Lesson Plan

Course: Patrol Academy Topic: Special Needs Citizens Instructor: Lesson Plan Originated by: Chad Sarmento, Ada CSO Date Prepared: June, 2009 Revision Date: September, 2009 Revision Date: October 2011 Revision Date: 4 hours

Training Program Details Instructional Time Goal

The goal of this class is to discuss the foundations of Special Needs Citizens in Idaho. To help students understand how this relates to their duty assignments and the community they work and/or live in.

Performance Objectives

At the end of this block of instruction the student will be able to: 02.04.01 02.04.02 Identify the prevalence of special needs conditions that an officer may encounter. Explain why it is important for law enforcement officers to be aware of various special needs conditions. Define mental illness per Idaho Code 66-601 & 66-317. Define disability per Idaho Code 32717(4)(b) and the Americans with Disabilities Act (ADA) section 12103. Recognize the legal requirements regarding an emergency detention of a mentally ill person per IC 66-326. Describe the options a responding officer has when dealing with a special needs
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02.04.03 02.04.04

02.04.05

02.04.06

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citizen. 02.04.07 Identify the characteristics of an individual with a mood disorder to include: A. Major Depressive Disorder/suicide B. Bipolar Disorder Identify the characteristics of an individual with a psychotic disorder to include: A. Schizophrenia B. Schizoaffective Disorder Identify the characteristics of an individual with an anxiety disorder to include: A. Panic B. Obsessive Compulsive Disorder C. Post Traumatic Stress Disorder D. Phobias E. General Anxiety Identify the characteristics of an individual with a developmental disability (Idaho Code 66-402(5) to include: A. Intellectual Disability B. Cerebral Palsy C. Epilepsy D. Autism Identify the characteristics of an individual with Dementia or Alzheimers. Identify the characteristics of an individual with a personality disorder to include: A. Paranoid B. Antisocial C. Narcissistic D. Borderline Personality Disorder Identify the characteristics of an individual with a physical impairment to include: A. Vision B. Hearing Identify how to use effective communication and response techniques when
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02.04.08

02.04.09

02.04.10

02.04.11 02.04.12

02.04.13

02.04.14

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encountering an individual with various special needs conditions.

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References

Brannon, G. E., and Bienefeld, D. (2011). Schizoaffective Disorder. Accessed 08/31/11 at http://emedicine.medscape.com/article/294763-overview Grant, B.F., Hasin, D.S., Stinson, F.S., Dawson, D.A., Chou, S.P., Raun, W.J., and Pickering, R.P. (2004). Prevalence, correlates, and disability disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry. 65(7); 948-958. Accessed 08/31/11 at http://www.ncbi.nlm.nih.gov/pubmed/15291684 Manning, A. (2011, March 28). Hearing loss 'incredibly common' as Boomers grow older. USA Today. Retrieved from http://yourlife.usatoday.com/health/story/2011/03/Hearing-lossis-incredibly-common-/45099370/1 Miller, L. (2008). Dealing with the mentally ill citizens on patrol, Parts 1-4. Accessed 09/06/2011 at http://www.policeone.com/columnists/laurencemiller/articles/1697438-dealing-with-mentally-ill-citizens-onpatrol-part-2/ Plassman, B.L., Langa, K.M., Fisher, G.G., Heerina, S.G., Weir, D.R., Ofstedal, M.B., Burke, J.R., Hurd, M.D., Potter, C.G., Rogers, W.L., Steffens, D.C., Willis, R.J., and Wallace, R.B.. (2007). Prevalence of Dementia in the United States: The aging, demographics, and memory study. Neuroepidemiology. 29(12): 125-132. Accessed 08/31/11 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705925/ Stinson, F.S., Dawson, D.A., Goldstein, R.B., Chou, S.P., Huang, B., Smith, S.M., Ruan, W.J., Pulay, A.J., Saha, T.D., Pickering, R.P., and Grant, B.F. (2008). Prevalence, correlates, disabilities, and comorbidity of DSM-IV narcissistic personality disorder: results of the wave 2 national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry. 69(7): 1033-1045. Accessed 08/31/11 at http://www.ncbi.nlm.nih.gov/pubmed/18557663 http://www.nfb.org/nfb/blindness_statistics.asp- Accessed 08/31/11 www.nia.nih.gov/Alzheimers/publications/adfact.htm - Accessed 08/31/11 www.cdc.gov/ncbddd/dd/dddcp.htm -Accessed 08/31/11

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http://www.nimh.nih.gov/statistics/index.shtml- Accessed 08/31/11 http://research.gallaudet.edu/Demographics/deaf-US.php- Accessed 08/31/11 http://www.nlm.nih.gov/medlineplus/psychoticdisorders.html (Psychotic disorders) Accessed 09/29/11 http://www.nimh.nih.gov/health/publications/schizophrenia/whatare-the-symptoms-of-schizophrenia.shtml- (Schizophrenia) Accessed 09/29/11 http://www.nami.org/Template.cfm?Section=By_Illness&Template =/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID =87235 (Schizoaffective Disorder)- Accessed 09/29/11 http://www.nami.org/Template.cfm?Section=By_Illness&Template =/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID =23050 (Panic Attacks)- Accessed 09/29/11 http://www.nami.org/Template.cfm?Section=By_Illness&Template =/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID =23035 (Obsessive-Compulsive Disorder)- Accessed 09/29/11 http://www.nami.org/Template.cfm?Section=Posttraumatic_Stress_ Disorder (Post-traumatic Stress Disorder)- Accessed 09/29/11 http://www.nami.org/Template.cfm?Section=By_Illness&Template =/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID =23050(Phobias)- Accessed 09/30/11 http://www.nimh.nih.gov/health/topics/generalized-anxietydisorder-gad/index.shtml (General Anxiety Disorder)- Accessed 09/30/11 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001934/ (Paranoid Personality Disorder)- Accessed 09/30/11 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001919/ (Antisocial Personality Disorder) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001930/(Narciss istic Personality Disorder)- Accessed 09/30/11 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001931/ (Borderline Personality Disorder)- Accessed 09/30/11

