addressing day to day risks with the team - part 3 1 · 2016-04-26 · addressing day to day risks...

Pennsylvania Department of Human Services Office of Developmental Programs

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Course Number C-018-03

1Addressing Day to Day Risks with the Team - Part 3


This webcast includes spoken narration.

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




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 3, Person Centered Risk Mitigation.

This webcast is the third 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 two webcasts.




In the first webcast, Introduction, Key Terms and Principles, 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.

As a reminder, 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 time talking about documentation later in this webcast.

The terms sentinel event and milestone helped 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.




In Part 2, Balancing Safety and Acceptable Levels of Risk, we discussed that balancing risk and opportunity in our lives is a decision we all make when we decide what is – or is not –an acceptable risk. Each of us decides what we will risk ‐ what we eat and even the things we do for fun, despite the risk. We all deal with risks, small or large, throughout our lives and expect others to respect our right to try – and even sometimes fail. This is the dignity of risk and we take risks to achieve what is meaningful and fulfilling, even when we know there is a possibility of embarrassment, rejection, or failure. Taking these risks can be related to important relationships or accomplishments.

Like the people to whom we provide support, balancing risk and opportunity is not something we do alone. Our choices are based on seeking advice, asking for support and, most importantly, being informed. We weigh potential consequences as well as benefits and try to fully understand what alternatives are available that may help avoid risk. When offering advice to people receiving support who are figuring out that balance, we can be prepared by researching the risks, asking a colleague to rehearse how to best approach a conversation about risk, and reviewing what the person has already tried to address risk.




Here are the overall objectives for this six‐part training series. The focus of the 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 webcast, Part 3 of the series, we will discuss the importance of preparation and conversations and use familiar person centered tools and concepts to support and guide collaborative, person centered conversations to address risk.

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.




As we’ve stated in previous trainings, not all risks are bad. Taking some risks allow us to grow and explore new opportunities. And remember, when we talk about risk, we’re not just talking about the physical risks, but also the emotional risks.

Think back for a moment to the story about Adam we shared in Part 1. Not only did Adam and the people who support him have to think through and plan for the supports needed to mitigate the physical risks associated with Adam becoming a hunter, they also had to consider the emotional risks. This was particularly true if Adam was not successful in passing the Hunter Safety course. In the end, his family’s decision to support Adam’s desire, despite the risks, was made by understanding what all the risks were, knowing or learning what steps each of them could take to reduce those risks, and developing a plan that allowed Adam the opportunity to take the risk, and ultimately benefit from the experience.




Taking some risks allow us to grow and explore new opportunities. When we recognize what the risks are, we can act proactively, before something happens, to decrease the likelihood of any negative impacts and increase the likelihood of a positive experience.




Think for a moment about a time when you applied for a job or promotion. If you choose to apply for the job,

• You risk rejection – not getting the interview or the job.• You risk embarrassment – people knowing that you didn’t get the job.• If you get the job, there is a risk that your work hours could change.• And once you are in the job, you may find that you don’t like it as much as you

thought you would.

Knowing what the risks are and choosing to act proactively, the likelihood of a negative impact from the risk is lessened.




More than likely, some of the things you may have done to avoid these risks the last time you applied for a job, could have included:

• Ensuring that your resume supports your qualifications for the job;• Getting additional training for any areas where your qualifications may be

weaker;• Researching the job to determine the reality of the work hours; and • Talking to people in the same position to better understand the rewards and

challenges of the position.

And by doing so, you put yourself in the best position to not only be considered for the job, but also to increase the chances that you’ll get that new job and be happy in that job.




Being proactive is about focusing your efforts in helping yourself and the team to understand all that may contribute to the risk, both positive and negative, before trying to develop a strategy to reduce or resolve the problem.

And as Albert Einstein said: “If I had an hour to save the world, I’d spend 55 minutes defining the problem”

If you invest the time defining or understanding the risks, that preparation and the information you gather, will help identify strategies to effectively address the risk and increase the likelihood of success.




Being prepared means being informed. It means having or getting the information you and the team need to identify, understand and address the risks.

As a reminder for Supports Coordinators: The time you spend in preparation, gathering information and increasing your understanding of a person’s specific situation is a billable activity.

Just be sure that the time that is documented for preparation is connected to the individual you support and specific to their situation.

For example: If you have a person you support who has Down Syndrome and has been recently diagnosed with dementia, the time spent researching and reviewing information on dementia in people with Down’s Syndrome to assist you and the team in being able to better identify the risks that the person you support will face, is considered billable time. However, attending a training on Dementia would not be billable (as it is not specifically about that person or their situation).




Being prepared is also about understanding the perspective of the person and the reason why he or she might want to or is engaging in a risk or risky behavior and the reason why others who may be involved see or don’t see this as a risk. For understanding to happen, it is less about knowing the answers to the questions and more about identifying the questions that need to be asked.




Let’s think about asking questions as we look at the Centers for Disease Control or CDC, top 10 reasons for all Emergency Room visits.

This list may or may not be surprising to you, but look at this list again from the perspective of a person who does not use words to communicate.…Of these 10 reasons for going to the emergency room, only four of these reasons (fever, cough, shortness of breath and vomiting) can be directly observed by someone else. For those people who do not use words to communicate, the other six reasons require they communicate their discomfort or pain, in other ways, such as their behavior. The challenge for the team is knowing the questions to ask about how the person communicates when he or she is in pain or discomfort and may need medical attention.

Once we know how the person communicates pain, it is important to make sure that the information is documented. The Understanding Communication section of the ISP is a good place to start.




Preparation also includes knowing or finding other available resources. These resources could be where you work, within your community or region, or even resources available on the internet. (Just be mindful to use reputable sites and that not everything on the internet is accurate.)

Preparation is also about networking. Making connections with other people who may have the knowledge or experience that you and the team can draw on as you work to mitigate risks. There is likely to be someone in your agency who has already learned about something that is brand new to you and can help you in your preparation.




In the statewide instructor‐led series, we posed this question to the participants and asked them to raise their hands to the answers that applied to them.

Take a moment and check each of the responses to this question that applies to you. When you are done, click the Next button.




Now while completely unscientific, what we observed during the statewide trainings was that the majority of participants raised their hands for Down Syndrome. There were a few less hands raised for Down Syndrome and Dementia and still quite a number of people who support people with a Dual Diagnosis. By the time we got to Cornelia DeLange or RettSyndromes, there may have been only one or two hands raised in the room.

This exercise demonstrated the knowledge and experience that exists among Supports Coordinators and the potential value of networking with colleagues in your local area. At the very least, if you can find one person who has had some level of experience with the topic, while their situation may not exactly match yours, they may be able to provide information or resources that you were not aware of. It’s also one more resource than you had before to focus your efforts on the individual’s unique characteristics and circumstances.




Another related part of being proactive with risk is a willingness to engage others in the conversation. Understanding the risk and learning from the individual, the family, team members and others, what they recognize as the potential benefits and consequences of taking the risk, is key.




Imagine for a moment that someone you support is at risk because caregivers in his home frequently leave food cooking unattended on the gas stove and the individual you support doesn’t have strong kitchen safety skills. You want to discuss this with the caregivers because you are concerned that they don’t seem to recognize this as a risk, understand the risk, or support addressing the risk.

As you are preparing for this conversation, you realize that before a solution to address the risk can be discussed, getting a better understanding of the situation from the perspective of the caregiver could help identify an effective plan to reduce the risk as well as gaining their cooperation and support for the plan.

What are the facilitation strategies and techniques that you would use to approach the conversation to help everyone better understand the situation? Remember the quote from Einstein and think about gaining understanding first, before beginning to look for the solution.




When we engage in a conversation with someone to gain understanding, there are several things to be mindful of.

Be aware of your words and body language to ensure you’re not communicating any judgement of what the person might be telling you. You also need to be sure to listen to the words and the body language of the person you are talking to and what they might be communicating. Throughout the conversation, look for areas of common ground, those things that both you and the person are in agreement on.

Ask questions that don’t limit the person to simple yes or no responses. Use open ended questions, that allow the person to provide additional information or clarification. Then follow‐up with clarifying questions, “Can you tell me more about…”

You also need to be aware of potential cultural preferences or influences that may exist. This is not simply limited to specific ethnic or religious beliefs. The culture of the person’s family, their neighborhood, their economic status, or membership within any group could influence how they perceive and react to a situation or solution.

In the example used on the previous slide where there is food left cooking on the stove, more than likely, it’s not being left unattended because the person wishes to harm someone. Understanding more about why the food is left unattended can lead to collaborative solutions, that everyone can support.

Let’s take a look at several tools that can be helpful to you in preparing for and framing a collaborative conversation with others about risk.




In order to fully utilize the information we have gathered or will gather, we should, as Stephen Covey would say, “Begin with the end in mind”. Covey authored, taught, and produced books and programs proposing what he termed The 7 Habits of Highly Effective People.

In the context of being person centered, that end regarding risk is achieving the balance between important for (healthy and safe) and important to (happy, content and fulfilled).

This Does Not Mean that the risk is eliminated; it Does Mean that the person is safe or safer.




When we approach risk mitigation within a Person Centered mindset, we need to consider: • The Purpose ‐What are we trying to achieve? Once we know the purpose, it helps us to

identify…• The People ‐Who needs to be involved to help us achieve it? Knowing the purpose and

the people that need to be involved will inform…• The Process ‐ How will we think and act to make the needed changes? Having the

Purpose, People and Process in place then puts us in a better position to monitor…• Progress ‐ How can we figure out how things are going?

One of the ways to support and guide a collaborative, person centered approach to risk is to use some of the available Person‐Centered Thinking tools, some of which you are already using within the ISP process.

