Business Section 8:00 to 10AM - Day One Instructor: Eric Brotman PHD

A. Starting a New Business

1. Business Entity a. For Profit Corporation/LLC Advantages b. Sole Proprietor c. Partnership d. Non - Profit Benefits: Fund Raising Grant Opportunity e. Secretary of State Filing f. handout: forming business

2. Liability a. Common Accidents in Residential Care b. Medication, Falls, Sexual Abuse b. Training Staff as Insurance c. Lawsuits d. Self Monitoring of Operation e. handout: Technical Support Manuals and ARF Tool Kit e. Neighborhood Relations and fielding complaints good practice. f. handout: liability Insurance

3. Budgeting and Accounting a. Three times operating expense for license application. b. Budget is a forecast and always changing. c. Consider using a bookkeeper. d. Profit and loss e. Personal and incidental funds accounting. f. handout: budget

4. IRS (Avoid an Audit) a. Maintaining records and receipts. Scanning system. b. Use computer program or spreadsheet to track expenses and income. Quickbooks or Money. c. Don’t mix personal expenses with business (separate accounts). d. IRS looks at small businesses for fraud. e. handout: IRS audit

5. Homeland Security a. ICD Form b. Citizen Green Card or Work Permit c. Risks of hiring undocumented immigrants

6. Marketing a. Who is your customer - small community b. Who do you market to? c. Marketing strategies.

Day 1 Page 1 of 11 d Making a pitch. How to craft it. e. handout: marketing d. Tracking marketing efforts and contacts e. Communication Skills are correlated with success. f. Brochure, Web Page, Facebook, Tweeter g. How you treat your employees - the culture you create h. Getting involved: Area Board Meetings, Vendor Advisory Committee i. Interfacing with day programs and other services. i. How you feed and take care of your clients is marketing. j. handout: cash resources

8. Funding Sources a. Regional Center b. SSI rates c. handout: RC rates d. handout: SSI rates

Break 10AM - 1015AM

Psychosocial Needs

1. Autism a. history in medical literature b. Leo Kaner 1940s research kids repetitive behaviors and extreme aloneness c. Hans Asperger 1940s same time higher IQ impaired social - little professors d. Identifying characteristics 1. autism: low to high IQ, repetitive behaviors, impaired social interaction fixed interests, always a delay in language 2. Aspergers: normal to high IQ, repetitive behaviors impaired social interaction, fixed interests and no delay in language e. describe examples of each condition - focus on behaviors and language - fear f. cooccurring seizure disorder 25% maybe more g. causes: genetic - describe twin studies 60 to 80% concordance rate h. vaccination myth - MMR vaccine Thimerosal - Andrew Wakefield - Jenny McCarthy i. Behavior intervention for autism and Asperger’s j. Anti Depressant Medication and Anti Seizure Meds

2. Cerebral Palsy Handout a. brain disorder that effect mobility balance and posture b. most common motor disability in childhood c. palsy means weakness or problem with muscles d. most also have intellectual disability, vision, hearing and speech difficulties e. Spastic Cerebral Palsy - 80% of CP 1. stiff muscles - awkward movements 2. spastic diplegia, spastic hemiplegia/hemiparesis (one side of body)

Day 1 Page 2 of 11 3. spastic quadriplegia/quadriparesis - severe all four limbs usually cannot walk, seizures and problems with vision hearing and speech f. Ataxic Cerebral Palsy g. Mixed Cerebral Palsy h. possible Causes and Risk Factors i. intervention

3. Down Syndrome a. most common cause of intellectual disability b. one in every 733 births c. chromosome damage - risk increases with age of mother d. most common is Trisomy 21 - 95% of people with Down Syndrome e. developmental delays in walking, talking - facial characteristics f. children with Down strengths in vocabulary/pragmatics (social interactive language f. good receptive language difficulty with expressive g. speech difficult area of Down of all ages. articulation oral-facial muscle tone h. physical: hyotonia, vision, heart defects, hearing, gastrointestinal defects and thyroid i. behavior challenges are same in general population j. Down Personality? sociable outgoing and happy - k. social perception : Andrea Friedman vs Sarah Palin TV show Family Guy

4. Epilepsy a. brain disorder in which neurons fire abnormally b. many famous people had or have epilepsy: name some c. one of oldest conditions of humans d. types of epilepsy e. types of seizures f. seizure response - show video g. causes and prevalence h. brain stimulation i. medications and treatment j. medical marijuana

5. Fragile-X a. most common form of intellectual disability (100,000 in US) one in 3500 males b. gene mutation/ cause of autism - up to 30% have autism c. leaning problems, delays, high rate of epilepsy and sensory difficulties d. physical characteristics: large ears and long face - develop at puberty e. good memory for pictures and visual patterns f. poor concept formation and problem solving g. social anxiety and behaviors: tantrums hitting biting repetitive behaviors g. up to 40% also have epilepsy h. may suffer from severe deficits in language and speech (many in social context) i. interventions

