For
twelve years I have worked with people suffering from various disabilities, and
for the last nine years I’ve worked primarily with adults struggling from severe and persistent mental illnesses. During this time I have often thought about the experience of having a significant "state sanctioned"
disability. Through my interactions with those who suffer from autism,
cerebral palsy, schizophrenia, and even mild depression—from a life stuck
inside of a mind that cannot verbally communicate, to a life stuck
inside of a body that cannot move, to a life stuck with a brain that cannot
interpret its surroundings—I have often wondered: what is that experience
like and what things can I do to help? Furthermore, regardless of having a state-sanctioned disability, am I really that
different in my own personal struggles? Are any of us?
I
have found myself asking those questions both in work settings and in day-to-day settings where I may happen to be; both when I have the opportunity to
help someone as a part of my job or when I am just a "people-watcher" observing folks live and interact with each other. Over the past five or six years, when I think about suggestions or solutions for them and for me, I keep coming back to a
few simple (but perhaps overlooked) observations.
A
few years back, while I was working at a vocational training facility—one that
served people with a wide range of disabilities—I started to notice some
patterns. I found that two components were consistently present to a
significant degree in the lives of those who were improving, and that those
same two components were consistently absent or lacking in those who continued
to struggle.
Those
two components are structure and support.
These
two common elements—which to some extent are present in the lives of everyone,
disabled or not—are broad ideas, certainly. However, the prominence of these
elements in the lives of the clients at the facility had a significant
correlation to their succeeding in their goals. I would realize later that the
presence of these two elements also has a significant correlation to success in
our own lives.
At
the training facility, each client’s success was partially
dependent on the amount, complexity, and type of structure
that the client was willing and able to participate in.
Additionally, in terms of support, each successful client had at least one
person in their lives who "had their back"—whether it was a
family member, a doctor, or agency staff. A team of supporters was the optimal
scenario, but it didn't need to be a large team, just a varied and involved
team—one who cared. Some clients had both components (structure and
support) in a strong way; some had one or the other; some had one weak
component and one strong component; and unfortunately a few essentially had
neither component. Success usually followed when the client had a strong amount
of both elements.
Now,
this is not an entirely new way of thinking about things. IEP programs, other
state and education programs, various nonprofits, rehabilitation centers, and
mental health facilities all recognize the importance of structure and support,
implement those two elements in some way, and have varying ranges of success.
In the medical field, interdisciplinary teams are now an essential part of how
a patient is cared for. Even in the "nondisabled" world, people try
to keep themselves emotionally healthy with many a self-prescribed fix-it that
could be vaguely grouped into one or even both of those two components (e.g.,
The 7 Habits of Highly Effective People, Alcoholics Anonymous). What seemed new
to me was the idea of purposefully implementing a focused package of support
and structure and measuring those two aspects alongside the client’s progress.
By noticing a correlation with these two factors in the lives of the clients at
the facility and intentionally applying more of each component into their
treatment, I was confident that we could help them move forward in some way.
My
colleagues and I at the training facility decided that it would be a good idea
to test our observations by purposefully implementing these two components in
each client's case. We started with just three clients, and we did see some
success. However, even though the plan seemed simple enough, it made a
lot of work for three agency staff working with ten to fifteen
clients. Fortunately, we had observed some initial success with the three
clients we chose to start with and this was the inspiration we needed to put in
the work to make those adjustments.
The
important thing was that the early hurdles in our first attempts did not negate
the apparent validity of the correlation between having these two components in
one’s life and the increased chances of moving forward in some meaningful way.
It looked like the hurdles were largely due to implementation only. The idea
stuck with me when I decided to go back to college and finish my degree.
I
finished my college degree in Management and Human Relations at Trevecca
Nazarene University in Nashville. With this program, the student is required to
complete a Project Thesis—essentially, a small research project set forth as a
50-page paper. Students were to devise an intervention for a problem in the workforce,
research the details, implement or propose implementation of that intervention,
measure or hypothesize results, and conclude how effective the chosen
intervention was for the workforce problem. This seemed like a good opportunity
to revisit the two components at the training facility. Maybe I could
refine it or improve it—or maybe I would find that it was an empty discovery,
in which case I could put it to bed in my brain.
