Behavioral Support Plan
Ken Ward
3-11-09
Rationale for Support
The purpose of this plan is to provide a positive and consistent approach for staff to
follow when working with Ken. This plan provides information and support strategies that
staff may employ to support Ken throughout his day and during times of extreme agitation.
Though the plan discusses at length what should be done to support Ken when he is not
adaptive, keeping Ken in a safe and adaptive space is where staff should spend the majority
of their efforts.
Historical Context of Supports
Kenny was born to Karen Bryant and Calvin Ward Sr. on June 10, 1986. Past records
indicate that he was described as a “super quiet baby” who seemed to be developing normally
until his leg was burned with hot water at the age of eighteen months. At that point, he
stopped using words and became very “clingy and dependent”. A growth spurt around the
age of eight made it more difficult to physically redirect Kenny and the use of food as
positive reinforcement during his middle school years contributed to weight and behavioral
issues that had to be addressed by his high school support staff.
Kenny’s parents separated when he was young and he reportedly stopped having contact with
his father around the age of fourteen due to challenging behaviors that he exhibited in the
home of Calvin sr. and his new wife. Attempts to re-involve Calvin sr. in Kenny’s life since
that time have not been successful. Kenny’s mother Karen was his primary support person
for several years and relied on help from her two oldest sons, Calvin Jr. and David Ward, to
do so. Calvin Jr. lives nearby to Kenny and Karen and David. Karen’s twin sister Sharon
and other relatives live nearby, but are not a source of consistent support due to reservations
based on Kenny’s history of aggression toward them. Since then, Kenny’s mother has
reduced the frequency of her visits to Ken’s house due to an aggressive incident on Ken’s
birthday in 2009. Karen calls Kenny on the phone at least weekly.
Essential Strategies
Getting to know Ken
Ken is non-verbal, and has a limited understanding of verbal communication. Staff
are working with Ken to expand upon the signs that he already knows and uses. Ken does
not understand complicated sentences, and does not appreciate staff that are “chatty”. Ken
likes staff that know and follow his routines, use one word sentences that he understands, and
that can reassure him that he is safe when he is feeling out of control. Ken appreciates staff
that are willing to “play” with him, even if that may mean periodic moments of mal-adaptive
behavior due to over-stimulation. Ken likes to help keep his place clean, and actually has
very good manners. Finally, Ken enjoys being with staff that are able to keep Ken’s routines
intact while making adjustments according to his mood and energy level. This is the most
effective way to communicate to Ken that you are there to help keep him safe and happy, and
that you are receptive to his needs. Please see Ken’s Sign Log for more information about
signs that will help communicate with Ken.
Approach
When staff first meet Ken, they should not greet him. On one’s first day, it is
essential that staff do not speak at all if possible. The first day staff should be “a fly on the
wall” watching the routine, but not attempting to interact with Ken. Staff should never have
conversations with each other in front of Ken unless absolutely necessary. If Ken approaches
staff, they should avoid direct eye contact, and maintain a heightened awareness of where
Ken is. Ken will often lean very closely to new staff, entering their space, when he initially
meets them. Ken is curious, and is attempting to judge a new staff’s reaction to him. On
subsequent training days, the training staff should make more contact with Ken, but it always
needs to be clear to Ken who is working with him. In the past, having two care workers at a
time has confused Ken. To avoid confusion, use proximity to Ken to distinguish who is
working with him. Observing staff should stand well away from Ken. Care giving staff
should stand an arm’s distance from him. The trainer should wear the keys round their neck
to further communicate who is working with Ken. To avoid logistical issues, training staff
should keep the spare set of keys on them at all times. This avoids staff having to pass keys
between them to enter and exit the kitchen if the locks are engaged.
A key component to working with Ken is using the icon wallet with him. When Ken
solicits the icon wallet, the training staff should always be the one to take the icon and get the
requested item. This give and take sets up Ken’s expectation that the new staff will be
responsive to his requests.
Activities
Activities are a good way for new staff to establish a relationship with Ken. Though
there are many activities Ken likely enjoys, few of these have yet to be discovered. Ken
enjoys new items/activities, but the novelty value often fades quickly. Ken does not enjoy
any type of electronic visual media such as computers or televisions. He does enjoy music of
nearly any kind. Ken enjoys “dancing” with staff and bouncing on his balance balls to the
beat of the music. Ken will periodically roll a ball back and forth with staff. Ken will catch a
ball, but will not throw it back. Ken has been known to enjoy doing puzzles, though he has
not requested doing a puzzle or attended to it very long in quite some time. Ken has some
smaller rubber balls that he has been known to enjoy throwing between his hands, rolling
round, and squeezing. Ken enjoys being outdoors, and should be outdoors for some period of
time every day, weather permitting. Ken enjoys going on walks of varying length with staff.
Ken is a climber and loves playground equipment. He enjoys the odd body positions and
counter-force climbing activities present. A timer should be used when Ken is climbing on
appropriate surfaces, as he tends to get to the top and then fall asleep which presents a fall
risk. A ten minute timer should be set, starting from when Ken reaches the top. Once Ken
has come back to the ground, the timer can be reset, and Ken can resume climbing if he so
chooses. Ken enjoys doing house work and maintaining his home. Ken has a blue activity
bin in the spare bedroom. Activities that can be offered or solicited by Ken are stored in that
area. Ken has basketballs that he may either play with in the house, or at the basketball court
in the park.
Ken enjoys playing “tag”. Staff should only attempt this when Ken is in a good
mood, and their relationship with him has a solid basis already. Ken enjoys this activity both
at home and in the park. In the community, this should only be done where there is a natural
“end” point to the activity such as a tree wall, or building, as getting Ken to stop running can
be challenging without such barriers. Staff should never chase Ken near a road. Staff touch
Ken on the shoulder, say tag, and then stomp their feet fast and loud. If Ken starts to move a
little faster, run after him. Ken will signal excitement and laugh very long after tag sessions.
Ken will not chase staff. Tag should not be continued after a few minutes or Ken will
become over-stimulated and the activity will cease being fun for either of you.
Ken has enjoyed doing water colors and coloring with crayons and markers. Ken will
periodically play with legos for a time, and tends to enjoy looking at other children’s toys.
There are play materials (such as play dough, floam, glurp etc.) at the house that Ken has
been known to enjoy manipulating. Staff remain, however, Ken’s primary source of
stimulation. Staff interactive activities include dancing, pushing and pulling to music, joint
inputs (from the OT tasks list), and massage. There is a vibrating massager that staff can use
to help with massages.
