Jones relates that statement of Corrigan: "Our work suggests that the biggest factor changing stigma is contact between people with mental illness and the rest of the population. The public needs to understand that many people with mental illness are functioning, fully contributing members of society." (Jones, 2006) Jones states that "the social cost of stigma associated with mental illness is high because it translates into huge numbers of people with treatable mental illness not getting help." Jones relates the fact that the National Alliance of Mental Illness (NAMI) is a group of advocates that works toward fighting the "inaccurate, hurtful representations of mental illness" that are found in the media. Jang (2002) states that the National Health Law Program has a priority to access of healthcare. In fact, the Executive Order (EO 13166) was focused toward the implementation of guidelines in overcoming the language barriers. Jang states that LEP individuals continue to face significant challenges and problems when healthcare providers use untrained interpreters, particularly family members and/or friends to interpret for patients. The reason for this is that many times friends or family members will misinterpret or self-interpret and in many languages there just are no words to convey the precise meaning that needs to be conveyed to the individual. There are many considerations in the initiative of assisting the independence of clients. Jones (2006) states that: "Social workers need to change some powerful mental models before they can effectively advocate and negotiate appropriate accommodations for their clients with mental illness who are entitled under the ADA."(Jones, 2006) This mental models are filled with misassumptions and myths. They are not 'evidence-based'. The mental models include the following:
Mental model: People get worse when they are forced to go to work.
Reality: "There is absolutely no research evidence to prove that people with mental health conditions will decompensate because they work. There is none. On the contrary, there is significant research evidence that suggests that people improve and recovery is promoted by employment."
Mental model: People don't want to work.
Reality: Seventy percent of people with a severe mental illness want to work.
Mental model: Individuals must have their benefits protected because you can't get back on benefits once you're off them; they will face a long waiting period to get back on benefits.
Reality: "It is not true that once you are working that you can't get back on benefits [SSI (supplemental security income) and SSDI (Social Security Disability Insurance)]. It also is not true that there is a long waiting period to get back on benefits once you are off them. In fact, there is no waiting period at all. Another misconception is that if you are working you will lose your health benefits."
Mental model: People on medications do not have the energy to work.
Reality: Medications can be adjusted to support working people. Morris has found that often medications do have to be adjusted because families have preferred that their family member with a mental health condition is sedated, which makes it easier for them but creates problems in the workplace." (Jones, 2006)
These are only a few of the misconceptions that exist in relation to mental retardation.
V. Human Behavior and the Social Environment
The work of Crnic (2004) states that it appear to be clear that "children with developmental disabilities have a greater risk for behavior problems than do children who are typically developing, and children with mild delays are at somewhat greater risk overall. The full range of behavior disorders may be found in these children..." Crnic additionally relates that in research that examines the parent-child interactions "in families with children with developmental delays has noted that these children pose unique parenting challenges that include intensified behavioral management issues (Baker, Blacher, Kopp and Kraemer, 1997)" (2004)
Because of the increased demands on parents it is likely that the resources of parents will be depleted leaving the parent "feeling ineffective" (Crnic, 2004) Crnic further notes that families of children who are developmentally delayed tend to "experience heightened levels of stress, particularly related to child rearing..." (2004) the work of Crnic, Friedrich and Greenberg (1983) establishes that "stress is related to behavior problems in both developmentally delayed and nondelayed samples of young preschool children (Baker and Heller, 1996) Baker et al. (2002) further affirm the fact that "parents of children with development delays were more stressed than parents of children without delays." (Crnic, 2004) Crnic relates the fact that both "child and family factors play key roles in the development of children's emotion regulation abilities" with the work of Brenner and Salovey (1997) and Calkins (1994) being cited. Cole et al. (1994) states that which defines regulation of emotion is the individual's ability to "respond to the ongoing demands of daily experiences with a range of emotions that are socially tolerable and sufficiently flexible to allow or inhibit spontaneous reactions." (Crnic, 2004) Emotion regulation is required in successfully developing so as to cope with emotions of frustration and to effectively maintain an interest in the learning process as well as successful adaptation in the engagement in social relations with others. Furthermore, the parental sensitivity to the emotions of the child play a role in determining the child's emotion regulation abilities in that children whose needs are ignored tend to experience dysregulation of emotions. Implications for practice includes the specific addressing of 'issues of family functioning, parent-child interactions, as well as children's temperamental functioning and emerging self-regulatory capacities" (Crnic, 2004) Crnic states further that stress should be focused upon "the degree to which families are stress...as stress is more common in families in which there is a child with developmental delay." (2004) the work of Andrea G. Zetlin entitled: "Mentally retarded teenagers: Adolescent Behavior disturbance and its relation to family environment" states that: The relationship between adolescent adjustment problems and different family environments was examined in 25 mildly retarded individuals. Analysis of the data revealed that those from supportive families were the least likely to experience serious behavior disturbances. When they did, as in the case of those from homes in which dependency was encouraged, it was most likely to be a form of emotional disturbance. Those from families characterized by conflict were most likely to act out and adopt antisocial forms of behavior. Factors in each of the family situations which may have had a shaping effect on the adjustment patterns were elaborated.
The work entitled: "Universal Preventative Practice for Use in the Home for Children with Behavioral Problems" (2007) states that "A family's main goal when using universal preventative practices in the home is to help their child use appropriate behavior. Facilitating his or her success requires the family's willingness to encourage, teach, re-teach and reinforce appropriate behaviors within the structure of the home environment." The family is stated to be in charge of:
1) the focus of the universal preventative practice (which child, what behaviors)
2) the goals (how much improvement is needed to demonstrate success)
3) the means of achieving the goals (what, how, and when the family will implement); and 4) the evaluation process (how the family will determine progress) (Universal Preventative Practice for Use in the Home for Children with Behavioral Problems, 2007)
Through use of the family's "unique knowledge of the child" the family is able to construct a support system in the home that supports the use of appropriate behaviors on a continuing basis. Three states "primary tenents" of application of universal preventative practices are as follows:
1) Reviewing routines and physical arrangements;
2) Defining and teaching expectations; and 3) Planning systemic response to both appropriate and inappropriate behavior. (Universal Preventative Practice for Use in the Home for Children with Behavioral Problems, 2007)
Critical review of the family's routines is the first step in addressing inappropriate behavior. This may involve engagement in discussions or each individual in the family writing down their issues to be discussed. Areas in which the home structure may be held to a consistent standard are:
Time of the day - Homework completed at a certain time and bedtime set to a certain hour.
Family members who are present - Example: Both parents eat with the children Monday through Thursday; brother does homework after swimming practice; other brother does homework first thing after dinner;
How the routine is executed.
How displays of inappropriate behavior are addressed. (Universal Preventative Practice for Use in the Home for Children with Behavioral Problems, 2007)
The behavioral expectations should be defined for family members and can be accomplished through a list that is "phrased in positive terms." A three-step process is suggested which includes the following three steps:
1) Develop positively worded expectations
2) Select expectations that all family members agree on and are willing to enforce; and 3) Combine expectations into three or four housewise rules. (Universal Preventative Practice for Use in the Home for Children with Behavioral Problems, 2007)
Effective instruction of this expectations for behavior may be accomplished through the following steps: