Most programs for people who have sexually abused say they follow Risk, Need, and Responsivity. This is a good thing, but do they really do that? We know that some programs ignore risk, while others don’t really focus on specific client needs. In my opinion, however, the biggest problem with RNR is that we still don’t know what to make of responsivity.
I work with a lot of clients with intellectual disabilities or other cognitive problems. I try to make sure that clients get assessed, treated, and managed in a way that fits their special needs, but what do I mean by special needs? Is it just low IQ or some kind of brain injury, or do we need to think about other problems? What about fetal alcohol effects? What about mental illness? Also, what about clients who were in prison for a very long time who can’t think so well anymore because prison didn’t give them much practice? This definition may be a bit broad, but the point I really want to make is that clients with special needs require special treatment – with specialized tools and procedures. Sometimes, this means we have to be creative.
Now that we know who the special needs people are, how we help them with their problems? A real problem with many programs is that they don’t have books or exercises that were made for special needs clients. Can we use those programs as they were originally written? Do we just talk slower? Do we make the program longer and give it in smaller bits? Research and experience tell us that slower and longer may help some clients, but no special changes at all doesn’t really work. Slower and longer may also lead to problems. My good friend tells a story of his early career when he was trying to explain something to an intellectually disabled client – slower and longer. After getting frustrated, the client said, “Man, I’m retarded. I’m not stupid!” Easier language, with more pictures, repetition, and social stories helps. We also need to remember that nobody likes to have their nose rubbed in their problems, so respect is also really important. What we work on may end up being pretty much the same, but we need to remember that special needs requires special attention.
Managing risk also requires a different approach. Sadly, many special needs clients will never enjoy the same quality of life as their friends without difficulties. A lot of staff are now focused on the idea that special needs clients have the same rights as people without disabilities or cognitive problems. I’m not totally sure about this. I agree that all special needs clients should be able to live as normal a life as possible, but I think we need to be realistic. Do our special needs clients also have the right to good service? What if getting good service means that some clients won’t get to do what they want to? Is that fair? I understand the need to ensure equal opportunity, but being kind and caring enough not to let clients fail is also important. Bill Marshall says Warm, Empathic, Rewarding, and Directive – I agree.
So, that’s 529 words…but they’re 529 words with an average character length of 4.5 and an overall Grade level of 7.2. Still too high for most of our special needs clients, but keep in mind, I’m a psychologist.
Robin J. Wilson, Ph.D., ABPP