Understanding People with
Developmental Disabilities,
Mental Illness, and/or
Special Health Care Needs
Tri City Partnership for
Special Children &
Families
First Responder
Smart Card Program
TM
1
Performance Objectives
At the end of this course of instruction, through
verbal response and use of notes and
handouts provided, the student will:


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Develop and describe practical skills that can be
used when interacting and communicating with
people who have mental illness, mental retardation
or special needs.
Identify appropriate referral agencies for various
situations involving individuals with MI/DD.
Demonstrate how to effectively handle situations
involving people with MI/DD or special needs.
2
Performance Objectives

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List several types of Disabilities that fall into the
special needs category
Identify safety techniques to be considered when
responding to calls for service involving
individuals with MI/DD.
Identify verbal and non-verbal behaviors that are
indicative of persons who are emotionally
unstable and/or potentially hostile.
ID the following w/ respect to detaining persons
w/ MI: Legal Basis; Notification Procedures;
Procedures for Serving Court Order; Procedures
for Restraining and transporting; Where to
Transport.
3
What Can Cause A Disability?
Genetic (or inherited) conditions
 Problems at birth
 Problems after birth
 Poverty and cultural deprivation
 Problems during pregnancy
 Accident or injury

4
Examples of Disabilities
Mental Retardation (MR)
 Autism
 Cerebral Palsy (CP)
 Epilepsy

Traumatic Brain Injury (TBI)
 Developmental Disability (DD)
 Seizure Disorder

5
Understanding Functional
Limitations
Communication
 Self-care
 Home living
 Social skills
 Leisure
 Community use

Health and
safety
 Self-direction
 Functional
academics
 Work

6
Disability Definitions
 AUTISM-
A condition which may be
characterized by severe disorders in
communication and behavior,
resulting in limited ability to
communicate, understand, learn, and
participate in social relationships.
7
Autism
Inability to relate to other people
 Delayed communication skills
 Language comprehension is impaired
 Highly sensitive to sensory input,
noise levels and touch
 May react indifferently or with
emotional outbursts
 Difficulty in dealing with changes
 Obsessive or compulsive behavior

8

BRAIN DAMAGE- Generally described
as any defect of the brain specifically
occurring from injury before, during or
anytime after birth. It may affect any
brain function, but is especially related
to movement, thinking and learning.

CEREBRAL PALSY- A permanently
disabling condition resulting from
damage to the developing brain which
may occur before, during, or after birth
and results in loss or impairment of
control over voluntary muscles.
9
Cerebral Palsy
10
•EPILEPSY- A neurological condition
characterized by abnormal electricalchemical discharge in the brain. This
discharge is manifested in various forms
of physical activity called seizures.
•SEIZURE DISORDER- The result of a
disorder of the central nervous system
causing loss of consciousness, muscle
spasms, mental confusion or uncontrolled
or aimless body movements.
11
Epilepsy
12

MENTAL RETARDATION- As defined
in Arizona, a condition involving
significantly sub average general
intellectual functioning existing
concurrently with significant deficits or
impairments in adaptive behavior and
manifested before the age of 18.
13
What is a Mental Disability?
IQ (Intelligence quotient) is below 70-75
 Mild - IQ 55 - 70
 Moderate - IQ between 40 - 55
 Severe - IQ between 25 - 40
 Profound - IQ is below 25
 Limitations in “Functional Limitations”

14
Most people are “mildly” affected
15
Intelligence means…
 Paying
attention
 Demonstrating good memory
 Using abstract thinking
 Using practical problemsolving skills
 Generalizing knowledge
16
Problem Solving
Ability
362,379 x 9,737 = ?
17
BENEFITS OF TRAINING

