Isolation and Restraint Planning for Change, Improving Outcomes and Lessons Learned:

Data Collection Data Collection Site Report and Analysis Performance Based Standards (PbS) Data Collection Site Report and Analysis Facility Improvement Plans PbS' cycle is modeled on the business quality assurance processes, current government emphasis on performance measurement and the philosophy and principles of learning organizations. Its goal is to use data to improve, manage, demonstrate effectiveness, show accountability and drive decision-making.

Strategic Planning The two goals established:   Within one year from implementation, NDYCC will reduce the amount of hours students are confined to their rooms to 50% of the current yearly average for the whole campus. Within one year from implementation, NDYCC will reduce the amount of physical and mechanical restraint to 50% of the current yearly average for the whole campus.

Reducing Room Confinement Pros Increase interaction for positive role modeling by staff/level students Decrease opportunity for suicidal behaviors Less chance of staff/youth injury Increase ability to utilize programming skills Sharpens staff skills to do their job Forces staff to deal with kids they normally could avoid Cons Assaults on Staff Students could experience mental or physical assault Students fear for their safety May Increase acting-out behavior May need to have an increase in training opportunities for staff. Increased youth injuries High Security Risk to staff and students

Reducing Restraints Pros Cons Lessen the chance of suicide Less injuries to staff Less injuries to students Increased ability to use skills Better relationship building Cons More injuries to staff More injuries to students May need increased training and staff May increase acting out behavior Staff question their decision making Students/staff feel unsafe

Strategic Planning (team approach) Created work groups to address identified needs Group A 1. Rewrite of discipline Policy/Process. 2. Clearer criteria for restraints. 3. Instruments to determine if/when a student should be out of their room. 4. Structured, consistent day program for discipline students. Group B 1. Diversity 2. Increased staffing 3. Increased communication Group C 1. Professional Recognition 2. Enhanced Support for JIRS 3. Increased Accountability

The Resulting Changes Added a third Security Officer MANDT MI Staggered case manager/program director scheduling New discipline policy and procedure Added nurse practitioner Added part time psychiatrist Monthly cottage meetings Rounds by mental health staff Debriefing

Order 07 Restraint chair or restraint bed use per 100 person-days of youth confinement.

Restraints

Order 08 Isolation, room confinement, segregation/special management unit use per 100 person-days of youth confinement.

Order 10 Percent of isolation, room confinement, and segregation/special management unit cases terminated in four hours or less.

Isolation by Hours

Rate of Disciplinary Hearings

Safety 14 Percent of staff who report that they feared for their safety within the last six months.

Lessons Learned The importance of Data

Order 08 Isolation, room confinement, segregation/special management unit use per 100 person-days of youth confinement.

Order 10 Percent of isolation, room confinement, and segregation/special management unit cases terminated in four hours or less.

Order 03 Physical restraint use per 100 person-days of youth confinement.

Staff/Youth Fear for Safety