Day programs, at least day programs that are well developed, employ specific learning, behavioral, and therapeutic strategies designed to increase or maintain the physical and mental health of the people the program serves. These formal strategies are necessary to ensure a meaningful program is developed for each individual, however, the emphasis on the mechanisms of these strategies can unintentionally objectify the people we care for. We begin to see these people as being the object of our efforts. We begin to see them as different from ourselves, as one of them rather than one of us. As well intended we are, as thoroughly as we plan and strategize, we increase their dependence, and steal a little of their dignity, when our focus is on the tasks and strategies involved in care giving rather than on the person we are supporting. Too often everything, and everyone, in their lives becomes part of a structure, a bullet point in a formal plan of individualized care. Opportunities for choice become limited. Opportunities to develop meaningful relationships are compromised.
When you reflect on your own life, most of your most precious memories are likely to involved moments you have spent with people you care about. Whatever brought you together, a holiday, a celebration, it was time spent simply, with friends and family in whom you are invested, with whom you have developed and shared a connection. Forming meaningful relationships with the people surrounding us make our lives fuller, and contribute significantly to our health and happiness. The people we support want and require the same thing as we all do; connection, engagement, and meaningful relationships with the people surrounding them. Whether we are at home or at work, developing these relationships requires being mindful of the moments we spend with others, the moments we spend together. Every moment spent together is an opportunity to connect and build relationships that enhance each of our lives.
Thomas E. Pomeranz, Ed.D, a nationally-recognized authority, clinician, and consultant in the field of intellectual disabilities, has described some of these moments in his book, The Principles and Practices of Universal Enhancement. Universal Enhancement is an approach that, as the author puts it, simply says "people who have the opportunity to develop significant and valued relationships in their lives are more likely to increase their potential to have meaningful and valued lives. It says that people who have the opportunity to engage in preferred and meaningful activities with those valued others - choir, bike riding, work, walking, cooking, and so on - increase their opportunity to be free from anomie."
The moments Dr. Pomeranz describes are not specific to an event or activity, but rather refer to behaviors that enhance our time together, for whatever reason, and whomever we are with. He has described a few examples of these moments in this list:
Universal Enhancement Moments
Referencing the person in respectful language
Sharing a smile and a sense of humor
Advocating for the person’s rights
Making introductions to promote relationships
Listening to understand what is being communicated
Being patient
Having fun together
Asking permission prior to assisting in moving or transferring
Providing eye contact when conversing
Knocking on a bedroom or bathroom door before entering
Encouraging and supporting participation in all daily routines
Speaking softly
Using an age-appropriate tone of voice
Offering options to support self-determination
Celebrating even the smallest of accomplishments
Moments captured, not on video, but in the heart
- Dr. Thomas Pomeranz
In his book, Dr. Pomeranz has also compiled a series of questions, divided into categories, comprising the Universal Enhancement Checklist. These questions can be used as a assessment to measure how Universal Enhancement is being realized in a particular setting:
Consider each question in relation to your home and the people you care for, and give a score from 0 to 10. A zero indicates the complete absence of the condition. A score of five means the glass is half full. A ten is full realization of that process.
Mend
Are obstacles in the person’s life identified?
Does the environment include modifications to hurdle those obstacles?
Do all staff participate in designing creative Life Styles to support each person in overcoming barriers to a full life?
Is gentle physical support used to redirect challenging behaviors and protect from injury?
Is choice-making supported as an option to challenging behavior?
Are temporary medication plans based on adequate assessment and regular review?
Are new medications doses started low and increased slowly as the need arises?
Socialize
Is tolerance of others modeled and encouraged?
Are staff teaching kindness and caring through role modeling?
Are people interacting with others in a way that is not task-focused?
Are people allowed to declare their own personal space?
Is attention and praise provided for everyone’s interests and gifts?
Are occasions provided for successful interactions?
Are people encouraged to give and do for others?
Are expressions of appreciation promoted?
Connect
Is the establishment of friendships nurtured?
Are opportunities provided for interacting with individuals who are not paid to interact?
Do staff recognize that friendship takes time and should not be rushed?
Are connections with others modeled through appropriate smiles and touches?
Is a sense of humor promoted?
Are good times shared?
Are celebrations included such as special events?
Communicate
Do staff understand and exercise the skills of listening?
Is listening to others modeled and reinforced?
Do staff listen slowly and carefully?
Do people share expressions of feeling?
Do staff model the sharing of feeling and revealing their emotional sides?
Is self-determination and self-advocacy supported in observable ways?
Are people encouraged to exercise control over their own lives?
Can staff point to ways they demonstrate how skill acquisition enhances self-determination?
Initiate
Are staff aware of individual preferences?
Are individual strengths (as well as deficits) identified?
Do new staff and new residents participate in rituals of membership?
Does everyone have the opportunity to participate in activities that say, I belong?
Are the milestones of developing a Presence - such as achievements, new memberships, and new relationships – celebrated?
Do staff look for opportunities to make introductions?
Is the formation of relationships that can become natural supports encouraged and achieved?
Scores (perfect = 180)
0 - 150 Is this an institution?
151 - 250 Some old paradigms are still at work here.
251 - 300 There is a new day dawning!
301 - 380 Universal Enhancement is making everyone's life better. Celebrate!
As you consider the time you spend with the people you care for, whether in the day program or outside of it, consider these questions and the issues they address. Assess for yourself how you are tending to the connections with the people you support. How do you approach your daily interactions with the people you care for? What could you change to take advantage of those moments, and to build more meaningful relationships with the people who need your support?
Citations: Thomas E. Pomeranz, Ed.D, The Principles and Practices of Universal Enhancement. High Tide Press, New Lenox, IL, 2009.
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