Through
this research project, I explored other programs that did similar things,
researched statistics about how much improvement people have actually had with
and without those components, and continued to ruminate on implementing them at
the facility. In the course of this research, I decided a third component was
just as necessary to success:
Individualization.
While
I was researching how other programs implemented treatment to their clients, I
saw that limited funds and large staff-to-client ratios forced small programs
to "blanket" therapy to all treated individuals, even though each
treated person might suffer from widely differing problems. This blanket
therapy often forced an ineffective solution on a person with a significant
problem who could otherwise be helped by a more tailored treatment. This lack
of individualization essentially guarantees a watered-down overall success
rate for any given facility. If that overall success rate is to improve, then
each structured action plan needs to be tailor-made to each client. For
example, IEP Plans (Individualized Education Program Plans) are individualized
to each student by a team of people, and the plans are successful in many
cases. At the training facility, we did indeed individualize treatment to the
fullest extent that was pragmatically feasible, but it was clear from the
success we saw that more purposeful and focused individualization was necessary
to increase the odds for success.
Furthermore,
I realized that the same point was valid in my own life. I wouldn’t
expect someone else's specifically designed goals to apply to me or any of my
plans. What I want is my own version of an IEP Plan—an Individualized Life Plan
(ILP)! So I added that aspect into the mix, and then there were three:
Structure, Support,
and Individualization.
The
idea did not end with writing a paper about it. After I finished school, the
three components remained prominent in my work, in my thoughts, and in my life.
I still had not fully vetted this observation; nor had I shaken out the bugs
regarding a way to deliver treatment with it. And so I had to ask myself: How
significant are these three components to the lives of people
struggling with a problem? Can these three components be packaged, wrapped, and
delivered in a payload format? Has this already been done in a comprehensive
and purposeful way by someone else? If not, does the world need one more
self-improvement idea?
I
have since left my post at the facility and gone on to get a Master's in Social
Work from The University of Tennessee, of which I am currently in my last
semester. I have participated in two internships: the first was a facility very
similar to the training facility I worked at while I was pursuing my
undergraduate degree; the second an internship at a university counseling
center doing what I would like to do for a post-collegiate career,
psychotherapy. The three components have held up in both internships. The
clients at the first internship facility, unfortunately, represented what can
go wrong without a strong presence of all three components. And with each
client I see at my current internship, success is apparent when all three
components are strong. Those with depression or addictions, in
particular, seem to respond to intentional implementation of all three
components.
The
difference between when I was working on the research project at Trevecca
and now is that this idea of purposefully implementing a focused package of
structure, support, and individualization to clients with a stated problem is
not obscured by my own desires to improve my current job. Back then, it would have been
difficult not to be plagued by rampant biases. Currently, I am in a better position to take a less biased perspective. As a researcher, one must ask
a specific research question that will help one to see a way to measure success.
In this case, I needed to ask if the purposeful and focused implementation of
structure, support, and individualization improved the chances for success in
the lives of people with stated problems. This is a broad question, and it probably needs refinement. Shall I choose a specific population? To what
intervention do I compare the three-component-intervention to?
In
my own life, I am currently trying to implement more of each component as a
response to regular, everyday problems. For example, since school began,
I have put on some pounds—about 30-40 of them! However, keeping these three
components in mind has helped me lose about twenty pounds over the last seven
months. Diets, for me, are best when they are well-structured and
individualized to my routine. My support team (who are all aware of my intent
to lose weight) consists mostly of my wife, who is on board with the healthy
menu each night, and my colleagues at the internship, who accompany
me to Subway three days a week to eat a healthy sandwich. A successful diet
approach is one of many examples of the everyday application of these
components.
What
do you think? Is this something, or is it just a rehash of what
everyone tries to do already? My current thoughts, four or five years after
noticing these patterns, revolve around a few questions: Is this a significant
correlation? Do most people try to do this and just need a simple reminder to
do it more purposefully? Is one component more important than another? Do
these three components form a different element I’ve overlooked? Is there
perhaps a fourth or fifth component to consider (I have recently considered
adding motivation as a fourth component)? Should any of the three aspects be
refined, redefined, or broadened in some way?
Please
tell me your thoughts. After all, I'm already stuck thinking about it!