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http://www.nimh.nih.gov/health/publications/autism/completeindex.shtml (Autism)- Accessed 09/30/11 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001734/ (Cerebral Palsy)- Accessed 09/30/11 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002172/ (Muscular dystrophy)- Accessed 09/30/11 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003531/ (Vision Impairment)- Accessed 09/30/11 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003535/ (Hearing Loss)- Accessed 10/03/11 http://icbvi.idaho.gov/- (Idaho Commission for the Blind)Accessed 01/02/2012 Power point, dry erase board, markers This course will be taught using instructor facilitation, presentations, power point, and group discussion.

Equipment Instructional Methods

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Instruction
Slide 1

I. Introduction- Introduction of instructor. Current job assignment. Experience in the field. II. Prevalence of mental and physical disabilities A. The prevalence of individuals with metal or physical disabilities is greater than one might first anticipate. It is not only probable, but likely inevitable that you will encounter individuals with many of these conditions in your careers. Knowledge of these conditions and their prevalence will help you as an officer to better prepare yourself for encounters with those who, because of mental or physical disabilities, do not respond to law enforcement as you may expect. B. Below are statistics showing how common these conditions are in the United States. These statistics represent a best attempt at estimating the prevalence of these conditions, but may not account for those suffering from untreated or undiagnosed conditions.

Objective 02.04.01 Slide 2

Slide 3

1.

Slide 4

Mood Disorders (www.nimh.nih.gov/statistics/index.shtml)In general, 20.8% of Americans will suffer from some type of Mood Disorder in their lifetime. Over the last 12 months, 4.3% of Americans have been recorded as having a severe Mood Disorder. a. Major Depressive Disorder/suicide- 16.5% of those in U.S. suffer from this sometime in their lifetime; 2.0% of U.S. population has been diagnosed with severe Major depressive disorder in the last 12 months. (www.nimh.nih.gov/statistics/index.shtml) b. Bipolar Disorder- 3.9% of U.S. population will suffer from Bipolar Disorder in their lifetime; 2.2% of U.S. population has been diagnosed with severe Bipolar Disorder in the last 12 months. (www.nimh.nih.gov/statistics/index.shtml) 2. Psychotic Disorders a. Schizophrenia- 1.1% of the adult U.S. population suffer from diagnosed Schizophrenia (www.nimh.nih.gov/statistics/index.shtml) b. Schizoaffective Disorder- Lifetime Prevalence of Schizoaffective Disorder is thought to be between 0.5% and 0.8% (Brannon & Bienenfeld, 2011) 3. Anxiety Disorders(www.nimh.nih.gov/statistics/index.shtml)In general 28.8% of Americans will suffer from an Anxiety Disorder during their lifetime; 4.1% of Americans have been recorded as having a severe Anxiety Disorder over the last 12 months. a. Panic- 4.7% of Americans will be diagnosed in their lifetime; 1.2% prevalence of sever Panic Disorder in the last 12 months. (www.nimh.nih.gov/statistics/index.shtml)-

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Slide 6

Slide 7

b. Obsessive Compulsive Disorder- 1.6% lifetime prevalence in Americans; 0.5% prevalence of severe Obsessive Compulsive Disorder over the last 12 months (www.nimh.nih.gov/statistics/index.shtml) c. Post Traumatic Stress Disorder- 6.8% lifetime prevalence in Americans; 1.3% prevalence of severe disorder in the last 12 months (www.nimh.nih.gov/statistics/index.shtml) d. Phobias- Phobia data according to the National Institute of Health is broken into three categories; specific phobias (spiders, heights, etc.), social phobias (the fear of being looked at/embarrassed in public); and agoraphobia (the fear of being in an enclosed space without escape. The prevalence of specific phobias is 12.5% of Americans over their lifetime (1.9% prevalence of severe phobia in last 12 months), the prevalence of social phobia is 12.1% of Americans over their lifetime (2.0% severe phobia in the last 12 months), and the prevalence of agoraphobia is 1.4% of Americans over their lifetime (0.3% severe phobia in the last 12 months) (www.nimh.nih.gov/statistics/index.shtml). e. General Anxiety Disorder- The prevalence of General Anxiety Disorder is 5.7% in Americans over their lifetime, 1.0% severe in the last 12 months (www.nimh.nih.gov/statistics/index.shtml). 4. Personality Disorders- In general, studies indicated that approximately 14.8% of adult Americans have at least one Personality Disorder (Grant, Hasin, Stinson, Dawson, Chou, Raun, and Pickering, 2004) a. Paranoid Personality Disorder- The prevalence of those with this disorder in the United States is estimated to be 4.41% (Grant, et al., 2004) b. Antisocial Personality Disorder- The prevalence of those with this disorder in the United States is estimated to be 3.63% (Grant et al., 2004) c. Narcissistic Personality Disorder- The prevalence of those with this disorder in the United States is estimated to be 6.2% over the course of their lives (Stinson, Dawson, Goldstein, Chou, Huang, Smith, Ruan, Pulay, Saha, Pickering, and Grant, 2008). d. Borderline Personality Disorder- The prevalence of those with this disorder in the United States is estimated to be 1.6% within the last 12 months (www.nimh.nih.gov/statistics/index.shtml). 5. Developmental Disorders a. Autism- A study being conducted in Atlanta suggest that 1/110 8-year olds in the U.S. is autistic (www.cdc.gov/ncbddd/dd/dddcp.htm) b. Intellectual Disability- A study being conducted in Atlanta suggest that 1/83 8-year olds in the U.S. has an intellectual disability

