Social, Physical, Emotional, and Cultural Profile…Just a Dialog

Written May 12th, 2005

The development of the SPEC Profile grew out of the observable need to improve the awareness and interaction of all types and levels of staff working with any kind of person with a disability or challenge. It also, grew out of a need to apply my “therapy” as customized to the uniqueness of the individual as possible. As a Clinician, I am trying to pair sound clinical reasoning and judgment with a possible treatment technique or modality based on probable outcomes and an evaluation process. I also want to adapt or setup the environment to build in as much success into the process of helping the individual as possible. I found I needed more information then was available through my evaluation tools and often unattainable at a Team meeting.

The most thorough information about an individual is procured at the time of intake at a school, hospital, clinic, nursing home etc. Often this information contains only that which is pertinent to the present situation for the individual. For example medical facts about the diagnosis or condition that is effecting the individual for their current placement or the educational history or testing for a school placement. Very often this information package does not contain incidental information about the individual. By incidental I mean places, events, people, history (not necessarily medical), things and experiences that are or were important to that individual. “The Stuff That Makes Life Meaningful”.
This incidental information may seem relatively unimportant to us but, holds valuable emotional and symbolic meaning for the individual. Our experiences are assigned relevance in our brain and laid down as emotional memories as we journey through life and is perceived by us as uniquely ours. Depending on the circumstances of the experience the memory may be assigned a value of positive, negative or neutral. Yet, this very tangible and significant information is often overlooked as a possible clinical tool to help the individual especially under the medical model.

Another problem is the information obtained at the time of intake may be shared only with the Professional or close immediate Team working with the individual. But, most often the Paraprofessional staff spends more time around the individual or assisting the individual then the Professional staff spends more time around the individual or assisting the individual then the Professional staff. Restrictions on the accessibility of information have grown considerably in the last few years, especially since the HIPAA regulations have come into effect. ln my opinion there is much confusion around these regulations. However, this is not a privacy debate and I am not talking about medical or personal identifying information. The information for which we are looking for is to provide choice, respect, dignity and pleasure to the individual in question. It is information required to help the person maintain or have a meaningful “Quality of Life.” We are asking what has or had a motivating influence on this person? We are seeking personal keys that define who we are, what makes us tick. Depending on the age of the individual there may be plenty of history or in the case of a child seemingly little. in both cases, finding out about the Social, Physical, Emotional and Cultural History of the individual will allow us insight into helping the individual.

I am not talking about another standardized test or form or something that takes an inordinate amount of time. I am talking about one index card that speaks to the positive significant, meaningful, emotional experiences in one’s life. So, what do I ask?

Depending on the age of the individual my questions maybe about favorite food, color, vacations, favorite holiday, TV program, music or a general one, what was the best time of your life? What did you love most about your job? What family event was the best? Who was or is your favorite family member? What about this person was special? Do you have a pet? If the individual is a child or lacks communications skills, I am going to ask the parent or significant other in their lives. If the person is or has been institutionalized and there is no family involvement I am going to look to finding answers
from the staff and environment that was around them. For example, what was the average age of the staff members around them, and what ethnic or cultural background did they come from. This will tell me a lot about what the individual might have been routinely exposed to and what maybe comforting and motivating to the individual. The individual experienced whatever the staff in attendance provided for their own motivating experience. So for example, a Caucasian child growing up in an institution with a predominantly Hispanic staff may have more fond memories of Latin Beat Music or songs then for traditional American music or songs. I am not making any judgments here just looking at potentially important history that might give me clues into helping the individual. The conversation should be sharing and form a basis in your mind for determining levels of comfort, pleasure and motivation. I cannot give you a cookbook of questions, just the promise that the joumey of the process will lead you to better treatment and better outcomes and a personal satisfaction! Sadly the medical model no longer allows for this and insurance companies allow for even less, we’ve become revolving door service providers. Ask yourself when I am in their shoes do I want me as a therapist?

So here is a list of ten suggested questions to get you started for the index card:
(Remember it is a sharing conversation not a test and asking why may be helpful.)
1. What is your favorite color?
2. What is your favorite name or nickname?
3. Who is your favorite hero?
4. What is your favorite meal?
5. What is your favorite Holiday?
6. What is your favorite smell?
7. What was/is your favorite vacation place?
8. What is your favorite texture?
9. What is your favorite song?
10. What is your favorite hobby?