In the spring of 2012, Ken’s team plans to purchase a trampoline for Ken to use.
Trampolines can be dangerous, and staff should use it at their own risk. A timer should be
used during this activity. Please see the trampoline protocol for further details.
Please contact your supervisor for other activity ideas and feedback on activities you
have done with Ken. His team is always looking for more ways to help Ken enjoy
recreational activities.
At home
Ken receives one to one, 24 hour support with asleep overnights. Ken must be within
staff earshot or eyeshot at all times, unless he is in the secure section of the house with the
parameter locks engaged. Staff may not leave the premises when Ken is in the house with
the parameter locks engaged, though they may be outside the residence for work purposes
such as getting the mail or shoveling snow. When staff are outside the house for work
purposes, they should be checking on Ken at least every five minutes. Staff should not
remain outside the house without Ken for any reason for more than twenty minutes (use the
timer) as it can be stressful to Ken. For large tasks such as snow removal, multiple sessions
may be required to complete the task. To minimize the need for staff to leave the house
without Ken, Ken’s landlord provides lawn care and snow removal services for heavy snows.
Light snow removal (less than 2 inches) remain the responsibility of Ken’s staff (there is ice
melt in the garage).
In the community
Staff must always be within an arms length of Ken. When Ken needs to use the
restroom, staff must accompany. If staff must use the restroom, Ken must accompany. The
best strategy is to have Ken wait in the bathroom stall while staff use the urinal, or to have
Ken use the stall next to them when making a bowel movement. Ken must be wearing his
backpack while he is in the community, and staff must be carrying the staff cell phone (or
their personal cell phone with the appropriate numbers programmed in if they prefer) and the
staff backpack with Ken’s additional supplies. Staff must put their hand on Ken’s backpack
and say “Street” when crossing the street. Staff should also put their hand on Ken’s
backpack when approaching potential stressors or dangerous areas. Ken’s backpack is not to
be used as a restraint device, but does provide something to grab onto should Ken attempt to
run into traffic etc. Staff should avoid areas that are filled with fast food restaurants and large
groups. Ken loves the outdoors, and should be going outside as often as weather permits.
Staff should not attempt to take Ken to shopping areas etc. without consulting their
supervisor first.
Staff may not transport Ken in their personal vehicles alone. If staff choose to
transport Ken in their vehicle, another staff must be present as Ken has a history of
aggressing toward the person driving the car and attempting to jump out of the car even if
that means jumping into the front seat to do so. In any car, Ken must sit in the rear passenger
seat with staff in the seat next to him to protect the driver. When driving in a personal
vehicle, the use of the child safety lock feature is approved and recommended for the door
closest to Ken. It is recommended that Ken wear his backpack across his chest while being
transported in cars. This can provide staff with a soft barrier to use to block attempted bites,
and to limit Ken’s ability to physically aggress. Staff will need to help Ken with his seat belt,
and ensure that he continues to wear it while the car is in motion.
Daily Structure
Ken’s day is punctuated by several routines. Ken’s routines structure his day, and
help him understand his environment and staff expectations. Given Ken’s diagnosises and
support needs, it is very important that staff help Ken move through his day by following his
routines. The following will provide a brief overview of a typical day in Ken’s life, and
procedural instruction for more complicated routines. Please note that no two days are
exactly the same, and times for events, with exception of food stations, will vary slightly
according to Ken’s mood and level of neurological interference. Though operating too far
outside Ken’s schedule greatly increases the probability of a behavioral escalation attempting
to follow the schedule too closely on days Ken needs more time may also result in escalation.
Staff should treat Ken’s schedule as something to help him through the day, NOT a regime to
force upon him.
Daily Schedule
Ken tends to wake up between 5 a.m. and 8 a.m. As Autism tends to cause chronic
sleep disruption, Ken may be awake several hours of the night and lethargic during the day,
or vice versa. This schedule presumes Ken woke up around 7 a.m.
Monday
Wakeup/grooming
Staff
transition to
channels,
(FS 1),
Meds, initial
steam
Walk to
park/pick-up
(FS 2 10a)
Skin
In home
activity
FS 3 12:30
Joint inputs
& blood kits
Walk/FS 4
3:30 trns to
CAI, long
steam
Joint inputs
Walk/meds
(4:30 FS 5)
laundry/
cooking/
cleaning
walk
Shower/
grooming
meds 8 p.m.
FS 6 7:45p
Tuesday
Wakeup/grooming
Staff
transition to
channels,
(FS 1),
Meds, initial
steam
Walk to
park/pick-up
(FS 2 10a)
Skin
In home
activity
FS 3 12:30
Joint inputs
& blood kits
Walk/FS 4
3:30 trns to
CAI, long
steam
Joint inputs
Walk/meds
(4:30 FS 5)
laundry/
cooking/
cleaning
walk
Shower/
Grooming
meds 8 p.m.
FS 6 7:45p
Wednesday
Wakeup/grooming
Staff
transition to
channels,
(FS 1),
Meds, initial
steam
Walk to
park/pick-up
(FS 2 10a)
Skin
In home
activity
FS 3 12:30
Joint inputs
& blood kits
Walk/FS 4
3:30 trns to
CAI, long
steam
Joint inputs
Walk/meds
(4:30 FS 5)
laundry/
cooking/
cleaning
walk
Shower/
grooming
meds 8 p.m.
FS 6 7:45p
Thursday
Wakeup/grooming
Staff
transition to
channels,
(FS 1),
Meds, initial
steam
Walk to
park/pick-up
(FS 2 10a)
Skin
In home
activity
FS 3 12:30
Joint inputs
& blood kits
Walk/FS 4
3:30 trns to
CAI, long
steam
Joint inputs
Walk/meds
(4:30 FS 5)
laundry/
cooking/
cleaning
walk
Shower/
grooming
meds 8 p.m.
FS 6 7:45p
Friday
Wakeup/grooming
Staff
transition to
channels,
(FS 1),
Meds, initial
steam
Walk to
park/pick-up
(FS 2 10a)
Skin
In home
activity
FS 3 12:30
Joint inputs
& blood kits
Walk/FS 4
3:30 trns to
CAI, long
steam
Joint inputs
Walk/meds
(4:30 FS 5)
laundry/
cooking/
cleaning
walk
Shower/
grooming
meds 8 p.m.