6. Fetal Alcohol Syndrome (FASD) a. group of conditions related to alcohol consumption during pregnancy b. there is no established safe amount of alcohol during pregnancy

Day 1 Page 3 of 11 c. people with FASD might have: 1. abnormal facial features 2. small head size 3. shorter than average height 4. low body weight 5. poor coordination 6. hyperactive behavior 7. difficulty with attention 8. learning disabilities and difficulty with memory and math 9. speech and language delay - significant: may have no language 10. intellectual disability - may be profound 11. vision and hearing problems 12. problems with heart kidney and bones 13. behavior problems d. often brings great challenges to individual e. no cure

7. Prader Wllie Syndrome a. rare disorder - constant sense of hunger b. not inherited: mutation of gene b. begins at age 2 c. want to eat constantly - they never feel full (hyperphagia) d. one in 10,000 e. chronic overeating leads to obesity, diabette f. mild to moderate intellectual impairment and learning disabilities g. temper outbursts, stubborn, compulsive behaviors such as picking skin h. interventions - Prader Willie Homes

12PM - 1230PM Lunch

Psychosocial Needs Continues Instructor: Vivian Regalo

12:30 to 130PM

Intellectual Disability a. IQ 75 below b. limitations in adaptive behavior c. communication - language and speech d. poor memory and learning disabilities e. problem solving f. socializing g. difficulty learning from experience h developmental delays i. may have behavior e.g. tantrums k. onset distinguished as Developmental Disability l. common causes Down Syndrome and Fragile - X

Day 1 Page 4 of 11 m. cause may be head injury or disease such as measles or meningitis

9. Alzheimers a. most common form of dementia b. chronic degenerative disease of the brain - plaques c. mood swings d. memory loss e. personality changes f. difficulty with language g. no treatment can reverse profession h. drug treatment may temporality improve symptoms i. some evidence that exercise and lifestyle change may prevent j. Down Syndrome prone to develop in 50’s

10. Other Types of Dementia a. vascualar b. subcortial dementia c. others

11. Mental Illness a. schizophrenia 1. thought disorder 2. hallucinations and delusions 3. poverty of thought 4. confusion 5. loss of motivation 6. medications

b. bipolar disorder 1. mood swings 2. euphoric to severe retarded depression 3. different cycles 4. medications c. Anxiety Disorders a. generalized anxiety b. phobias c. OCD

d. Depression a. chronic b. reactive c. self esteem d. energy e. medications and therapy

12. Alcohol and Drug Abuse a. common in mentally ill population b. lower SES higher risk c. one half to one third of severe mentally ill abuse alcohol and drugs

Day 1 Page 5 of 11 d. drugs often used to self medicate e. anxiety and depression less painful when high f. alcohol and drugs can worsen underlying mental illness g. use of drugs and alcohol makes for wrose prognosis fo mental illness h. severe cases of alcohol intoxication my require emergency tx i amphetamine, crack cocaine can result in heart attacks stroke and or death j. resistance to admitting problem k. Alcohol Anonymous 12 Step program highly effective treatment l. Narcotics Anonymous

13. Bereavement a. severe stressor b. everyone reacts differently c. normal grieving is acute painful period of dealing with loss with recovery d. complicated bereavement becomes chronic e. intense sorrow that is ongoing f. becomes preoccupation - g. persistent longing h. numbness and detachment from others i. sducidal ideation and possible attempt i. therapy ideal intervention j. for developmentally disabled with limited language and resources important to convey empathic response and listen.

14. Client Rights a. philosophy of normalization b. President Kennedy and Sargent Shriver catalyst for recognition of DD population c. Special Olympics single most important event to bring attention to DD d. move away from viewing DD as limiting or disorder in itself - change to people like everyone else who have challenges e. engine in 60s debated Bruno Bettelheim on Autism - strong voice for the idea that DD population out of institutions into community and jobs f. client centered or person centered planning. The old medical model of the doctor on top is out. People have a right to fail. g. Regional Center System outgrowth of LPS ACT in 1973 h. students create list of - house rules h. Review personal rights LIC personal rights and compare to student list i. Discussion: sex, marriage, having children, contraception, STDs j . Practice of religion. Don’t push your religion on clients. Can happen in subtle ways. e.g. convince of just taking clients to your church. k. communicate with client and family regarding their religious ideas and f feelings. Important to make accommodation e.g. diet holidays etc.

