A soda goes a long way
A soda goes a very long way. That's what we learned from Mr. Richard, whose aggressive behaviors once made visits to the psychiatric emergency room routine.
When Mr. Richard arrived at CRC in 1989, his adjustment was difficult. He already lived with many behavioral disorders, including autism, Asperger's obsessive-compulsive and impulse control disorders, as well as medical problems, such as obesity and seizure disorder. Then, his self-harming behaviors, like biting his arm or scratching under his eyes, and his aggression towards others, including biting and head-butting, spiked sharply. By 2010, his aggression had become so hazardous that we had to provide one-on-one staffing at the residence and his day program. We had to switch his room because he constantly attacked his roommate, and assign two staff members to monitor him on community trips.
But what made the greatest impact was a new behavior plan that praised and rewarded Mr. Richard with coffee and soda--his two obsessions--for controlling himself. This reward program, in adjustments in medication and staffing, lead to a gradual decrease in his aggressive behaviors, and yearly psychiatric emergency room visits, from fifteen to three. By 2014, he needed one-on-one staffing only every other night.
Today, we use the standard one-to-four staffing ratio to monitor Mr. Richard. And, he has begun going into the community to buy his own soda. The 'one soda a day' reward system was so successful that we have replicated it to the community.
A Medical Double-Success Story
Mr. Ralph, a profoundly intellectually disabled 62-year-old man, had multiple complex medical conditions that might have ended his life or landed him in a nursing home had it not been for CRC's highly skilled and conscientious care.
When he arrived at our East Harlem facility in 1997, Mr. Ralph was barely surviving on an 1800-calorie-a-day soft diet. Cerebral palsy, spastic quadriplegia, seizure disorder and other conditions confined him in a wheelchair. He struggled to breathe and swallow and could not feed himself.
Consistent medication management and neurological care brought his seizures under control. The personalized feeding plan that our speech and physical therapists developed to correct his mealtime wheelchair positioning, breathing and swallowing, in addition to close monitoring of his swallowing, portion size, and food intake pace, helped him gain seven pounds and maintain good health for more than 18 years. But in 2015, Mr. Ralph began to have coughing and choking episodes while staff fed him. Increasingly afraid to eat, he withered from 108 to 86 pounds, jeopardizing his health.
During a two-week hospitalization in October 2015, physicians recommended a feeding tube (G-Tube) to replace all food by mouth for Mr. Ralph. Although CRC typically refers G-Tube patients to nursing homes for specialty care, we knew Mr. Ralph would not thrive in such an environment. After consulting with everyone involved with his Plan of Care, including his sister, we trained nursing staff and all direct service professionals in G-Tube protocol, sparing Mr. Ralph transfer to a nursing home. Today he is thriving, weighing a healthy 124 pounds, and enjoying community activities in the neighborhood that he has loved for more than 22 years.