FS 6 7:45p
Lays down
to sleep
Lays down
to sleep
Lays down
to sleep
Lays down
to sleep
Lays down
to sleep
Saturday
Wake-up
8 a.m.
Staff
transition
to cai, (FS
1), Meds,
initial
steam
Walk
Sunday
Wake-up
8 a.m.
Staff
transition
to cai, (FS
1), Meds,
initial
steam
Walk
Time
7-8
Walk/FS 4
Cooking,
Cleaning,
portioning,
Joint inputs
Walk/meds
(4:30 FS 5)
laundry/
cooking/
cleaning
walk
Shower/
grooming
meds 8
p.m.
FS 6 7:45p
Lays down
to sleep
Walk/FS 4
Cooking,
Cleaning,
portioning,
Joint inputs
Walk/meds
(4:30 FS 5)
laundry/
cooking/
cleaning
walk
Shower/
grooming
meds 8
p.m.
FS 6 7:45p
Lays down
to sleep
2-3
3-4
8-9a
910a
(FS 2 10a) (FS 2 10a) 10Skin
Skin
11
In home
In home
11activity
activity
12
FS 3 12:30 FS 3 12:30 12-1
Joint inputs Joint inputs 1-2
4-5
5-6
6-7
7-8
8-9
9-10
Routines
Food and Eating
Food stations
Due to Ken’s dietary proclivities, family history of diabetes and tendency to not
understand portion control, a series of structured food stations have been developed with
consultation from a nutritionist to ensure that Ken is provided with both choice about what he
is eating and ample nutrition. Ken is provided with 20 minutes on the timer to complete each
food station. Staff should not stand in the room with Ken while he is eating due to his
tendency to become cue dependant while eating. Staff should, however, stand in the kitchen
where they can see Ken in the reflection on the window, or through the window by the
refrigerator. Staff must monitor Ken relatively closely to ensure that he is not choking. Ken
tends to eat extremely quickly, moving the plate to his mouth and shoveling food into it as a
bulldozer would push dirt. For this reason, all of Ken’s food must be cut into bite sized
pieces prior to serving it to him. Food station times should be as consistent as humanly
possible given the importance they play to Ken and for keeping him within his structure.
After the 20 minute timer has rung, staff should take a wet rag, a dry rag, and the dish bin
from under the sink to the table. Staff should then ask Ken to put his dishes in the dish bin
and put his ball away. Then ask Ken if he would like to wash or dry holding up both rags.
After Ken chooses a rag, begin cleaning the table with Ken by wiping it with the appropriate
rag and counting slowly to five as you do so. As verbal stimuli are challenging for Ken,
simply tapping your foot five times is generally preferred. Then ask Ken to do the same,
counting to five as he scrubs the table. When the table is clean and folded up, staff should
ask Ken to sit on the toilet, and the food station is complete. Periodically, Ken will abruptly
change this routine with a few variations: folding up the table and bringing the dishes to the
staff, bringing just a cup to the staff, or simply leaving the area all together. If Ken chooses
to change his routine, that is his choice. Staff should not attempt to force Ken to do it as it is
written if he chooses to do it otherwise. Typically, if he leaves the area altogether it is
because he needs to use the bathroom prior to the timer being completed. Attempting to
make Ken wait for the timer to ring to use the bathroom is inappropriate. When Ken brings
just the cup to the staff, he is typically a little extra thirsty and would like an additional cup of
water. Simply take the cup, ask Ken to return to the table, bring him some water and
complete the routine. This is Ken attempting to communicate, we should encourage this.
When Ken folds up the table and brings the dishes to staff, staff should compliment Kenny
on taking care of his house. This is Ken showing independence and initiative which is our
goal. The table routine is not more important than Ken’s independence and initiative (just
wipe the table later). Please note that FS #1 cannot begin prior to 5:30 a.m. and the overnight
food station is initiated by Ken and can happen at any time. The issue with giving Ken
breakfast prior to 5:30 a.m. is that this signals the start of a morning routine that logistically
cannot be followed through on until the appropriate time.
New Foods
For the last several years, Ken’s team has been working on strategies to introduce
new (healthier) foods to Ken, and to increase the variety of foods that he is eating on a daily
basis. In the past, several strategies have been attempted to accomplish this with limited
results. In February of 2010, Ken’s team decided to use random chance to accomplish what
planning had failed to do, resulting in many improvements in Ken’s diet. If staff have ideas
for healthy food items Ken may enjoy, please feel free to mention them. If staff have healthy
food items in their lunches that they feel Ken may enjoy, they may feel free to offer a small
portion of it to Ken with one of his food stations. They are then asked to document the food
item and results on Ken’s food chart on the bulletin board. If Ken has enjoyed the healthy
food, additional portions of it will be offered to Ken. If Ken refuses the additional portions
three times, his initial acceptance of the food item will be considered a fluke. If he accepts
the portions of food three times, home staff will attempt to add it to the menu. It is Ken’s
team’s goal to have Ken eating a different series of food stations every day of the week.
Fruit and Vegetables
Ken is not a big fan of fruits and vegetables. Offering them with every meal seems to
be helping Ken become accustomed to seeing them, and has definitely helped him try a few
things he may not have otherwise. That said, Ken often (99.9% of the time) leaves them
untouched on his plate. To prevent excessive waste, staff should store the untouched fruit or
vegetable serving in a Tupperware container in the refrigerator between meals so it can be
offered at each food station. The unused portion of the fruit or vegetable should be discarded
after the final food station of the day. It is important to note that, though Ken will eat both
raisins and prunes, he should not be eating or offered more than one serving of each daily.
As both are diuretics, overconsumption can be harmful to Ken. The “naked” brand juice Ken
consumes three times daily should be measured and metered out carefully. It is not only rich
in nutrients, but also calories and expense.
Ken’s Food Stations
Revised: 10/16/11
FS # 1 ~ 8:30 a.m.
1 cup raisins
1 slice of American cheese
1 bowl of cereal (w/ 1 cup of milk to 1 cup of dry cereal)
4-7 oz “naked” juice
4-7 oz water
- offer one cup fruit or veggie -**
FS #2 ~ 10:00 a.m.
1 serving oatmeal w/ apple sauce
2 slices of turkey bacon
4-7 oz “naked” juice
4-7 oz water
- offer one cup fruit or veggie -
FS #3 ~ 12:30 p.m.
1 cup Hamburger Helper
4-7 oz “naked” juice
4-7 oz water
- offer one cup fruit or veggie -
FS #5 ~ 2:30 p.m.
