THE RUAL SETTING

One of the criticisms of farm communities is that they are away from the city, isolated from the general stream of life. Some think that’s a negative feature. Brookwood picked its location, with 475 acres, because it was far enough out so they didn’t have to worry much about security. It’s less true today, but there are no fences, and there is still no sign posted to keep people out. It’s just a neighborhood, yet close enough to the city to take advantage of one of the best medical centers in the world. There is also easy access to Houston’s wonderful art and sport centers. They can take advantage of all these things, while even closer is the West End of town. It grew towards them faster than they ever thought or would have believed it would. This has not really been a disadvantage, because Brookwood’s large piece of property and that of their neighbors, still buffer them from any encroaching commercial development.

The people in the local community are touched by Brookwood’s presence in number of ways. Sunday mornings Brookwood residents go off to their own choice of the local churches. They play softball games in the local softball tournaments. Neighbors are invited to Brookwood’s festivals. People don’t hesitate to drive thirty or forty miles to come to the horticulture center on Brookwood’s grounds to buy plants and crafts. Staff members come from a thirty mile radius.

THE HEALTH CLINIC

In the Health Center, there are an exam room, the nurses’ office, a two person sick room for contagious illness, and a medical records room. In the medical records notebook, the nurses log medications for illnesses as well as everyday psychotropic or other medications.

Even vitamins are logged. They enter, and keep up to date, physician’s name, address, phone number, family contact, and emergency contact for each student taking medicine.

The two registered nurses are on site Monday through Friday. Then on the weekends, trained staff provide needed services, while the nurses are on call. If someone is really sick, or in case of emergency, 911 is called. For minor problems, the teachers take care of the students in the homes. The nurses are responsible for ordering medications, based on the doctor’s prescription. Then the nurses train the staff as to what the medication can do, and how to deliver them. Then they monitor the delivering of the medication, as the home teachers in the residences hand out medications at meal times. This is a double check system, understood and endorsed by the parents, that works quite well.

In the state of Texas, there is a real push concerning medication. If at all possible, the state says, a person should be taking his or her own medication. With many at Brookwood, however, that would be very dangerous. They are at Brookwood, because their families have determined that they cannot take that responsibility.

Medical Complexities

When residents at Brookwood become sick, they do not always display typical signs of their illness. Apnea can be hard to identify and difficulty to treat. Patients don’t communicate their discomfort in specific ways. A twisted bowel, can occur without a fever and without signs of pain.

A woman with an obsessive compulsive disorder, likes to draw pictures. She whittles the crayons down to almost nothing. She uses half a bar of soap every time she bathes. She just rubs and rubs until the soap is gone. When she is planting, however, she does a splendid job. She sticks with her task and perfectionistically fills each pot.

Psychiatric Liaison

The National Association on Dual Diagnosis is composed of leaders working with adults with mental retardation and other mental and emotional conditions. Their goal is to help physicians and psychiatrists improve their diagnosis of emotional disturbances in this population. Beyond using medications to reduce acting out behaviors, they have learned, for example, more about what an anxiety disorder looks like for somebody who is forty years old, has Down Syndrome with mental retardation. They identify panic disorder, depression, and situational problems in this population, and provide more specific reasons for a person’s disturbances. Through such careful diagnosis, treatment can become more sophisticated.

For this knowledge, Brookwood works closely with some neuropsychiatrists. A neuropsychologist on the Brookwood staff works as a psychiatric liaison. If, for example, a resident is functionally poorly, not eating or sleeping well and not wanting to work, she will gather all the background information from the the family, from the home teachers, the work teachers, and from medical file. She will put together a report and take him to a specially selected psychiatrist. The psychiatrist will want to look at the resident’s environment and his work schedule. He will prescribe medication that will be tried for a period of time. The liason then brings the information back, teaches the staff what the doctor has said, informs the parents of the recommendation, and then Brookwood staff, as a group, decides how they will proceed. Then if they adopt the recommended plan, they then monitor it and provide feedback to the prescribing psychiatrist. The nurses keep track of the medical aspects of the plan, while the psychiatric liaison is responsible for pulling together all the elements of that persons life.

Over the last fifteen years of this program, Brookwood has learned that at any given time, about thirty of their people are stressed. They are not always suffering severe psychiatric distress, but rather, some kind of anxiety, or emotional problem. Over time, almost 100 percent of them have been affected one way or another, sometimes needing medication, sometimes not. Since this population reacts in idiosyncratic ways to psychotropic medications, their use must be judicious, and where possible reduced and/or discontinued over time.

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