Positive Intervention Culture Initiative - Ohio Association · PDF file · 2016-06-02Positive Intervention Culture Initiative ... Set the plan for the work and ... O H I O D E P A

Positive Intervention Culture Initiative

A challenge has been put forth to thosewithin the state of Ohio to work towardsreduction and eventual elimination ofaversive interventions, especially timeoutand restraint except where there isimminent risk to health and safety.

All people will interact in ways that promote respect,trust, and safe healthy relationships.

I agree to uphold the following values of Positive Intervention Culture withthe people I serve, the people with whom I serve, and the community in

which I serve.

To support others

To strive to meet the needs of others

To work to understand others regardless ofcommunication means

To empower choice making To assist ALLto be and feel safe

______________________________________ ___________Signature Date

Anita Allen, Ohio Provider Resource Association Steve Maenle, Sunshine Inc., NW

Brent Baer, NW Ohio Developmental Center Kelly Miller, Ohio Department of MR/DD

Susan Blum, Independent Consultant Rachel Perlstein, Clermont County Board of MR/DD

Ginger Curtiss, Ohio Department of MR/DD Carla Rinto, Advocacy & Protective Services, Inc.

Chuck Davis, Ohio Department MR/DD Mike Schroeder, Ohio Department of Mental Health

Susan Dloughy, Ohio Association of Adult Services Steve Schwartz, Jewish Family Service Assoc. of Cleveland

Kelly Girts, Butler County Board of MR/DD Scott Phillips, ResCare Inc.

Willie Jones, Belmont County Board of MRDD David Simcoff, Athens County Board of MR/DD

Sandy Kidd, Evant, Inc. Jennifer Sleeper, Viaquest Inc.

Joe Kovesdi, Tiffin Developmental Center Melanie Stretchbery, Wood County Board of MR/DD

Peggy Kurz, Hamilton County Board of MR/DD Heidi Taylor, Ohio Department of MR/DD

Greg LaForme, Medina County Board of MR/DD Pam Walters, Union County Board of MR/DD

Laura Leach, Ohio Department of JFS Cindy Ison, Advocacy & Protective Services, Inc.

Appointed Statewide Behavior SupportAdvisory Committee (SBSAC) Members:

Positive Intervention CultureInformation Notice

Developed in conjunction with the SBSACto provide guidance to individuals andorganizations as they strive to move Ohiotoward the development of the PositiveIntervention Culture.

See handout

Unauthorized Behavior SupportsSubcommittee

Goals:

To collect and review data regarding statewideMUIs involving Unauthorized BehaviorSupports (UBS) (approximately 9% ofall MUIs are UBS)

Summarize data

Make recommendations regarding this data to thefull Behavior Support Advisory Committee

Unauthorized BehaviorSupports Subcommittee

Reviewed MUIs involving UBSs from9/1/07 - 2/29/08

Reviewed a total of 755 MUIs involving UBSs

Consensually agreed the sample was a validindicator of UBS usage

Type of UBS

The most noted UBS report is theManual category, which involvesplacing hands on a person as theintervention, resulting in the UBS.These manual restraints includeEscorts, Basketholds, Held Extremity,Prone and Supine interventions.

Withhold Property1%

Manual87%

Time Out2%

Mechanical5%

Chemical4%

Withhold Food0% (3 incidents)

Privileges1%

# of individuals involved: 583Total # of incidents applicable: 755

Location

The Day Program Workshops include the County Board asa provider.

Another's Residence 0%

Transportation7%

Community5%

Co. Board School 4%

Residence43%

Day Program WS40%

# of individuals involved: 583Total # of incidents applicable: 755

Manual Restraint Type

Egress1%

Carry5%

Held Extremity42%

Basket Hold15%

Prone3%

Supine11%

Escort23%

# of individuals involved: 507Total # of incidents applicable: 663

Manual Restraint TypeWith Time Over 5 Minutes

Held Extremity32%

Carry0%

Escort5%

Egress1%

Supine32%

Prone12%

Basket Hold18%

# of individuals involved: 121

Total # of incidents applicable: 149

Was a BSP in Place?

Yes52%

No48%

# of individuals involved: 583

Total # of incidents applicable: 755

Prevention Plan

Develop BP w/Restraint16%

Develop BP w/o Restraint3%

No ChangesNeeded

44% Train Staff13%

Add Restraint to BP6%

Modify BP16%

# of individuals involved: 583

Total # of incidents applicable: 755

Statewide Behavior Support AdvisoryCommittee

Made up of 4 sub-committees Action Planning Data Collection Crisis Intervention Unapproved Behavior Supports

Action Planning Sub-committee

Set the plan for the work anddirection of the committee.

In 2008: Position Statement Shared the words and philosophy of

Positive Intervention Culture with over700 people.