Let’s take a look at these tools and how they can be used to help in mitigating risk.




As a reminder, the foundation of person centered thinking is recognizing what is important to and for the person. Important To focuses on those things that, when in place, make the person happy, content and satisfied. Important For focuses on the elements in the person’s life that are needed to be healthy, safe and a valued member of their community.




Using a graphic like this can help the team identify and prioritize suggested mitigation strategies that consider the balance of Important To and Important For.

Strategies that support or maintain what is Important TO the person and also keep the person safe (Important FOR) would certainly be strategies that could be successful in mitigating the risk and help to maintain that balance. These strategies should be maintained.

On the opposite end of the spectrum, strategies that don’t promote what is Important To and For (making the person unhappy and unsafe) would be mitigation strategies we would want to reconsider and likely revise.

There could also be strategies that support what is Important To the person, but do not help to keep the person safe. In these instances, we need to consider what other steps might need to be added to make sure the person stays safe while remaining happy.

Lastly, when we consider some strategies, we may find that while they would keep the person safe, it conflicts with what is important to the person. If these strategies are necessary, we need to consider the available options that would make the person least unhappy.




Sometimes mitigating risk may not be a straightforward solution. Sometimes there can be disagreement in the team about the risk and what is or is not working at the time.

A Person Centered Thinking tool that should be familiar to you is the What Makes Sense/What Doesn’t Make Sense tool or What’s Working/What’s Not Working tool. This tool is intended to support the team in looking at specific areas of the person’s life and assist in gathering perspectives of the individual and the team. The tool can help to identify areas of agreement and disagreement.

Using this tool specifically to discuss areas of risk can be a starting point for determining common ground or helping to negotiate disagreements within the team. Remember that when using this tool we should be recording what is working or not working in the present and not in the future or the past.

Use of this tool can also clarify perspectives of those involved in relation to the risk and identify areas of agreement and disagreement. When similar items appear in the same column it signifies agreement. When similar items appear in both columns, this identifies disagreement. This tool can help define what success looks like from each perspective and to provide understanding of areas where there might be disagreement and where negotiation is needed.




There may be times, despite the best efforts of all those involved, that things don’t work out as you thought they would.

Let’s take a moment to consider Wile E. Coyote.

In every episode of the Roadrunner cartoon, Wile E. Coyote devises an ingenious plan to capture the Roadrunner and yet none of them work. With each failed effort, Wile E. scraps the whole plan and in the next scene he’s devised a whole new plan, seemingly more intricate than the last… and yet it fails as well.

Why do his plans fail?

• It’s not from a lack of resources. It seems that Wile E. has an open account with the Acme Co. to purchase whatever he needs for his plans.

• It’s not a lack of creativity because with each plan, Wile E. incorporates his environment and the resources available to him and at least on paper, everything should work. But when the plan is put into action, something unanticipated happens and the plan fails.

The mistake Wile E. makes is that with each failed attempt, he scraps the entire plan and starts over from the beginning, devising what he believes to be a new, better, more ingenious plan. He fails to learn from the experience of his previous attempts and apply what he’s learned to his next attempt.




To avoid the fate of Wile E. Coyote, another Person Centered Thinking tool that can be very helpful for teams, especially when the first attempts at reducing risk are not successful or the team is still struggling with conflict between what is working or not working, is the 4+1 Question Tool.

The 4+1 tool is a way to look back at our solution in a thoughtful way, to assess and evaluate what we’ve tried; what new leaning may have come from what we tried; what pieces of the plan were we pleased with the results; and what concerns remain? And then, based on those answers, what will we do next to revise, adapt or change the plan to improve the plan so it is more successful, the next time?




Thinking back to the Risk Mitigation Cycle for a moment, the step in the cycle after we implement a strategy is Evaluation.

Evaluation is not always as simple as asking if it keeps the person safe, but within the context of Person Centered Thinking, we also need to ask, “Did it keep the person safe while maintaining a balance between what is Important To and Important For him? Were we successful in addressing the various perspectives of What’s Working and What is Not Working?

Despite our best efforts and even using the Person Centered Thinking tools, it is likely that as we attempt to mitigate risk, our first attempts will not be entirely successful. Our strategy may fail to fully maintain all the things that are Important To or Important For the person or may fall short of addressing all the concerns identified in What’s Working/Not Working. When this happens, we can use the 4+1 Tool to learn from what happened and revise the plan to try again.




In this webcast, we’ve provided several tools designed to support you in having conversations related to risk with the team. As stated previously, these tools are offered as ways to support your work in mitigating risks with the team, but are not newly required forms. These tools are available for downloading where you accessed this webcast.

In the next webcast, we’ll look at a proactive tool designed to guide the team in their conversations and planning when a risk is identified.




This concludes Part 3 of the series Addressing Day to Day Risks with the Team, PersonCentered Risk Mitigation. Part 4 can be found 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 3 1 · 2016-04-26 · addressing day to day risks...

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