addressing day to day risks with the team - part 2 1 · welcome to addressing day to day risks with...

Pennsylvania Department of Human ServicesOffice of Developmental ProgramsCourse Number: C-018-02

1Addressing Day to Day Risks with the Team - Part 2

Pennsylvania Department of Human ServicesOffice of Developmental Programs

This webcast includes spoken narration.

To adjust the volume, use the controls at the bottom of the screen. While viewing this webcast, there is a pause and reverse button that can be used throughout the presentation.

The written version of the narration appears to the right of the screen.

Course Number: C-018-02



Certificates of Achievement will be available to Administrative Entity staff, Providers, Supports Coordinators, and SC Supervisors after completing all course requirements. Please view and then save or print your certificate in order to receive credit for this course.

For SCs and SC Supervisors, course requirements include successful completion of a pre‐test and post‐test.




Hello, my name is Amy Tomalinas. I am a Risk Management Specialist with the Office of Developmental Programs and will be presenting this training.

Welcome to Addressing Day to Day Risks with the Team, Part 2, Balancing Safety and Acceptable Levels of Risk.

This webcast is the second in a series. If you have not yet completed the previous parts, please do so before continuing. All six parts of this webcast series will need to be completed in order to receive credit for this course.

We’ll begin with a review of the main points of the first webcast.




In the first webcast, you heard Adam’s story, the young man who grew up in a hunting family and wanted to hunt with them, despite the risks. Adam’s story illustrated how what is important to a person can be achieved by developing a plan to address risks. Adam’s accomplishment of becoming a hunter shows that an effective risk management system balances responsibility for safety with promoting independence and self‐determination.

Part 1 also reviewed the distinction between risks which are imminent and require action to ensure health and safety and those which are non‐urgent and allow time to plan and strategize. Non‐urgent risks will continue to be the emphasis during this webcast.

The Risk Mitigation Cycle demonstrates a step‐by‐step process for addressing risk: recognizing risk, assessing it, developing, implementing, and evaluating the effectiveness of risk mitigation strategies. Remember the center of the risk mitigation cycle –documentation and communication; we’ll spend some time talking about documentation later in this webcast.

The terms sentinel event and milestone help set the stage for a deeper discussion of risk. Sentinel events are adverse events that may happen for one person, but also cause systems to stop and take notice in order to develop strategies that reduce the likelihood that others could be affected.

Milestone events are those which we celebrate in our lives – big events like starting families or finishing education. Taken together, sentinel events and milestone events can be a reflection of how all our lives unfold. Risk is a part of life, and without taking risks, there is no opportunity, change or growth.




The focus of this six‐part series is to provide tools and strategies for teams to use to recognize and record risk; and to practice critical thinking skills in developing proactive person‐centered risk mitigation strategies to assure that risks are addressed.

In this Part 2 webcast, the objectives are to identify and implement strategies that recognize an acceptable level of risk and need for support; utilize new tools in preparing for discussions on risk mitigation and understand the role of the team in supporting a person to make informed choices.

The tools, concepts and strategies presented throughout the series will help you to work collaboratively with teams to have person‐centered conversations on how to address risk.




Remembering the Part 1 webcast, we said that the goal of zero incidents is unrealistic. People have the right to take a risk and have the right to fail. This is the core concept of the principle called – Dignity of Risk.

In other words, any person living a life with dignity routinely takes risks of different degrees. Sometimes we try new things and it doesn’t work out as expected. But we tried, had an opportunity to learn something about ourselves and maybe found out something new along the way. For example, promoting opportunity for employment, new friendships or personal adventures is achieved by determining an acceptable level of risk and putting the right supports in place to reduce the risk.

It is the role of the team to have meaningful conversations about dignity of risk and work with the person to make decisions that balance risk and opportunity.




Principles of Risk Management as identified on this slide stress:

‐ Protection from harm, including from abuse, neglect and exploitation

‐ Quality of Life as defined by the person

‐ Safety is everyone’s responsibility; people are trained and skilled in providing services and supports and

‐ Collaboration is integral to ensuring safety

Underlying the principles of risk mitigation is the idea that conversations will be required and while creativity might be required; it will surely help.