Effecting positive change in our
communities.
18
Common Syndromes Associated
With Mental Retardation
Fetal Alcohol
Syndrome
Fragile X
Syndrome
Down
Syndrome
Caused by drinking
during pregnancy
Inherited disorder;
Chromosome
males more affected disorder
than females
Severe learning
Short attention
disabilities and
span, repetitive
behavioral disorders speech, lack of eye
contact.
Risk of developing
severe behavior
disorders is low
Small eyes, thin
Large ears, loose
upper lip, large ears, joints, long face,
shortened fingers
prominent forehead
and chin.
Slanting of eyelids,
depressed nasal
bridge, small mouth,
hands and feet.
19
What Would You Do?
A suspect is read his Miranda rights by
an officer who asks, “Do you waive
these rights?” and the individual
responds by smiling and waving his
right hand.
 A middle-aged woman sees a sign in
the window of an empty parked car that
says, “baby on board.” She spends a
long time looking inside the window of
the car searching intently for a baby.

20
Waiving Rights?
21
Traits to Consider
 Communication
 Limited
vocabulary
 Speech Impairment
 Unable to read or write
 Say what others want to hear
 Have difficulty understanding directions
or answering questions.
 Takes things at face value
22
Traits to Consider
 Behavior:
 Be
easily influenced and anxious to please
others.
 Easily victimized
 Easily frustrated (not able to understand
others)
 Don’t want their disability to be noticed
 Have difficulty making changes, reading,
using the telephone, telling time and giving
accurate directions.
 Unable to pick up on social cues.
 Unable to relate socially to others
23
May Be Easily Led
24
Traits to Consider
 First
Responder (FR) contact:
 Not
able to understand Miranda
rights or commands.
 Overwhelmed by FR presence
 May act upset and try and run away
 Be over willing to please officer and
admit to something they did not do.
 Be less likely and less able to report
criminal acts or victimization
25
Vulnerability of victims
Segregated from others
 Heavy dependence on caregivers
 Praised for compliance
 Easily persuaded or led by others
 Impaired judgment
 Not trained on safety or basic legal
rights

26
One Officer’s Personal
Experience

“I’ve got an uncle. He has down
syndrome. He is just slow. Like he has all
the same feelings and emotions as
anyone else but he’s just like a ten year
old…often people with mental retardation
won’t stand up for themselves, and when
someone says to them, ‘you are wrong,’
well, they say, ‘OK’… they’d just rather
agree with you.”
27
Developmental Disability
A First Responder Approach
Speak directly to the person
 Keep sentences short
 Use simple language
 Speak slowly and clearly
 Ask for concrete descriptions
 Break complicated instructions down
into smaller parts
 Use pictures, symbols and actions to
convey meaning

28
Individuals w/ DD as Witnesses
29
Developmental Disability
A First Responder Approach

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Take time giving or asking for information
Repeat questions more than once
Avoid confusing questions about reasons
for behavior
Don’t speak louder in an effort to increase
the person’s understanding.
Use firm and calm persistence if the person
is non-compliant.
Avoid “yes” or “no” answers
30
Keep an Open Mind
 Don’t
assume he or she can’t
understand or communicate
 Be genuine in your desire to
understand him or her
 Demonstrate the same respect
given to others without a disability
31
Victim case scenario

While on patrol you get a call from across
town about a sexual assault that has just
occurred. You arrive on the scene to find two
middle-aged women talking. One woman,
Mary, has a mental disability and is alleging
sexual assault by the driver of the bus she
just exited. She says it happened many
times, but she has been too afraid to tell
anyone until now. The other woman is Mary’s
caseworker who sees Mary on a weekly
basis. She works at the local mental health
center. Mary’s case worker called the police
immediately after the allegation was made.
32
BENEFITS OF TRAINING
Effecting positive change in our
communities.
 Increased safety for first responders,
consumers and the public.

33
Mental Illness
34
Mental Illness
A disorder causing severe disturbances
in thinking, feeling and relating. The
result is a diminished ability to function
or cope with ordinary demands of life.
 Characteristics are abnormalities in
perception, thought and mood.
 Usually triggered when an individual
experiences distress.
 Observe duration and frequency of
cognitive, emotional and behavioral
impairment.

