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| Organizational Approaches to Restraint Prevention |
| Sunday, May 30, 2010 |
| 3:00 PM–4:20 PM |
| Seguin (Grand Hyatt) |
| Area: CSE; Domain: Service Delivery |
| Chair: David B. Lennox (QBS Inc.) |
| Discussant: Michael F. Dorsey (Endicott College) |
| Abstract: The use of restraint as an emergency intervention has come under increasing, regulatory, legislative, media, consumer, and activist scrutiny in recent years. Restraint - used either as a planned punishment procedure or as an emergency intervention to briefly suppress dangerous behavior - has for decades generally been considered to be highly restrictive and therefore to be avoided in most circumstances, current focus on the dangers and potential abuses of restraint have made it particularly critical to take active steps to prevent the need for restraint whenever it is reasonably possible to do so. This symposium will focus on several topics relevant to preventing the need to restraint use, including the collection, aggregation, and analysis of incident data; functional engaging in restraint; and application of organizational behavior management principles to changing the behavior of groups of staff working with individuals who might engage in behaviors that might require use of restraint as an emergency safety intervention. |
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| Aggregation and Analysis of Critical Incident Data From Multiple Sites |
| DAVID ROURKE (QBS, Inc.), Elisabeth Kinney (Quality Behavioral Solutions, Inc.) |
| Abstract: In many settings, data from incidents involving behavioral escalation and use of restraint are collected and analyzed individually, but not aggregated. In this presentation, detailed incident data from three sites providing residential rehabilitation treatment to individuals who neurological conditions such as traumatic brain injury are presented. The data set, representing all reported critical incidents, goes back up to four years in each site, representing hundreds of critical incidents involving behavioral escalation. It includes detailed information on antecedent events, times of day, antecedent behaviors, de-escalation procedures attempted, interventions used, dangerous behaviors, and response to intervention. Aggregate data from these sites will be presented graphically. We will drill down into the data set, identifying patterns of incidents and demonstrating how this information presents implications both for further functional analysis of individuals as well as deployment of staffing resources, implementation of group contingencies, and need for increased supervisory and training support to staff. Implications for how to design incident data collection systems are discussed, with recommendations about which data to collect and how to design an efficient system for aggregation and analysis. |
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| Functional Analysis of Physical Restraint Behaviors |
| ZACHARY HOUSTON (Quality Behavioral Solutions, Inc.) |
| Abstract: Although the use of physical restraint is generally acknowledged as an occasionally necessary intervention for very dangerous behaviors in, it is infrequently examined as a class of behaviors in itself. The speaker discusses various potential antecedent and consequent effects related to the use of restraint. The various stimuli associated with the use of restraints and their potential evocative and abolishing effects are also discussed. The antecedent, consequent, motivational effects are examined both in terms of the restrainers and the person being restrained. The importance of tracking trends not only in the target behavior of consumers, but also for the trends in restraint use across individual staff and individual consumers is discussed. The importance of the use of these data, along with other behavior assessment tolls, to obtain functional relation data on behaviors associated with restraint is then discussed. Although not typically meant as a consequent intervention, the use of restraints is considered for its potential reinforcing, punishing, and motivational effects over time and this consideration is applied to a functional analysis of the behavior of trained staff and consumers. |
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| Critical Elements of a System-Wide Restraint Prevention Program |
| DAVID B. LENNOX (QBS Inc.) |
| Abstract: The use of physical restraint in education and treatment settings has come under significant scrutiny in the past year, forcing administrators to review and possibly work towards changes in organizational policy and practices. Effecting change in restraint practices at schools, institutions, and other settings typically involves primarily, if not solely, focusing on staff training sessions in the topics of regulations, rights, and, perhaps, de-escalation. Unfortunately, restraint practices in these types of settings are often part of and support by the larger culture and history of an organization - and, as may be inadvertently supported through various administrative conventions, peer reinforcements contingencies, and training practices, to name a few. However, much like other attempts to change in restraint practices of an organization must influence and be influenced by many levels of the organization. The current presentation outlines the critical elements of a system-wide restraint prevention program utilizing organizational behavior management (OBM) principles and strategies including obtaining organizational commitment, establishing valid and practical data collection, comprehensive training, and system-wide interventions. |
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