Data Collection

Developed the Statewide aversivedata collection tool.

Data Collection Begins on October1, 2008

Ohio Department of Mental Retardation and Developmental Disabilities

Aversive Behavior Support Summary

Provider:________________________________________ Month:_____________________

Indicatethe # of

restraintsused

duringthis

reportperiod

#of formalBehavior

Planswith:

Total #Served byProvider

Total #Individuals

w/ approvedaversive

interventionplans

Total #Chemical

Interventions

Total #Manual

HorizontalRestraints

Total #Manual

Restraints(not including

horizontal)

Total #MechanicalHorizontalRestraints

Total #Mechanical

TransportationRestraints

Total #Mechanical

Restraints (notincluding

horizontal ortransportation)

Total#of

TimeOutsTotal #

Person Reporting:___________________________________________________ Phone #:______________________________

Email Address:_______________________________________________________ Date Submitted:______________________

Submit to the attention of Behavior Support Consultant by:Email: behavior.support@odmrdd.state.oh.us orFax: 614/644-5529

Crisis Intervention Sub-committee

Developed the crisis interventionprogram assessment tool.

See Crisis Intervention ProgramAssessment Tool handout.

ASSESSMENT OF CRISISINTERVENTION PROGRAMS5 Categories of assessment

PREVENTIONDE-ESCALATIONINTERVENTIONDEBRIEFINGTRAINING

PREVENTION Does the program emphasize prevention vs. intervention

and allocate time at a 4:1 ratio in this regard? (4 times asmuch total time spent on prevention and de-escalation incomparison to the time allotted for intervention) Does theprogram emphasize quality of life vs compliance? Does theprogram emphasize the importance of respecting theneeds and wishes of the individual in arranging theenvironment, developing of relationships, and providingactivities?

DE-ESCALATION Are the de-escalation techniques based on identification of

risk factors? Does the program teach the staff member the importance

of nonverbal expressions (facial, body, breathing rate)during a potential situation?

INTERVENTION Does the program specify that the purpose of intervention

is protection, that the intervention should be the leastintrusive intervention that provides protection, that theintervention should use the minimum force needed toprotect.

Does the program develop a clear understanding of the“imminent risk” – relating to immediate risk of health andsafety?

DEBRIEFING Does the program require a description of the situation

related to the incident? Does the debriefing process address the issue of re-

establishing the relationship with the client?

TRAINING Is training provided on the length of time

restraint techniques can be used? Does the program curriculum include a variety of

instructional strategies, (e.g., role play,simulation, demonstration of techniques andstrategies, etc.)?

Does the program have a mandatory written testto evaluate classroom knowledge?

Does the program teach the dangers ofasphyxiation?

Unapproved Behavior Supports Sub-Committee

Gathered MUI data on current UBSusage.

Info shared earlier in presentation

SBSAC 2009…

Continue to engage in PositiveIntervention Culture dialog

Develop Positive InterventionCulture “Tool Kit”

Develop Positive InterventionCulture training curriculum

Prioritize aversive techniques tofocus on decreasing.

Prone Restraint

National Survey by NASDDStatewide SurveyData Collection on dangers

FIVE-DAY RESTRAINT ORTIME-OUT NOTIFICATION

FORM

Common concerns:Restraint for verbal aggressionRestraint for property destructionWhat is done not matching what issubmitted on the notification

OHIO DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES

BEHAVIOR SUPPORT PLAN USING RESTRAINT OR TIME-OUT

NOTIFICATION FORM

Individual’s Name: Date of Birth: County:

Time-Out Mechanical Manual Chemical

Type of Intervention

Target Behavior for the

intervention (describe briefly)

Baseline Frequency of Target

Behavior (specify time and

interval)

Maximum duration for one

episode

Was informed consent obtained from the individual or guardian? YES NO

Date of Behavior Support Committee approval: Date of Human Rights Committee approval:

Effective Date of Plan: Author of Plan: Position:

Notification submitted by:

Name Agency & Title Phone

Date Notification submitted: Means of submission: Fax: Electronic Means:

ODMRDD

REGIONAL BEHAVIOR SUPPORT COMMITTEES

Region 1A Region 1B Region 2 Region 3 Region4 Region 5 Region 6

R EGION 1B

REGION 5

REGION 4

R EGION 6

R EGION 2

R EGION 1A

ODMRDD Behavior SupportContacts:

Pam Berry, Senior Policy Analyst - Cell- 614-208-6393 - Pam.Berry@dmr.state.oh.us

Heidi Taylor, Behavior Support Consultant Office- 614-466-2755 Cell- 614-302-1152 Behavior.support@odmrdd.state.oh.us

Ginger Curtiss, Behavior Support Consultant Office- 614-466-2755 Cell- 614-302-1140 Behavior.support@odmrdd.state.oh.us