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I began working as a Qualified Mental Retardation Professional/Qualified Mental Health Professional (QMR/HP) in October of 1991. At Trinity Services, Inc (in Frankfort, IL), I carried a caseload of eight in-home individuals (that is, individuals living in the home of their parents/guardians) and thirty-two Illinois state facility residents, ranging in age from eighteen to seventy years old. In addition, I was a member of the Interdisciplinary Teams for those individuals living in Trinity-run Community Integrated Living Arrangements (CILA), Community Supported Living Arrangements (CSLA), and Intermediate Care Facilities/Mental Retardation (ICF/MR) that received services at the Frankfort location. In all, I was wholly or
partly responsible for approximately forty individuals plus
CILA/CSLA/ICF/MR. These individuals covered the full range of ability
(mild, moderate, severe, and profound). Perhaps one third of the
individuals I served were additionally diagnosed with a chronic mental
illness--generally, some type of schizophrenia. Furthermore, many of our
individuals had a medical or behavioral need: many were non-verbal; some
were deaf; others had cerebral palsy; several had autism; overall, our
population was a blend of abilities and challenges too numerous to detail
in so concise a paper. Treatment modalities at Trinity tended toward
behaviorism. Usually, if a resident needed psychotherapy, we utilized the
services of a consultant. To teach individuals new skills and maintain old
ones, we generally designed each program for the specific individual along
the lines of chaining. On rare occasions, we used the backwards-chaining
model. To deal with challenging behaviors, we designed behavior treatment
programs (BTP). Because of my educational background, I wrote my own
BTP's; in addition, I wrote BTP's for other QMRP's and sat on the
Behavioral Committee, a committee responsible for overseeing BTP's
agency-wide. A number of the individuals Trinity worked for received
behavior-modifying medications, but we always strove to teach them
alternate coping skills that would allow these medications to be reduced
or eliminated.
To ensure that the programs so carefully designed
were actually working, I reviewed each individual's data each month. This
consisted of reviewing behavioral and program data recorded during the
course of the month, interviewing staff working directly with the
individuals, and utilizing my own observations from my daily rounds. This
information would be integrated into a monthly progress note. Furthermore,
if, in the course of my rounds, I noted that a particular area was not
working, active treatment was not occurring, data was not being collected,
or so forth, I could call a special team meeting, alter the program, coach
the responsible person, or utilize other methods of correction as the
situation might warrant. Lastly, each individual received a complete IDT
annual review. At this time, with the input from the individual being
paramount in determining the team's direction, we developed the Individual
Habilitation Plan.
I left Trinity Services in March of 1993. In May
1993, I began working as a Residential Services Supervisor at Bethesda
Lutheran Homes and Services in Watertown, WI. Here, my duties on the IDT
are somewhat lessened--I am no longer responsible for running the whole
IDT show, so to speak, but I am far more directly involved in working with
the residents, maintaining the integrity of data collection, ensuring that
active treatment is taking place, and providing for the resident's
well-being. In addition, I have far more supervisory responsibility and
some administrative duties; things I did not have at Trinity. Generally
speaking, however, my duties and methods are largely similar. My current
caseload fluctuates around thirty-two behaviorally-challenged, severe and
profoundly retarded residents with a variety of diagnoses, both adult and
children.
I have had the pleasure of working on a variety of
interdisciplinary teams (IDT) in my working life. As a certified nursing
assistant, I worked with a team consisting of the resident, myself,
nurses, doctors, family members, social service personnel (such as
activity director and case aides), physical and occupational therapists,
dieticians, and, for some residents, speech and language pathologists. My
primary role on this team was to provide information; the team sought to
provide either the best custodial care possible or the most complete
recovery treatment for the residents. I worked with this team for three
years.
Currently, I am a member of a team at Bethesda
Lutheran Homes and Services. Like all Bethesda teams, ours is quite
extensive, consisting of the resident, the resident's family and/or
guardian, a variety of medical doctors, nurses, speech and language
pathologists, dentists, social workers, myself (Residential Services
Supervisor), residential aides, program service personnel (vocational and
educational training), physical and occupational therapists, recreation
therapists, psychologists, psychiatrists, psychology specialists,
chaplaincy representatives and chaplains, pharmacists, and dieticians.
