A Working Alliance:  Person-Centred Planning and

Employment

Brian McCleanBrothers Of Charity Roscommon

Social Role Valorisation

• Raise consciousness• Challenge perceptions• Provide valued social roles• Promote social inclusion

Wolf Wolfensburger 1934 - 2011

From the bedroom door…• Mild intellectual disability• Autism• Schizophrenia• Attended specialised treatment service till 18.• Home for four years behind the bedroom door• Suicidality• Assaulted his mother• Coercion and physically assaulted • 4 month stay in acute psychiatric hospital

…To the Factory Floor

• Rapport• Shaping• Diary• Treatment of intractable

medical conditions• Mental Health Review• Individualised costing• Low arousal Residential• Job• Car Maintenance Class

FIVE STEPS IN BEHAVIOUR SUPPORTLow ArousalRapport BuildingPredictabilityCommunicationIncentives

Aidan

Brendan

Cormac

Darragh

Num

ber o

f Inc

iden

ts

0

2

4

6

8

10

12

14

16

18

20

1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156

AggressionSIB

A B

0

5

10

15

20

25

30

35

1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156

AggressionGrabs

0

5

10

15

20

25

30

35

40

45

1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156

AggressionSIB

B+C

B+

C +

D +E

B+C+D

B+C +D +E+F

0

5

10

15

20

25

30

35

1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156

AggressionHandbiting

A = Baseline B = Low ArousalC = Rapport BuildingD = Visual SequencingE = Escape Communication TrainingF = Differential Reinforcement

Weeks

An Evaluation of an Intervention Sequence Outline in Positive Behaviour Support for People with Autism and Severe Escape-Motivated Challenging Behaviour

McClean and Grey, 2012 Journal of Intellectual and Developmental Disabilities

Readiness for Work

• Safety• Exchange• Heart• Purpose• Identity• Engagement• Paradise

Behaviour Support Plan

Rapid effects Generalisation Maintenance Quality of lifeNo side effects

Proactive Strategies Reactive Strategy

Vision based planning

Every person should have a vision statement of what is

Important to him or her…Important for him or her…And a circle of support

able to speak from a position of love and concern

Paradise

• Positive Emotion• Flow• Meaning

To be seen and met as a fellow human being with the capacity to discover one’s personal vision is to be encouraged determine for oneself, the things that happen in one’s own life. If, as staff, our actions inspire others to dream more, to learn more, to do more and to become more, we are working as effective skilled helpers.

Not All Services Are Effective

Mover (N = 20)

Mean

Non Mover (N = 22)Mean

F df1 df2 Sig

Adaptive Behaviour Scales – Support Needs

132.5 94.0 21.6 1 40 .000

Autonomy 9.6 5.2 10.5 1 40 .002

Mental Health (HONOS) 8.5 15.5 10.1 1 40 .003

Adaptive Behaviour Scales – Challenging Behaviour

44.6 38.3 4.8 1 40 .034

Year of Birth 1973 1970 1.0 1 40 N.S.

Acceptability of the Vision Statement

57.7 53.5 7.7 1 40 .008

Working Alliance Inventory 66.6 58.5 26.4 1 40 .000

Acceptance of Risk -Taking 15.2 13.3 5.5 1 40 .024

Additional Cost Of Vision (€56) €10,813 3.6 1 40 N.S.

Empowerment Instrument 95.5 92.4 2.8 1 40 N.S.

Role Clarity 87.1 85.5 0.4 1 40 N.S.

Standards 21.4 20.2 2.5 1 40 N.S.

Structure 31.2 29.0 4.9 1 40 N.S.

Conflict 13.5 12.7 2.4 1 40 N.S.

Responsibility 25.6 24.9 0.6 1 40 N.S.

Warmth 19.4 18.5 1.4 1 40 N.S.

Ability to express 3.8 4.2 0.1 1 40 N.S.

79% of the variance is explained

Adaptive Behaviour Scale -Support NeedsWorking Alliance

Unexplained

Variable Entered into the Equation -2 Log likelihood

Cox & Snell R2

Nagelkerke R2

Adaptive Behaviour Scales – Support Needs 39.33 .361 .48

Working Alliance Inventory 20.28 .594 .79

The Working Alliance

The extent to which frontline staff and family members – agree about the goals– share a mutual respect and

trust – have a common

appreciation of the person