Environmental Adaptations and Modifications

What:

Environmental adaptations and modifications come in all shapes and sizes and go beyond what one might think. People often think of ramps and other modifications to make a house more accessible when discussing this topic, but there are several other modifications that can be put in place that create a safer environment for people with aggressive tendencies. Soft furniture is sometimes a good way to prevent self-injuries, sometimes door alarms are required for those who attempt to leave their homes during times of instability when they are not safe. Reinforced windows are commonly used to prevent breakage and subsequent injury, many people who are loud during times of increased anxiety and agitation risk eviction or disturb others if rooms are not soundproofed. Even a piece of tape over a clock so an individual does not obsess over time can be an environmental adaptation.

One of the most important environmental choices to be made is whether the person will live alone or with others. Many times, funding constraints do not allow for individuals to live without a house mate but having a private room should always be an option unless the person specifically chooses to share personal space with a trusted friend. In instances where there is no option for private rooms, other modifications to the living arrangement may be necessary. Sometimes just a quiet space to regain control is helpful.

People who become violent may require a time-out room in their residence; many times these rooms are unfurnished or have soft furniture items in them to keep the person safe while she/he regains control. These rooms are not used for punishment; the person enters them voluntarily because they know they are feeling out of control and unsafe. Fencing is another modification that is sometimes added to residences, particularly for those who enjoy time outdoors but have no danger or safety awareness, or who might wander off. Fencing a yard must not take the place of staff supervision however; unknown dangers can exist in all outdoor areas and without supervision, people have been known in ingest inedible items in their yards, injure themselves on swing sets and hop over fences in attempts to explore their environments.

Why:

The impact the chosen living environment has on behavior cannot be underestimated. Many people who challenge us through their behavior have difficulty sharing personal space with anyone else and may manifest this through many means; behavioral outbursts and aggression to others are common as are competing for staff attention, intruding into others’ personal space or taking items that belong to others. While modifications may risk violating residents’ rights, in many cases, the person will voluntarily give up his/her rights as he/she develops insight into the destructive and dangerous nature of the behavior. Safety is one of the most important reasons for modifications and adaptations. Often an individual feels safer knowing that the doors can be locked, the stove may not turn on, and the windows are reinforced; sometimes knowing that these traditional targets "won't work anymore" actually decreases the urge for property destruction and ultimately makes the person feel safer; needless to say, staff are also feeling safer.

A final reason to implement adaptations and modifications is for the community.  Individuals who can become aggressive draw attention to the home.  Neighbors and the community often develop a negative impression of the individual or home based on biases, ignorance, assumptions, hearsay, and perceptions; other times, these impressions are created by the presence of police cars, loud noises, yelling or observations of conflict around the home. Minimizing these negative impressions to the degree possible is one way for adults with disabilities to be better accepted into stable neighborhoods. Soundproofing, maintaining the yard and home to the standards of the neighborhood, and teaching boundaries will all go a long way in facilitating acceptance and helping the home to blend into the existing community.

How:

Any adaptation or modification to a person’s residence must be in the best interests of the resident's heath and safety and must not infringe on the rights of the person nor of others in the home. Let thoughtful, person-centered thinking be your guide; include the entire team in the discussion including the persons who will be most affected by your decision. Staff convenience should never be part of these discussions.

Go HERE to view photos of environmental adaptations.