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Slide 8

(www.cdc.gov/ncbddd/dd/dddcp.htm) Cerebral Palsy- A study being conducted in Atlanta suggest that 3 to 4/1,000 8-year olds in the U.S. has Cerebral Palsy (www.cdc.gov/ncbddd/dd/dddcp.htm) 6. Aging Disorders (Dementia and Alzheimers) a. Dementia- In a recent study of those 71 years old and older, 13.9% had dementia. This equates to about 3.4 million people in the U.S. in 2007 (Plassman, Langa, Fisher, Heerina, Weir, Ofstedal, Burke, Hurd, Potter, Rogers, Steffens, Willis and Wallace, 2007). b. Alzheimers- It is estimated that 5.1 million Americans have Alzheimers Disease (www.nia.nih.gov/Alzheimers/publications/adfact.ht m) 7. Physical Impairments a. Hearing- It is estimated that 2 to 4/1,000 people in the United States are functionally deaf. This number raises to 9 to 22/1,000 if one considers those that are deaf or have severe hearing impairment (http://research.gallaudet.edu/Demographics/deafUS.php). b. Vision- In a 1995 National Center for Health Statistics study, 1.3 million individuals were found to be legally blind (http://www.nfb.org/nfb/blindness_statistics.asp). c. III. The need for officers A. Establish a safe and more controlled environment 1. This starts with the phone call to dispatch, and how we respond to these calls. 2. When we go to the call, do we go with the mentality of a call we have to go on much like a call over a barking dog, or 3. Is it a call of going out to assist on gaining control over those who are having difficulty controlling their own situation? 4. Arrival to these types of calls should stir up the highest of personal safety concerns. 5. Establishing a safe scene should be your first concern as on every call. 6. If needed you may have to control that persons environment even more such as by committing them to a mental health hospital, or to a local medical facility for treatment. B. Providing protection for the special needs citizen 1. Often we are focused on the caller and their well being. 2. This is important, but we must also be concerned with the special needs of this persons well being. 3. Is there a possibility that this person is being victimized in their current setting?

Slide 9

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1. Local examples of lack of care at some retirement homes. i. Medication not being given. ii. Persons being mistreated. iii. Obvious signs of abuse. 4. Are they currently homeless, or living in substandard living arrangements? C. Provide protection for the public at large 1. A large portion of those that suffer from special needs pose little to no immediate danger to the general public. 2. However there are those smaller amounts that pose a significant risk. What will you do with those? 1. Schizophrenic persons for example. i. Give example of where a schizophrenic person waited in a local shopping store and attacked a person with no provocation. 3. Take the person into protective custody 1. This needs to be done with thought not emotion. 2. Is the person in need for closer supervision? 3. Is the person in need for a balanced medication program? 4. Is there anything that can be done other than housing the person somewhere? 4. Greatest agent of change 1. We are that agent of change. 2. We are seen as the lifesaver of the public at large. 3. We can communicate where others have failed. 4. We must communicate; this is hands down our most important asset. 5. What is your current style of communication? i. Are you using a militant style? ii. Are you hard to approach by nature? iii. Can you turn on your compassionate side? IV. Officer concerns
Slide 10 Objective 02.04.02

A. The location 1. When responding, where are you going? 1. Do you know the residence? i.Have you had trouble at that residence before? 2. Are you going to a hospital? i. Is there security staff there? 3. Are you going to a public place such as a store or gas station? 4. Is this person living in temporary housing such as a hotel or shelter? These are all questions that you need to be thinking when responding to this type of call.

2.

B. Family members present

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1.

This is one problem that is hard to predict. 1. The call comes from those who are around, however the presence of the officer can prompt the RP to change their mind. 2. Are they calling to have you mediate or actually take action? 3. Family members can be some of the biggest problems.

C. Security of the individual 1. How will you detain if needed? What are you going to do with them? What is legal? 1. Placing that person in restraints could be harder than you first imagine. i. Use example of placing the 78 year old man in handcuffs who had to be transported to a secure facility because he abused his wife. 2. Are you going to be able to detain in the home, or will family get in the way? D. Possible weapons 1. This should be your concern on every call. 2. Persons who have mental disabilities can increase this threat if weapons are present. 3. Remember that weapons are everywhere and you need to be on constant guard. 4. Consider the fact that everyone you come into contact may have a weapon. E. On lookers 1. How does it look when the 78 year old is taken to the ground and placed in handcuffs? 1. Do we have a disparity of force issue? 2. This cant be your primary concern, however the general public, household members and fellow professional staff are watching. 3. On lookers may be a problem; but dont be afraid of them. They may be able to help. F. Those trying to help, when you are already there 1. The good Samaritan 1. This can sometimes create more problems than solutions. 2. Can you professionally move yourself into the control position and move that person out of it? 2. Remember that there are groups of special needs persons who are easily confused. 1. More talking by more individuals does not always help the situation.

