from restraint reduction to creating sanctuary brian farragher, lmsw, mba executive vp / coo andrus...
TRANSCRIPT
From Restraint Reduction to Creating Sanctuary
Brian Farragher, LMSW, MBAExecutive VP / COO
Andrus Children’s Centerhttp://www.andruschildren.org/
"If you don't change your beliefs, your life will be like this forever.
Is that good news?"
~ Dr. Robert Anthony Educator & Writer
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
27
9 3
5
7
17 15
75
40
0
0
10
10
20
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40
50
60
70
Time Line
# o
f Res
trai
nts
Myths About Restraint
• Keeps Kids Safe• Keeps Staff Safe• Manages Agency Risk• It’s a Therapeutic Intervention
Features of Andrus Process to Reduce Restraints
• Leadership Commitment & Vision• Staff Training• Staff Supervision• Maintaining a Focus• Documentation and Data Analysis• Clinical Review• Program Review and Performance Improvement• Understanding Trauma
Leadership Commitment & Vision
• Clarifying Mission & Philosophy• It Starts With What You Believe• Restraint as Treatment Failure• Defining the Problem / Sharing Data• Setting Bold Goals• Staying Involved• Developing Effective Systems
Staff Training
• Commit to an Approach• Thoroughly Train Formal & Informal
Leaders • Watch Your In-House Trainers for Drift• Make Adjustments Based on Data
Staff Training Focused on…
• Self Awareness and Affect Management
• Understanding Trauma & Reenactment• Disengagement & Team Work• Faith in the Entire Process• Stay Back …Give Time & Space…
Hands Off
Staff Supervision / Processing the Incident
• Debrief All Incidents with Staff• Reinforce Training• Encourage Expression of Affect• Check Techniques• Explore Alternatives• Cultivate Values• Provide Perspective• Affirm Staff’s Best Efforts
Restraint a “BIG DEAL”
What We Pay Attention to Flags What’s Important!!!
Documentation & Data Analysis
• Incident Reporting• Supporting Documentation Follows: (Supervisory
Review, Medical Review, Safety Plan Update)• Administrative Review of Specific & Aggregate
Reports…Trends Inform Decision-Making• Behavioral Support Committee Review
Clinical Review
• Identify & Manage Potential Risks• Individual Safety Plans Developed & Updated• De-escalation Preferences Assessed• Team Review of All Restraints• New Strategies Developed
Program Review & Performance Improvement
• Data Analysis Flags Trouble Spots• Leadership Reviews Data & Encourages Problem
Solving• Understanding the Social Context of Violence• Program Areas Develop Corrective Action Plans• Improvement in Performance Is Recognized and
Celebrated
Understanding The Impact of Trauma & Creating Sanctuary
• Impact of Stress on Our Systems - Parallel Process
• Staff Training on Trauma• Identifying Traumatic Reenactment – Sins of
Commission and Omission• Identifying Collective Disturbance• Understanding Vicarious Trauma
Understanding The Impact of Trauma & Creating Sanctuary
• Building a Positive Culture – The Seven Commitments
• Focus on SELF• Building in Protective Factors
Challenges
• Connection and Engagement at All Levels is Key• Disregulated Adults Result in Disregulated Kids• Kids & Families as Partners Not Adversaries – Injury, Not
Sick or Bad• Changing the Question from “What’s Wrong with You?” to
“What’s Happened to You?”• Assessment • Anticipation• Setting Limits & Standards Without Fear• Are We Losing Control??
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
27
9 3
5
7
17 15
75
40
0
0
10
10
20
30
40
50
60
70
Time Line
# o
f Res
trai
nts
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
27
9 3
5
7
17 15
75
40
0
0
10
10
20
30
40
50
60
70
Time Line
# o
f Res
trai
nts
Major TCI Training Push
Begins
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
27
9 3
5
7
17 15
75
40
0
0
10
10
20
30
40
50
60
70
Time Line
# o
f Res
trai
nts
Data Shared with Staff
Consistently Goal to reduce
restraint articulated
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
27
9 3
5
7
17 15
75
40
0
0
10
10
20
30
40
50
60
70
Time Line
# o
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trai
nts
• Supervisory Debriefing• Monthly Review• Parent Notification• Medical Review
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
27
9 3
5
7
17 15
75
40
0
0
10
10
20
30
40
50
60
70
Time Line
# o
f Res
trai
nts Sanctuary
Process Begins
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
27
9 3
5
7
17 15
75
40
0
0
10
10
20
30
40
50
60
70
Time Line
# o
f Res
trai
nts
New TCI Curriculum
Training
Restraint Incidents
66
42
16
9 9
11
2
4
268
5
9
27
9 3
5
7
17 15
75
40
0
0
10
10
20
30
40
50
60
70
Time Line
# of
Res
trai
nts
Full Staff Trauma Training Begins
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
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9 3
5
7
17 15
75
40
0
0
10
10
20
30
40
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60
70
Time Line
# o
f Res
trai
nts Agency
LeadershipChange
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
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9 3
5
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17 15
75
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0
0
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Time Line
# o
f Res
trai
nts Implement
Red FlagReviews
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
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9 3
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17 15
75
40
0
0
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Time Line
# o
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trai
nts
School Leadership Change
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
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9 3
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Time Line
# o
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trai
nts
Another School Leadership
Change
Restraint Incidents
42
16
9 9
20
24
2
6
2
66
11
1 2
12
4
268
5
9
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9 3
5
7
17 15
75
40
0
0
10
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60
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Time Line
# o
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trai
nts
One More School
LeadershipChange – For
Good Measure
SYSTEM WIDE APPROACH TO REDUCINGRESTRAINT INCIDENTS
LeadershipLeadershipSets Goals
Develops Vision
Maintains Focus on the Issue Through
Training SupervisionClinical and Program Review
Number of Restraint Incidents in Programs
Data CollectionData CollectionFlags Problems
Identifies TrendsAffirms Progress
Focus on Trauma
