Private and Public Policy Reviews for the Disabled

May I Change the Subject?

The Limits of Redirection

By Stephen Rex Goode, BSW

I am a behavior support specialist in the developmental disabilities system in the State of Oregon. I am also a personal support worker (DSP) and a partner in ARISE Mentors, LLP, a provider organization employing several people as direct support professionals to work with adults with developmental disabilities. In all three of these roles, I see the service agreements and potential client announcements of a great many customers in that system.

A common theme I see in recent years is a mention that the customer “needs a lot of redirection.”

As a personal support worker and employer of direct support professionals, my reaction is something like, “This is not going to be fun!”

It usually means that someone before us has found him to have significant behavioral issues, especially around obsession with certain topics that cause him to become upset and escalate into anxious or angry communication.

As a behavior support specialist, my reaction is quite different, though my assumption about why lots of redirection is recommended is the same.

This is only my opinion, but I think that changing the subject, as redirection, is overrated. I’m not saying that it doesn’t have its place, but I feel that a note on a service agreement that says, “needs lots of redirection,” is grossly inadequate as a plan for how to deal with challenging behavior and may be more problematic for the customer than to leave the note off entirely.

What bothers me about it is that there is almost an assumption that the things the customer is trying to express when she escalates should be cut off and redirected to something more acceptable and comfortable for the worker. Yes, there does come a point when it may be doing a customer more harm than good by getting upset, but it is likely that the upsetting topic is exactly what the customer needs to discuss.

The safest assumption I make in writing functional assessments and behavior plans is that the customer experiences a lot of frustration around feeling heard. Escalation is likely to be the result of the anxiety that one more person is not going to listen.

Many adults with developmental disabilities grew up in environments where they were told what they were getting, had to like it, and that they weren’t entitled to make their own choices or have their own preferences. Because of their cognitive challenges, it was assumed they couldn’t structure their own lives around their own values. They often have found themselves in a situation where they not only couldn’t make certain choices for themselves, they were not allowed to even express their preferences.

We who serve them usually recognize this when we begin to work with a customer, but fail to notice when we start doing it to them too. After all, we’re in a profession who understands these things so we know even better than their families and custodians what they need, right? Wrong.

So, while redirection can be a useful technique for helping a client remain calm and not get upset, like a lot of techniques, it’s only postponing a problem. It will arise again in the future, and more’s the pity, because solutions may be closer than they seem with a little patience and tolerance.

One of my deepest believes about people, whether disabled or not, is that the path to positive change makes its way through the forest of self-expression. It’s like they say in 12-step groups, “If I stay in my head, I’m dead.”

For myself, when I am in an environment where I can say whatever I feel I need to say, that the very act of saying it changes my thinking about it. There’s nothing better to sort out thinking errors than to try to say them out loud. While I’m only thinking about something, it makes perfect sense to me.

I experienced that very thing in writing this. I had all sorts of what seemed to be valid arguments to support my theory here, but upon writing some of them, I promptly deleted them because I finally saw the thinking errors I had when I was only rehearsing them in my mind. When I try to say it or write it, it becomes clearer.

Yet, we deny people with developmental disabilities that opportunity by redirecting them prematurely. For a profession that prides itself on supporting people in having the same opportunities as others, we can be quick to deny them the opportunity of self-expression when the tone becomes the sort of tone that creates as much upset in us as it does in our customers.

Verbal redirection does have its place. While honoring someone’s need to express themselves, we are also responsible to protect them from harm, including self-harm. It is appropriate to redirect the tone of what they are saying, for safety’s sake, or help them postpone it until a more private setting.

Similarly, we want them to have a good social experience in activities that involve others, so redirecting them may be appropriate to facilitate a good social experience, with the promise that they can express themselves later in a more private setting.

Of a greater priority than redirection, is the setting of boundaries. Many professionals would say that setting boundaries is a form of redirection. I agree with that, but to try to change a subject is a far lesser kind of redirection than having firm, professional boundaries.

An example of this is when it comes to a worker’s private life. It is important, especially with customers with behavioral issues, that a strict professional relationship be maintained. Workers should not use examples from their private lives when trying to teach a concept to a customer. Customers will ask. It should be a firm professional boundary that a worker will not reveal things like going through a divorce, having family problems, or even irrelevant medical information.

When a customer asks, the only response should be to decline to answer, citing the professional boundary that needs to exist. This is a form of redirection, but if the customer persists, then changing the subject could be the next step.

For other things on a customer’s mind, as uncomfortable as some topics may be for the worker, the customer should be allowed to have her say in an appropriate and safe setting. Changing subjects should not circumvent an opportunity for a customer to explore their feelings and wishes on difficult and challenging topics.

It seems to take longer, but consistently letting customers stay on uncomfortable topics for longer than the worker wants to listen, is more likely to result in permanent changes than trying various ways to keep them from expressing themselves. Workers who don’t have the capacity to bear with difficult verbal and nonverbal communication should consider only accepting clients with no behavioral issues.

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2 Responses to “May I Change the Subject?”

  1. Deanna Petersson said:

    This is really good Rex, thanks for taking the time to write it. I am a PSW to my 22 year old daughter, and my husband is an HCW and a new PSW to a 21 year old man, so we find this thought provoking and useful!

  2. Stephen Rex Goode, BSW said:

    Deanna, I appreciate that feedback very much.

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