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V. Legal guidelines I.C. 66-601

Slide11

A. Definition of Mental Illness 1. A substantial disorder of thought, mood, perception, orientation or memory. 1. This would go beyond what we would experience in everyday life. i. Such as through general life ups and downs. 2. Which grossly impairs judgment, behavior, or capacity to recognize and adapt to reality. 1. This will vary depending on the special need of the individual. i. It could be lesser such as judgment that would keep you from going out in the cold without a coat, ii. To pointing a gun at a uniformed officer. iii. As an officer, listening is the most important part of communicating.

Slide 12 Objective 02.04.03

VI. Legal guidelines I.C. 66-317 A. This code defines mental illness the same as I.C. 66-601 with one addition; 1. It requires care and treatment at a facility or through outpatient treatment. 1. Now the individual is unable to remain without some sort of either formal or informal supervision. 2. Depending on your policy, these people will need to be taken to a facility or hospital for care. 3. You become an officer of change. i. Remember the importance of communication. ii. Most important is listening.

Slide 13 Objective 02.04.03

VII. Legal guidelines I.C. 66-317 A. This code continues to define gravely disabled; 1. In danger of serious physical harm due to the persons inability to provide for any of his/her own basic personal needs. 2. Including nourishment, essential clothing, medical care, shelter, or safety. 1. Depending on the area and time of the year, these could be very serious concerns. 2. Essential clothing in Bannock County during January would include major winter wear. i. Would an Alzheimers patient know that? ii. Would a person with Dementia be aware of subzero temperatures and its consequences? 3. Medical care needed would include basic medication or follow up in the event of an injury. i. Does that person just sit in their campsite on

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BLM land after a fall, which broke a leg or hip? How will that individual provide for his or her own basic needs? 4. Shelter is a major concern no matter where we live in this state. i. From extreme heat during summer months to the extreme cold of winter. ii. Recently a case of a homeless man with diagnosed mental health conditions was killed after the dumpster he was staying in overnight was loaded into a garbage truck. 1. He was found covered in cardboard apparently to stay warm during a winter storm. iii. In rural areas of Idaho, do you have those who are squatting on public land? 1. Are there bathroom facilities available? 2. Do you know are there medical requirements of those persons? ii.
Slide 14 Objective 02.04.04

VIII.

Legal guidelines I.C. 32-717(4)(b)

A. This law defines a person who is physically disabled. 1. Any mental or physical impairment; 1. This now has a wider range of issues that are not only including mental health, but physical impairment as well. 2. Which substantially limits one or more major life activities of the individual; 3. Such as self-care, manual tasks, walking, seeing, hearing, speaking, learning, or working. 1. Self-care has already been addressed in prior laws mentioned. 2. Manual tasks would include walking, taking care of personal hygiene. i. Those who cannot walk and are restricted to a wheelchair. Are they in a place that has proper ramps or ADA requirements? ii. Do they have the capabilities to call for a ride if they do not have their own transportation? 3. Persons who have severe loss of sight or blindness. i. Are they in a dangerous area because they cannot see? ii. Make sure that you speak your intentions. They cannot read your body language. iii. These type of persons may invade your personal safety space without knowing. 4. Persons with serious loss of hearing or deafness. i. How are you going to communicate with them? ii. Are you able to sign to them or have access to a person who can? iii. Remember that most people who are deaf can

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understand by reading your lips. 1. Make sure to make good eye contact and speak clearly and slowly. 2. Be patient, it may take a couple of tries. 3. If that doesnt work a written request may be your only option. You can give them a note pad to write with. 5. Some persons with mental disabilities have difficulty speaking. i. Speak slowly to help them understand. ii. Then take the time to listen. iii. Dont be afraid to ask to have them repeat what was said or confirm they understand your directions. iv. Remember that some of those who have this speaking problem are embarrassed by the inability to communicate clearly, show understanding and compassion. 6. Often those with the before mentioned disabilities have difficulty learning jobs or working. i. Specific jobs can be detailed for persons with these disabilities depending on the area.
Slide 15 Objective 02.04.05

IX. Legal guidelines I.C. 66-326 A. This code talks about legal requirements for emergency detention. 1. It says that a person may be taken into custody by a peace officer and placed in a facility. 1. That is one of our duties. 2. What type of facilities do you have in your area? 2. They can be brought to either medical or mental health facilities. 3. If the peace officer or medical health provider of a hospital has reason to believe that the person is gravely disabled due to mental illness or; 1. This should be on your mental health commitment forms at your agency. 4. The person is gravely mentally disabled as listed in the before mentioned I.C.; 5. Or the persons continued liberty poses an imminent danger to person or others, as evidenced by a threat of substantial physical harm. 1. There are obvious ones that fall into this category. i. Is the person suicidal? ii. Does this persons lack of medication make it so they cannot control their anger? 2. Substantial physical harm to include not just themselves but others. Remember our oath as officers. 3. As Officers you can detain them, but need to have an evaluator make the decision.

