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

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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

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

9. Restraints

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

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

12. Isolation by Hours

13. Rate of Disciplinary Hearings

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

15. Lessons Learned
The importance of Data

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

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

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

21. Staff/Youth Fear for Safety