Keeping conversation and creativity in mind, let’s talk about a man named Vinnie.

Vinnie is a guy who likes to get around and do things in his home town on his own. He bowls in a local league and hangs out with his friends there on Thursday nights. He likes going to movies for matinee discounts on Wednesdays and meets up with his friends there too.

Vinnie lives in the ‘in‐law’ apartment above the garage at his parents’ house and comes and goes as he chooses.




I have just told you a little bit about Vinnie but in these few sentences we can begin to identify what is important to Vinnie. Think about Vinnie for a moment and type into the text box some things that you guess are important to Vinnie.




Vinnie’s team identified the following as important to Vinnie. Did you think about the same things?

Important to Vinnie are:

His friends

Bowling

Movies

Being out and about on his own

Living near his parents

Choosing what he does and when




To continue the story . . .

Recently Vinnie has gotten lost on the way to the bowling alley and to the movie theater. Because of this, his parents are very concerned about his safety when he is going by himself to town.

At this moment, it is important to recognize that there is a crossroad decision about to be made in Vinnie’s life. The team can decide to restrict Vinnie, hold him back from some of the things that we know are important to him. Or the team can use their creativity to help Vinnie move forward with supports and take an acceptable risk.

It is time for a conversation.




This tool Framing a Conversation about Risk with the Team, is a new resource for you to use to help the team to think about risk to be sure that the conversation includes both the potential for harm and the possibility of lost opportunities. This is not a required form, but rather something that the team can use to better understand the importance of balancing what is Important To the person (happy, content and fulfilled) and what is Important For the person (health and safety).

Let’s review the chart first.

‐ The first column identifies the people who might be part of the conversation. The team looks to include multiple perspectives to be sure that a full picture is developed. Of course, the person (in this case Vinnie) would be included and then other team members.

‐ The second column identifies the negative impact if the risk is not addressed. What bad thing might happen if the risk is not addressed?

‐ The third column provides the balance by identifying what opportunity will be lost to the person if we cannot figure out the support needed to take the acceptable risk? In other words, what are the things that are Important To the person that might be gone if the person’s need for support is not met.

‐ And the fourth column is where the team can use their creativity to brainstorm alternatives and come up with ideas for how to address the risk to reduce the likelihood for harm while helping the person to have a life that includes growth and opportunity.




Let’s practice using this chart by pretending that we are a member of Vinnie’s team. We know that Vinnie is getting lost but how can we use this chart to see the balance needed between the risk of harm against the lost opportunity?

So, if we do not address Vinnie’s risk of getting lost, what is the possible harm or consequences to Vinnie? Enter your ideas into the text box in this column and click Enter when you are finished.




Here are some of the concerns that the team had for Vinnie in terms of possible harm or the negative impact in getting lost.

‐ He could be really lost and never found

‐ He might be victimized

‐ He might get so scared that he chooses to stay at home

‐ His parents would be so worried that they would not let him go alone to town to be with his friends




Now, let’s consider lost opportunities. What may be lost to Vinnie if the team is not able to provide the supports to take the risk? Type your answers in the text box and click Enter when you are finished.




Here are the possible lost opportunities (the things that Vinnie would miss) that the team identified if we don’t support Vinnie to be in town on his own.

‐ Confidence and self esteem

‐ Friends

‐ Things he likes to do; that make him happy – like going to the movies and bowling

‐ New people, relationships, interests that he might have found along the way

Identifying the lost opportunities reminds the team why it is important to work on identifying alternatives to help the person take an acceptable risk with support. Conversation that includes creative alternatives can reduce the likelihood of harm while promoting what is important to the person.




And then the last column to be completed asks the team to brainstorm those alternatives that would help Vinnie to address the risk and reduce the possibility of harm.

