Seclusion and Restraint Reduction in Texas:

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Seclusion and Restraint Reduction in Texas

• Your Stories of Success!

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• There is now a standardized state-wide
  initiative to reduce restraint use in state
  schools.

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We decreased the duration a consumer can be
in mechanical and personal restraints.
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• We successfully eliminated the use of
  restraint boards.

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We established a level of buy-in and
enthusiasm at the supervisory level.

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Our line officers efforts to implement change
is creating an organizational culture dedicated
to using safer practices.
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We have significantly revised our in-service
training curriculum to promote skills needed to
reduce S/R use.

• Our new training topics include
• Staff Emotional Response to Residents
• Adolescent Psychopathology
• Working with Individuals with Conduct
  Disorder

8
We formed a 15 member leadership team,
representing all levels of staff, to conduct
regular priority meetings and actively address
seclusion and restraint reduction.
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We experienced a 61 reduction in campus-wide
restraints.

• We reduced the number of seclusions on the
  childrens unit by 66.

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To assist consumers with developing self-calming
skills, we created two new soothing rooms!
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We also created a relaxation station with a
beach theme so consumers can process their
feelings in a peaceful environment.
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We achieved a 50 reduction in our restraint
use.
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We increased the use of verbal de-escalation
tools.
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We increased staff awareness of S/R reduction.

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After a volunteer interior designer presented
recommendations on environmental changes we could
make to our facility, many exciting changes
occurred!

• Our bedrooms were painted!
• The lighting was changed to create a more
  pleasing atmosphere!
• A color scheme chart is now available in both
  the admissions and nurses stations!

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We developed a cross-discipline shift report
that includes a debriefing tool.
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We increased staff communication during shifts
and even between separate shifts!

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We now have an executive team member on-call at
ALL TIMES to debrief S/R incidents with staff.
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We created a student council that gives us
feedback on our facility operations.

• Weve also successfully implemented a system
  to elicit input from family members.

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Our leadership team conducted a kick-off event
to initiate our seclusion and restraint reduction
campaign, which was attended by roughly 90 of
our staff.

• We ordered t-shirts that symbolize our interest
  in reducing S/R use for each team member.
• We featured educational activities, posters, and
  videos.
• We showcased a sensory room and presented
  updated procedures, which demonstrates why we
  want to change and where we are in the process.

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So that all employees can see our success as
they enter our campus, we display a poster with
the number of consecutive days we have gone
without using a restraint.

• As of the end of May, we have gone 56 days
  without a reported restraint!

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For keeping the unit free from S/R use for 16
months, we honored our team members with a
facility-wide reception where we presented
individual awards!
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Our R/S Elimination Reduction Workgroup hosted a
one-day, facility-wide training session in which
all staff completed STARS III (Staff Training
About Restraint/Seclusion).

• At the training, we presented our R/S
  Reduction Plan and a report of the number of
  staff and consumer injuries resulting from R/S
  use.

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We use a pulse oximeter during all restraints
and seclusions.

• This serves two purposes
• 1. It monitors oxygen stats, and
• 2. Sends a clear message to staff and
  consumers that restraints and seclusions are
  extremely dangerous.

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Our staff and therapists have created a safe,
nurturing environment that supports positive
behaviors and provides space for our kids to make
mistakes and process through their traumatic
histories without shame or self-deprecation.
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We have campus-wide buy-in to reduce, and
someday eliminate, the use of restraint. This
buy-in has reinforced our determination to reduce
restraints despite the everyday challenges of our
busy jobs.
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Our mid and upper management has bought-in to
the concept of reducing S/R use and openly
encourages our reduction plan.
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When comparing the first quarter of 2006 to the
first quarter of 2007, we saw a 60 reduction in
S/R use!
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For our annual employee refresher training, we
significantly increased our emphasis on early
identification of escalating situations and the
use of verbal interventions.
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A former consumer and a master PMAB trainer have
been added to our Restraint and Seclusion Quality
Improvement Team (R/S QIT).
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The R/S QIT has developed and revised a
facility-wide plan to guide us in reducing and
striving to eliminate restraints and seclusions.
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Individual R/S events, as well as comprehensive
R/S statistics, are monitored by several
different groups in order to identify problematic
patterns and provide early interventions.
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In our new employee orientation and training
program, a consumer provides new employees with a
personal account of what it is like to be placed
in seclusion and restraints, as well as what
employees did for her to help prevent seclusion
and restraint incidents from happening.
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We implemented a new debriefing procedure which
includes an administrative staff member talking
with the nursing staff involved in every R/S
event.

• This has helped us focus more attention on
  identifying early warning signs and on reducing
  conflicts between staff and consumers.

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We added a Peer Support Department, which is
made up of 4 consumers, to provide support on
the unit and to run a drop-in center called the
Oasis.

• We plan to involve these individuals in the
  debriefing process with consumers who witness R/S
  events.

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Since September of 2006, we formed several
workgroups to investigate and implement
additional R/S reduction efforts.
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A facility-wide Trauma-Informed Care training
conducted in April 2007 provided education on
trauma and emphasized the need to significantly
reduce R/S use.

• Almost 600 employees attended, which is
  approximately 96 of our direct-care staff.

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We identified several program rules and
schedules that are contributing to the conflict
between staff and consumers.

• Efforts are being made to introduce more
  flexibility in order to reduce these conflicts
  and power struggles which play a part in R/S.

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We are in the process of turning an area of each
unit into a calming room.

• The rooms have been painted and furniture was
  just delivered!

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A behavioral response team will be implemented
this summer.

• A pager alert system has been ordered and
  staff are being recruited to participate on
  teams.

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Our superintendent gave public accolades to a
staff member who used her sensitivity and verbal
skills to diffuse a dangerous situation.

• He also used this occasion to remind staff
  that we should always ask ourselves if there are
  less restrictive, less dangerous, and more
  therapeutic interventions that can be used.
• He stressed that physical interventions
  should only be used to prevent imminent physical
  harm.

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We developed a team to improve the assessment of
incoming consumers for trauma histories. This
team is also developing a safety plan which will
identify and document the consumers preferred
interventions for crisis situations.
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We involved consumers in refurbishing our
rehabilitation and recreation areas so we can
provide constructive and enjoyable activities."
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Our executives review each S/R staff
debriefing.
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We are in the process of developing an
incentive program as a means to reduce power
struggles between staff and consumers.
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• CONGRATULATIONSTEXAS!!!