Positive Intervention Culture Initiative A challenge has been put forth to those within the state of Ohio to work towards reduction and eventual elimination of aversive interventions, especially timeout and restraint except where there is imminent risk to health and safety.
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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: [email protected] 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 - [email protected]
Heidi Taylor, Behavior Support Consultant Office- 614-466-2755 Cell- 614-302-1152 [email protected]
Ginger Curtiss, Behavior Support Consultant Office- 614-466-2755 Cell- 614-302-1140 [email protected]
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