The team came up with these ideas:

‐ A cell phone GPS

‐Walking or taking the bus with a friend that knows the way

‐ Figure out why he is suddenly getting lost and perhaps do some new skill building

‐Make sure he carries his cell phone and the Find My Cell Phone APP is turned on

The chart that we have been using to identify the risks against the lost opportunities is available as a supporting document to this webcast. While not a required form, using this chart to guide discussion can help teams to balance the focus on health and safety with what is Important To the person.




Now let me tell you the end of the story for Vinnie. Here’s what really happened.

First, the team discussed the assessment of the risk, including the seriousness and likelihood of the risk of being lost in the community. While the team understood Vinnie’s parents’ concerns, team members were able to frame the risk as perhaps not as serious as the parents originally thought.

Vinnie has strengths and skills in crossing the street, stranger awareness, clear communication, and seeking help from people in authority, like the police. The team also highlighted how Vinnie can learn new things and has shown his ability to manage on his own. Reminding Vinnie’s parents of his skills and abilities, helped provide some balance to the worry and allowed his parents to think about how to move forward rather than restrict or take away.

Through brainstorming, and recognizing Vinnie’s skills and abilities, the team came up with different ways that Vinnie could use his cell phone as a support. Vinnie was taught how to use his phone for help and directions if he became disoriented. The team then realized that Vinnie may call for help with directions, but that he might not be able to describe his location. The team then explored various applications for Vinnie’s phone that would assist with directions (for example – GPS and speed dialing functions) that Vinnie could use to safely get around to where he wanted to go. Vinnie’s Community Habilitation service provider taught him how to use those applications.

Team creativity and conversation between Vinnie, his family, the supports coordinator and provider staff made for an effective collaboration that helped keep Vinnie safe while promoting his relationships, choice and control and independence.




We have been talking about determining an acceptable level of risk. Over the next six slides you will see an image; each with their own level of risk. As you see the photograph, think about whether what is shown is an acceptable level of risk for you. Choose your response and when you are finished click next.




Is having a dog an acceptable level of risk for you?




Is eating a bacon cheeseburger an acceptable level of risk for you?




Is crossing a street an acceptable level of risk for you?




How about going to a NASCAR race. Is that an acceptable level of risk for you?




Is going white water rafting an acceptable level of risk for you?




If you are unfamiliar with this pastime – these people are cliff camping. Is camping on the side of a cliff an acceptable level of risk for you?




In considering what is an acceptable level of risk; it is important to remember that the question is asked and answered from the person’s perspective. Even something reallycommon like owning a dog may be seen as acceptable or not acceptable by two different people when considering the same risk factors – cost, allergies, restriction to time. One person says – yes, this is an acceptable level of risk, while another person says, no, I don’t want to take this risk.

Whether it is owning a pet or cliff camping, you had the ability to consider your own interests, strengths and abilities and made a choice that reflects what is important to you.

Let’s listen now to a personal perspective on risk, choice and decision making from a woman named Olivia. As you listen to Olivia think back to our previous discussion about the Dignity of Risk.




This video, from a self advocate, stresses the need to explore with and find ways to understand and support individual choice making that the team might disagree with.

Addressing Day to Day Risks with the Team, Part 2

Course Number C-018-02

28


One health care decision that is common for all of us is whether we take the medication that is prescribed for us. But if a doctor told us to take a medication, why would we try to stop or change what was recommended? Finding out the reason why, asking the question – why does the person want to do something risky to their health – is the place to start.




There are many different reasons why people decide to stop taking medication. In our own lives, we probably have examples of medications that have not ‘agreed with us’.

Some medications may make us drowsy when we should be alert. The medication may cause a stomach ache or some other uncomfortable side effect. For some people, the cost of the medication is too high and they simply cannot afford it. There are certain medications that might make a person feel self‐conscious. Maybe there is a problem with access to the pharmacy. Or maybe the person does not like or trust the doctor.

Finding out the reason why someone is making a risky choice is the core concept. Reviewing What’s Important To the Person and What’s Important For the Person can help with these situations.




So once the team understands the reasons why, we can focus our attention on brainstorming alternatives. Here are a few simple alternatives that can be considered in stopping a prescribed medication.

