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April 2018

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Let the Children Play

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As a pediatric occupational therapist with many years of learning in both formal and informal ways about early child development, I have developed some personal “guiding rules:" A child’s relationship to his/her mommy/daddy/loving adult is primary. Our role with an infant is to nurture and protect. Easy. The not-so-easy role is the gradual changes that should occur during childhood where parents step back and allow the child to learn from their own experiences. Allowing a child to take a risk; difficult. A child’s relationship to “Mother Nature” is a key component of development. For babies, this refers to gravity. As a society we have “over-containered” babies: infant seats, strollers, swings. Babies need to move and maximize the time they are playing on the floor. Children, too, need to move. Run. Climb. Roll down a hill. The evidence is in and it indicates that these activities promote far more than physical development. The architecture of the brain is established by our early experiences. We are sensory beings. Information gets into the brain by the sensory systems. Some of these are not widely recognized by everyone such as the proprioceptive system (information from our muscles and joints) and the vestibular system (information about movement and how we relate to gravity). They are vital components of our development. Play IS a child’s occupation. As an occupational therapist, I have frequently been asked how occupation relates to children. Play is the answer. Not all play is created equally. We must choose those opportunities that allow children to develop critical thinking and problem-solving skills while having fun. We want to stimulate their imagination and creativity. Knowing the above, it will not be surprising that I was very excited to learn about TimberNook. It knows, understands and supports my “guiding rules." Tagged as the Ultimate Sensory Experience, TimberNook is both a philosophy and curriculum. Set in the outdoors, Mother Nature is used as a “third teacher” to provide an environment where children can have authentic play experiences. With multiple options for programming, TimberNook can serve toddlers from 18 months-4 years (Tiny Ones) in a parent-child setting, and 4-7 year olds (Little Wild Ones) and 7-12 year olds (Wild Ones) in a child-and-staff setting. Excentia is excited to announce that we are now a TimberNook provider and will be doing programming in 2019! We are working in partnership with the Lancaster County Conservancy to use Climbers Run Nature Preserve as our site. This unique location will have an area specifically planned to facilitate “play the TimberNook way” as well as the existing trails, meadows, a stream, and forested areas. Head over to our TimberNook Facebook page and click the ‘Like’ button to stay informed as we roll out the plans for next year. We will also start posting more detailed articles about subjects that support the philosophy of TimberNook of Lancaster County!

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What it Means to be the LPN for Excentia

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What it Means to be the LPN for Excentia In February of 2014, I joined Excentia as the only nurse. My background was varied, working with physicians for most of my career, skilled nursing facilities, dialysis, staff & training development, and dialysis education with patients and their families. My career as a nurse has now entered the 43rd year and I am still learning and growing as a nurse. Being new to working in ID/IDD I didn’t know what to expect or what challenges that I would be facing. How can I improve the health and well-being of the individuals that Excentia serves? Much to my surprise, the experience I had already attained prepared me on many levels for this position but it has given me the opportunity to expand my knowledge. What I find that is key to my position has been educating the staff, providing processes/protocols that involve the standard of care (i.e. hydration, dysphagia, infection control). Education gives the staff the skills, confidence and the knowledge to provide excellent care to those we serve. Talking to the individuals that may suffer from chronic, debilitating diseases on how to take care of themselves and to provide support should they struggle with lifestyle changes. Another key role is being a medical advocate for the individuals we serve. Unfortunately, my peers in the medical profession have limited experience and knowledge about working with the ID/IDD population. Decision making is a major problem for many medical providers, due to individual’s inability to understand informed consent when a medical procedure or immunization is recommended. This truly has been my greatest challenge. This delays the care that our individuals need and deserve. Lastly, but most importantly to me, is spending time with the individuals we serve. The simple act of holding someone’s hand when they are upset or scared, being the shoulder to those that are struggling with physical ailments is gratifying to me. Many years ago I was assigned a hospice case. This person was 90 yrs old and dying from cancer. She was in severe pain which was managed by morphine. When I finished giving her a bath and re-positioning her, I began to brush her hair. She looked at me and said “I love having my hair brushed, it feels so good”. So I kept brushing until she fell into a deep sleep. That day I had done my job, but I came home feeling so satisfied and thankful that I had given this lady real comfort. That is what my goal is everyday. I want to give of myself to provide support, comfort and real caring to the staff and individuals that Excentia serves. I feel extraordinarily blessed to have been hired by Excentia to care for such an awesome group of people! I love what I do and the people I serve as the agency nurse!

