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

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

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

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)
  • Dont want their disability to be noticed
  • 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 Officers Personal Experience
  • Ive got an uncle. He has down syndrome. He is
    just slow. Like he has all the same feelings and
    emotions as anyone else but hes just like a ten
    year oldoften people with mental retardation
    wont stand up for themselves, and when someone
    says to them, you are wrong, well, they say,
    OK theyd 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
  • Dont speak louder in an effort to increase the
    persons understanding.
  • Use firm and calm persistence if the person is
    non-compliant.
  • Avoid yes or no answers

31
Keep an Open Mind
  • Dont assume he or she cant 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
    Marys caseworker who sees Mary on a weekly
    basis. She works at the local mental health
    center. Marys 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 Mental Illness are NOT the
same thing
  • Mental Retardation
  • Decreased ability to learn
  • Low IQ
  • Before the age of 18
  • Disability usually noticeable
  • 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
  • Anybodys Fault
  • Preventable or curable at this time
  • Hopeless

40
Contributing factors
  • Biological factors - inherited genetic factors
    influence persons present functioning.
  • Social influences - environmental norms of
    persons 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 arent 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.
  • Dont tell them there is no one there
  • Dont tell them you see or hear something that
    you dont
  • Consider asking what the voices are saying to get
    an idea of what the person is going through

51
SchizophreniaA First Responder Approach
  • Recognize they may be overwhelmed and frightened
    by sensations, thoughts, sounds, voices, or their
    current environment.
  • Use brief, clear and simple language
  • Never argue
  • Announce your actions

52
Hallucinations Norman / Part 2
53
Mood Disorders
  • Mood disorders are mental disorders characterized
    by periods of depression, sometimes alternating
    with periods of elevated mood.
  • Sad or elated moods.
  • Prolonged mood states that disrupt their daily
    functioning.
  • May appear as severe agitation

54
Depression
  • Major depression, known as clinical depression,
    is an abnormal low of mood characterized by
    disturbances in eating, sleeping and
    concentrating.
  • Estimated in 9.9 million adults

55
Depression
  • Common Medications
  • Prozac
  • Paxil
  • Effexor
  • Side effects can be dry mouth, constipation,
    blurred vision, insomnia, dizziness, agitation
    and/or confusion.

56
Mood Disorders
57
Depression A First Responder Approach
  • Ask if they are having thoughts of suicide
  • Use a calm and supportive approach
  • Empathize with their dilemma
  • Give strong reassurance that they are safe and
    you will assist them in getting help

58
Bipolar
  • Also known as manic depression
  • Experience alternating episodes of mania (severe
    highs) and depression (severe lows).
  • Manic Phase May include hyperactivity, anger,
    impaired judgment, aggressive behavior,
    delusions, exaggerated feelings, extreme
    irritability and disorganization.
  • Often described as the best feeling ever.

59
Bipolar
  • Common Medications
  • Lithium can cause seizures, blackouts and the
    appearance that the individual is drunk
  • Depakote
  • Lamictal
  • Side effects can be tremors, dizziness, dry-mouth
    and memory problems

60
Bipolar Manic PhaseA First Responder Approach
  • Use a firm and direct approach
  • Set clear limits on behavior
  • Reduce environmental stimuli
  • Re-direct behavior and thoughts if they begin to
    escalate
  • Help them to slow down by using controlled,
    rhythmic breathing

61
Bipolar Disorder
62
BENEFITS OF TRAINING
  • Effecting positive change in our communities.
  • Increased safety for first responders, consumers
    and the public.
  • Increased professionalism through education
    thereby lowering issues of liability.