While the example we just reviewed focuses on medication, understanding why and honoring and respecting the reason is an important component in appreciating why people make any risky choice. Understanding the reason can help us to identify alternatives and provide support to address the risk.




Having a conversation to discuss and understand why people take risks can be challenging. Preparing for this conversation can be helpful to you in supporting someone who is taking a risk in stopping a prescribed medication or any other risk.

Here is a suggested model for preparation – the 3 Rs:

Research: The condition or situation, current supports, and alternatives.

Rehearse: How to listen, ask questions, respond to answers in a respectful, non‐judgmental manner, role play, figure out if there is a possible win/win scenario.

Review: Previous history of support, including prior actions and strategies and their results.

Remembering the 3 Rs and spending time in preparation for challenging conversations is time well spent and will assist you in discussing acceptable levels of risk and supports needed.




The last topic that we will discuss in this webcast is ‐ Informed Choice. This ties directly to Dignity of Risk and the thoughts that Olivia shared in her video.

While a person (any person) may choose to do things that put themselves into or stay in a risky situation, the role of the team supporting that person is to assure that the choices the individual makes are informed. So, what do we mean by fully informed.

The person is fully informed when‐ potential risks are recognized‐ potential consequences of taking the risks are understood and‐ alternatives that can reduce the impact of the risk factors are available




As we have been talking about throughout this webcast, taking an acceptable risk is part of every day life. Because of this the team may find themselves in situations where the individual has been fully informed of what may happen should they continue to make risky choices, yet they continue to do so.

To ensure that the individual is fully informed, the team needs to describe a complete array of consequences in a way that helps the person to best understand the choice that he or she is making. Simply saying that ‐ this is the person’s choice ‐ is not sufficient if the person does not have all the information on consequences and alternatives to make the best choice. Teams are encouraged to keep going; to always work to increase understanding and provide support to make better choices.




Here’s an example about informed choice for a woman named Tina.

During a routine monitoring visit to Tina’s apartment the SC identifies some concerns regarding the condition of her home. There were stacks of dirty dishes in the sink and on the kitchen counters; there were broken window blinds; worn and dirty carpeting; and it was apparent from mold, mildew, and stains that the toilet and shower stall had not been cleaned.

Is Tina making an informed choice by living in this way? To answer that question our role is to figure out if she is aware of the risks and consequences. And before we can act to support Tina, we need to ask why. What is the reason that Tina is making these choices. Once we understand the reasons we can then offer alternatives to reduce the risk.




There are several risks to Tina continuing to live in this way. She could become sick or get hurt; her friends and family might stop coming to visit and she could be at risk for eviction and loss of a security deposit due to the condition of her apartment. Identifying the risks and consequences with Tina is the first step.

But it all depends on the reason why and that is the next step to suggesting alternatives. If she does not know how to clean, perhaps someone could teach her. If it is time management, maybe someone could work with her on scheduling. If she does not have money to buy cleaning supplies, perhaps she wants to learn about budgeting and buying off‐brand items. If she is depressed perhaps some supportive counseling would help. And maybe this is partially the responsibility of the landlord and Tina needs information on her tenant rights and support to exercise her rights.

Once Tina fully understands the risks and consequences, and alternatives are suggested based on what we know are the reasons for taking the risk; we can feel more confident that she is making an informed choice.

But our work does not stop when we know that Tina is fully informed. We still need to work with her and the team to identify things we can do to support her if things should go badly; like save money for a new security deposit.

As we have said, identifying and mitigating risk is a continuous, ongoing process. For Tina and all the people you support ‐ the need for new information and help to understand consequences and consider alternatives will be necessary to ensure that the person is making an informed choice.




This concludes Part 2 of the series, Addressing Day to Day Risks with the Team.

Part 3, Person Centered Risk Mitigation, can be located in the course where you found this webcast.




This webcast has been developed and produced by the Pennsylvania Department of Human Services, Office of Developmental Programs in partnership with The Columbus Organization.

Thank you for participating in this lesson.



addressing day to day risks with the team - part 2 1 · welcome to addressing day to day risks with...

Documents