35
Mental Retardation & Mental
Illness are NOT the same thing

Mental Retardation
Decreased ability to
learn
 Low IQ
 Before the age of 18
 Disability usually
noticeable


Mental Illness
Impacts moods
and emotions
 Low or high IQ
 Occurs at any time
 Disability may be
noticeable

36
Dually Diagnosed

Term used to describe a condition
where a single person has more than
one major clinical psychological/
psychiatric diagnosis. (mental
retardation/mental illness, mental
illness/poly-substance abuse)
37
Mental Illnesses Are:
Biological brain disorders that
interfere with normal brain chemistry
 Very common
 Equal opportunity diseases
 Devastating to ill persons and their
families
 Treatable

38
Mental Illnesses Are Not:
 Anybody’s
Fault
 Preventable or curable at this time
 Hopeless
39
Contributing factors
Biological factors - inherited genetic
factors influence person’s present
functioning.
 Social influences - environmental
norms of person’s support system.
 Emotional influences - general
temperament of the person.
 Developmental influences - current
developmental stage and tasks.

40
Seriously Mentally Ill
 SMI
is a legal term not a diagnosis
 SMI is a term for people who are
eligible to receive publicly funded
services in Arizona.
41
3 Basic Types of Illness
 Psychosis/
Thought Disorder
 Mood Disorder
 Anxiety Disorder
42
Psychosis / Biochemical
A
symptom or feature of mental
illness typically characterized by
radical changes in personality,
impaired functioning, and a
distorted or non-existent sense of
objective reality.
43
Schizophrenia
 Schizophrenia
will impact:
 Way
a person sees the world
 Their thought patterns
 Speech
 Movement
 Almost all aspects of daily living
44
Schizophrenia - WDC Shooting
45
Delusion
A
delusion is a persistent belief
that something is true when there
is no evidence suggesting that
this is the case. The delusional
person cannot be dissuaded from
the delusion by force of logical
argument.
46
Hallucination
 Seeing,
hearing, smelling, tasting,
or feeling things that aren’t there.
 Disorganized speech-symptom
can be observed if the person
discusses issues illogically, jumps
from topic to topic or uses
unintelligible words.
47
Schizophrenia

Common Medications
 Haldol
 Zyprexa
 Risperdal

Side Effects: blurred vision, tremors,
stiffness, drowsiness, muscle spasms,
uncontrolled muscle movements,
jerking, and twisting movements.
48
Hallucinations – Norman / Part 1
49
Schizophrenia
A First Responder Approach

Recognize and acknowledge that their
delusions or hallucinations are real to
them.
Don’t tell them there is no one there
 Don’t tell them you see or hear something
that you don’t
 Consider asking what the voices are
saying to get an idea of what the person is
going through

50
Schizophrenia
A First Responder Approach

Recognize they may be overwhelmed
and frightened by sensations, thoughts,
sounds, voices, or their current
environment.
Use brief, clear and simple language
 Never argue
 Announce your actions

51
Hallucinations – Norman / Part 2
52
Mood Disorders
Mood disorders are mental
disorders characterized by periods
of depression, sometimes
alternating with periods of
elevated mood.
 Sad or elated moods.
 Prolonged mood states that
disrupt their daily functioning.
 May appear as severe agitation

53
Depression
 Major
depression, known as
clinical depression, is an
abnormal low of mood
characterized by disturbances in
eating, sleeping and
concentrating.
 Estimated
in 9.9 million adults
54
Depression

Common Medications
 Prozac
 Paxil
 Effexor

Side effects can be dry mouth,
constipation, blurred vision, insomnia,
dizziness, agitation and/or confusion.
55
Mood Disorders
56
Depression
A First Responder Approach
Ask if they are having thoughts of
suicide
 Use a calm and supportive approach
 Empathize with their dilemma
 Give strong reassurance that they are
safe and you will assist them in getting
help

57
Bipolar

Also known as manic depression
 Experience
alternating episodes of mania
(severe highs) and depression (severe
lows).