Objective 02.04.06

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X. Mood disorders
Slide 16 Objective 02.04.07(a)

A. The first one we will deal with is major depression. 1. Moods exhibited in this type of disorder include; sadness, crying, agitation, eating issues, pessimism, thoughts of death/suicide, and hopelessness. 2. Symptoms last for most of the day, every day for at least two weeks (http://www.depression-help-resource.com/types-ofdepression.htm). 3. Characteristics (Miller, 2008): 1. Lasts weeks or longer 2. In severe cases may immobilize sufferer 3. Feelings of helplessness and hopelessness 4. Change in sleeping patterns (more or less than usual) 5. Change in eating patterns 6. Decrease in concentration and memory ability 7. Lack of motivation to normal life events 8. Fatigue 9. Often cyclic 10. Normally will respond to treatment 4. May or may not include thoughts, plans, or attempts at suicide (http://www.depression-help-resource.com/types-ofdepression.htm) 5. Notes: 1. We have all experienced some level of depression. 2. Although the symptoms we experience were probably not to this extreme level. 3. Persons with major diagnosed depressions are often on medication. i. Most of the time they are able to tell you what they are taking or show you their prescription. 6. Other types of depression 1. Dysthymic- A more persistent but less severe depression. People can limp through life but find no joy in anything (Miller, 2008). 2. Post-Partum Depression- Depression after childbirth (http://www.depression-help-resource.com/types-ofdepression.htm). 3. Seasonal Affective Disorder (SAD)- Depression associated with specific times of the year (i.e. winter)( http://www.depression-helpresource.com/types-of-depression.htm ). 4. Situational i. These are due to real life events; such as deaths, recent changes in a persons life (http://www.depression-helpresource.com/types-of-depression.htm ). ii. Find something to make their day better. 5. Agitated depression- Characterized by agitation, restlessness, irritability, and insomnia (http://www.depression-help-resource.com/types-ofdepression.htm)

Slide 17

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These people are very dangerous if you encounter them. ii. It will start with a deep sense of depression, then follow up with a sudden change to happiness or at least the situation being resolved. 1. Often times it is with suicidal ideations or attempts in mind. 2. Monitor closely. 3. They will not admit that they are going to kill themselves 4. Oftentimes these are in DUI or Domestic Violence situations. 6. Chronic- Defined as a major depressive episode that lasts at least two years (http://www.depression-helpresource.com/types-of-depression.htm) i. This is a life long condition that requires medication for balance. ii. Often times in the outside world they will self medicate. 1. This can also cause problems because the drug mix is not a consistent one. 2. They often will self medicate with alcohol. 7. Endogenous i. Endogenous means from within the body and is when one feels depressed for no apparent reason http://www.depression-help-resource.com/typesof-depression.htm) 8. Manic-depressive- Often called Bi-Polar Disorder i. These people will have very wide mood swings, cycling between manic and depressive states (http://www.depression-helpresource.com/types-of-depression.htm). 1. Again these individuals should cause you to be concerned for their wellbeing. ii. However the person will have an intact personality when they are either medicated or not struggling with a bought of depression.
Slide 18 Objective 02.04.07(a)

i.

B. Suicidal persons 1. Those with a mood disorder such as major depression may be at greater risk for suicide. Someone who is suicidal may try to seek help and communicate with others or make suicide threats. 1. This could be by calling dispatch and informing of their intentions. i. What is the motive of the individual doing this? 2. This also can be found in letters. i. These letters may be in areas where they could be found. 3. And it can be through telling others. 2. Gestures that are demonstrated by suicidal persons. 1. Watch while interviewing or when sitting quietly.

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2. Are they looking for areas that may have weapons or means to do harm to themselves? 3. Are there physical motions they are making such as touching their neck or wrist areas? 3. Have they attempted suicide 1. Did they attempt by using weapons? i. Knives, gun, razors, etc. 2. Had they attempted by use of pills? i. Are there pills in the area? ii. Are they in an open area, which might suggest contemplation? iii. Have they attempted a hanging? 1. If so where and how? iv. Attempted asphyxiation 4. Most suicides happen from midnight to 9:00 am C. Bipolar Disorder (Miller, 2008) 1. Individuals cycle between highs (manic phase) and lows (depressant phase) 2. Characteristics of the manic phase 1. Energized and overconfident 2. Impulsive 3. Thinking and speech speed up 4. Person sleeps less 5. May be hypersexual 6. May abuse stimulant drugs to maintain the high as long as possible 7. In late manic phase the person may become shorttempered, irritable, anxious, and paranoid 3. In some cases, the manic phase will mostly include irritability, anger, and paranoia. 4. An individual with Bipolar Disorder may abuse amphetamines, cocaine, or alcohol in order to maintain the manic phase as long as possible. XI. Psychotic disorders A. Psychotic disorders cause abnormal thinking and perceptions and cause individuals to lose touch with reality. Two main symptoms of psychotic disorders are the presence of delusions and hallucinations (http://www.nlm.nih.gov/medlineplus/psychoticdisorders.html)
Objective 02.04.08(a)

Slide 19 Objective 02.04.07(b)

B. Schizophrenia is one disorder that you must be on high guard for. 1. These individuals will commonly self medicate on the outside, and generally with illegal drugs. 2. Moods will change rapidly depending on the amount of medication or drugs that they are currently on. 3. If persons are in an active episode it is very difficult to communicate. 4. The following is a breakdown of symptoms that you need to be

