It Just Didn't Feel Right

by Joan Sweeney, Independent Organizational Consultant and
Rennae O'Connor, Service Director for SESDAC

When Kate began going to the Pizza Hut for lunch after her shift at the sheltered workshop, no one thought much of it, until we got a call from the Pizza Hut manager. It seems Kate was enjoying multiple visits to the lunch buffet without having money to pay. The Pizza Hut workers tried to get her to show them the money before she indulged herself, to no avail. She would often force her way to the buffet. As an agency who provided support to Kate, our initial reaction to this news was to either keep her from going to Pizza Hut by escorting her home (using physical restraint if necessary) or the other not so great option—tackle her at Pizza Hut! One of the things we began to realize is that some of the options we were using to control behavior in the agency were not very pretty when used in the workshop and were downright ugly when used in the community.

The South East South Dakota Activity Center, Inc. (SESDAC) is located in rural Vermillion, South Dakota. Vermillion is a small university town with a population of 10,000 (until students and faculty leave during school breaks, which results in a population of 5,000). It's a community where everybody knows somebody who knows you and word gets around town quickly. This makes embarrassing behavior in public (such as stealing, eating too much, and/or physical aggression) doubly embarrassing because news travels fast and is not easily forgotten. The fact that we live in a small town has also worked in our favor. Using our personal connections to educate via the rumor mill can often turn around perceptions about people we work with. Given all this, we were concerned about the messages we were conveying to the community about how to treat people with disabilities and were also beginning to struggle agency-wide with the use of physical restraint as a method of behavioral control. Our experience had taught us that taking control of a person's behavior using traditional methods (i.e. physical restraint, tangible reinforcers, etc.) never resulted in long-term behavior change and was also emotionally and physically draining to all involved. Plus, physical restraint often resulted in injury to staff and the people we supported. It just didn't feel right!

This was the beginning of the end of SESDAC's long time use of physical restraints. We made a commitment not to use physical means to keep Kate from the buffet but rather to try and understand why Kate was helping herself to the food without paying. Observation became the data collection strategy we used for our problem solving. We had turned a corner. Little did we know that making this seemingly small commitment would result in a much bigger agency-wide resolution to never use physical restraint again.

We had been through a similar experience with Kate a few years prior to this when she was taking donuts from the gas station. At that time, we used physical restraint with Kate many times. It usually started with some basic body positioning that Kate could shove through, followed by a controlled wrestling match necessary for the staff member(s) to get her in the hold. It always resulted in the staff member(s) and Kate on the ground in a heap. The silliest part of the whole thing is that she usually had already consumed the donut. So, besides the public struggling, lots of sore muscles, dirty pants, and negative messages in the community, it still ended up in a lose-lose situation for all involved. Kate, our staff members, and the agency were all losing their dignity.

We knew what we had to do. We had to figure out what she loved so much about Pizza Hut and try to replicate it. Kate was gaining a lot of weight, couldn't afford to eat out everyday, and was not being accepted with dignity at Pizza Hut. One of our staff members went to Pizza Hut for lunch one day, which provided the opportunity to observe Kate at the buffet.

Kate sat alone, drank pop from a straw and ate many heaping plates of macaroni salad and pizza. Of all the items on the whole buffet, all she wanted was macaroni salad and pizza. We then talked to her family about our concerns. Guess what? During the forty-plus years she was at home, she went to restaurants and to stores on a regular basis, was encouraged to take what she wanted, and her mother or brothers paid for it at the counter. Kate didn't know about paying for what she wanted. She thought you just went in and got it. She had grown up in a small town where everyone knew her, so even if she was alone, all the business owners knew her family would pay for her things later.

After a lengthy team meeting, we came up with a plan to replicate Pizza Hut. We had to teach Kate that she could get lots of pizza and macaroni salad without going to Pizza Hut (she was on a tight budget). So, we began to help her make macaroni salad each evening—a five-quart ice cream bucket of it! We also assisted her to buy the personal size microwave pizzas at the grocery store and to put this all together to bring as her lunch. We also helped her ask her boyfriend to eat lunch with her everyday and manipulated the schedules just a bit to make that happen. We assisted her in purchasing a calendar and helped her mark each Friday as Pizza Hut day. We gave her a consistent message that she could go to Pizza Hut every Friday, just because it was Friday. There were no strings attached to Pizza Hut day—it didn't matter whether the alternate plan worked everyday and she went to Pizza Hut without money, she still went on Friday.

So, everyday Kate came with her five-quart bucket of macaroni salad and her five or so microwave pizzas to the workshop. She walked down the hall with her boyfriend on her arm and a smile on her face. Several staff members were very upset; they were sure that Kate would eat until she became sick, and she was gaining weight. (It took some convincing to get people to accept that she was gaining weight anyway—either here or at Pizza Hut). Once this plan was enacted she seldom went to Pizza Hut, except on Fridays. Today her lunches are normal size and don't consist of macaroni salad and pizza everyday. We lost track of exactly how long it took for her to change her lunches to other things. Actually we never kept track; it wasn't important. What was important was that Kate's life, and the lives of every person in our agency, had been changed forever.

We now have an annual Dignity Week celebration commemorating the anniversary of the last use of physical restraint in our agency. As we train new staff members, they give us strange looks and ask, "what's physical restraint?," when we talk about our policy that says physical restraint is not an acceptable option. For those of us who have lived through the whole story, there is a great sense of pride, accomplishment, and relief that we have overcome our dependence on such an undignified idea.

Currently, we focus our staff training efforts in the areas of functional analysis, communicative intent of behavior, quality of life, and teaching positive replacement behaviors. We're closing our sheltered workshop and helping people find real jobs in town. It has forced us to completely change our mind-set. Now we ask ourselves why? and how can we? to develop a strategy for understanding and problem solving for each behavior that occurs. Many years ago we used MANDT and our own rendition of behavior intervention techniques. We have now learned that if staff members aren't taught physical restraint holds as an intervention option, they can learn different and dignified approaches to build positive behavioral supports.

You can reach Joan Sweeney at (843) 406-7685 and Rennae O'Connor at (605) 624-4419.