Manic Phase – May include hyperactivity,
anger, impaired judgment, aggressive
behavior, delusions, exaggerated feelings,
extreme irritability and disorganization.

Often described as “the best feeling ever.”
58
Bipolar

Common Medications:
Lithium – can cause seizures, blackouts
and the appearance that the individual is
drunk
 Depakote
 Lamictal


Side effects can be tremors, dizziness,
dry-mouth and memory problems
59
Bipolar – Manic Phase
A First Responder Approach
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Use a firm and direct approach
Set clear limits on behavior
Reduce environmental stimuli
Re-direct behavior and thoughts if they
begin to escalate
Help them to “slow down” by using
controlled, rhythmic breathing
60
Bipolar Disorder
61
BENEFITS OF TRAINING
Effecting positive change in our
communities.
 Increased safety for first responders,
consumers and the public.
 Increased professionalism through
education thereby lowering issues of
liability.

62
Anxiety Disorders

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
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
A group of illnesses that have in common
persistent feelings of apprehension,
tension, or uneasiness, and are
accompanied by physical symptoms such
as sweating, palpitations, and feelings of
generalized stress.
Phobias
Panic attacks
Generalized anxiety disorder
Obsessive Compulsive Disorder
Posttraumatic stress disorder
63
Anxiety Disorders

Common Medications
Ativan – can cause memory loss
 Valium
 Klonopin


Side effects include sleepiness, dizziness,
nausea, irritable bowel, loss of memory
64
Anxiety Disorders
A First Responder Approach
Be calm, supportive and empathetic
 Reassure them they are safe and you will
assist them in getting help
 If they are exhibiting OCD compulsions do
not ridicule them or try to make them stop
 If their actions make you nervous, let
them know and try to agree on a possible
alternative

65
Post Traumatic Stress Disorder
A specific type of anxiety disorder.
 Fear of re-experiencing a traumatic
event.
 May try to avoid these experiences
by self numbing or medicating with
substances.
 Possible extreme reaction to
normal actions

66
Emotions and Behaviors
Emotions are a way of communicating
and often substitute for language.
 All behavior is purposeful
 This behavior is an attempt to get a
need met.

67
Behaviors you always
counted on may not exist
with the person who has
a mental illness.
68
Responding to Mental Illness
69
Behaviors that MAY NOT be present
Insight about what is happening
 Ability to focus and concentrate
 Pride in appearance and personal
hygiene
 Ability to exercise self-control
 Willingness to follow a treatment plan
 Emotional resiliency

70
Behaviors that MAY be present
Irritability, criticalness, nervousness
 Irrational statements and
responses
 Uncontrollable sadness or crying
 Rudeness and hostility
 Inappropriate and bizarre behaviors
 Constant tension and nervousness

71
Defensive Coping Strategies &
Behaviors

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Controlling
 Running Away
Anger and attack  Refusing medication
Blaming others
 Abusive criticism
Substance abuse  “I don’t want to talk
Violent behavior about it.”
Refusing services  Stubbornness
 Self-blame
Denial
Making excuses  Suspicion
72
Psychotropic Medications
A
medication which is prescribed
for the purpose of reducing or
eliminating certain behaviors.
(behavior modifying)
73
Keep an Open Mind
 Don’t
assume he or she can’t
understand or communicate
 Be genuine in your desire to
understand him or her
 Demonstrate the same respect
given to others without a disability
74
“SLOW DOWN”
75
In-Custody Deaths
Excited Delirium


Delirium – A mental disturbance marked by
illusions, hallucinations, short unsystematized
delusions, cerebral excitement, physical
restlessness and incoherence.
Excited Delirium – A state of extreme
mental and physiological excitement,
characterized by extreme agitation,
hyperthermia, hostility, exceptional strength
and endurance without apparent fatigue. (also
called in custody death syndrome)
76
Physical Characteristics

