Frontline Initiative Complex Needs

My parents always taught me that “it is better to give than to receive.” It was this frame of mind that inspired me to work with individuals with disabilities, many of whom have complex needs. I have continued for 16 years, but I have found that a more apt saying might be, “It is by giving that you receive.” About a year ago, I began working with Brian, an individual who has complex needs; he has a diagnosis of mental retardation, he aggresses toward others and property, has difficulty using words, and receives mostly one-on-one supports. Working to overcome his barriers has taught me a lot about my own limitations and strengths and about listening to him.

Before Brian came to the employment supports division of the agency I work for, he had become aggressive toward others, was destroying property at home, refusing to eat, and getting very little sleep. When I agreed to take Brian onto my caseload, I knew he would require intensive supports. I found out from a teacher who knew him well that he didn’t deal well with change. The transition from school to work would be a big change for him, and I knew his first day would likely be a challenge for us both.

Brian’s first day and many following were very stressful. We had decided to try a picture schedule to help him understand his routine. Brian was quick to show us what he thought of it all. Work materials, his shoes, the pictures, and more went sailing across the room. I spent most of the day with Brian picking up what he had thrown or guarding against his attempts to hit me or other staff. He was exhausting, yet I knew that he had real potential.

While his behaviors persisted, I used several strategies to help me cope with the stress. Sometimes I sought encouragement from our behavioral specialist and other staff. It’s important to have outside support on an ongoing basis in stressful environments. Other times I would use creative imagery, which worked well for me. For example, I would imagine I was lying on a beach with a cold drink in hand and was listening to waves lap against the shore. When this didn’t work, I would ask another DSP to step in to give me a break. Recognizing one’s limitations and being willing to ask for assistance are crucial skills for a DSP to have to remain effective. In every situation, regardless of the technique or support, I also needed to have a sense of humor. One must not take challenging behaviors personally, but react to them with a sense of humor. Finally, when the day is over, leave your work at work.

One of the most important things Brian taught me was the importance of establishing trust. It was clear that it was important to be firm with him and to follow through with what you said you were going to do. When he first arrived, he would hit people, break glasses, tear clothing or throw materials, daily. Many staff were afraid to work with him, but I decided to stick with him. After a few months, he began seeking me out and communicating his preferences with his pictures. His aggressive behaviors are now rare. I would attribute this change to the trust established between us. By being strong and following through, I was able to show Brian that he could trust me.

Remaining calm while learning how best to communicate with Brian was also invaluable for providing him supports. It can be very difficult to understand what he says, so I must watch his gestures and facial expressions and use a lot of trial and error. For instance, when I asked him where he wanted to go for fun, he would say, “Orange Crown.” We had no idea what this meant. After many attempts at guessing and talking to residential staff, we figured out that he was referring to a marquee outside a bowling alley that had a giant orange crown on it, though it wasn’t part of the place’s name. It was well worth the time it took to understand what he was saying.

I have worked with many like Brian who have complex needs during my 16 years in the field, and I’ve found that the behaviors people display are barriers to a better life. By persisting, I have been able to help these individuals live better lives. I still believe it is better to give than to receive; but now, I think I am often the one receiving by working with people with complex needs. Working with Brian has been very rewarding and has helped me be a better DSP and a better listener.