Legislation and Promising Practices for Reducing Restraint & Seclusion Use Restraint and Seclusion...
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Transcript of Legislation and Promising Practices for Reducing Restraint & Seclusion Use Restraint and Seclusion...
Legislation and Promising Practices for Reducing Restraint & Seclusion Use
Restraint and Seclusion in Foster Care
Presented by Lloyd Bullard, M. Ed.
LB International Consulting, LLC.
Legislation
Children’s Health Act of 2000 (H.R. 4365)
Signed into Law October of 2000 by President Clinton
The Act contains two significant section:– Part H and;– Part I.
Children’s Health Act of 2000
Part H - applies to public and private general hospitals, nursing facilities, intermediate care facilities, or other health care facilities
Part I – applies to public and private non-medical, community-based facilities for youth (as defined by the secretary)
Children’s Health Act of 2000
Part I – required physical restraints and seclusion to only be imposed in emergency circumstances and only to ensure the safe of the child, staff or others
Other less restrictive interventions would have been determined to be ineffective
Children’s Health Act 2000
Restraints or seclusion are imposed only by an individual trained and certified by state recognized body (as defined by the secretary)
Interim Procedures – Supervisory or senior staff with training in restraint and seclusion who is competent to conduct a face-to-face assessment (as defined by the secertary)
Supervisor or senior staff continues to monitor the situation for the duration of the restraint or seclusion
Secretary 6 months to develop standards/States 1 year to develop standards once the Federal standards are implemented
Foster Parents and Restraint & Seclusion Use
Cornell University’s Research – Numerous focus groups with children in foster carte and foster parents
Cornell has refused to train foster parents on restraint techniques.
Based on children perceiving that the foster parents were attempting to hurt them
Liability issues related to safety risks
Why So Many Restraints?
Caretakers say:– It’s the clients.–They have such severe problems–They often put themselves, other
clients, and staff at risk.– It’s necessary to keep everyone
safe.
But Some Studies Suggest Otherwise
Programs serving similar children have widely varying rates of restraint.
Some programs serving very difficult children have low restraint rates.
Many programs have significantly reduced restraint without changes in their populations.
What is it about us?
Our belief that the problem lies with the clients
Focus on management and control as opposed to support and teaching
Lack of staff skills in effective de-escalation
Bad News or Good?
Being identified as the source of the problem may sound like bad news or an indictment of caretakers.
But it’s actually good news.– If it really were the clients, we’d be stuck
doing thousands of restraints forever.
– If it’s us, we can do something about it.
The Issue Brief(NETI, 2003)
Reducing the Use of Restraint and Seclusion: Promising Practices and Successful Strategies
– An issue brief that annotates policies and practices that successfully reduce the use of restraint and seclusion
Chapters• Leadership• Organizational Culture• Agencies’ Policies, Procedures and Practices • Staff Training and Professional Development• Treatment Milieu • Continuous Quality Improvement
The Issue Brief
Information pulled from a variety of sources as outcomes and data on children is scarce
• Project’s own preliminary quantitative and qualitative findings
• Subject matter experts• Focus groups findings (Federation of Families
for Children’s Mental Health - FFCMH)• Published research findings
Leadership(NETi, 2003)
Supportive Executive Leadership– Identify Restraint and Seclusion as a Top Priority
• Sustained commitment by the executive leadership team.