63
Anxiety Disorders
  • A group of illnesses that have in common
    persistent feelings of apprehension, tension, or
    uneasiness, and are accompanied by physical
    symptoms such as sweating, palpitations, and
    feelings of generalized stress.
  • Phobias
  • Panic attacks
  • Generalized anxiety disorder
  • Obsessive Compulsive Disorder
  • Posttraumatic stress disorder

64
Anxiety Disorders
  • Common Medications
  • Ativan can cause memory loss
  • Valium
  • Klonopin
  • Side effects include sleepiness, dizziness,
    nausea, irritable bowel, loss of memory

65
Anxiety DisordersA First Responder Approach
  • Be calm, supportive and empathetic
  • Reassure them they are safe and you will assist
    them in getting help
  • If they are exhibiting OCD compulsions do not
    ridicule them or try to make them stop
  • If their actions make you nervous, let them know
    and try to agree on a possible alternative

66
Post Traumatic Stress Disorder
  • A specific type of anxiety disorder.
  • Fear of re-experiencing a traumatic event.
  • May try to avoid these experiences by self
    numbing or medicating with substances.
  • Possible extreme reaction to normal actions

67
Emotions and Behaviors
  • Emotions are a way of communicating and often
    substitute for language.
  • All behavior is purposeful
  • This behavior is an attempt to get a need met.

68
  • Behaviors you always counted on may not exist
    with the person who has a mental illness.

69
Responding to Mental Illness
70
Behaviors that MAY NOT be present
  • Insight about what is happening
  • Ability to focus and concentrate
  • Pride in appearance and personal hygiene
  • Ability to exercise self-control
  • Willingness to follow a treatment plan
  • Emotional resiliency

71
Behaviors that MAY be present
  • Irritability, criticalness, nervousness
  • Irrational statements and responses
  • Uncontrollable sadness or crying
  • Rudeness and hostility
  • Inappropriate and bizarre behaviors
  • Constant tension and nervousness

72
Defensive Coping Strategies Behaviors
  • Controlling
  • Anger and attack
  • Blaming others
  • Substance abuse
  • Violent behavior
  • Refusing services
  • Denial
  • Making excuses
  • Running Away
  • Refusing medication
  • Abusive criticism
  • I dont want to talk about it.
  • Stubbornness
  • Self-blame
  • Suspicion

73
Psychotropic Medications
  • A medication which is prescribed for the purpose
    of reducing or eliminating certain behaviors.
    (behavior modifying)

74
Keep an Open Mind
  • Dont assume he or she cant understand or
    communicate
  • Be genuine in your desire to understand him or
    her
  • Demonstrate the same respect given to others
    without a disability

75
SLOW DOWN
76
In-Custody DeathsExcited Delirium
  • Delirium A mental disturbance marked by
    illusions, hallucinations, short unsystematized
    delusions, cerebral excitement, physical
    restlessness and incoherence.
  • Excited Delirium A state of extreme mental and
    physiological excitement, characterized by
    extreme agitation, hyperthermia, hostility,
    exceptional strength and endurance without
    apparent fatigue. (also called in custody death
    syndrome)

77
Physical Characteristics
  • Dilated pupils
  • High body temperature hyperthermia
  • Profuse sweating
  • Skin discoloration

78
High Risk Individualsfor Sudden Death
  • Obese specifically having a large belly
  • Enlarged Heart or Heart Problems
  • Coronary Atherosclerosis
  • Myocardial Infarction
  • Myocarditis inflamed heart muscle
  • Fibrotic heart scar tissue formation
  • Under influence of alcohol and/or drugs
  • Weather is hot and/or humid
  • Head injury

79
Behavioral Cues High Risk Individuals for
Sudden Death
  • Demonstrates intense paranoia, violent, bizarre
    behavior
  • Is extremely agitated
  • May be running wildly and/or screaming
  • Stripping off clothing
  • Psychotic in appearance
  • Rapid fluctuations in emotions
  • Disoriented about place, time, purpose and even
    himself

80
Behavioral Cues High Risk Individuals for
Sudden Death
  • Possess great or even super-human strength
  • Seemingly unlimited endurance
  • Diminished sense of, or is insensitive to, pain
  • Impervious to Pain Control Pepper Spray Taser
    Baton Strikes
  • Violently resists during control and restraint as
    well as after being restrained