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Slide 20

Slide 21

aware of: (http://www.nimh.nih.gov/health/publications/schizophrenia/w hat-are-the-symptoms-of-schizophrenia.shtml; Miller, 2008) 1. Mood i. They are in a daydreaming state, ii. Withdrawn, iii. Reluctance to talk or mute. 2. Communication i. It is very vague, ii. Ambiguous, iii. Hard to follow, iv. Trouble focusing and paying attention, v. Problems with short-term memory 3. Irrationality i. May believe someone is out to get them ii. May have grandiose beliefs about self iii. Illnesses attributed to unreasonable causes 1. The devil 2. Enemies (real or fictional) 4. Hallucinations i. They may be frequent, ii. Usually auditory, sometimes visual iii. May be threatening or warn them of danger, iv. Appear to be real to the person, v. Rationalizations of the hallucinations are almost totally rejected. 1. These may lead to violent outbursts, particularly if the person feels threatened. 5. Delusions i. They are common with those suffering from this, ii. They may be classified as paranoid. 1. This also makes it difficult to get them on medication. 2. They will have difficulty understanding that you are trying to help. 3. Medical staff must consider prescribed medications. 6. Mannerisms i. They may exhibit bizarre mannerisms, ii. Irrationality, iii. Paranoid, disorganized or disconnected C. Schizoaffective Disorder (http://www.nami.org/Template.cfm?Section=By_Illness&Templa te=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID =87235) 1. Schizoaffective Disorder has been described as one of the more common and disabling mental illnesses. 2. This condition includes both symptoms of schizophrenia (delusions, hallucinations, and/or disorganized speech and behavior) and a mood disorder such as major depression or mania. 3. Behaviors of these individuals include those of both mood

Slide 22 Objective 02.04.08(b)

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disorders and psychotic disorders. XII. Drug induced psychosis A. This is important to us, because of the symptoms that sometimes resemble a schizophrenic episode. B. It is common to mix them up from time to time. 1. General symptoms of this: 1. Mood i. Daydreaming 1. Same as schizophrenic ii. Introspective state 1. Similar to schizophrenic iii. Prefer to talk about them 1. Different 2. Communication i. Rambling but related to reality 1. Different ii. Tries to communicate 1. Different iii. Present tense is used 1. Different 3. Irrationality i. Great interest in the new sensations 1. Different 2. Mostly visual, not auditory ii. Symptoms attributed to reasonable causes 1. Different 2. This should be one of your biggest clues that they are on drugs and this is more than likely the cause of this episode. 4. Hallucinations i. Predominantly visual 1. Similar as schizophrenic 2. You need to use your listening powers here. What are they describing? ii. Rarely auditory 1. Different 2. Very important! iii. Person attempts to explain them to you 1. Different 5. Delusions i. Rare 1. Different ii. Probably due to individual personality conflicts 1. Different 6. Mannerisms i. Rare 1. Different 2. This is a little tougher to pick up on with limited contact. XIII. Anxiety Disorders

Slide 23 Objective 02.04.08(c)

Slide 24

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Slide 25 Objective 02.04.09(a)

A. Panic attacks (http://www.nami.org/Template.cfm?Section=By_Illness&T emplate=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54 &ContentID=23050) 1. The general symptoms of a person with this condition should raise concern for us as officers. They are: 1. Chest pain, hot/cold flashes, chocking sensation, racing heart, trembling, shortness of breath, tingling hands and feet, dizziness, headaches, and sweating. i. These put together resemble a person having a heart attack. ii. The person may also feel as if he/she is losing control or dying iii. Panic attacks normally last approximately 10 minutes. iv. We must assume the worst-case scenario in this incident and seek medical assistance. B. Obsessive compulsive disorder (OCD) 1. OCD is a condition, probably related to a chemical imbalance in the brain, where an individual has both obsessions and compulsions. If certain rituals are not performed, often repetitively, the individual experiences anxiety. (http://www.nami.org/Template.cfm?Section=By_Illness&Tem plate=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&Cont entID=23035) a. Obsession- Intrusive and irrational thoughts or impulses that continually run through a person's mind disturbing normal and rational though. b. Compulsions- Repetitive rituals, such as hand washing or counting, that the person is compelled to complete. C. Post traumatic stress disorder 1. Triggered from an extreme event 2. Involves an initial event that threatens injury to self and others as well as a feeling of persistent fear, helplessness or shock (http://www.nami.org/Template.cfm?Section=Posttraumatic_S tress_Disorder) 3. Seen in people from rape victims to war veterans to terrorist attack survivors 1. This is becoming more common. 2. The person can communicate the thought process if given the chance. 3. Use your communication skills. D. Phobias- Intense, irrational, and inappropriate fear of ordinary items or events (http://www.nami.org/Template.cfm?Section=By_Illness&Templat e=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID= 23050) 1. Varying degrees of reaction 2. There are many different phobias such as specific phobias

Objective 02.04.09(b)

Slide 26 Objective 02.04.09(c)

Objective 02.04.09(d)

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(heights, spiders, etc.), social phobia (fear of looking foolish in front of others), and agoraphobia (fear of being trapped in a situation). 1. We may trigger some by doing our daily duties. 2. Alcoholism often occurs with this condition
Slide 27 Objective 02.04.09(e)

E. General Anxiety Disorder (GAD)- A condition where a person experienced chronic anxiety, worry, and tension, even though the situation does not warrant this response (http://www.nimh.nih.gov/health/topics/generalized-anxietydisorder-gad/index.shtml). It is common for someone with this condition to also abuse drugs and alcohol, as well as exhibit other types of anxiety disorders. Symptoms of General Anxiety Disorder include: 1. Fatigue- Individual may not be able to fall asleep or stay asleep 2. Headaches 3. Inability to concentrate 4. Muscle aches 5. Trembling/twitching 6. Irritability 7. Sweating 8. Nausea 9. Being "out of breath" 10. Hot flashes XIV. Personality Disorders

Slide 28 Objective 02.04.12(a)

A. Paranoid Personality Disorder- A condition in which someone has chronic suspicion and distrust of others but it does not raise to the level of a psychotic disorder like schizophrenia (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001934) 1. The person does not realize that their suspicion is not consistent with the facts of the situation. 2. Symptoms may include: i. Belief others have hidden motives ii. Belief they will be taken advantage of by others iii. Inability to get along with other people iv. Isolation from other individuals v. Detachment vi. Hostility B. Antisocial personality or ASP (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001919/) 1. An individual with ASP has a history of manipulating, disregarding the rights of, and taking advantage of others 2. This disorder is most common with those who have a criminal history. 3. These individuals are self-centered, manipulative, impulsive, and feel little to no guilt when hurting others. They may be witty, charming, flattering, abuse substances, lie, and become angry or arrogant.