Some residents who have special needs may have additional members on their
teams. Here, I am responsible for the creation, implementation, and
monitoring of goals and objectives specific to the department, assisting
other disciplines to work on their specific areas, assessing the
resident's skills and abilities, writing appropriate reports regarding the
resident's progress, and providing input regarding the resident's future
direction and needs. Our goal, after all, is to provide the resident with
the ability to grow and move on to the least restrictive living
environment possible. I have been a part of this team since May 1993.
Previously, from October 1991 until March 1993, I
was the Qualified Mental Retardation/Health Professional responsible for
directing a team composed as the Bethesda team. Like the Bethesda team,
our goal was to provide the most growth possible in the least restrictive
environment. On this team I performed duties like those of the Bethesda
team. However, as QMR/HP, I was also responsible for the leadership and
oversight of the entire team, making referrals as needed, advocating for
the resident, ensuring that communication flowed between all team members
(particularly the family members), assessing individuals from other
agencies for acceptance into Trinity and assisting them to assimilate into
our program, writing behavioral treatment programs, monitoring data from
all sources, preparing written reviews of the teams' data regarding the
resident's progress, writing the final Individual Habilitation Plan, and,
when necessary, coaching team members not providing adequate data and
treatment. While at Trinity, I was also a part of the Behavior Committee.
This team consisted of QMRP's, administrators, the psychologist, the
pharmacist, and nurses. This team was primarily responsible for
approving--in conjunction with the Human Rights Committee--and reviewing
behavior treatment programs. This was likely the most egalitarian team I
have ever worked with; we all shared responsibility equally for most
things. The only exception occurred when, in 1992, we were reviewed for
accreditation by the Accreditation Council for Developmental Disabilities.
At that time, because of my educational background, I was asked to review
and expand the Trinity behavioral manual. I served quite happily on this
committee for the duration of my employment at Trinity.
As a Qualified Mental Retardation/Health
Professional, I have been responsible, in part or whole, for a caseload of
approximately forty people. The individuals I work with cross the full
spectrum of abilities--mild, moderate, severe, and profound retardation
and, in some instances, chronically mentally ill individuals-- and ages,
from child to adult. I have worked in this field since October of 1991, in
two different agencies. While there are some differences in the two
positions, both require similar oversight.
To provide proper monitoring, I do several things.
First, I make rounds of the facility each day, assessing each resident's
current state, looking for appropriate dress, proper hygiene, state of
health and physical well-being (sadly, among my community-based caseloads,
there were instances of individuals being physically or sexually abused or
neglected--these individuals were eventually removed from their homes and
placed in CILA's), and monitoring their programming as it occurs. Once a
week, on a random day, I look through the data being kept in the
classrooms/work shops/living arrangements (as appropriate) to both ensure
that records are being kept and to get a thumbnail sketch of the
resident's progress. Once a month, I gather and compile the data into a
monthly progress report. This report contains a summation of the
individual's data that month, notes on any problems encountered, and
statements of intent regarding how those problems may be solved. This
information comes from all disciplines involved on the interdisciplinary
team (IDT). On a quarterly basis, this information is reviewed by the
entire IDT, where input is solicited and recommendations made regarding
the individual's needs. Yearly, the entire team meets to discuss the next
year's direction--the Annual, as we call it. At this meeting, each
discipline presents a written summary of the individual's progress over
the last year, results of any assessments, and recommendations for future
goals.
From this, I create the Individual Habilitation
Plan (IHP), the overall summation of where we have been, where we are
going, and how we want to get there. Different agencies have different
methods of constructing these plans; the agency I currently work for
includes each disciplines' entire report in the IHP, and the QMRP is
responsible only for writing a short overview, a discharge plan, a
statement of the goals, and reviewing the individuals strengths and needs.
In fact, once this is done upon admission, the QMRP need only update these
yearly, re-writing portions only when there are major changes. However, at
the agency I previously worked for, repetition of any material from the
prior annual review was severely frowned upon; everything had to be
re-written every year. Furthermore, the IHP did not include reports from
other disciplines; therefore, the QMRP had to write a summary of that
information as well. It was quite a task! But it was worth the effort. It
is no small task to balance an IHP; to be certain that the resident's
goals meet his/her needs; to ascertain that assessments accurately reflect
the resident's skills; to ensure that the goals are in accordance with
both the assessments and the discharge plan and appropriately prioritized.
Still, whenever an individual makes progress and moves on, everything is
worth all the time and care.
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