But their effectiveness has impressed the professional Developmental Disabilities community enough to make the O’Keefe’s go-to people in crisis situations, including them in the plan for a Youth Respite Crisis Center planned for Oesterlen Services for Youth.
Said Kathryn LeVesconte, director of clinical and community services at Oesterlen, “they’ve been instrumental in teaching families how to work with their tough, challenging kids in a way that’s more effective.”
“You can’t really look at them as a provider, even though they’re paid for their services,” said Scott Jones, path coordinator for Developmental Disabilities of Clark County.
“They go beyond that,” he said, and they do it time and again with the most difficult clients.
Cara Neal, whose 16-year-old son Christian lived with the O’Keefes for months and still spends two weekends at months with them to give her family a rest: “I don’t know where Christian would be if they didn’t come into my life. I truly believe, in my own heart, that they have saved my family.”
“Back in Ireland, Sarah’s brother talked us into fostering mentally challenged kids,” Joe O’Keefe explained. “We had some pretty profoundly affected children: blind, non-verbal, medically fragile.”
“We didn’t get paid for that,” Sarah added. “We did it on a volunteer basis.”
They immigrated when Joe was one of 100 truck drivers hired by an American company. For four years, he drove while she did foster care for special needs people. Then Joe got back into the the mental health field at Adriel School in West Liberty and Oesterlen Services for Youth in Springfield.
“When you do the job we do you have to figure out as you go on where you fit,” Sarah O’Keefe said.
While her husband has no difficulty working with young sex offenders who are acting out, “mine is more with autistic (children) — the sneerers, the spitters the biters,” she said.
She said the two of them “tag team” on solving problems in the developmentally disabled arena, especially when there are mental health issues involved.
“Now you’ve got a lot of individuals with dual diagnoses,” she said.
And although more seem to be coming into the system, not a good sign, Sarah O’Keefe said “the younger we get the individual the better.”
“Most of the kids are dumped on our door with a bag,” she said.
The children are often confused and in crisis, as are their families at that point.
The O’Keefes say the “Gentle Touch” model is as close a model as exists to what they do, and Joe O’Keefe remembers spending six months desensitizing a client to touch by “walking by him and touching him on the head real quick” while walking on.
“Now I can go up and rub his head.”
The touch helps to make it possible for severely autistic children to be in closer proximity to other people, helps the O’Keefes establish a relationship with them and serves as a route to providing positive reinforcement of the sort most people associate with a hug.
Because of the severity of the problems of their clients, “it normally takes up to 30 days” to figure out the nature of the problems, a time in which they often have to push the behavioral buttons that set the clients off, Sarah O’Keefe said.
During that time, they have to be aware of their own physical safety and their clients.
Sarah O’Keefe said that in helping Christian Neal, “I just stood up to him and didn’t back down. Face to face, give him that eye to eye contact. They smell your fear. He didn’t smell that fear.”
After that, she said, “he didn’t have that anxiety” over knowing who was in control.
But even reaching that important milestone has its hazards, she said.
“When they realize you’re not afraid of them, they’ll try to hurt themselves,” she said.
In that instance, it’s important to provide a safe space for the child to throw a major tantrum because “he has to be allowed to vent,” she explained. That’s critical for non-verbal people who “can’t express it any other way, except through behavior.”
Cara Neal said it was five years ago when Christian “started to become aggressive to himself and others,” flying into a “manic rage” even by things as simple a part of family life as going to the store for groceries.
Four years ago, “he started targeting his younger siblings,” of which there are three, two with autistic issues of their own, she said.
When he started pulling their hair and choking them, “I felt I had to choose between Christian and (the safety of) my other children,” she said, fearing she’d do further harm to Christian in the process by leading him to believe she was giving up on him.
“It was so heartbreaking. I didn’t want him to think I was giving up on him or didn’t love him.”
After the O’Keefes spent months learning how to manage Christian’s behavior, they taught Mrs. Neal what worked for them: to spot the signs of a coming episode and intervene so it doesn’t spin out of control; to redirect his attention by offering a snack or counting to five with him and breathing deeply; to let Christian know others are in charge of the situation; and to make sure he’s in safe surroundings if the situation worsens.
Mrs. Neal said one important lesson is not feeling sorry for him “and not letting him get away with anything you wouldn’t let anybody else get away with.”
The same techniques, she said, have worked with her other children.
If the idea is simple, the reality of it requires an iron sense of patience.
“We had one child once who hated stores,” said Joe O’Keefe. “So we’d bring him to Kroger’s and he couldn’t make it past the vegetable aisle.”
“It must have been eight months” until he was able to make it to frozen foods, he said. But when he did “we had a party.”
Said Sarah “We have parties over the simplest of things.”
The point was not that they had made it that much farther in the store but that his behavior had changed to the point that he could function well in what had been a situation that made him come apartment and made living with his family almost impossible.
“They’re always focused on maintaining people in their family,” Jones said.
And being able to re-integrate children into their families has benefits not only for the family. As expensive and time-consuming as it can be to manage children’s behavior in this way, having families like the Neals care for special needs children at home is much cheaper than the public paying for residential care that runs into the hundreds of dollars a day.
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