objects (aversives) 5. Removal of favored items or opportunities (deprivation) 6. Environmental limitations (locked areas of the house, unable to go to certain places) 7. Use of psychotropic medication (medical restraints)

The 5 Rights

1. Right Person 2. Right Medication 3. Right Time/Date 4. Right Dose 5. Right Route/Preparation/Technique

Drug Schedule to control drug abuse

1. Schedule I - These are drugs with the highest abuse risk that are designated as having NO safe, accepted medical use in the United States government. These drugs include heroin, marijuana, and other street drugs. 2. Schedule II - These are drugs with the highest abuse risk that are designated as safe for medical use in the United States. These drugs are closely monitored because they can cause severe psychological or physical dependence. This schedule includes certain narcotics, stimulants and depressant drugs. 3. Schedule III, IV, or V - These are drugs with an abuse risk less than Schedule II. These drugs also have safe and accepted medical uses in the United States. Schedule III, 4. IV, or V drugs include those containing smaller amounts of certain narcotic and non-narcotic drugs, anti-anxiety drugs, tranquilizers, sedatives, stimulants, and non-narcotic analgesics.

Signs of a problem with a medication

1. Severe pain including headache, stomach ache, or muscle aches. 2. Signs of severe allergy. This can include: shortness of breath, or hives, redness, rash, or severe itching as well as swelling of the lips, tongue, face, hands, or feet. 3. Unexpected seizures or convulsions. 4. Extreme lack of energy, confusion, or loss of consciousness. 5. Sleepiness or drowsiness at unusual times. 6. Change in appetite, thirst, or sleep patterns. 7. Increase or unexpected decrease in usual challenging behaviors. These may include aggression, self-injury, yelling, crying, or repetitive behaviors. 8. Unusual behaviors for the person. A change in his or her mood. 9. Rashes, hives, signs of a "cold," discomfort, or illness.

The way to deal with maltreatment

1. Stop the maltreatment. 2. Seek appropriate medical attention as needed. 3. Inform the correct agencies and people about the incident. 4. Support complete and effective investigations. 5. Support a lasting resolution to the matter.

Role of the DSP

1. The DSP must educate the individual and employer about the skills needed to provide a positive work experience. 2. The DSP must assist the individual in advocating for his or her support needs on the job and in the community. 3. the DSP must facilitate the person centered employment support plan by always asking for, thinking about, and respecting an individual's personal preferences and choices.

person-centered planning processes.

1.Look at the whole person including assets and strengths. 2.Focus on the dreams, desires, and wishes of the person. Build on personal strengths. 3. Use existing resources (friendships, family connections, etc.) and develops new ones. 4. See barriers to goals as being about shortcomings i available supports, community capacity, and resources, rather than just shortcomings in the person.

Sheltered Workshop (lacks in social inclusion and individuals with developmental disabilities get payed below the minimum wage)

A place where paid work and work-like activities and recreational activities are available to people with developmental disabilities. Work available at a a sheltered workshop often pays below a competitive wage and does not provide opportunities for people to meet and get to know members of the community without disabilities as coworkers and employers.

behaviorism

A school of psychology that focuses on the effects of antecedents and consequences on observable and measurable aspects of behavior

Work Enclaves (more social inclusion than sheltered workshops)

A type of supported employment option where groups of people with disabilities work together in a community setting. These groups typically vary in size from 2-15 people. This type of supported employment is advantageous for people who may not be able to work consistently enough to maintain a daily job. The disadvantages are that the group situation makes social contact with workers without disabilities less likely and that the person can be stigmatized (e.g., seen as one of "those" workers with disabilities, as opposed to a natural and productive contributor in the workplace).

Duties that DDD do with medication

Administering medications or supporting someone to self-administer medications. Documenting daily medications. Observing for medication reactions. Communicating problems to medical professionals. Taking people to medical appointments. Getting prescriptions filled. Organizing health and medication histories. Teaching people how to take their medications. Helping people understand the risks and benefits of medications. Serving as an advocate or supporting self-advocacy regarding medications. Setting up systems for organizing and securing medications. Developing individual or organizational risk management plans. Helping to select or find a medical professional. Helping with admission or discharge from a hospital.

ADA

Americans with Disabilities Act

BSP

Behavior Support Plan

Non-life threatening emergencies

Call supervisor and do appropriate action

Antecedent manipulation

Changing the antecedents and setting events in the environment. Decreasing the ones that predict the challenging behavior. Increasing the ones that predict desired behavior.

If a new medication is needed of discontinued..

Cross a line through the the days that the medication does not need to be taken, or add a line and point to the day that the new medication needs to be taken.

In NJ...

Direct Support Professionals who have passed the required Pre-Service Training and successfully completed on-site supervision and competency assessment are allowed to administer medication.

DEA

Drug Enforcement Agency

to know if the person has a stroke

FAST 1. Ask the person to smile (does one side droop) 2. Ask the person to extend both arms (does one drip downward) 3. Ask the person to repeat a sentence (can the person repeat the sentence correctly) 4. Clock the time and never lose track of the time

Life threatening seizure

First time seizure seizure lasting longer than 5 minutes Back-to-back seizures (3 or more in a row) result in serious injury the person is not breathing once seizure stops occur in someone who is pregnant occur in someone who has diabetes

PRN medication...

