Addressing Specific Challenges

Service Refusals

Service refusal by individuals manifests in several ways, such as when an individual:

–  Is not physically at the specific service location when services are scheduled to be provided
–  Refuses to engage in services as DSP attempts to provide them by:

o Not letting the staff enter (won’t open door)
o Refusing to leave with DSP to engage in activity (attend appointments, run errands, go to work)

–  Damages or refuses to use equipment or applications installed in the home for use as remote supports.

When someone refuses support, teams often respond by doing “more.” This results in more staff being assigned to work more hours, or even a more restrictive setting.

Instead, teams can start by re-evaluating the true level of support the person needs in their life. Instead of automatically adding more support, reconsider what kind of support is truly needed based on the identified risks. While there will always be situations where hands-on support from a DSP is necessary, there are also many instances where education, practice, natural supports, and remote supports will be just as effective at reducing risk. This is particularly true if the person will accept and engage with the remote supports more readily than with a person. Consider questions like:

–  What is the reason for the refusal? A desire for independence, conflicts with a particular DSP, anxiety about an appointment, miscommunication about a schedule, or something else?
–  How can the team address the underlying reason for the refusal?
–  Are there alternative services (including technology or natural supports) that could also address the identified risks?


Knowing When to Make Changes

When an individual has intensive services in place–such as 2:1 staffing–it can be difficult to decide when to scale back those supports. If things are going well for the person, teams may question whether it is because of the supports that are in place, or in spite of them? There may be a desire to reduce the supports but concerns that the hard-won progress will be lost if changes are made.

It is important to get the perspectives of the individual, DSPs, and others who are involved in supporting the person about issues such as:
–  Has there been a change in the person’s mental or physical condition?
–  Is there any behavioral data that shows a decrease or changed pattern of risks?
–  Should another evaluation be completed to re-determine the current risks?

Based on this information, if the team believes that it is appropriate to reduce the intensity of the supports, consider implementing the change gradually with a periodic review.

Options include:
–  Using behavioral data to identify particular locations or times where reduced supports could start
–  Making reductions on a trial basis and then reviewing whether they should become permanent
–  Implementing technology in place of or as a supplement to reduced supports