Slide 29 Objective 02.04.12(b)

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1. Remember to keep your guard up as to not get fooled into doing something that you did not originally plan.
Slide 30 Objective 02.04.12(c)

C. Narcissistic Personality Disorder- People with this condition have an inflated ego and are extremely occupied with themselves (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001930/) 1. Symptoms may include: i. React to criticism with rage ii. Use others to get what they want iii. Be preoccupied with fantasies of power or intelligence iv. Expect to be treated better than others v. Selfish and obsessive D. Borderline Personality Disorder- Those with BPD have a history of unstable emotions that can manifest in impulsive actions and chaotic behavior http:/www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001931/ 1. Symptoms may include: i. Quickly shifting thoughts and feelings ii. Feeling of abandonment, boredom, anger iii. Impulsive sexual relationships, binge eating, stealing, substance abuse, etc. iv. Self-injury such as cutting XV. Developmental disorders

Slide 31 Objective 02.04.12(d)

Slide 32 Objective 02.04.10

A. Defined in Idaho Code 66-402(5) 66-402(5) "Developmental disability" means a chronic disability of a person which appears before the age of twenty-two (22) years of age and: (a) Is attributable to an impairment, such as intellectual disability, cerebral palsy, epilepsy, autism or other condition found to be closely related to or similar to one (1) of these impairments that requires similar treatment or services, or is attributable to dyslexia resulting from such impairments; and (b) Results in substantial functional limitations in three (3) or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, selfdirection, capacity for independent living, or economic selfsufficiency; and (c) Reflects the need for a combination and sequence of special, interdisciplinary or generic care, treatment or other services which are of lifelong or extended duration and individually planned and coordinated.

Slide 33 Objective 02.04.10(d)

B. Autistic persons 1. Autism is a spectrum of disorders but all forms impact the social ability and communication skills of the individual as well

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as manifesting in repetitive behaviors and interests (http://www.nimh.nih.gov/health/publications/autism/complet e-index.shtml) 2. They can exhibit obsessive behaviors. 1. We need to monitor this especially if we are going to transport them to another place or facility. 2. These obsessive behaviors can come out and give the appearance of some safety concerns for us. 3. They can function quite well. 1. Normally in structured settings. 4. They exhibit difficulty with change. 1. Movement to another area could become difficult and challenging for them to accept. 2. Begin to show signs of resisting.
Slide 34 Objective 02.04.10(b)

C. Cerebral Palsy/Muscular Dystrophy 1. Varying degrees of physical handicap. a. Cerebral Palsy is a range of disorders that involves abnormal brain function. These can impact mobility, speech, hearing or vision, and digestive problems. It can also lead to decreased intelligence (although not always) learning disabilities, tremors, and muscle weakness, to name a few. As there is no cure for Cerebral Palsy, individuals will have various aids (such as a wheelchair or eye glasses) to compensate. (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH000 1734/) b. Muscular dystrophy is a degenerative muscular disease that causes muscle weakness and loss of muscular tissue. There are many types of muscular dystrophies and all are inherited through family genetics. Symptoms of MD may include intellectual disability, muscle weakness, difficulty using one or more muscle group, drooling, drooping eyes, stumbling/falling, and problems walking. As with Cerebral Palsy, there is no cure for Muscular dystrophy so individuals with this condition will likely have aids to help them control symptoms. (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH000 2172/) 2. If transport of this person is needed, what will you need to do? 3. What type of concerns would you have? D. Epilepsy Epilepsy is a brain conditions that leads to seizures in those who suffer from the condition. There are a variety of seizure types, and not all of them would be easy to recognize. Some seizure types will lead to an individual having convulsions, while others may cause one to wander around, repeat behaviors that may not be appropriate in the situation, or experience memory loss (Miller, 2008). More on seizures will be covered in Emergency

Slide 35 Objective 02.04.10(c)

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First Aid and CPR.

Slide 36 Objective 02.04.10(a)

E. Intellectual disability is a growing issue within law enforcement duties. We are seeing increases in care givers that are pressing charges with persons with these types of disorders. Those who are intellectually disabled may be more likely to commit misdemeanor crimes, such as shoplifting, because of their childlike impulsivity (Miller, 2008). Most of the people in this category are born with the disorder and continues through their entire life. Symptoms of an intellectual disability include: 1. Lowered ability in memory, both long and short termRemember this when giving instructions or directives. 2. Difficulty reasoning- Most of the people in this category are working with an IQ between 45 and 70. Because of this lowered ability reasoning is more difficult. 3. Basic language- Communication generally speaking is in the area of a 6th grade education once adulthood is reached. Communicate slowly and methodically. 4. Visual-motor perception and coordination issues- This can cause several problems for us in our daily duties. What will you perceive when questioning or giving directions? Working with these individuals you must; 1. Make repetitive instructions or requests. 2. Make special efforts to not become frustrated through this process. 3. Staying calm can help you accomplish you end goal.

