Frontline Initiative Complex Needs

Explaining to others what you do when you work as a Direct Support Professional (DSP) can be difficult at best, but when the people you support have a variety of complex needs, the job can be even more difficult to explain. But for many in the field, like Aaron Masden, the challenge and the satisfaction of supporting people with complex needs is a critical part of the profession. Like

Aaron, many stay in the field because supporting people with complex needs requires an ability to think critically and problem solve on a daily, and sometimes minute-by-minute, basis. Aaron works for a residential support agency for people with developmental disabilities which was founded on the vision of providing service to those who have not been readily accepted into our communities. ACR Homes (Acceptance, Communication and Relationships) started with a plan to support those with autism or similar disabilities. Over time the agency found it has strengths in providing supports to people with complex medical needs as well. 

In recent years, ACR has been using person-centered planning as a way to assist staff in better understanding what the people they support need and want. Because many of the people receiving services at ACR have a variety of complex needs, including a lack of effective communication skills, the staff at ACR have been trained in many methods of person-centered planning, allowing them to choose which methods work best for each individual they support. They have found that the cornerstone of effective person-centered planning is knowing the person’s daily routine well and having a close connection to that person. Often, a DSP plays a vital role in shaping these plans.

Aaron started as a DSP at a home for people who are medically fragile when ACR was first beginning their new methods of planning. He now supervises a home for four children and young adults who have complex needs, including autism, dual diagnoses of MR/MI, profound hearing loss, communication difficulties, challenging behaviors such as personal endangerment, property damage, aggression, and yelling. Despite their complex needs, the people at this home have been able to identify and achieve several personal goals.

Aaron, who still spends 15-20 hours a week providing direct support, offers the following suggestions for supporting people with complex needs.

Identify people’s goals by —

• Using the knowledge of a variety of people when seeking to identify a person’s goals. Aaron finds that all members of a support team (often the family, case manager, a representative from the school or vocational support team, and a full-time DSP who knows the person well) make valuable contributions. One individual who doesn’t use words to communicate was going to move. Those who knew her recognized that she enjoyed spending time with her parents, and that it would be good for her to move close to them. The family’s interaction provided this insight.
• Considering what the person is trying to say through unwanted behaviors. One person would get upset when a meal was served. By seeing things from his perspective, they found he wanted to choose what food items went on his plate. When he chose them, his behaviors stopped.

Help people achieve their goals by —

• Helping people make honorable choices. One man wanted to cut down the trees in the back yard. DSPs were challenged to find alternative activities that met the man’s needs without leading to property damage — instead they go to a treeless park.
• Not taking things personally. A DSP must not personalize aggressive verbal or physical behaviors. One man would yell at staff when upset. Instead of taking offense, staff let him vent his anger and then later continued on with their usual friendly relationship.
• Celebrating the small steps. One individual is preparing to move to his own apartment. He got a checkbook to prepare for the move, but was frustrated by his lack of writing skills. Staff prepared letter-writing worksheets for him which he diligently attended to (though at times with some protest at their homework-like nature). Eventually, he was able to write his letters independently and use his checkbook effectively. The staff celebrated with him by presenting him with a certificate of achievement for excellent work.

Aaron cautions people looking into this type of work to nurture their ability to see and celebrate the small steps. Progress and change can be slow for a variety of reasons related to people’s disabilities or to their experiences. Nevertheless, he feels that the rewards from seeing someone achieve a personal goal or a better quality of life definitely make the job worthwhile.