Published on January 2, 2009
Planning and Implementing a Therapeutic Person-Centered Adult Respite Program : Planning and Implementing a Therapeutic Person-Centered Adult Respite Program Kay Saunders MS, LPC The Bradley Center of St. Francis Hospital This presentation will not discuss off-label use of any commercial product nor recommend any product by name. Presenter receives no financial gain from the information shared in this presentation. Person-Centered Theory : Person-Centered Theory WHAT is Person-Centered Theory Therapeutic approach developed by Carl Rogers Goals: increase self-esteem and encourage willingness to experience Core Conditions: (1) genuineness, realness, congruence (2) acceptance, caring, prizing (3) empathic understanding WHY Person Centered Care Works : WHY Person Centered Care Works Emphasizes the client’s perspective and their needs Accepts that ALL behavior is a result of an unmet need Incorporates Rogers’ core conditions to maintain the personhood in the face of failing cognitive ability Validation Theory : Validation Theory WHAT is Validation Theory Method of communication Helps reduce stress and anxiety, promotes dignity, prevents withdrawal Based on empathic attitude and listening Requires a holistic view of the individual Built on Erickson’s Theory of Developmental Stages WHY Validation works Allows the very old disoriented to express long repressed emotions Expression helps decrease the intensity of feelings Individuals communicate more and are less likely to withdraw further HOW Validation Therapy Works : HOW Validation Therapy Works Based on Eight Principles Everyone is UNIQUE Everyone has VALUE All behavior has REASON Behavior reflects a COMBINATION of influences Change cannot be FORCED Everyone is ACCEPTED nonjudgmentally Based on Erickson’s Theory of Developmental Stages EMPATHY builds trust, decreases anxiety, restores dignity Techniques of Validation Therapy : Techniques of Validation Therapy Centering-releases frustration and negative feelings in caregiver Use Non-threatening Factual Words Disoriented person cannot/will not understand their feelings Use “WHO, WHAT, WHEN. WHERE. HOW” Never ask “WHY” Techniques of Validation Therapy : Techniques of Validation Therapy Rephrasing Comfort factor- helps to hear your own words repeated Paraphrase- do not parrot Repeat the IDEA of what is said using Key words Tone of voice Cadence Techniques of Validation Therapy : Techniques of Validation Therapy Polarity Give extreme example of complaint/comment Allows for full expression of feelings Linking Behavior to Unmet Need Pound, pace, rub, pat, wander, cry Look for connection between the behavior and 1 of 3 human needs LOVE USEFULNESS NEED TO EXPRESS RAW EMOTION Techniques of Validation Therapy : Techniques of Validation Therapy Imagining the Opposite Often leads to recollection of familiar coping skill/ solution Reminiscing Explore past to restore familiar coping methods Use words “always” and “never” Techniques of Validation Therapy : Techniques of Validation Therapy Maintaining Eye Contact Genuine contact makes person feel secure, cared for & nurtured Use Ambiguity Allows communication when confused person’s words have no meaning Use pronouns Techniques of Validation Therapy : Techniques of Validation Therapy Use Clear. Low, Loving Tone of Voice Triggers memory of loved ones Decreases stress Mirroring Observing & matching motions & emotions Que on eyes, facial expressions, hands, breathing, body position, body motion Techniques of Validation Therapy : Techniques of Validation Therapy Identifying and Using Preferred Sense Know and use to build trust Use sensory words that reflect preferred sense Touching NOT appropriate for maloriented person Excellent for individuals with time confusion, impaired hearing or vision Techniques for Validation Therapy : Techniques for Validation Therapy Using Music Familiar tunes remain long after words are forgotten Calms and relaxes Energizes Encourages vocalization and speech Understanding Individual Needs : Understanding Individual Needs Holistic view of the individual Assess for emotional status, personal skills and interests, cognitive ability, physical ability Geriatric Depression Survey www.stanford.edu/~yesavage/GDS.english.short.score.html Farrington Leisure Interest Mini Cog www.hartfordign.org Personal observation and interaction Guidelines for Selecting Activity : Guidelines for Selecting Activity Goal: “A goal without a plan is merely a wish.” A plan without a goal is busy work Doable- appropriate level of difficulty to assure success yet challenging enough to stimulate Individual appeal- consider interests and skills past and present Enhance quality of life at some level Oasis Activities and Therapeutic Goals : Oasis Activities and Therapeutic Goals Arts and Crafts- promotes sense of well-being and accomplishment; stimulates creative thinking; encourages fine motor skills; provides opportunity to engage in meaningful pursuit and social interaction Oasis Activities and Therapeutic Goals : Oasis Activities and Therapeutic Goals Exercise- releases energy; maintains physical fitness; promotes sense of well-being; manages agitation Music- independent enjoyment and relaxation; promotes sense of personal satisfaction through recall of memories associated with specific songs; increases self-esteem Oasis Activities and Therapeutic Goals : Oasis Activities and Therapeutic Goals TV and Movies- provides sense of familiarity; opportunity to identify with character roles; encourages reminiscence Group Discussion- provides opportunity to explore feelings and express self; receive feedback from others Oasis Activities and Therapeutic Goals : Oasis Activities and Therapeutic Goals ADLs- encourages individual functioning and independence; increases self-worth and improves quality of life Games- encourages cognitive stimulation; memory rehabilitation; concentration, increases attention span Oasis Activities and Therapeutic Goals : Oasis Activities and Therapeutic Goals Dining-offers physical, social ,emotional, spiritual and sensory experience; opportunity to contribute to common effort and demonstrate individual skills Reading Aloud-allows for moments of enrichment and empowerment; opportunity to express self in words Humor-reduces stress; releases tension; helps individuals cope; promotes relaxation References : References Borson,S., Scanlan, J., Brush, M., Vitallano, P., & Dokmak, A. (2000). The Mini-Cog: A cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15(11),1021-1027. Buettner, L. & Fitzsimmons, S. (2003). Dementia Practice Guidelines for Recreational Therapy. Alexandria,VA: American Therapeutic Recreation Association. Epp, T. (2003). Person-centered dementia care: a vision to be refined. The Canadian Alzheimer Disease Review, April 2003, 14-18. Feil, N. (2002). The Validation Breakthrough. Baltimore,MD: Health Profession Press. Feil,N. (2004). Principles of validation: allowing a return to the past. Activities Directors’ Quarterly for Alzheimer’s & Other Dementia Patients, 5 (2), 5-7. Kolanowski, A. (1999). An overview of the need-driven dementia compromised behavior model. Journal of Gerontological Nursing, 25(9), 7-9 Mitty,E. & Flores, S. (2007). Assisted living nursing practice: the language of dementia: theories and interventions. Geriatric Nursing, 28(5), 283-288. Rogers, C. (1980). Way of Being. Boston, MD: Houghton Mifflin Press. Yesavage, J. (2008). Geriatric Depression Scale. Retrieved on June 2,2008, from http://www.stanford.edu.!yesavage/GDS.english.short.score.html.