From Restraint Reduction to Creating Sanctuary

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From Restraint Reduction to Creating Sanctuary

• Brian Farragher, LMSW, MBA
• Executive VP / COO
• Andrus Childrens Center
• http//www.andruschildren.org/

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• "If you don't change your beliefs, your life will
  be like this forever.
• Is that good news?"
• Dr. Robert Anthony
  Educator Writer

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(No Transcript)
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Myths About Restraint

• Keeps Kids Safe
• Keeps Staff Safe
• Manages Agency Risk
• Its a Therapeutic Intervention

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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

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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

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Staff Training

• Commit to an Approach
• Thoroughly Train Formal Informal Leaders
• Watch Your In-House Trainers for Drift
• Make Adjustments Based on Data

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Staff Training Focused on

• Self Awareness and Affect Management
• Understanding Trauma Reenactment
• Disengagement Team Work
• Faith in the Entire Process
• Stay Back Give Time SpaceHands Off

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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 Staffs Best Efforts

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Restraint a BIG DEAL

• What We Pay Attention to Flags Whats
  Important!!!

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Documentation Data Analysis

• Incident Reporting
• Supporting Documentation Follows (Supervisory
  Review, Medical Review, Safety Plan Update)
• Administrative Review of Specific Aggregate
  ReportsTrends Inform Decision-Making
• Behavioral Support Committee Review

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Clinical Review

• Identify Manage Potential Risks
• Individual Safety Plans Developed Updated
• De-escalation Preferences Assessed
• Team Review of All Restraints
• New Strategies Developed

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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

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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

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Understanding The Impact of Trauma Creating
Sanctuary

• Building a Positive Culture The Seven
  Commitments
• Focus on SELF
• Building in Protective Factors

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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 Whats Wrong with
  You? to Whats Happened to You?
• Assessment
• Anticipation
• Setting Limits Standards Without Fear
• Are We Losing Control??

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Major TCI Training Push Begins
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Data Shared with Staff Consistently Goal to
reduce restraint articulated
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• Supervisory
• Debriefing
• Monthly Review
• Parent Notification
• Medical Review

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Sanctuary Process Begins
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New TCI Curriculum Training
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Full Staff Trauma Training Begins
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Agency Leadership Change
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Implement Red Flag Reviews
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School Leadership Change
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Another School Leadership Change
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One More School Leadership Change For Good
Measure
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• Leadership
• Sets Goals
• Develops Vision

Maintains Focus on the Issue Through
Training
Supervision
Clinical and Program Review
Focus on Trauma
Number of Restraint Incidents in Programs

• Data Collection
• Flags Problems
• Identifies Trends
• Affirms Progress

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• Andrus Childrens Center
• www.andruschildren.org
• Brian Farragher
• bfarragher_at_jdam.org