1 cup Mac & Cheese
4-7 oz water
- offer one cup fruit or veggie -
FS #5 ~ 4:30 p.m.
1 chicken breast
1 serving of fries (1 large handful)
4-7 oz water
- offer one cup fruit or veggie -
FS #6 ~ 7:45 p.m.
2 slices of cheese pizza (to equal ¼ pizza)
4-7 oz water
- offer one cup fruit or veggie -
FS #7 ~ overnight*
granola bar
4-7 oz water
Meal Preparation
For staff safety, and Ken’s, staff will do all cooking prior to the meal without Ken’s
assistance in the kitchen. There are five primary food items that must be prepared prior to the
meal: Mac & Cheese, Hamburger Helper, Turkey Bacon, pizza, chicken breasts.
To prepare Mac & Cheese, follow the instructions on the box. Preparing two boxes
at the same time allows for easier measuring (1 whole stick of butter, ½ cup milk). Allow the
Mac & Cheese to cool. Take 1 cup measuring cup, 6 Tupperware containers, and matching
lids with the Mac & Cheese to Ken’s activity table. Ken should work with staff to portion his
food by scooping the food with the measuring cup into the containers. Do not use the word
scoop in front of Ken – see physical interventions portion of this plan.
To prepare Hamburger Helper, begin by determining if there is precooked ground
beef in the box, fridge, or freezer. If there is not precooked ground beef, staff should thaw
and cook three pounds of beef. When cooled, portion the beef into three equal sized
servings, package and freeze two of the servings. Take the third serving, or the precooked
beef, and cook following the directions on the box. Cook one box at a time. Allow the food
to cool. Take 1 cup measuring cup, the food, 5 Tupperware containers with matching lids
and go to the activity table. Ken should work with staff to portion his food by scooping the
food with the measuring cup into the containers. Do not use the word scoop in front of Ken –
see physical interventions portion of this plan.
To prepare pizza,
Grooming
With each of the following procedures, you first have Ken do what he needs to do while
counting to 5, and then repeat the action yourself while counting to 5.
For instance, hand Ken a moist paper towel to wash his forehead, point to his forehead and
say “forehead.” Ken may look at you and try to hand the towel back to you. In these
instances, point to his forehead again and gently prompt: “Kenny, help.” Ken will then begin
to wipe off his forehead. While he is doing that, count: “1 – 2 -3 – 4 – 5”; Then, Ken will
hand you the towel back – you repeat the same action (wiping his forehead) and count. Then
move on to the next portion of grooming, again having Kenny begin and you follow up.
Here is the order you should do things in:
1) Have Kenny sit down on the toilet; Grab one of the balls from the living room to sit
on yourself.
2) Get the yellow bag from the care closet (next to the bathroom – key is on the keyring). Also, get a roll of paper towels for face-washing.
3) Have Ken wash his face in the manner described above – in the following order:
1. forehead
2. eyes (closed – first left then right – get the “sleep” out)
3. nose
4. cheeks (first left then right)
5. mouth
6. chin
4) Have Ken brush his teeth using the same counting procedure in this order:
1. top front
2. top back
3. bottom front
4. bottom back
5. left top front
6. left top back
7. left bottom front
8. left bottom back
9. right top front
10. right top back
11. right bottom front
12. right bottom back
13. tongue
Finally, place Ken’s finger in the Carmex, and he will apply a layer on his lips.
There are gloves in the bottom bathroom drawer.
Sleep
Ken is supported with asleep overnight staff. Ken will go to sleep generally between
10 p.m. and 11 p.m. As a feature of his disability, Ken’s sleep is often disrupted, and he can
be up for several hours during the night. Staff should prepare for overnights with Ken by
attempting to get adequate rest prior to arriving in case Ken is awake. If staff are scheduled
for extended periods of time at the house and Ken has had a night during which he has been
awake for the majority of the time; staff should call their supervisor or on-call supervisor to
report that they have not received adequate sleep to continue working with Ken competently.
This phone call should be made no more than 3 hours prior to the time at which you
anticipate functioning under par due to exhaustion. Replacement staff or supervisor support
should arrive prior to that time.
Prior to initiating the sleep portion of the shift, staff should close the front door and
engage the parameter locks. Staff should push and pull on the front door from inside the
residence to ensure that it is locked appropriately. In the past, the door has been “ajar” when
the locks have been engaged and Ken has exited the premises without staff. Procedures for
elopement are discussed later in this plan. With the kitchen door ajar, engage the parameter
locks and enter the kitchen. Close the kitchen door, and engage the parameter locks. Push
and pull on this door to ensure that it is locked. If it is locked, staff may enter the staff area at
the back of the house where they may sleep.
Structure
Timer
Ken’s timer is the most important tool to structure his day, complete activities, and
help him make transitions between activities. Ken’s timer is his watch, calendar and planner
rolled into one; it gives Ken a sense of control over his world. Timer durations will vary
slightly day to day based on Ken’s mood and ability to move between tasks. The following
should be a rough guideline of average times for timers. Additionally, timers should be used
any time there is a need to ask Ken to wait, and should always to be used to structure
unstructured time. Walks tend to be times when Ken does not work well with a timer, as
walk times are more contingent on Ken’s energy level, how many stressors are in his
environment, and weather conditions. Also, operations that have defined end times, such as
folding laundry and doing blood kits do not necessarily have to be accompanied by a timer.
The timer is meant to help Ken understand beginning and end times for activities that have no
defined duration.
Steam:
Initial Steams: 15 minutes
Each additional Steam: 2.5
Lowest Steam time: 2.5 minutes
Food Stations: 20 minutes
Walks: No timer is used
Waiting: Ask how long the expected wait will be…more minutes can be discretely added to
the timer if needed.
Between Activities: 15 minutes of down time on the mat table
Skin: 4 minutes of staff lying near Ken, skin conditioning is finished upon completion. Ken
will generally attempt to get up half way through; this most often means that he requires the
use of the restroom.
Shower/Grooming: no timer, natural end point
Climbing: 10 minutes from when he gets to the top
Blood Kits: no timer, natural end point
Down Time: 5 minutes (staff not in the area)
Home Modifications and Procedures
Ken’s house has been modified in the following ways to ensure that he can live safely
in the least restrictive environment possible. Given the nature of Ken’s disabilities and
behaviors, some of the modifications made to the house have needed to be authorized by the
Dane County Restrictive Measures Committee. The need for these modifications will be
reviewed at each of Ken’s team meetings, and all restrictive measures will cease when Ken’s
behavior changes in such as way as to make not having these modifications safe.
