Wednesday, March 25, 2015

When you have to Restrain....

The issue of restraining individuals in ICF programs is a touchy one to discuss, plan for or to deal with especially when a surveyor is questioning you about your methods.  Many states, like Texas, do not have a standardized restraint or restraint training for facilities, so most are left up to their own devices to develop a program, seek out one offered by another provider, or just take the chance they will never have to do a restraint.  If you are lucky, you will have a good solid program that you rarely have to use.  Some places are not that lucky.

As some of you know I run a consulting company (My QIDP).  Naturally, I am usually hired when things are going bad.  I rarely get a call that says, "Hey, things are great, survey just left and didn't write any tags, but we were just wondering if you'd like to contract with us?"  No, I get the calls like, "State is in the building now!  We don't have a QIDP!" or "We're in major trouble, these tags are too long and our Q just left!"  Yes, that's when I'm called to try to help.   Recently I went into a program that had a restraint policy and even program they had adopted from another provider.  I wasn't too worried until the provider informed me of the number of "Take Downs" they were doing daily.

Please understand that when I say a "Take Down," I am actually talking about staff members having to physically take a person down to the ground and hold them there for a period of time.  I was surprised to see so many being used.   To further complicate things, the provider's administrator explained to me that he had watched some of these "Take Downs" and felt they were wrong for their facility.  I reviewed the training material, talked with staff, had staff demonstrate some of the maneuvers and returned to the administrator with a grim assessment.  To me it appeared many of these "Take Downs" were actually a form of modified Judo.  They seemed like they could easily become aggressive, and were obviously habit-forming.

After hearing my assessment, the provider asked me to develop a program.  I informed him that I had some information, training, and that I'd be happy to provide a program, but once it was developed I wanted to use it with other providers.  He immediately agreed that it sounded like a good idea so My QIDP set out to develop a program.

The first thing that I had to keep in mind was that complete a "Take Downs" should be the last resort.  This should happen close to the time you're calling 911 in other words.  There is a lot that can be done between the initial confrontation and a total "Take Down".

Because I had worked with several good organizations, served as the staff training coordinator for one, and taught their version of restraints as well as attended several different provider trainings on restraints, coupled with the fact that I have a black belt in Karate, I felt qualified to develop the program.  The goal became to keep restraints to a minimum and take downs to the last resort.

Out of this project was born "ARC".  ARC stands for "Assess," "Restrain" and finally "Contain".  The program is now offered through our website if someone would like to become a certified instructor (My QIDP).  The program breaks down on the three levels as follows:

A - Assess the situation.  Spend time talking to the individual, trying to determine what the problem is, and calming the person down through verbal cues without touching them.  Sometimes the person is mad and just wants to talk to someone.  There's no reason to restrain for that.  You have to talk to the person and try to learn what is bothering them to the point that they may require restraining.

R-Restrain next - If you do have to restrain a person this area should combine talking to the person and gentle restraining.  Several techniques are discussed in the class and demonstrated.

C- Containing a person is the last resort.  You should be close to calling 911 at this point.  A containment requires a full, and safe, take down of the person.  This is usually reserved for the most violent situations.

After we provided training to an initial set of trainers and they in turn trained their fellow staff, the facility saw a 95% drop in containment's in the first month!    Needless to say the administrator was very happy.  The staff were happy too because there were fewer incidents of restraining or containing the people served.

Bottom line, examine your form of restraints that your facility uses.  If they are harsh or you are using them too often, then assess them and determine where the problem is located.  It could be you need new behavior plans or approaches or it may be that you just need to wipe the slate clean and develop a new program that is less aggressive.  You could also contact us (My QIDP) for assistance or training in the ARC Program.  Whatever you decide to do, just remember that restraining someone or even containing someone on the floor should be the last thing you do before calling 911.   If restraints and containment's are use often, sooner or later a staff or individual served will end up hurt.

Sunday, March 22, 2015

Disaster Plans and Buckets

I was recently reading through some articles on survival tips and ran across one about buckets.  Specifically, the article was talking about 5 gallon buckets, the kind you can find for around $5 with the lids at Lowes or Home Depot.   The idea was to use this bucket for anything from rice and beans, to transporting needed water.  The article really gave some good ideas and I began to consider how a 5 gallon bucket could be used in a 6 to 10 bed ICF/IID.

The first thing to know, and hopefully you do, is that most ICF programs are required to have disaster plans.  These plans, in Texas for example, require that you not only have a plan for what you are going to do if you have to stay at the facility, but also what you are going to do if you have to leave the facility and travel somewhere else.  The basic requirements (and certainly not all of them) is a 72 hour supply of food, water, and medications.  In addition you need clothing, hygiene products and other items for each individual in the facility.  With the individual is where I began to consider how a bucket could be used.  In fact, I realized that the bucket could be prepared easily, stacked in storage, and ready to go at a moment's notice.  A prepared bucket for an individual could save you several minutes or longer in an evacuation.  Not to mention, given time you could add items to the bucket that you know you'll need, but may not think about during the disaster (If you think of some others let me know).

So, as I sat thinking about this during some disaster television show such as The Walking Dead (AMC), I came up with a small list of things that I would think a bucket survival package would need.  I would put the heavier stuff toward the bottom of the bucket with clothing items last on the top.  Here's my considered list:

1.  Hygiene packet - these can be purchased at Wal Mart and other stores for about $3-$5 each.  They contain deodorant, shaving cream, toothpaste, a razor, a toothbrush and often some other minor items such as hand sanitizer.  Naturally, you would want to decide what items are needed per individuals and abilities.