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What does Excentia do to enrich the lives of its individuals?

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Excentia reaches out to individuals with ASDs Empowering people with development needs, Excentia is a growing nonprofit organization with a great reputation, a respected human services presence in the Lancaster, PA. Excentia offers services to individuals with physical and intellectual disabilities, and more recently, our support services recognize Autism Spectrum Disorders (ASDs) as covered under Excentia’s umbrella of care. According to the NIMH, ASDs encompass individual difficulties in communicating with others, seeing things from another's perspective (theory of mind), and making sense of information in his or her environment. Residential Services and the Autism Support Program This Autism Support Program operates within Excentia’s Residential Services, which provides housing options, community accommodations, and support resources for its clients. Direct Support Staff and Community Inclusion Specialists, for instance, are employed within Residential Services to facilitate their client’s individual-driven growth. We help the individuals reach their own goals, and we perform the groundwork that is a day-to-day living assistance. Simple acts of service foster an individual’s independence and inclusion within the larger community. My role in the Autism Program Direct Support Staff and Community Inclusion Specialists within the Autism Support Program offer a unique set of skills and services to their clients. We must do more than merely “show up” when scheduled because we as competent staff must be aware of our individual’s particular social, emotional, and sensory needs and challenges. I remember that my clients with ASD possess a sometimes-profound understanding of their own needs and limitations. The individual’s “problem” is that a piece is apparently missing when he or she engages a challenging-to-them task, like cooking a good meal or interacting positively with peers. My job is to provide that missing piece, which can be called “presence”. “Presence” Having presence with an individual helps motivate the person with an ASD to achieve his or her own level of success and independence. Within the Autism Support Program, my clients represent a range of capabilities and diverse degrees of independence and performance. Presence with an individual means being alert to his or her particular level of functioning in a given area. This social-emotional quality is a supportive force that is felt by the client who is often not able to verbalize his or her own need for appropriate help. My presence enables me to step in or back off. To assist the individual or to refrain from assisting. It is all about what the person needs presently to perform the task at hand. I am ready to help and respond in respect with my client’s needs. Working with an individual with an ASD One of my clients is responsible for tasks like wiping surfaces, reordering his belongings, and vacuuming floors, since his apartment is comprised of four rooms which all need cleaning and organization. So during one particular session, I scrubbed bathroom surfaces alongside him. I am no cleanliness expert, but this instance required my hands-on effort, and with a curious yet concerned demeanor, he watched my cleaning progress. Thus, our joint attention, my several verbal prompts, and his conversation about my point of view, cleared a vista into my personal mental state and as well as my own expectations. My presence in this instance incited a teaching moment that reinforced my client’s theory of mind (understanding the world from another's perspective) and, of course, we bolstered his cleaning habit. Commitment to “presence” Excentia is able to support its support staff who in turn support their individuals. The management and direct support staff of this organization really want to see the growth of their clients! Indeed, one of the company’s values is commitment, a virtue that highlights the dedication that is needed to see the most profound and lasting personal growth of individuals with or without ASDs. I can see this commitment expressed in my own presence with clients on the autism spectrum, and I have seen other staff show consistency, attentiveness, and follow-through with their own clients, too. Let us persevere and mature as committed support staff! Our individuals are ready to engage, and we should be, too. by Sean Jesiolowski, Community Inclusion Specialist / Direct Support Staff

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