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Dilated pupils
High body temperature – hyperthermia
Profuse sweating
Skin discoloration
77
High Risk Individuals
for Sudden Death


Obese – specifically having a large belly
Enlarged Heart or Heart Problems
Coronary Atherosclerosis
 Myocardial Infarction
 Myocarditis – inflamed heart muscle
 Fibrotic heart – scar tissue formation




Under influence of alcohol and/or drugs
Weather is hot and/or humid
Head injury
78
Behavioral Cues: High Risk
Individuals for Sudden Death

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Demonstrates intense paranoia, violent,
bizarre behavior
Is extremely agitated
May be running wildly and/or screaming
Stripping off clothing
Psychotic in appearance
Rapid fluctuations in emotions
Disoriented about place, time, purpose
and even himself
79
Behavioral Cues: High Risk
Individuals for Sudden Death



Possess great or even super-human
strength
Seemingly unlimited endurance
Diminished sense of, or is insensitive to,
pain


Impervious to Pain Control; Pepper Spray;
Taser; Baton Strikes
Violently resists during control and
restraint as well as after being restrained
80
Excited Delirium
A First Responder Approach

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Assess the scene
Wait for back-up
Call for EMS or Fire Personnel
Attempt to verbally diffuse the situation
81
Excited Delirium
A First Responder Approach


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Quickly and safely CAPTURE the subject
Quickly and safely CONTROL the subject
RESTRAIN the individual

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Do not hog tie
Do not allow to lie prone for too long
Roll subject on his side to aid breathing
Can have them sit up if safe
Provide information to EMS/Fire personnel
Transport immediately
82
Excited Delirium
DOCUMENTATION

Document physical assessments of the
subject
Skin color
 Body temperature
 Sweating
 Clothing (or not)


Obtain vital signs from EMS personnel on
scene
83
Excited Delirium
DOCUMENTATION



Quote what the subject said during the
incident
Obtain detailed witness statements
Take as much time as needed to complete
a comprehensive, detailed report
YOUR CAREER MAY DEPEND ON
HOW WELL YOU ARE ABLE TO
DOCUMENT THE INCIDENT
84
In-Custody Deaths - Excited Delirium
85
BENEFITS OF TRAINING
Effecting positive change in our
communities.
 Increased safety for first responders,
consumers and the public.
 Increased professionalism through
education thereby lowering issues of
liability.
 A better understanding on the part of first
responders of individuals with MI/DD.

86
MI/DD – Your Initial Response
Arrive safely
 Use cover
 Use sound officer safety practices
 Call for a supervisor if necessary (per
you agency policy)
 Begin getting as much information as
possible from others at the scene.

87
MI/DD – Scene Assessment

Gather as much information as
possible about the history of the
individual
Family members
 Case managers if receiving mental health
services
 Reporting party, neighbors or bystanders
 Dispatch
 Criminal history files
 In-house files

88
Contacting Someone in Crisis
Establish communication
 Calm the situation
 Establish rapport – show empathy
 Gather information
 Slow the situation
 REMEMBER: Time is on your side

89
Contacting Someone in Crisis
A First Responder Approach

Safety
Use cover, distance, and barriers
 Move if you find yourself in a vulnerable
position


Reduce your own anxiety
Avoid “face-to-face” if a weapon is involved
 Base all decisions on safety and control

90
Contacting Someone in Crisis
A First Responder Approach

Self Control
A person in crisis can put you in crisis
 You can only control your own emotions
 Project that you are calm and in control
 Be non-judgmental, sincere, genuine and
empathetic
 Time is on your side and will reduce the risk
of unnecessary escalation of the situation

 T.A.C.T.
model
91
T.A.C.T. Model
Tone – Calm and non-confrontational
 Atmosphere – Scene calm and controlled
 Communication – Build rapport
 Time – Slow the situation down