Given as needed

Components of a Behavior Support Plan

Good behavior support plans (BSP): 1. Are specific to the individual (not the behavior). 2. Are based on the person's life goals. 3. Are developed, reviewed, and approved by the person. The rest of the support team including those who will implement the plan also participate. 4. Describes the behavior(s) in objective and measurable terms. 5. Offer a hypothesis for the function and the context of the behavior. 6. Clearly describe all interventions. It reviews any risks of interventions. If applicable, it describes who is responsible for the interventions. 7. Uses positive approaches, including teaching new skills. 8. Provides strategies for effective response. 9. Describes what and how to document. 10. Describes success and when the plan will be revised.

teaching Strategies

Helping people learn preferred behaviors. This includes behaviors that are functionally equivalent to the challenging behavior. It can also include behaviors that are important to long-term success. For example, learning to read or cook

ISP

Individual Support Plan

Job applications should not ask about a person's disability because:

It could negatively influence an employer's decision

Employers do not have to pay for a work site accommodation if

It creates an undue hardship for the company

In NJ

It is REQUIRED that you have a doctor order for herbal/natural supplements, vitamins, and over the counter medications for any person with a developmental disability supported in a licensed residential program or day program.

Discrimination Training

Linking current skills to the right antecedent is called

In NJ

Medication Administration Records (MAR) are required for licensed settings and day programs in New Jersey. These documents may be in paper or electronic format.

You must have a doctors order for...

OTC medications

Small Business Tax Credit

Pays for work site accommodations

PCPT

Person Centered Planning Tool

types of medication

Pills Lozenges Liquids Creams or ointments Patches Suppositories Sprays

Behavior Support Plan

Plans developed to let support people (staff, family, friends and others) know how best to identify, track, prevent, and respond to an individual's challenging behaviors. These plans should have an emphasis on teaching new more appropriate skills for communicating needs. These may also known as behavior management plans, or behavior intervention plans, however, the term support is meaningful and may be evidence that the plan has an emphasis on positive behavior support as opposed to simply "managing" behaviors.

Secondary reinforces

Reinforces that a person has learned to find valuable. Secondary reinforces are diverse. They can include interactions, privileges, recognition, or items. Some examples include going to an amusement park, listening to some favorite music or someone saying "You did a great job." They can include tokens, badges, or trading cards.

DSP

The Direct Support Professional's roles in supporting an individual's access to community-based employment services are many. For example, the DSP may act as a liaison between the supported employee and employer by promoting communication between them. This is helpful because it facilitates a good working relationship. It also provides an opportunity for the employee and employer to identify and address work concerns. After identifying areas needing further support, the DSP may also assist the individual and the employer by providing job training, coaching, and consultation.

Vocational assessment

The goal of vocational assessments is to compare the demands of a job to the abilities of the job seeker. This is typically done prior to obtaining a job. Therefore, it allows the direct support professional to assist the individual in finding work that meets her or his interests, abilities, and needs.

Community Based Employment (promote normalization) Most social inclusion and like most jobs

This term refers to the traditional type of employment, where individuals are employed and paid by the company which hired them. Additionally, the work takes place in the actual work setting and is performed independently or with the support of co-workers and/or support staff.

Aversives

Used in positive punishment. They are products, events, or things that are presented to the person after a behavior is used in order to discourage or stop the behavior. Caution! The use of many types of aversives are not allowed by law. Any aversives that cause discomfort or harm (physical or psychological) are usually not allowed. When they are allowed they are supposed to be carefully monitored and controlled.

Job Tryout (situational assessment)

When an individual works at a company for one day for no money, it just to try out that type of work.

If you support people at a day program and medication must be administered while someone is at your program, you must have:

a. A copy of the signed order from the prescriber with the word "copy" written or stamped on it. b. The medication in the original container issued by the pharmacy and it must be properly labeled. c. A record of the receipt of the medication including the date received and the number of pills indicated on the bottle. If medication comes in another form (e.g. creams, liquids, etc...) the amount received must be documented. d. Your agency might have a policy to count the pills. Check with your agency for specifics.

According to the Standards for Adult Day Programs, if you are going to be away from the program when a medication is due then the medication must be in a sealed container labeled with the following:

a. Individual's name b. Name of medication c. Dosage d. Frequency e. Time of administration, and f. Method of administration

Keeping in contact with an employer even if they turn your client down can...

can produce future job leads to your other clients

Goal behaviors

desired behaviors that are long-term goals for the person. Sometimes these will be the same as replacement behaviors. This is likely if the person lacked an appropriate way to communicate. In this situation, having a positive alternative could be enough. However, in other situations goal behaviors will be different. They may include a number of new skills. These will need to be taught beyond the replacement behavior.

In Refusal Medication

f the person will not take the medication as recommended, follow procedures that are appropriate for the medication. For example, in some cases documenting the refusal may be enough. In other cases, a medical professional must be contacted immediately. You must know the medication, the person, and the consequences of missing the medication. If in doubt, seek advice from a supervisor, health professional or pharmacist. In most cases, it will be important that you document exactly what happened. The details may be important in discovering why the person is refusing the medication. You will learn more about documentation in the next lesson.

The ADA addresses

fair hiring practices

1. normalization movement 2. inclusion movement

movements that helped to shift public opinion and ways to use to help people with disabilities

Deprivation

negative punishment. They remove something from the environment after a behavior. This is done to discourage the use of the behavior.

SIB

self-injurious behavior

consumer-directed supports

states provide consumers direct control over services. They do this by providing control over hiring and organizing supports. They also give people more direct control of the money to pay for services.

PBS

use of ongoing methods of support

If the person has medication that needs to be administered both at home and at work/day program, staff working at residential programs must:

• Get or make a second copy of the signed order from the prescribing person for the work/day program. • Calculate how much medication is needed in each location. • Tell the pharmacist that you need a separately labeled container for each location and explain how much needs to be in each container. • Check with your agency on how the medication must be transported to and from the work/day program. If the person has medication that will be needed while away from home (e.g. visiting friends and family, movies, shopping, etc...), the Standards for Community Residences for Individuals with Developmental Disabilities (N.J.A.C. 10:44A) states that "all medications shall be kept in their original containers from the pharmacy and shall be properly identified with the pharmacist's label."