– Set the Tone• Mission statement supports a violence- and
coercion-free environment• Restraint and seclusion are crisis events, treatment
failures, and high-risk interventions• Leaders must model the interest, time commitment,
and “sell” the initiative to managers and direct care staff
Leadership(NETI, 2003)
Supportive Executive Leadership continued:– Provide Training and Resources
• Emphasize training in alternatives to restraint and seclusion
• Ensure integration of training into practice
– Establish an Oversight Committee• Include executive leaders, managers, supervisors,
direct care staff, family members, children, and advocates
• Committee empowered to implement changes
Leadership(NETI, 2003)
Supportive Executive Leadership continued:– Take Responsibility
• Administrators shoulder the burden of reducing restraint and seclusion
– Maintain Accountability• Executive leader(s) on-call 24 hours a day to whom
each incident is immediately reported
Leadership(NETI, 2003)
Supervisory and Managerial Involvement• Set the Tone
– Send a clear message
– Support coercion-free environment, partnerships, choice, and proactive communication
– Elimination of the unnecessary use of restraints and seclusion is paramount
• Model and Coach– Alternative approaches
– High expectations, time commitment, training resources, 24 hour on-call support
Leadership(NETI, 2003)
Supervisory and Managerial Involvement continued
• Lead Debriefing– Exercise for learning not punishment
– Gather data
– Discuss
– Document timelines
Leadership(NETI, 2003)
Elimination by Mandate • Banning restraint use or types,
eliminating of seclusion rooms, or use of prns
• Constant vigilance and ongoing training in de-escalation
• Requires emphasizing behavioral support instead of emergency intervention
Organizational Culture(NETI, 2003)
Relationship Building– Facilitates support of positive behavior – Helps de-escalate children in times of crisis
Healthy Relationships are developed over time
Organizational Culture(NETI, 2003)
Person-Centered Environment– Needs of the child are at the forefront of care– Use supportive language, and express an
unwillingness to label children as “manipulative” or “needy”
– Emphasize collaboration rather than compliance– Offer culturally and linguistically competent
services
Organizational Culture(NETI, 2003)
Staff Empowerment Youth Involvement Family and Natural Support Involvement
– Treatment Planning– Programming– Participation on Review Team– Advocacy
Agency Policies, Procedures and Practices(NETI, 2003)
Comprehensive Assessment• History of aggression, and the physical, psychiatric, and
emotional risks of restraint and seclusion• Inform the behavior support and treatment plans
– Treatment Planning• Individualized and strengths-based • Developed in conjunction with child and family
– Individualized Behavior Support Plan• Identify triggers, successful intervention strategies, and
options for self-calming• Communicated to all relevant staff• Revisited regularly
Agency Policies, Procedures and Practices(NETI, 2003)
Monitoring– Face-to-face, third party – Assess the physical and psychological well-being of child– Authority to stop intervention if signs of distress are evident
Debriefing– Occurs with the child, witnesses, staff, and family
members– Express feelings about the incident and to make a plan to
avoid for incidents – Debriefing does not assign blame– Should be carefully documented
Staff Designated to Implement Restraint and Seclusion
Staff Training and Professional Development(NETI, 2003)
Training on Trauma-Sensitive Care, Prevention, and De-escalation– AT LEAST 50% of all training should focus on these three
core elements Competency-Based Training Culturally and Linguistically Competent Services
– Tones, gestures, and postures that may be misinterpreted by youth
Frequent Refreshers to Minimize Training Drift Regular Staff Supervision, Mentoring, and
Coaching
Treatment Milieu(NETI, 2003)
Treatment Philosophy– Coercion-free and non-punishment based
Trauma-Informed Care– Culture of empathy– Acknowledge that most children have experienced trauma– Restraint and seclusion is re-traumatizing– Staff should know signs of trauma
Positive, Structured Environment– Requires active programming– Well-maintained environment
Behavior Support – Give children anger and anxiety management skills.– Constant role playing.
Continuous Quality Improvement (CQI)(NETI, 2003)
Setting Organizational Goals Collecting and Analyzing Data Reporting Results Corrective Feedback Mechanisms Celebrating Successes Program Evaluation
Best Practice Guidelines For Behavior Management
Ethical & Legal Framework Administration & Leadership Continuum of Intervention Medical Issues Professional Development & Support
for Caregivers.
Reducing the Use of Restraint & Seclusion: Promising Practices &
Successful Strategies Leadership Organizational Culture Polices, Procedures & Practices Training & Professional Development Treatment Milieu Continuous Quality Improvement
Best Practice Guidelines for Behavior Support & Intervention
Training
Organizational Leadership & Culture Behavior Support & Intervention
Training Programs Risk Factors Emergency Interventions Training Process
Supervisors Training Curriculum Changing Organizational Culture Behavior Support Plans Program Factors Family Involvement Diversity Issues Reward & Consequence Systems Supervisory Role No Blame Culture De-Briefing
State Regulations Definitions
Criteria
Monitoring
Ordering
Post Assessment
De-Briefing
Family Notification
Training
Documentation
Reporting
CQI Plans
Prohibited Practices
Data Collection
Reduction Plans