DEAR ÁINE

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Uncomfortable coexistence
Q.

Our Head of Unit is universally popular with both staff and clients. In fact she’s impossible not to like! But other staff members are increasingly frustrated at her lack of initiative—we’ve all got just a little bit too comfortable. Several innovative approaches have been suggested by top management, and also from among ourselves—but our manager continues in the same comfortable rut, never implementing a new idea! Is there any pleasant way we can light a bomb under her?

A.

From your description of the situation, I wonder what sort of message the Head of Unit is getting from Top Management, and from those around her? Does the feedback she is getting lead her to think there is no problem? Or does she choose to ignore the fact that there is a problem because she is ill-equipped to do anything about it? You would like a ‘pleasant’ way to address the problem. Maybe the staff, as a group can sit down with her, with a member of top management, to agree on desirable outcomes for the clients, and the ways for all of you to make them happen. If someone from higher management attends, there should be a sharper focus and better follow-up. Such a discussion would allow those who feel passionately about quality outcomes for clients to enthuse and persuade others to make changes happen. Of course, ‘pleasant’ ways may not work in your situation, and direct and honest conversation with the Head of Unit may be necessary—but even so, it may be easier for her to hear such views from her own staff members, than from her management superiors.

Giving a voice
Q.

I’d like to learn more about alternative communication methods which might be useful for two clients I work with—in a residential care setting Unfortunately, like many others, we have no access to the services of a speech and language therapist. How might I find out about signing, and perhaps a symbols system?

A.

There are several alternative/augmentative systems available, e.g. LAMH, PECS, etc. However, from your question it is not clear which one might be most suitable for the people with whom you work.

There are a number of ways of finding out more about such systems. There is a lot of material in articles/books/journals that cover this general area—you should be able to find them in a good library, or on the Internet. (See, for example, The Journal of Augmentative and Alternative Communication.) You might contact staff or speech and language therapists working in other agencies for people with an intellectual disability. They may be able to give you advice and direction. Other good contacts may be the School of Clinical Speech and Language Studies at Trinity College Dublin, the Irish Association for Augmentative Communication, of the Irish Association for Speech and language Therapists, or the Clint Technical Services at the Central Remedial Clinic.

You might also find a course or conference useful, or a study visit to an agency where augmentative systems are already in use. Perhaps your agency could invite an ‘expert’ to give a workshop to staff

Sitting pretty
Q.

My 8-year-old son has cerebral palsy and a learning disability. His OT just got him a new chair to sit in at home, as a break from his wheelchair- I think it’s a lovely, comfortable chair, but he cries every time we put him in it. I think he’s too used to lying on the couch in the evenings. How can we help him get used to the new chair?

A.

Before I address the issue of getting your son to sit in his chair, there are a couple of questions you may need to consider. You say that the chair looks comfortable to you—can we be certain that it is comfortable for your son? As comfortable as his wheelchair? Has he been sitting in a wheelchair all day—does he see the couch as his opportunity to sprawl out?

Are there important long-term physical implications that require him to sit (as opposed to stretch out on the couch)? Or do you want him to sit in a chair in order to be more socially acceptable?

If you satisfy yourself that your son needs, or will benefit from, sitting in his new chair, then you might help him to associate sitting in the chair with enjoyable activities—e.g. sitting in it while playing a game, painting or eating ice cream. A psychologist may be able to help you to find systematic ways to increase the amount of time your son is willing to spend in his new chair.

Life without Dustin
Q.

My daughter with autism has a fascination with Dustin, the TV turkey. She gets very upset if she misses him on TV. I am dreading the summer holidays when he will be off-air. I’ve tried showing her old programmes on video—but she isn’t fooled. Any ideas?

A.

I appreciate it isn’t uncommon for some children with autism to have a limited and narrow range of interests, such as Dustin the Turkey. No doubt your child will find it hard to accept that Dustin takes a holiday and clearly reshowing programmes has not worked for you. As a parent you will not always be able to protect your child from the realities of life and, while it may seem harsh, your daughter will have to learn to accept the reality of Dustin’s absence from summer TV. I suggest you begin to introduce the idea that Dustin can be around both on TV and in other ways—pictures, puppets, drawings, etc. It may be possible to use your child’s fascination with him to develop some useful skills. Perhaps you could use a Dustin puppet to help develop your child’s linguistic skills, or make-believe play. Or you might photocopy little ‘Dustin’ pictures and use them for colouring, or to teach number skills. Hopefully, with effort and imagination you should be able to find ways around this problem.

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