2.  Hand Sanitizer - although mentioned above, not all packets have this item and you simply can not have too much of this during a disaster.  A small alcohol based sanitizer could have other uses as well should things get bad.

3.  Clothing - Don't worry at this point about the winter clothing, but instead consider the needed items such as underwear, socks, T Shirts and then put anything like jeans, shirts, etc.  There are several good sites that can teach you how to pack clothing tightly (Example)  It's likely that if the disaster is during the winter, the individual will wear his or her coat for the trip - at least they should!

4.  Information Sheet - on the top of the clothing put the person's information sheet.  This should have diagnosis, medications, allergies, emergency contact numbers, etc.

After you have put the items above in the bucket, put the lid on and snap it tight.  The bucket will keep water out of the items, serve as a seat if needed somewhere and has many other uses in really bad situations.  Regardless of the situation though, you now have 6 (if you are a six bed facility) buckets prepared to go.  Finally, write the person's first name only on the outside of the bucket and stack them in the storage area.

By using a bucket, you will reduce your evacuation time tremendously.  You can have the individuals put their buckets on the van or transport while your staff focusses on the food, water, medical and medications supplies - most of which should already be ready to go as well.

Finally, if you like the bucket idea, you can expand other ways to use them.  A bucket might present a smaller and easier way to manage the food supplies, toilet paper, or even emergency charts during the transportation.  Buckets can keep electronics such as cell phones, radios, chargers, and even a small solar charger ready and dry to be used as needed.  So the next time you head out to Lowes or Home Depot for supplies, be sure your buckets are on the list.

Thursday, March 5, 2015

Avoiding the "Duck Syndrome"

Several years ago I first used the phrase "Duck Syndrome" to describe a large group of people with developmental disabilities accompanied by one or two staff going to an event or a store together.  The thought came to me after I watched a group of six people enter a store with a staff member at the front of the group and a staff member at the back of the group.  The group walked through the store, picked up the one item they needed, walked back to the counter, paid for it and walked out in single file.  It seemed to me that it looked like a group ducks walking together.  The thought and phrase wasn't to belittle anyone, it's just a fact.  That fact is they all looked like little ducks following the mother duck through an area.  It was a syndrome I hated seeing for two reasons.  First, it draws attention to the group.  Everyone looks and notices the group walking through the store.  It's bad enough they all road the van with the handicapped plates to the store together, but now they had to all walk through the store for one item.  Second, it served absolutely no purpose whatsoever.  What were the people with disabilities learning?  How to walk through a store, pick up an item and let the staff pay for it.  That was about it.  There was no training from the staff on what they needed, why they needed it, how much it would cost, how to pay for it and count the change....nothing.  The entire "parade" through the store only served to pick up a needed item and walk people in and out of a store.

Since that time I have hated the idea of mass groups going somewhere for one event or one need.  I've seen it with physician appointments (one person has an appointment, but ten go!).  I've seen it with shopping trips, trips to the zoo, trips to the mall, trips to parades and even trips to events like Special Olympics.  It's degrading and wrong, but supporters (of the Duck Syndrome if you will) have some valid points of concern.  They say that if they don't line everyone up and walk through a store or event, someone will get lost and they (the staff will get in trouble for it).  I also hear the excuse of they simply do not have enough funds to have staff for "individualised outings" There is actually merit to both of these arguments.  In the ICF setting, the regulations and funding cuts have made it tough to ensure individual outings.  But there is ways to try to avoid the problem.

Consider the following solutions if you find yourself working in a facility where the "Duck Syndrome" is used frequently:

1.  Asses your staffing ratios - can you increase it so that everyone is not forced to go on a march?

2.  Consider bringing in staff for special events - can you bring in an extra staff during a scheduled appointment time, or for a special event?  Sometimes that person could be a part-time person or a staff flexing a schedule a little.

3.  If you have to go somewhere together consider the staff dropping off one staff and the person(s) who needs to go to the event or appointment and then taking others somewhere else.

4.  Consider breaking the group up - if you have six to ten people, can a staff go with four or five and another staff go with the others?  If you're in a restaurant, nothing says you have to all sit at the same table, ask for and even have a few tables around the restaurant for two or three individuals only.  Have your staff monitor the room.  In the movie theater, you don't all have to sit on the same row.

5.  Look at the schedules - does everyone go to bed at eight, but yet you have two people or more working until ten or later?  If so, flex those schedules to where those people can help out during the special events.

Ultimately, whatever you decide to do as the QIDP, always put yourself in the place of a person with disabilities.  It could easily be you walking in that line through the store to pick up one item.  How would you feel if you knew other people in the store were looking at your, even staring at you?  How would you feel to walk through a store with ten other people just to pick up one item?  Would you want to be in the "Duck Syndrome"?  I'm betting the answer to most of those questions is "No" or "Not really feeling good about this."  If that's what you're thinking, then you need to work to find a way to avoid this syndrome.  The people you serve have been singled out and handed a rough hand in life already.  It's your job to take that rough hand dealt and make it better.  As the QIDP you have a unique opportunity to make a difference and to make that difference in someones life......don't let that opportunity slide by you for the convenience of something like the "Duck Syndrome".