Windows
Ken has a history of breaking large and small pieces of glass. Because Ken does not
see the danger presented by broken glass, he has sustained severe cuts from handling or
walking through broken glass. For this reason, all of the glass windows in Ken’s home have
been covered with Lexan, a material that is shatter resistant. All of Ken’s light bulbs are
“rhino coated”, shatter resistant bulbs. All plates and drinking cups will be made of
shatterproof plastic. All glass mirrors and other glass items have been removed from Ken’s
house.
Internal Doors
Ken has in the past, locked himself in small rooms, such as bathrooms, for extended
periods of time while engaging in property destruction. In December of 2008, Ken locked
himself in the bathroom in the staff area of the house and broke the toilet and the pipes
connecting to it. Aside from causing significant damage to his house, Ken injured himself on
broken porcelain and glass from the mirror. For this reason, all internal doors have been
removed with exception to Ken’s bedroom door.
External Doors
Ken has a history of eloping from his home without staff. Given Ken’s inability to
recognize dangerous situations, including dangerous cold and snow, a magnetic locking
system has been installed on the front door to ensure that Ken cannot leave his home without
staff accompaniment. The same type of lock on the kitchen door prevents Ken from entering
the kitchen and accessing the back door of the house which does not have a magnetic lock.
The parameter locks (magnetic locks, aka restriction locks) must be used any time staff
cannot see Ken for any reason. The parameter locks are controlled by a small remote control
on the staff key chain. This key ring should be in the possession of staff at all times.
Parameter locks should be engaged at all times when staff are outside the house to shovel or
retrieve mail, in the rear of the house in the staff area, in the restroom etc. Staff should also
use the parameter locks during times when elopement potential is elevated such as when Ken
is very agitated, in emotional or physical distress or during overnight hours when Ken a
significant elopement history. Though staff should evacuate into kitchen, engaging the
parameter locks behind them, when Ken is being physically aggressive; the locks should not
be engaged for a period of time longer than twenty minutes without checking on Ken.
Parameter locks are not used to force seclusion, they are there to contain Ken in a safe
environment while he regains his emotional equilibrium. The parameter locks are linked to
the home’s smoke detectors. Should the smoke detectors be activated, the parameter locks
automatically disengage so that no one could be inadvertently locked in the home should a
fire start.
Locked kitchen
Ken has a history of having safety related issues in the kitchen. He also has
demonstrated not only an inability to determine when he has eaten enough, but also that
having access to food can be a significant stressor. For that reason, there is a solid core door
between Ken’s living room and kitchen. Ken should not be permitted in the kitchen at any
time or any reason. The kitchen door is keyed to the parameter locks. Letting Ken in the
kitchen “simply to retrieve what he wants” may seem convenient, but it is not. Letting Ken
into the kitchen sets up an expectation that you and other staff cannot follow through on. Do
not let Ken in the kitchen.
Staff office
The door between the kitchen area and the staff area is lockable with a key. This is to
ensure that even if Ken gains access to the kitchen area, he cannot access the non-modified
staff area of the house. Given the staff area of the house is not modified, it is not a safe
environment for Ken. In the past, when Ken has been able to access the staff area, he has
destroyed the toilet, broken glass, locked himself in the bathroom, and thrown the chairs
through the drywall. Do not let Ken in the staff area of the house for any reason.
Furniture
All furniture items have been removed from Ken’s house and replaced with durable
“mat tables” that are bolted to the floor. Ken has a history of breaking other furniture items
during times of stress, and generally tends to be “hard” on these items even when not
agitated. Safer furniture, such as bean bag chairs and exercise balls supplement the mat table
to meet Ken’s furniture needs. Ken has two tables bolted to the wall that can fold down
when not in use. One of these tables is for activities, and the other is for eating. These tables
are durable and present less of a danger of being damaged or destroyed because they are
foldable.
Personal Effects
Due to the risk of Ken breaking, throwing, or hitting with small items these items are
stored in locked closets. Ken may have access to “knick-knack” type objects upon request.
When these items are no longer in use, they should be returned to the locked area from which
they came.
Stressors and Interventions
Staff should work to proactively anticipate and plan for stressors in Ken’s day. The
below is a list of known stressors for Ken, and intervention techniques that have worked to
help Ken cope with them in the past.
Stressors
Food
- seeing McDonalds
- seeing food in trash cans
- seeing staff eating preferred food
items
Parked Cars
- Ken will attempt to climb on top of
cars
- Ken will attempt to enter cars he
thinks are unlocked
- Ken will lock himself in cars he is
able to enter
Too much talking
- Ken will become increasingly
agitated the longer he is subjected to
people talking
- “chatty staff”
Intervention Strategies
- keep all food in Ken’s kitchen
- do not bring McDonalds to Ken’s
- Try to eat when Ken eats
- Eat in the staff kitchen
- Avoid letting Ken see you eat
- Do not go on walks to areas that have
many fast-food restaurants
- Do not take Ken into food stores
- Scan the area more than fifty paces in
front of your location while on walks
for garbage cans without lids, and
trash on the ground
- Stick to the food stations
- Avoid walking too close to cars that
people will exit when Ken is nearby
- Avoid parked cars whenever possible
- Lock your car doors when at Ken’s
- Staff should park on the side of the
house nearest the kitchen, where Ken
cannot see them entering or exiting
their vehicles
-
-
attempt to avoid situations where
Ken will be subject to too much
talking
Do not talk to Ken yourself more
than is necessary
Move Ken away from people that are
talking loudly
-
Staff changes
- Change is stressful for Ken
- When staff change, Ken can be
confused as to who is working with
him
- Ken may prefer one staff to another
Planned or Unplanned Company
- Anyone stopping in at Ken’s can be
stressful for him.
- Solicitors
- Ken’s family
- Ken’s team
If there is a situation, such as a
doctor’s appointment, that
necessarily entails a lot of talking;
give Ken a PRN before the
appointment.
- If Ken has been subjected to too
much talking, reduce the amount of
verbal communication you use
- Encourage a steam if you note that he
is becoming agitated
- Give Ken a “high five” immediately
when entering the house
- follow through with the food station
immediately upon entering the house
- use a 15 minute timer on the steam
when Ken requests it
- resume Ken’s schedule
- be consistent with other staff
If the company is not Ken’s family:
-
Ask the company to call your
supervisor and schedule and
appointment to return.
