by Hanna M. Jagow

Created on: January 27, 2010

Individuals with conditions such as developmental disability, autism and mental illness pose myriad challenges for caregivers.  Only those with genuine affection to give should do this work, since it can be draining.  While caring is paramount, tweaking the environment is also needed to provide safety, comfort, and peace around those who do not adjust to change well, are emotionally volatile, and may not be able to learn new behaviors easily.  

"Structure" is surrounding the person with planned interventions:

Schedule

For those whose inner world is chaotic, having a predictable schedule can alleviate anxiety and decrease problematic behaviors.  An easy-to-read clock next to a large-print written daily plan can keep both caregivers and clients on track, and be a point of reference during and immediately following disruptive behavior.  Being able to point to the daily schedule can can be a way to get back on track and leave the episode behind.   Without some way of returning to a base line, drama can erupt with a never-ending story following.  It is so tempting at times to engage in what is called "power struggles" and some clients can and will turn a five-minute incident into an hour long verbal battle. 

There are several techniques that can help in a situation where a caregiver and a client butt heads.  Trading places with another parent or caregiver, stating the facts and walking away if possible, or totally distracting the client with some other topic may work.  This is one time when a real relationship with the client can serve as a way to ameliorate conflict.  Taking another tack, such as "Wow, how are you doing on that craft project you started?" or "What snack/movie/tv show should we plan to watch later, or would you rather go for a walk?" can defuse the tension, at least for a time.

If a particular client is extremely sensitive to any change in the expected schedule for the day, such as a doctor or therapy appointment, it is a good idea to encourage that person's ability to accept the disruption by giving them a warning ahead of time.   A careful evaluation will indicate the timing needed, and how much information to give.

Rules

Rules are actually part of the structure, but require adjustments depending on the age and abilities of the client.  Rules should be clear, fair, and the consequences for breaking a rule spelled out precisely, to be followed without exception.  Not

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