WV Behavioral Health Care Providers Crisis Collaborative for People with Autism

Promoting evidence based crisis prevention, intervention & recovery services for people with developmental disabilities &/or mental health support needs

Solution based approach Facilitates teamwork & accountability Enhances quality planning

DHHR/BHHF Behavioral health providers Behavioral health crisis respite providers Hospital emergency room workers State hospital administrators Mental hygiene commissioners Homeless shelter liasons Center for Excellence in Disabilities

Reduce frequency of Calls Reduce frequency of requests for state hospital assistance for individuals who have developmental disabilities Reduce injury rate and liability for behavioral health care providers Increase capacity for coping with high stress position Know when is necessary Gain devotion of outpatient providers Streamline service access for people transitioning into care Create standards for safe intervention Clarify policy, procedure & expectations

System of services and supports designed to maximize individual independence and capacity for community living Must be free of state interference or violation of individual rights Must be person-centered Must be proactive

20 year old male throws himself out of wheelchair everyday upon return home while cursing staff Older, non-verbal female keeps hitting her side & hits you when you tell her not to hurt herself 23 year old female repeatedly runs away

18 year old football player sized, ambulatory male who has intermittent explosive disorder and a seizure disorder threatens to hurt staff and peers 66 year old woman with brittle diabetes throws chair at peer and then hits her own head on the wall 10 consecutive times with increasing force 35 year old man hears voices telling him to kill the agency CEO

A plan to call if anything goes wrong A plan to call the supervisor if anything goes wrong A plan to commit to the State Hospital if anything goes wrong A plan to seek crisis respite housing if anything goes wrong A plan to transfer services if anything goes wrong

Detailed action steps explaining what each team member will do to before, during and after a crisis situation as approved by team consensus and independent review when applicable 1) Proactive prevention 2) Direct intervention and de-escalation 3) Re-act following process implementation Plans must be individualized according to “best guess”

Person-centered planning- ASK them Positive behavior support planning Proactive & frequent adaptation of positive behavior support plans Service planning & delivery, especially outpatient consultation Adequate administrative supervision ratios Ongoing staff training Ongoing evaluation, assessment and attention to dynamic client needs Strong circle of supports based on respect, trust and honor Teach & role model self control regardless of others behavior using practice sessions

Build meaningful relationships Support sufficient communication systems on clinical and administrative levels Construct routines and teach adaptation Establish caring protocols for staff to assess each client well-being at the beginning of each and every shift Give people things to look forward to Demonstrate positive expectations Guarantee a positive staff approach Know client personality & behavior trends

Active daily schedules including exercise Person-centered planning Positive behavior support planning Proactive & frequent adaptation of positive behavior support plans Service delivery Adequate administrative supervision ratios Ongoing staff training Ongoing evaluation, assessment and attention to dynamic client needs Individualize services Listen to the client & their direct care providers Track the # of times a person smiles everyday Build on strengths Detail action plans Assure adequate supports are available Interview staff to encourage meaningful relationships with residents Go thru stress with them Prepare safe environments Seek professional/medical consultation when changes may occur

Take a deep breath & stay calm Practice safety first Follow agency wide notification protocols Prevent rights restrictions or infringements

Follow w THE PLAN M Look for discoverable potentially hidden dynamics Opportunities for for Growth? Teach alternative behaviors before, during & after crisis

Self abuse Assess for pain Use pillows for blocking and padding Environmental change Distraction Individualize Follow individual team approved protocols Property Damage Remove objects of risk or value that can not be protected Follow individual team approved protocols Call in mobile supports Other abuse Learn warning signs using individually approved team protocols Remove any potential targets from the environment Call in mobile supports

Assessment Physical restraint where team approved Check medical and care routine Stress Medical Often useless for individual reform Undermines need for behavioral health system increasing likely use of correctional/institutional systems of care Avoid Legal

LEARN Detail incident reportsDe-brief person & staffUse communication systems to increase understanding, comprehension & clarityLet it RestMinimize unnecessary attention to the situationRe-call team meeting to identify lessons learned

Person shows antecedent behaviors Interview person & staff & give suggestions Call a team meeting Emerging Person shows heightened reactivity/irritability May make threats, or damage property Staff are alert for ways to minimize impact Urgent

Immediate Safety Threat Scratched peer Broke television Has a weapon Is it time to call 9-1-1?

Must be based on Medical Necessity & the need for safety Last resort Doctors give you what you ask for Requires physician orders Are stitches needed? Follow RN and therapist recommendations. Depends on the reason Have all options been tried? Who might have new ideas? What will TEACH? Team decision Ethics based Nurse recommendation Different outcomes? Repeat use signals need for system to adapt Repeat acquisition Home IS an outpatient provider & must have supports to maintain community integration Use of outpatient community providers