-
Let Ken take a 15 minute steam if
requested.
-
Resume Ken’s schedule
If the company is Ken’s family:
- Be polite to Ken’s family
- After they leave use as little verbal
communication as possible
- Allow Ken to take a 15 minute steam
- Give Ken a Risperdal PRN if
according to protocol
Garbage Cans
- Ken has been known to use garbage
cans as food sources, and become
frustrated when he is not able to
eat/drink what he finds
- Given the speed Ken eats/drinks it is
nearly impossible to get whatever he
picks out of the trash away from him
prior to him eating/drinking it
-
-
-
Attempt to avoid walking too close to
garbage cans
Keep Ken’s garbage cans where he
cannot see them at home
If Ken fishes a food product out of
the garbage can, move him away
from the garbage can
If Ken fishes a beverage out of the
garbage can, move him away from
the garbage can
Scoop Ken past the garbage can
Toileting
- Ken can become extremely frustrated
when he needs to use the bathroom,
but is not being prompted
- Ken can become extremely frustrated
when he is out in the community and
is told that he cannot go to the
bathroom where he is standing
-
-
-
Restricted areas
- Ken points to go to the basement
- Ken points to go to the kitchen
- Ken points to go to the staff area
- Ken attempts to grab the keys from
staff
- Ken attempts to push his way into the
kitchen
- Ken attempts to enter the house from
the rear door
- Ken attempts to enter another house,
yard, or vehicle
-
Under Stimulation
- Ken gets bored and does not know
how to deal with this emotion
- Ken has been isolated too long
- Ken has not had sufficiently
stimulating activities during the day
- Ken is becoming agitated and the
bathroom has already been offered
- Ken will fluctuate between over
stimulation and under stimulation
throughout the day
Over Stimulation
- Ken has had too much stimulation
during the day
- There is too much noise
- There are too many distractions
- Staff expectations are too high due to
neurological interference
- Ken will fluctuate between over
stimulation and under stimulation
throughout the day
-
-
-
-
-
-
-
when it is not an option to avoid them
Plan ahead
Ask Ken to sit down every time he
uses the restroom
Prompt Ken to go to the restroom at
least four times during any eight hour
period
Always prompt Ken to use the
restroom prior to leaving the house
with him
If Ken is becoming agitated and there
does not appear to be a clear
antecedent event, offer the restroom
Be aware of Ken’s agitation level
If Ken has attempted to push his way
into the kitchen, engage the
parameter locks
If Ken is attempting to enter a
restricted area from outside the
house, end the activity and return to
the secure area within Ken’s house
If Ken is attempting to grab the keys,
but them in your REAR pocket ~ he
will continue to grab at them if he
knows where they are, including a
front pocket
Always pay close attention to Ken’s
behavior
Determine if he is under stimulated
or over stimulated by attempting to
offer activities
Turn on the radio
Dance with Ken
Go on a walk
If Ken seems to become frustrated by
offered activities, he is likely over
stimulated
Always pay close attention to Ken’s
behavior
Turn off the radio
Increase your distance from Ken
Give Ken a “down time” timer and
leave the area
If training, remove yourself from the
area for a few minutes
Family Contact
- Ken loves his family, and does not
want them to leave
- Ken hopes his family will have fastfood
- Due to the amount of emotions Ken
feels when he sees his family, Ken
becomes over-stimulated
- Ken is not yet fully adjusted to life in
his own residence
-
ABC Gum
- Ken has trouble identifying when he
is done chewing his gum
- Ken may want the same piece of gum
back after he has spit it out
- Ken will throw his gum in the toilet
and then put it back in his mouth
- Ken will throw is gum in the trash
and then pick it out
-
-
-
If possible, Ken should be given a
Risperdal PRN prior to prolonged
contact with his family
Allow Ken time to relax & stabilize
in a steam
Offer activities
Ken will signal that he is done with
the gum by playing with it with his
fingers, or attempting to offer it to
staff
Ask Ken where it goes
Direct Ken to the bathroom
Ask Ken to place the gum in the
toilet
Ask Ken to flush the toilet
Say “It’s gone”
Approved Physical Intervention Techniques
The following is a list of physical intervention techniques that have been approved by
the Dane County Restrictive Measures Board and Ken’s support team on 1/13/09. Please
note that this list is comprehensive, and the use of unauthorized techniques can be considered
abuse depending on the circumstances. Staff should always choose intervention strategies
that are the least restrictive possible given the situation, and should attempt other
interventions in favor of physical interventions whenever possible. Detailed explanations
will be included for more complicated interventions. All staff working with Ken should
attend MTC training through the Waisman Center to be trained in the use of the following
techniques. Please contact your supervisor with questions.
-
evacuation
hit block
kick block
use of ordinary objects as shields
hold release
choke release
bite release
protective posture
safe distancing techniques
scooping
bulldoze
bear hug
Backpack escort
One person escort
-
Two person escort
Definitions
Evacuation
Evacuation refers to leaving a potentially dangerous situation as possible. “Fleeing
with dignity”. Evacuation is the best technique to use with Ken. Evacuation cannot be used
in the community due to the risk of elopement. When possible, staff should remove
themselves to the locked kitchen when Ken has physically aggressed, and stay in the locked
kitchen until it is safe for them to return to the common areas.
Protective Posture
Assume a proactive stance when Ken is in emotional distress to be ready for possible
physical distress. Staff should raise their arms to protect their head (using forearm like a
shield), feet shoulder distance apart, knees slightly bent, one foot slightly ahead of the otherfingers are together but not in a fist.
Safety distancing
This is the area where staff are the safest. The safety zone is the area that is an arm’s
length distance from Ken and slightly behind him. Using the protective posture and safety
zone in conjunction will provide make it significantly more difficult to be hit, kicked, head
butted, bitten or charged.
Scooping
When staff are walking with Ken and a potentially stressful or dangerous
situation/area is identified, and the area/situation cannot be avoided, scooping is used to help
Ken through the area as quickly as possible. Staff should place one hand on Ken’s back or
backpack strap and apply resistance to Ken’s back while walking faster. Staff should say the
word “scoop” to Ken prior to applying resistance to ensure Ken is prepared and reduce the
risk of him stumbling.
Bulldoze
Using the protective posture, move into Ken’s space, pressing him backward and
away from a dangerous situation. When he has moved enough to hold him in position for a 3
count, then move away. Bulldozing may also be used when Ken is attempting to charge past
staff into an unsafe situation. Bulldozing Ken when he is standing in front of staff is not
recommended, and should only be used in an emergency situation.
