Developmental Services Conference

An Individualized Approach to Services

Tony Schrick met Gary Ryason in the fall of 1986. "He shuffled when he walked," Schrick recalled, "and he couldn't look at me. He could not communicate. All he wanted to do was sit in a chair, rock back and forth and listen to the radio."

Schrick is co-owner of an Intermediate Care Facility for persons with developmental disabilities. Located in Penryn, California, his facility, separated into four homes, is referred to in the industry as an "ICF/DD-N." The acronym stands for "Intermediate Care Facility for Persons with Developmental Disabilities-Nursing." Licensed and certified by the Department of Health Services, it is one of more than 200 such facilities throughout the state designed to provide comprehensive nursing care for persons with developmental disabilities.

ICF/DD-Ns, however, are not alone in the vast world of developmental disabilities. The rapidly growing industry also includes "ICF/DD-Hs." These facilities, called "Intermediate Care Facilities for Persons with Developmental Disabilities-Habilitative," also serve persons with developmental disabilities. However, those receiving services generally require intermittent, specialized nursing care. There are also "ICF/DDs." These facilities, similar to their counterparts in responsibilities, are primarily distinguished from ICF/DD-Hs and -Ns by their size: They generally have more than 16 beds.

Regardless of the category, ICF/DDs, DD-Hs and DD-Ns share common characteristics. All three facilities are considered "Developmental Services Providers." All address the needs of persons with developmental disabilities. And all are highly sought after by the families of persons afflicted by cerebral palsy, spina bifida, mental retardation, autism, accidents and other developmental disabilities.

Gary Ryason is a typical ICF/DD-N client. Institutionalized since the age of four, he was brought to Schrick's home by his family eleven years ago. He suffered from a variety of disorders, including mental retardation, diabetes and epilepsy. He was deaf in one ear and blind in his right eye. Epileptic seizures often racked his body violently, throwing him to the floor. One such episode broke his jaw. Another knocked out several of his teeth. His circulatory system, ravaged by diabetes, frequently malfunctioned, depriving his feet of oxygen. He walked with a painful, shuffling gait. His social and communication skills were nonexistent, and institutional records noted his long history of explosive outbursts toward staff members and other patients. He hoarded food and refused to wash his laundry.

"He was one of our toughest challenges." Schrick recalled. "But there was something there inside. I could see it."

Scattered throughout California, the facilities of developmental services providers are usually indistinguishable from the surrounding homes. Schrick's facilities, nestled in rural Northern California, are fashioned in traditional ranch style.

"We don't want to stand out." Schrick said. "The whole idea is to integrate individuals into the community as easily and quickly as possible."

Provider facilities have been modified to accommodate the unique challenges of people with developmental disabilities. Wheelchair access ramps extend from each doorway. Each bedroom has a separate exit. Fire alarms and sprinkler systems are plentiful. "Activity" calendars, posted on the walls, chart upcoming events. These events frequently include craft making, music lessons and the ever-popular "community outings." These excursions, done with the assistance of specially equipped transport buses, are available daily in most facilities.

"Community excursions are an integral part of the normalization process." Schrick explained. "Everyone has regular opportunities to shop, rent videos, go to the doctor's office or drop off mail at the post office. They have a chance to do all the things you and I do, including buying double scoops of ice cream."

Within these supportive environments, ICF/DDs, DD-Hs and DD-Ns, address the particular challenges of persons with developmental disabilities. In Ryason's case, Schrick's DD-N facility began his training with the formation of an Interdisciplinary Team (IDT). This is standard procedure throughout the industry. IDTs are groups of health care professionals, such as speech therapists, physical therapists, psychologists and facility staff. After thoroughly assessing and reviewing new participants, they develop a detailed care plan that specifically addresses that particular person's needs and goals.

Comprehensive Team Approach
Ryason's IDT was comprehensive. A speech therapist began improving his communication skills. A neurologist, visited twice monthly, monitored Ryason's epileptic seizures, in part through the use of electroencephalograms (EEGs). Based on the results of these brain-wave examinations, his medications were adjusted. Physicians monitored his general health, especially his diabetes. His blood sugar levels were monitored twice daily. Two types of insulin were administered to regulate his blood sugar. An optometrist and an ophthalmologist worked in tandem to monitor Ryason's eyesight and adjust his lens prescription.

Ryason's IDT also addressed his emotional outbursts and his tendency to express his frustrations by striking out physically. These type of challenges are common among people in ICF/DDs, DD-Hs and DD-Ns, where administrators and personnel often serve persons who exhibit emotional and behavioral problems. These problems can range from minor temper tantrums to dangerous self-injurious behavior. Regardless of their severity, however, ICF/DD, DD-H and DD-N staff address these emotional issues through a wide variety of progressive techniques. In Ryason's case, these techniques involved the systematic application of positive reinforcement.

"We gave Ryason a great deal of extra personal space, which allowed him a greater sense of security and gradually built his confidence in his new surroundings. " Schrick explained. "He also began to earn 'stars' for cooperative behavior. These 'stars' were redeemable for additional community outings. He enjoyed exchanging them for bonus trips to livestock auctions and field trips."

Striking Results
The results of these combined approaches were striking. Within 18 months, Ryason's physical and emotional growth improved so rapidly he began volunteering three times a week at a local senior citizens center. Shortly thereafter, he began working part-time at a local fast-food restaurant. "This type of success is not uncommon," said Mattson. "It shows what can happen when our industry is given the financial and staffing resources to do our best."

"It's exciting," added Ryason's sister, Sue Ray. "Just the other day I took him home for a visit. I watched him help wash the car. I watched him get a soft drink out of the refrigerator. I watched him make his own peanut butter and jelly sandwich. I feel like I finally have my brother back after all these years. It's like a dream come true."

California Association of Health Facilities | 2201 K St., PO Box 537004
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