Slide 37 Objective 02.04.11

XVI. Aging disorders A. Alzheimers/Dementia 1. As our elderly population is growing we are seeing increases in these types of persons in our community. 2. Symptoms of persons with these disorders; 1. Increased loss of mental capabilities, i. Are these individuals still active in your community? 1. Driving 2. Community events 2. Easily confused, i. This is where we need to watch our weather conditions. ii. If a person becomes lost, how will they reason when they are alone? iii. Where will you start your search? 3. Possible physical resistance, i. Once found can they be talked into going back with you? ii. Often times once found they did not believe they were lost. iii. Difficult then to take them back.

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4. These individuals are common walk-aways from senior community or controlled environments. 3. Always be aware of the risk of exposure with these individuals. We see this almost yearly in all parts of our state. Generally the reporting is not immediate and we are already many hours behind. 4. Remember when communicating with these individuals to keep it basic. 1. Always remember not to demean. 2. It is a careful balance. XVII. Vision and Hearing Impairments
Slide 38

A. Vision Impairment Vision is measured by how much a person can see at 20 feet from a vision chart compared to others. Someone with 20/40 vision can see from 20 feet what a "normal" person could see from 40 feet. In Idaho, a person is considered legally blind when their best corrected vision is 20/200 in their better eye. (http://icbvi.idaho.gov/) Blindness or partial blindness can be caused by physical injury to the eye, cataracts, stroke, tumors, blocked blood vessels, surgery complication, diabetes, glaucoma, macular degeneration or it could be that the person's vision never developed normally (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003531/)

Slide 39

1. Cataracts- The person may have cloudy or fuzzy vision and they may have trouble seeing shapes. 2. Diabetes- The person may have blurred vision, shadows or missing areas of vision, and difficulty seeing at night. 3. Glaucoma- The person may have blurry vision or a "tunnel vision" effect. 4. Macular degeneration- The person may have normal side vision but lose the central vision as degeneration continues. B. Hearing Impairments Hearing loss or impairment is very common. It is estimated that 25% to 40% of all people over 65 have some hearing loss (Manning, 2011). With a growing elderly population, the contact between those with mild to severe hearing loss is likely to increase. Hearing loss can be attributed to a variety of reasons including structural problems with the ear, birth defects, genetic conditions, infections, injury to the ear, frequent exposure to loud noise, or simply due to aging (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003535/).

Slide 40

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Hearing impairments makes communication between citizens and officers more difficult for obvious reasons. Officers must be aware of laws related to law enforcement contact with the hearing impaired as well as agency policy.
Slide 41

XVIII. Other Conditions to Be Aware of A. Attention Deficit Hyperactivity Disorder (ADHD) Individuals with ADHD are characterized by an inability to remain focused, impulsive actions, inability to control their frustration, poor judgment, and a desire for immediate gratification. Due to this, they are likely to come in contact with law enforcement because of their own impulsive actions or because of their involvement with other individuals whom they follow for acceptance (Miller, 2008). C. Narcolepsy Narcolepsy is characterized by a disruption of sleep during the night and excessive drowsiness during the day. A person with this condition may suffer vivid hallucinations or even pass out (Miller, 2008). D. Tourette Syndrome In Tourette's Syndrome, an individual will experience frequent and uncontrollable "tics." These of most often physical twitches of one type, but they can be verbal. Verbal tics are most often grunts or noises, but they can rarely be foul language which can bring them in contact with law enforcement (Miller, 2008). E. Traumatic Brain Injuries Traumatic brain injuries can be a permanent condition from previous damage done to the brain or a temporary injury from something like a concussion. A person suffering from a traumatic brain injury may exhibit headache, confusion, trouble balancing, sensitivity to external stimuli, difficulty concentrating, short-term memory loss, and emotional/behavior problems. An officer at the scene of an accident or physical assault may encounter an individual with a brain injury. This person may exhibit any of the symptoms described above, and may have difficulty answering questions and seem confused or disoriented (Miller, 2008).

Slide 42

XIX. General Ideas- Dealing with these special needs individuals A. Remember to always be professional. 1. This can be difficult when being challenged by other persons. 2. Remember that you must put your personal feelings aside. B. Create understanding on all sides.

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1. 2. 3.

In group home settings, this is important. Help the providers with information. Help family members that are present understand what is next in the process.

C. Communicate at that persons level. 1. Being careful that you do not offend persons by talking down to them. 2. It is the careful balance, much like when using force. 3. We must get it right. D. Always be careful to not belittle the person. 1. Find out what their issues are. 2. What do you need to do to help them? 3. Help bring that person into participation with the solution. E. Listening is your greatest tool. 1. Without fail communication is our most important tool. 2. The greatest part of communication is listening. 3. We get use to telling people what to do in our line of work. 1. When that fails, what is generally our next step? 2. That may not be the answer with this group of individuals.
Slide 43

F. Utilize standard intervention techniques (5 Rs) 1. Reassuring 2. Respectful 3. Reliable 4. Relatively simple 5. Resonating calmness G. Officer Safety is KEY (DBEAT) 1. Distance 2. Back-up 3. Empathy 4. Awareness 5. Time

Slide 44

Understanding

A. At this time, the instructor should answer any last minute questions students have. Make sure that students believe that they know all of the information for the objectives listed in their objective booklet for this class. B. Give students an oral quiz over material covered in this lesson C. Thank the students for attending and encourage them to continue their education in how to identify and respond to those with special needs through in service training.

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Closure

Inform students that this class is an introduction to law enforcement response to special needs population. Students should continue to develop their understanding of these populations at their own agency, as well as familiarize themselves with federal, state, and local laws and resources.

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