Bear hug
Standing behind Ken, staff should sweep their arms over Ken’s head and upper torso
to the bottom of his rib cage pinning his arms against his body. This intervention should be
used to stop Ken from hitting staff while moving him to a safer environment. A protective
posture must be maintained from behind Ken, tucking your head off to the side, to avoid head
butts.
Modified backpack escort
When Ken is crossing the road, or staff identify a potential stressor in the community,
place one hand on the strap of Ken’s backpack.
Backpack escort
Place one hand on the strap of Ken’s backpack and the other on his upper arm.
Backpack escorts should be used when Ken is attempting to “bolt” or elope in the
community. The backpack escort is used to help guide Ken to a safe location or away from
potential or actual dangers.
One-person escort
Staff place one hand (thumbs tucked against your palms) on the inside of Ken’s upper
arm and the other on the outside of his opposite shoulder to guide him to a safer area.
Two-person escort
This intervention is used when there are two staff present, and a one-person escort is
not safe due to Ken’s behavior and Ken is in immediate risk of being injured due to unsafe
conditions i.e. he is in the road etc. The two-person escort is executed by placing one hand
between Ken’s arm and body, grasping his upper arm, and placing the other hand on Ken’s
wrist. Both staff should hold onto Ken in this manner, walking slightly behind him with their
hip pointed to Ken’s hip. Staff should use this escort to guide Ken out of danger releasing
immediately upon entering an area safe enough to release him or use a one-person escort.
Behavioral Challenges and Intervention Strategies
It is important to note that Ken’s patterns of aggression are not premeditated. Though
Ken can be very physically aggressive with staff and objects, this behavior is generally
motivated by either the intention to remove a barrier (staff or items) between Ken and what
he wants, or reflexive as in the case of Ken hitting staff when they attempt to move him away
from such objects. Ken’s ability to communicate is very limited, and his team believes that
much of his aggression is caused by being unable to adequately communicate his needs and
desires to staff. Ken tends to slap at staff with over head “swats” instead of throwing
coordinated punches. Ken tends to be physically aggressive in “bursts” rather than “attacks”,
meaning that there is not a series of coordinated strikes intended to injure staff. Instead, there
are one to two swats, generally not lasting longer than staff are between Ken and the
item/area he is attempting to access. Immediately after Ken has calmed down, he will
attempt to make contact with staff to reinforce his relationship with staff. This is a great time
to give Ken a high 5 instead of avoiding him or becoming intimidated by him. It is important
to note that Ken gives clear warning signals of distress, and will most times, provide staff
with many indicators that he is beginning to feel unsafe or out of control. For instance, Ken
will often request the use of the icon wallet to receive a stabilizer during times of stress.
Often, Ken’s ability to cope with these stresses are contingent upon the ability of his staff to
determine what he is requesting and to comply with that request. That said, some instances
of physical aggression are unavoidable no matter the efforts of his staff.
The list of behavioral challenges is far from comprehensive, intending instead to
highlight specific behavioral challenges that staff will find most challenging. A definition of
the behavior will be included as will examples of the behavior, possible intervention
strategies, examples of when it may occur and how often staff can expect to see the behavior.
Behavioral Challenges
Physical aggression:
Intervention strategies
- maintain calm
-
hitting
biting
kicking
slapping
pushing
pulling
Examples of when it may occur
- When Ken has been over or understimulated for an extended period of
time
- When staff are making demands of
Ken that are not consistent with his
mood and level of neurological
interference
- When significant stressors are
encountered and immediate
dissimulation is not possible
- As a reflex action when staff are
forced to say no to Ken
- As a reflex action when staff have
placed themselves between Ken and
a desired object
Behavioral Challenges
Elopement
- Ken attempts to leave his home
without staff present
- Ken attempts to run away from staff
when they are in the community
-
maintain a safe distance
prepare to defend
attempt to remove possible stressors
use approved techniques
attempt to remove yourself into the
secure kitchen if you feel unsafe
- Offer Ken a PRN according to the
protocol for use
- Call for back-up if you feel the
situation is becoming unsafe,
unmanageable, or if you feel yourself
starting to loose emotional
equilibrium.
Frequency
Ken will have low level instances of physical
aggression (a single hit or slap) on a weekly
basis.
Ken will have an instance of prolonged
intense physical aggression (lasting more
than 20 minutes uninterrupted) about once a
month.
Intervention strategies
- maintain calm
- Ensure that the front door is closed
tightly prior to going to sleep for the
night
- If in the community, use a backpack
escort to remove Ken to a safe
location
- If a backpack escort is not possible
due to continued aggression use a one
person escort to remove Ken to a safe
location
- If a one person escort is not possible,
call for back-up and use a bear hug to
help keep Ken from endangering
himself while waiting for additional
support staff
- If Ken has eloped during sleep hours
Examples of when it may occur
- Ken can attempt to elope almost any
time he feels that he can leave his
home when staff are not attending
him
- Ken can attempt to elope in the
community when staff are attempting
to redirect Ken away from an object
he desires
- Ken can attempt to elope when he
sees an item or destination that he
desires
Behavioral Challenges
Verbal Agitation
- Ken will engage in long periods of
time during emotional distress in
which he will scream and yell
Examples of when it may occur
- Ken will engage in verbal agitation
when he is emotionally distressed
due to some source of stress that he is
not able to cope with. Though he
may physically aggress at this point,
it is not a guarantee.
- Ken will engage in verbal agitation to
show frustration at not being able to
communicate needs and desires
- Ken will engage in verbal agitation
when he is not able to execute
desired activities or when staff
indicate that he cannot do something
or other time during which staff are
not directly aware of when Ken may
have eloped, OR if Ken’s
whereabouts have been unknown for
a period of 30 minutes or longer,
please call 911 and inform them that
there is a vulnerable adult whose
whereabouts are unknown.
Frequency
Ken has successfully eloped twice from his
home in the last year when staff thought the
front door was secure and it was not.
Ken will attempt to elope any time his
motivation to reach and object is high, or the
external controls presented by staff and the
parameter locks are low.
It can be noted that Ken has historically
eloped out of windows.
Intervention strategies
- Maintain calm
- Maintain a defensive posture
- Be aware that Ken may physically
aggress quickly at this point
- Attempt to determine what is causing
Ken emotional distress
- See stressors section for possible
causes and interventions
- If in the community, end the activity
and return to Ken’s house as quickly
as possible.