Balance of one hour of psychosocial needs completes on Day 4

Physical Needs 130PM to 530PM Instructor: Vivian Regalo

Day 1 Page 6 of 11

1. General License Requirements Food a.Storage and preparation b. Meals Served/Dining Room c. Equipment d. Tablewares e. Adaptive Devices for Eating f. Food prepared off the premises g. Sanitation h. Foods that support bacteria i. Temperatures j. Dishwasher - Sanitize k. Pesticides and Vermin l. Menu Planning - Nutrition j. Private Sources - Inspection k. Powered Machine l. modified diets - cholesterol blood pressure diabetes m. personnel requirements - capacity n. dietician o. handout: food pyramid bonus p. handout: sample menu

2. Epilepsy a. What is epilepsy b. Types of Epilepsy c. Causes d. Intellectual Disability and Epilepsy e. Autism and Epilepsy f. Types of Seizures g. Drug Therapy f. Seizure Response g. Helmets

3. Obesity (Chronic Disease) a. Prevalence b. Developmental Disabled and Mentally Ill Population c. Weight correlated with heart disease d. Comorbidity with numerous other diseases e.g. diabetes and high blood pressure e. Lifestyle - lack of exercise f. Contributing Factors g. Care providers believe disabled will never make good choices on own. h. How to create conditions for consumers to make healthy food choices. i. Rewarding good choices

4. Diabetes a. Diabetes Disease - High glucose levels b. Type 1 and 2 c. Gestational diabetes d. 25.8 million people suffer from Diabetes

Day 1 Page 7 of 11 e. What is pre-diabetes f. genetic predisposition g. Cultures at high risk h. monitoring i. treatment j. increased incidence in Down Syndrome k medications can lead to weight gain l.food used as reward l. lack of exercise m compliance n. preventing diabets

5. Assisting With ADLs and Personal Care

A. Basic Principles a. Follow IPP b. Dignity c. Cultural and Religious Issues d. Observing and Reporting

B. Skin Care a. bruises and cuts b. Pressure Ulcers

C. Bathing Dressing and Grooming a. skin care b. Bathing c. hair care d. dressing e. shaving f. nail care g. foot care h. oral care

D. Toileting a. urinary incontinence b. incontinences pads c. ostomy care d. use of bedpan e. skin after toileting

E. Meal Assistance a. setting up meal b. eating c. feeding individual who has difficult swallowing d. feeding individuals with developmental disability

Day 1 Page 8 of 11 6. Reporting Physical Injury A. Types of Physical Injuries a. bruises b. cuts (is the skin broken) c. concussion d. fractures

B. Causes of Physical Injury a. suspected abuse ( follow mandated reporting requirements) b. balance issues with client c. navigating hazards in home or other environment d. accidents involving other clients or staff. e. illness, stroke, seizure, dizzy, heat, dehydration f. falls in the shower g. lack of supervision (like in the shower)

C. Reporting and Response a. complete SIR for CCL - LA County protocol b. If Regional Center follow Regional Center SIR Reporting c. First Aid d. Does injury require medical treatment? e. How to prevent future events - action plan f. Reward staff for identifying possible hazards

D. Prevention a. Is this a chronic injury that can be prevented? b. Does client need helmet or other protections/supports c. Does envimenorent need to be altered to prevent future falls

Break 3PM to 515PM

7. Individual Health Care Needs A. Dental a. many consumers and mentally ill have poor dental hygiene b. develop reward based system for flossing and brushing c. electric tooth brush for consumers d. look for dentist familiar with mentally ill and DD population e. make sure Medi-Cal or other insurance is up to date F. keep good records of dental visits

B. Vision Impairment in Developmentally Disabled a. definition of vision of impairment b. more prevalent in DD population c. genetic causes - injury and disease - Down Syndrome d. visual impairment and communication e. visual impairment and mental health f. low vision optometrist for non verbal clients

Day 1 Page 9 of 11 g. learning strategies for visually impaired h. proper use of cane for visually impaired

C. Podiatry a. congenital deformities of limbs, ankles and foot b. club foot c. higher incidence in DD population d. proper shoes and gait

D. Hearing Loss a. higher incidence in DD population b. cerebral palsy c. hearing test - audiologist d. hearing loss and aging e. hearing loss and communication f. alter environment , E. Physical Medical Conditions Developmentally Disabled a. orthopedic conditions such as contractures b. skin breakdown c. failure to thrive d. gastrointestinal disorders e. heart disease - Down Syndrome f. Alzheimer’s - Down Syndrome g. Spasticity

F. Hospice Care a. What is Hospice Care (85001 definitions) b. Most often associated with elderly and RCFE and previously AIDS c. Hospice team d. Prognosis of less than 6 months to live or less e. Hospice Agencies f. Hospice Care Waiver 85001 g. Hospice Care Plan 85001

H. Universal Precautions a. approach to infection treats body fluids as infectious (85001) b. hand washing c. gloves d. cleaning with disinfectant e. proper disposal of infectious materials f. staff training in Universal Precautions within ten days of employment

I. Sexuality and Disability a. general education b. myths about sexuality and developmentally disability c. intimacy and social skills

Day 1 Page 10 of 11 d. contraception e. STDs f. sexual orientation g. consent h. preventing sexual abuse

Day 1 Page 11 of 11