81
Excited DeliriumA First Responder Approach
  • Assess the scene
  • Wait for back-up
  • Call for EMS or Fire Personnel
  • Attempt to verbally diffuse the situation

82
Excited DeliriumA First Responder Approach
  • Quickly and safely CAPTURE the subject
  • Quickly and safely CONTROL the subject
  • RESTRAIN the individual
  • Do not hog tie
  • Do not allow to lie prone for too long
  • Roll subject on his side to aid breathing
  • Can have them sit up if safe
  • Provide information to EMS/Fire personnel
  • Transport immediately

83
Excited DeliriumDOCUMENTATION
  • Document physical assessments of the subject
  • Skin color
  • Body temperature
  • Sweating
  • Clothing (or not)
  • Obtain vital signs from EMS personnel on scene

84
Excited DeliriumDOCUMENTATION
  • Quote what the subject said during the incident
  • Obtain detailed witness statements
  • Take as much time as needed to complete a
    comprehensive, detailed report
  • YOUR CAREER MAY DEPEND ON HOW WELL YOU ARE ABLE
    TO DOCUMENT THE INCIDENT

85
In-Custody Deaths - Excited Delirium
86
BENEFITS OF TRAINING
  • Effecting positive change in our communities.
  • Increased safety for first responders, consumers
    and the public.
  • Increased professionalism through education
    thereby lowering issues of liability.
  • A better understanding on the part of first
    responders of individuals with MI/DD.

87
MI/DD Your Initial Response
  • Arrive safely
  • Use cover
  • Use sound officer safety practices
  • Call for a supervisor if necessary (per you
    agency policy)
  • Begin getting as much information as possible
    from others at the scene.

88
MI/DD Scene Assessment
  • Gather as much information as possible about the
    history of the individual
  • Family members
  • Case managers if receiving mental health services
  • Reporting party, neighbors or bystanders
  • Dispatch
  • Criminal history files
  • In-house files

89
Contacting Someone in Crisis
  • Establish communication
  • Calm the situation
  • Establish rapport show empathy
  • Gather information
  • Slow the situation
  • REMEMBER Time is on your side

90
Contacting Someone in CrisisA First Responder
Approach
  • Safety
  • Use cover, distance, and barriers
  • Move if you find yourself in a vulnerable
    position
  • Reduce your own anxiety
  • Avoid face-to-face if a weapon is involved
  • Base all decisions on safety and control

91
Contacting Someone in CrisisA First Responder
Approach
  • Self Control
  • A person in crisis can put you in crisis
  • You can only control your own emotions
  • Project that you are calm and in control
  • Be non-judgmental, sincere, genuine and
    empathetic
  • Time is on your side and will reduce the risk of
    unnecessary escalation of the situation
  • T.A.C.T. model

92
T.A.C.T. Model
  • Tone Calm and non-confrontational
  • Atmosphere Scene calm and controlled
  • Communication Build rapport
  • Time Slow the situation down

93
Three Ways to Obtain Treatment
  • Voluntary Treatment
  • Court-Ordered Evaluation
  • Emergency Petition

94
Voluntary Treatment
  • Per A.R.S. 36-518 - Any person who is eighteen
    years of age or older and who manifests the
    capacity to give informed consent may be
    hospitalized for evaluation, care and treatment
    by voluntarily making a written application.

95
Mental Health Pickup Orders
  • An officer has the legal ability to detain a
    mentally-ill person under A.R.S. 36-525 and
    36-526.
  • Per A.R.S. 36-520, any responsible individual may
    apply for a court-ordered evaluation of a person
    who is alleged to be, as a result of a mental
    disorder, a danger to self or to others or is
    disabled.

96
Emergency Detention Orders
  • Per A.R.S. 36-525 - A peace officer may take into
    custody any individual in which there is probable
    cause to believe, based on observations, that a
    person is, as a result of mental disorder, a
    danger to self or others, and continues to be
    during the time necessary to complete the
    petition screening procedures.

