Positive Approaches Journal, Volume 14, Issue 2

Volume 14 ► Issue 2 ► September 2025

Transforming Lives with Technology

Stephanie Williams, LCSW

As a residential provider, we are frequently called to think outside the box when it comes to delivering services in a person-centered environment and in a way that fosters true independence and autonomy, not just the illusion of it. Many of the things that you or I control daily, individuals in services cannot control. For example, you or I would get to choose who we live with or if we’d like to live alone. We would be able to dictate who we let into our homes, and most likely, would not be required to have another person monitoring us 24/7. With our freedom, we would not have daily documentation completed for us about the bad mood we experienced or the medication we didn’t want to take. As residential providers, we frequently face these situations that cause a multitude of challenging behaviors. So, what do we do about this? How do you change behavior when the function of the behavior is to escape from the services themselves? The answer is independence. But independence is not always easy to achieve. It sounds easy, when we say, “our goal is to provide individuals in services with an everyday life,” but how many providers truly do that?

One of the biggest dilemmas we experience in this difficult, yet meaningful pursuit is balancing risk with self-determination and autonomy. The best way to illustrate this idea in action and demonstrate the core philosophy of our agency is through an example. For this purpose, the name of the individual has been changed to maintain confidentiality, but the circumstances and outcomes are real.

Meet Mike: Mike is 24 years old and has lived in residential services for the last six years. Mike is an exceptionally intuitive young man with a loquacious nature. He enjoys, quite frankly, what a lot of other 24-year-old young men enjoy. Mike wants to go to the bar for a beer, play video games all night, make content for YouTube, start his own business, banter with friends, and have his girlfriend live with him. However, over the last several years, all those typical desires have made it difficult to support Mike in a traditional three-person community living arrangement, due to the inherent restrictiveness of the setting compared to living without services. Mike is also very self-conscious about telling others he lives in a CLA and that he has support staff. He is embarrassed, to say the least, which is understandable when you put yourself in his shoes.

Over the years, Mike has been the topic of many interdisciplinary meetings due to the challenges his behavior was presenting, such as false allegations toward staff and housemates, eloping from the home, property destruction, verbal aggression and disrespect toward community members, and discontinuing services altogether with no stable plan for living.  Due to the behavior, he was moved to several different homes and eventually ended up with 1:1 support in a one-person CLA. The team continued to try to modify the environment and external stimuli, but outcomes did not improve as intended, and the power struggle continued. Mike continued to feel like a “prisoner to the state,” despite the attempts to incorporate new strategies, being offered a variety of opportunities to thrive, and an increase in his supports. Why? Because the solutions being offered did not meet his need and desire for autonomy and independence, therefore, the behaviors did not decrease. The more supports we offered, the more the behaviors increased in frequency, duration, and intensity.

Following a critical incident in which Mike was charged with harassment, which lead to being involuntarily admitted for psychiatric care, and having a PFA placed against him, we decided to take the opposite, more “risky” approach and give Mike as much freedom and independence as possible. We chose to honor his desire for autonomy and self-determination even though it was risky to remove physical staffing. The team worked together to incorporate remote support services for Mike, which included audio/visual cameras, sensors, geolocation watch, and a two-way communication tablet. Remote supports provided Mike with the independence and autonomy that he so desperately desired. Although there was a lot of rightfully-placed hesitation leading up to the implementation, the team agreed that all other traditional options had been exhausted.

Within two weeks, the challenging behavior we had been seeing for six years had dropped by almost 85%. Mike seemed like a whole new man! His overall mood improved drastically, and his willingness to practice and engage in prosocial behavior increased. He began to take responsibility for his own physical well-being and didn’t rely on his “slaves” (direct support staff) to meet his needs nor to protect him from natural consequences he may encounter. Mike continues to thrive, and his story is a testament to the importance and impact of truly practicing what we preach about an everyday life and the idea of respecting self-determination, even if it is risky. If provider teams can balance risk versus autonomy with creative solutions like remote supports, we can impact the hearts and minds of individuals in our care more than we ever thought possible.

As a provider agency, it would be easy to turn away all the individuals who are complex and require creative solutions, but in reality, that is not what is needed. We live in a world with people, and people are complex to say the least. People are more than their diagnosis and their challenging behavior. Understanding and implementing creative and self-determined supports should be the goal of every agency and every support team, however we still have a lot of work to do to make creative solutions the norm.

Biography

Stephanie Williams is a Licensed Clinical Social Worker and is the Executive and Clinical Director at Independent Living LLC, a residential provider agency operating in Luzerne County. She has 11 years of experience providing services to adults with IDD/autism. Stephanie’s professional interests include promoting person-centered, ethical, and sustainable approaches within residential settings, with a specific focus on developing autonomy and self-determination.

 

Contact Information

Stephanie Williams, LCSW

Independent Living, LLC

Executive Clinical Director

Email: s.williams@independentlivingllc.com
Phone: 570-486-9616