Prevention & Redirection Providing a proactive responsive environment Kelly Hutton & Peggy Akinlosotu

What is Prevention? stopping something from happening before it occurs

Prevention in Everyday Life: You are driving in the parking lot and suddenly someone begins to pull out from a spot that is right in front of you. How can you prevent an accident from occurring?

What situations do we want to prevent in program? Behavioral Incidents (Ex: Yelling/Swearing, Assaults, Self-Injurious Behaviors, Property Destruction, Restraints) Program member/staff injury from restraints Choking Falling Feet being run over by wheelchairs PICA

Total Time Outs and Restraints 2015 Month Restraints Time Outs Jan '15 13 128 Feb '15 11 134 Mar '15 12 233 Apr '15 16 187 May '15 5 161 June '15 14 207 July '15 193 Aug '15 200 Sept '15 44 260 Oct '15 28 262 Nov '15 21 168 Dec '15 27 Total: 216 2261

Program Incidents **Incident type and frequency is kept for Transportation, Extended Day and Supported Apartments

How can we learn to prevent these situations from occurring? Spending time with the person and forming a relationship with them Reading behavior plans and guidelines Reviewing dining guidelines and implementing them Being aware of the environment around you and the potential hazards (ex: raised threshold) Learning from your colleagues

What is Redirection? directing someone to a new place or purpose Prevention is accomplished through successful redirection

You see Peter swearing under his breath and as a peer walks by him You see Peter swearing under his breath and as a peer walks by him. Peter begins yelling at the peer. You know that if Peter continues to become upset, he may hit someone. How would you redirect him and prevent him from hitting anyone? Ask him what is bothering him Calmly remind him that you cannot help him until he talks quietly Bring him to a quiet area to calm down Encourage him to take deep breaths, squeeze a stress ball, or count to 10 Ask him if he would like a drink of water Ask him to go for a walk If he has a reinforcer through a behavior plan, ask him how he earns his reinforcer Divert his attention to another topic of interest

While sitting in a skills training, Andre begins hitting himself in the head with force. As his 1:1 staff attempts to verbally redirect him, Andre begins to hit his 1:1 staff and attempts to bite him. What should the staff around the incident do to ensure everyone’s safety? Staff can assist in safely securing Andre in a restraint Staff can make sure that while holding Andre, pressure is not applied near his joints and that there is no pressure coming from their fingers which can cause bruising Staff not involved in the restraint can get a pillow or mat to put under his head to prevent self-injurious behavior Staff in the area can move all program members, chairs, books and tables away from the restraint Senior management staff (Program Administrator/Director/Clinical staff) should be notified If staff assisting in the restraint become tired or injured, they should ask for an alternate staff to take their place Staff should monitor Andre’s breathing and check to make sure there are no red marks forming where staff are holding his limbs

Dining guidelines were recently created as Dana choked on her food 2 days ago. Dana does not want help from staff, but rather wants to take her lunch and eat it. How would you interact with Dana while you are cutting up her food to ensure she doesn’t choke? Acknowledge that you know this is a change for her but remind her that this will keep her safe Let her know that she can watch you cut up the food so she can see that she will get the same amount While you are cutting up her food, talk about topics of preferred interest Provide her with a compliment to increase her self-esteem Continue to sit and converse with her while she is eating so you can monitor her food intake and remind her to take a sip of her drink

Sarah needs to use the bathroom and requires assistance Sarah needs to use the bathroom and requires assistance. As she begins walking to the bathroom, you notice that someone spilled a cup of coffee all over the floor in front of the bathroom. How can you redirect Sarah so she does not slip on the floor and make sure that no one else does? Point out the spill and ask her to go around it Ask her to use a different bathroom if possible Ask another staff in the area to make sure no one walks through the spill Ask another staff to bring Sarah to the bathroom so that you can clean up the spill Set up a wet floor sign

Go over to Elise and ask her if you can push her wheelchair You see Elise maneuvering her wheelchair through a crowded area of the program. Many of the people in the area are engaged in conversation and Elise tries to let them know she needs to get through but they don’t hear her. How can you prevent someone from getting injured by the wheelchair? Go over to Elise and ask her if you can push her wheelchair Ask the people around her to move out of the way Move any chairs or other items that may be in Elise’s way

Sam has a diagnosis of PICA Sam has a diagnosis of PICA. He will often try to eat small pieces of plastic, crayons and colorful liquids. There is a fine motor class that is making a project with these items. How can you ensure that Sam does not try to ingest these items? Redirect Sam to another skills training Ask Sam if he would like to complete another preferred activity When the group finishes, complete a visual sweep of the area to make sure that all of the items are put away Make sure that the items are stored in a locked closet Ask Sam if he would like to color using markers

Things to Remember: Our goal is to provide the safest and most enriching environment possible for the individuals we serve Our method of redirection will effect every outcome Successful redirection is the key to preventing unsafe incidents