92
Three Ways to Obtain Treatment
Voluntary Treatment
 Court-Ordered Evaluation
 Emergency Petition

93
Voluntary Treatment

Per A.R.S. 36-518 - Any person who is
eighteen years of age or older and who
manifests the capacity to give informed
consent may be hospitalized for
evaluation, care and treatment by
voluntarily making a written application.
94
Mental Health Pickup Orders


An officer has the legal ability to detain a
mentally-ill person under A.R.S. 36-525
and 36-526.
Per A.R.S. 36-520, any responsible
individual may apply for a court-ordered
evaluation of a person who is alleged to
be, as a result of a mental disorder, a
danger to self or to others or is disabled.
95
Emergency Detention Orders

Per A.R.S. 36-525 - A peace officer may
take into custody any individual in which
there is probable cause to believe, based
on observations, that a person is, as a
result of mental disorder, a danger to self
or others, and continues to be during the
time necessary to complete the petition
screening procedures.
96
Procedure for Civil Commitment
Court Ordered
If officers have probable cause to believe the
person is inside their residence, and the person
refuses entry by the officers, this pick-up order
will be treated like an arrest warrant.
A.R.S. 36-520 and 36-521 - Court ordered
detention is possible if the person is likely,
without immediate hospitalization, to suffer
serious physical harm, or serious illness, or to
inflict serious harm on another person.
97
Civil Commitments Emergency

If apprehension takes place on or about
the premises of the apprehended person,
the officer shall take reasonable
precautions to safeguard the premises and
the property thereon, unless such property
and premises are in the possession of a
responsible relative or guardian. A peace
officer who makes a good faith effort to
follow the requirements of this section is
not subject to civil liability. (ARS 36-525)
98
Procedure for Civil Commitment
If entry into the third party residence is not
granted, a search warrant is required and
may be written based on the order itself,
as well as the information specified in the
order.
99
Who Can Help?

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Family counseling and child guidance
Victim / witness services
Social services / behavioral health
Substance abuse programs
Adult Protective Services (APS)
Child Protective Services (CPS)
Division of developmental Disabilities (DDD)
Local Guidance Clinic
Local hospital
101
FIRST RESPONDER
SMART CARD PROGRAM

Tri City Partnership, in cooperation with
local First Responders (Police, Fire and
EMS,) have developed the First
Responder Smart Card Program (FRSCP)
This program offers a registration process,
alerting First Responders that there is a
Smart Card on site and an individual with
special needs may be at the registered
address.
102
FIRST RESPONDER
SMART CARD PROGRAM


FRSCP includes training for First
Responders on special needs, and how to
better recognize and respond to an
individual with special needs.
This program also provides training for
parents and providers on when to call first
responders and what happens once the
call is made.
103
SMART CARD
Please Print in English
DOB: ____________________
NAME
LAST, FIRST MIDDLE
SPECIAL NEEDS DIAGNOSIS:
TOPICS/ACTIONS TO AVOID:
OFFICER SAFETY ISSUES:
GUARDIAN/ RESPONSIBLE PARTY:
NAME
PHONE NUMBER(s)
RELATION
YAVAPAI REGIONAL MEDICAL CENTER 445-2700
WEST YAVAPAI GUIDANCE CLINIC
445-5211
JUVENILE DETENTION
771-3174
LOCAL POLICE AGENCY: _______________________
For more cards or information contact Tri-City Partnership for Special Children and
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Families (928)772-5048.
SMART CARD
Please Print in English
NAME:
DOB: ________________
LAST, FIRST, MIDDLE
MEDICATIONS:
DOSAGE:
(PLEASE WRITE OUT THE SPECIFIC SPELLING)
LIST PHYSICIANS/ COUNSELORS AND PHONE NUMBERS:
ALLERGIES:
BRIEF MEDICAL HISTORY:
(LIST MAJOR MEDICAL EVENTS)
DATE LAST UPDATED:
For more cards or information contact Tri-City Partnership for Special Children and
Families (928)772-5048.
105
First Responder Smart Card Program
Thank-you
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