Self-Determination: An ADL Worth Addressing
Did you know that the cluster of attitudes and skills that fall under the umbrella of “self-determination” have been shown to be one of the strongest predictors of success for people with disabilities’ attainment of their transition goals? It’s as necessary to quality of life and independence as the other basic ADLs we traditionally focus on and, like grooming and hygiene, it’s a teachable skill set.
I have a hunch (and some research to back it) that most occupational therapists do not explicitly and systematically pursue self-determination as part of everyday clinical practice. Like a lot of the more psychosocial goals, I think we often expect clients to just pick it up by osmosis because we’re so nice and we offer opportunities to choose whether to work on putting on socks or learning to button first. While this is essential to building self-determination, it’s hardly sufficient.
Or we expect other team members to do the job. I have honestly never seen this happen, but even if another professional was working on it, self-determination must be practiced across all settings if it is to develop. If we aren’t actively helping in the effort, our clients are deprived of prime opportunities to acquire this essential skill set.
What is sufficient intervention for building self-determination? It includes (a) presenting and supporting the integration of certain knowledge, attitudes and abilities, and (b) preparing the social environment to receive and reward (and appreciate) the client’s growing assertiveness.
The knowledge needed includes:
• That there are choices to be made
• What’s possible– what are the choices in any given situation?
• Identifying and understanding one’s own emotions / thoughts as they arise
• Identifying problems and options for their resolution
Attitudes needed:
• Considering oneself worthy and capable of making choices and decisions
• Owning one’s personal strengths and limitations in general
• Being aware and considerate of others’ perspectives and needs
• Assuming responsibility for making personal choices and decisions
• Assuming responsibility for identifying and resolving problems
• Being comfortable with asking for help, owning errors and limitations
• Comfort in setting limits and refusing
Behaviors needed :
• Choosing or deciding in a thoughtful and timely manner
• Making one’s wishes known effectively
• Asking for assistance effectively
• Describing one’s preferences and needs assertively
• Self-management skills for coping with emotions
• Effective and polite refusal/limit-setting
In addition to teaching and supporting the development of the requisite knowledge, skills and actions, we need to make sure that our clients are supported (and not punished) for their efforts toward self-determination. People with disabilities are consistently rewarded for compliance. They often learn to just agree with whatever others suggest, resulting in learned passivity and a high tolerance for frustration. These patterns may make life easier for others, but ultimately leave the client vulnerable, unable to direct their own lives, and unfulfilled.
Family members, teachers, caregivers and health professionals should be brought on board to help support each client’s fledgling and ongoing actions toward self-determination. They will sometimes find that a more independent and self-directed person is more complex and less consistently easy to deal with, so it’s important to facilitate their appreciation for how important self-determination is to attaining a richer, more satisfying, and safer life. They need to know what the client is learning and practicing at each phase so they can respond supportively. Of course not every request or choice can be accommodated, but you can offer suggestions for ways to respond that reflect respect and validation in any case. (And reminders of why learning habits of self-determination is basic to acquiring independence, working, keeping safe in the world, etc.)
It is never too late or too early to facilitate the path toward increased self-determination, and clients of all sorts can benefit. Occupational therapy includes psychosocial skill development. Self-determination is evidence-supported and foundational to living life to its fullest. It’s right in our wheelhouse. Let’s do it!
References and Resources:
Increasing Student Success through Instructional Self-Determination
http://www.apa.org/research/action/success.aspx
National Gateway to Self-Determination
Self-Determination: Supporting Successful Transition
http://ncset.org/publications/viewdesc.asp?id=962