97
Procedure for Civil Commitment Court Ordered
  • If officers have probable cause to believe the
    person is inside their residence, and the person
    refuses entry by the officers, this pick-up order
    will be treated like an arrest warrant.
  • A.R.S. 36-520 and 36-521 - Court ordered
    detention is possible if the person is likely,
    without immediate hospitalization, to suffer
    serious physical harm, or serious illness, or to
    inflict serious harm on another person.

98
Civil Commitments Emergency
  • If apprehension takes place on or about the
    premises of the apprehended person, the officer
    shall take reasonable precautions to safeguard
    the premises and the property thereon, unless
    such property and premises are in the possession
    of a responsible relative or guardian. A peace
    officer who makes a good faith effort to follow
    the requirements of this section is not subject
    to civil liability. (ARS 36-525)

99
Procedure for Civil Commitment
  • If entry into the third party residence is not
    granted, a search warrant is required and may be
    written based on the order itself, as well as the
    information specified in the order.

100
  • Who Can Help?
  • Yavapai County
  • Adult Protective Services- 877-767-2385
  • Child Protection Services- 888-767-2445
  • Division of Developmental Disabilities
  • Prescott-(928) 778-5290
  • Cottonwood-(928) 649-6883
  • Trauma Intervention Program (TIP)- 708-2009
  • Tri-City Partnership (928) 772-5048
  • Verde Valley Guidance Center-(928) 634-2236
  • Verde Valley Medical Center-(928) 634-2251
  • West Yavapai Guidance Clinic-(928) 445-5211
  • Yavapai Regional Medical Center (928) 445-2700

101
Who Can Help?
  • Family counseling and child guidance
  • Victim / witness services
  • Social services / behavioral health
  • Substance abuse programs
  • Adult Protective Services (APS)
  • Child Protective Services (CPS)
  • Division of developmental Disabilities (DDD)
  • Local Guidance Clinic
  • Local hospital

102
FIRST RESPONDERSMART CARD PROGRAM
  • Tri City Partnership, in cooperation with local
    First Responders (Police, Fire and EMS,) have
    developed the First Responder Smart Card Program
    (FRSCP) This program offers a registration
    process, alerting First Responders that there is
    a Smart Card on site and an individual with
    special needs may be at the registered address. 

103
FIRST RESPONDERSMART CARD PROGRAM
  • FRSCP includes training for First Responders on
    special needs, and how to better recognize and
    respond to an individual with special needs. 
  • This program also provides training for parents
    and providers on when to call first responders
    and what happens once the call is made.

104
SMART CARD Please Print in English NAME
DOB
____________________ LAST, FIRST
MIDDLE SPECIAL NEEDS DIAGNOSIS TOPICS/ACTIONS
TO AVOID OFFICER SAFETY ISSUES GUARDIAN/
RESPONSIBLE PARTY NAME
PHONE NUMBER(s) RELATION YAVAPAI
REGIONAL MEDICAL CENTER 445-2700 WEST YAVAPAI
GUIDANCE CLINIC 445-5211 JUVENILE
DETENTION
771-3174 LOCAL POLICE AGENCY ____________________
___ For more cards or information contact
Tri-City Partnership for Special Children and
Families (928)772-5048.
105
SMART CARD
Please Print in English NAME
DOB ________________
LAST, FIRST,
MIDDLE MEDICATIONS
DOSAGE (PLEASE WRITE
OUT THE SPECIFIC SPELLING) LIST PHYSICIANS/
COUNSELORS AND PHONE NUMBERS ALLERGIES BRIEF
MEDICAL HISTORY (LIST MAJOR MEDICAL
EVENTS) DATE LAST UPDATED For more cards or
information contact Tri-City Partnership for
Special Children and Families (928)772-5048.
106
First Responder Smart Card Program
Thank-you
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