Frequency
Ken will engage in verbal agitation several
times a month. Though duration is extremely
variable from an isolated outburst to several
hours, the average instance is about thirty
minutes.
he wishes to do.
Behavioral Challenges
Property Destruction
- Ken will break furniture
- Ken will hit or kick walls
- Ken will run into objects with his
body
- Ken will pull apart objects that are
secured to the house such as the toilet
and trim around doors.
- Ken will attempt to destroy barriers
between him and what he wants
Examples of when it may occur
- Ken will engage in property
destruction when there is barrier
between him and what he wants
- Ken will engage in property
destruction when he is frustrated or
stressed and is hitting things to
demonstrate this
- Ken will engage in property
destruction when he perceives the
object as the source of his stress or
frustration
- Ken is just really hard on things even
when he is not upset. It is important
to know how Ken is feeling to
distinguish between these accidental
Intervention strategies
- Maintain calm
- Maintain a defensive posture
- Be aware that Ken may physically
aggress quickly at this point
- Attempt to determine what is causing
Ken emotional distress
- See stressors section for possible
causes and interventions
- If in the community, end the activity
and return to Ken’s house as quickly
as possible.
- Remove broken objects and items
that Ken may be able to injure
himself or others with
- Attempt to remove items that are
more breakable or that could be used
for weapons
- If Ken is attempting to damage
something that is immobile and
potentially dangerous to him
physically or financially such as a
parked car or furnace, remove Ken
using approved techniques to a safer
location
- Offer Ken a PRN according to
protocol if other interventions do not
work.
- Ensure that Ken has not injured
himself after he has calmed
Frequency
Ken will engage in property destruction
about once every other day. Given the
majority of his house is not breakable;
damages are only incurred about once a
month.
damages and deliberate ones.
Behavioral Challenges
Self Injurious Behavior
- Ken will bite himself
- Ken will pick at his arms
Examples of when it may occur
- Ken will pick at his arms or bite
himself when he is stressed.
Intervention strategies
- Redirect Ken to other activities
- Offer gum or straws
- Apply bandages
Frequency
- Ken will pick his skin daily
- Ken bites himself rarely
Continuum of Support
Adaptive
Stress influenced
Behavior
Behavior
Smiles
Requests stabilizer
Dances
Requests steam
Completes routines with
minimal prompting
Initiates high 5 w/
staff
Emotional distress
Behavior
Flicks fingers under nose
and makes noise
Makes distress
vocalization
Ken may be fatigued after
physical escalations
sleep
Bites staff
Engages in property
destruction
Does not follow routines
Has flat affect
Increased facial
expressivity
Behavior
Hits (slaps) staff
Recovery
Behavior
Kicks staff
Makes louder
vocalizations
Requests many steams
Giggles
Physical distress
Does not acknowledge
staff requests
Points to “restricted
areas” or keys
Attempts to blow past staff
or bolt into restricted areas
or away from staff in
community
Attempts to elope
Lays in closet for
extended periods of
time
Attempts to take keys from
staff
Ken may be uncertain about his
connection with staff
Ken may not be aware of where
he is in his routines
Ken may still show signs of
agitation
May requests steams or time in
his closet to process and destimulate.
Resume activities as if nothing
happened
Check Ken to ensure that he has
not injured himself
Reinforce
Redirect
Reduce
Execute routines as
prescribed by plan
Reduce stimulation if
over-stimulated
Stimulation
Seek out and avoid
stressors
Offer activity if
under-stimulated
Verbal communication
Offer activities as
appropriate
Offer stabilizer
Eye contact
Reduce expectations
If in the community, end
the activity and return
home
Remove
Ken from the community to
his home
Expectations
Use an initial steam timer
of 5 minutes
Use an initial steam
timer of 10 minutes
Maintain a defensive
posture
Use approved physical
intervention techniques as
needed
Prepare to cope with
physical aggression
Yourself from the situation
if at home: engage
parameter locks and go into
the kitchen
Use an initial steam
timer of 15:00 minutes
Hold Ken’s backpack strap
in community
Re-establish
Provide Ken with hand taps to
re-establish his connection to
staff
Slowly resume routines
Remain prepared for Ken to reescalate
Provide Ken with opportunities
to rest
Use an initial steam timer of 5
minutes
Your self from the situation
by evacuating into the quiet
room
Administer Ken’s
Risperdal PRN per protocol
Use a steam timer of 20
minutes
* Ken does not demonstrate typical diffusion behavior such as declining aggression etc. He tends to move
directly from physical aggression to recovery.
Behavioral Data Collection:
In an effort to better understand Ken’s behaviors and to determine that his behavioral
supports are tailored and appropriate, the following data will be collected (see attached copy).
Instances of verbal aggression, physical aggression, property destruction and elopement will
be recorded including the number of minutes that it lasted. On the chart PA will represent
physical aggression, VA verbal aggression, E elopement, SI for self injury, and PD for
property destruction. Please note that property destruction will only be considered those
instances that damages were actually sustained by some item. Place a check mark in the box
corresponding to behavior you have witnessed. In the intervention category, please include
what the effective intervention was. If there was really nothing that effected behavioral
change or cessation, please note that.
Review
This plan will be reviewed as a part of Ken’s team meetings and as needed. As the
plan is always a work in progress, it is important to communicate changes in behavior and
alternate intervention strategies to your supervisor.
Ken’s support team has reviewed this plan and agreed that it should be followed
when working with Ken.
Approvals:
_____________________________
County Case Manager
Date
______________________________
Residential Service Coordinator Date
_____________________________
Behavioral Consultant
Date
______________________________
Director of Program Services Date
_____________________________
Legal Guardian
Date
______________________________
Vocational Case Manager
Date
Behavioral Data Collection for Ken
Month:____________________________
Date
PA PD E
VA
SI
Duration Intervention
Staff
initials
Staff Sign off Sheet
I have been given the opportunity to read and ask questions about Ken’s
behavioral support plan. I understand the plan, and agree to follow the guidelines it
presents. I know that I can contact my supervisor with questions in the future should they
arise.
_______________________________
Signature
_____________________
Date
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Signature
_____________________
Date
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Signature
_____________________
Date
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Signature
_____________________
Date
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Signature
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Date
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Signature
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Date
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Signature
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Date
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Signature
_____________________
Date
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Signature
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Date
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Signature
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Date
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Signature
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Date
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Signature
_____________________
Date