Thursday. An open line, video and report on restraints | Arkansas Blog

Thursday, January 14, 2016

Thursday. An open line, video and report on restraints

Posted By on Thu, Jan 14, 2016 at 3:53 PM

Here's your open line, plus today's video with headlines and comment. Also:

* RESTRAINTS AT BOONEVILLE: Disability Rights Arkansas distributed a new report today on the excessive use of restraints at the Booneville Human Development Center. This follows a 2015 report that called for closure of the facility for developmentally disabled.  “It is gravely concerning that in 2016 the reliance on restraints to overcome behavioral challenges at Booneville Human Development Center is so prevalent,” said Tom Masseau, executive director of DRA. “The potential for injury or loss of life is greatly increased.”

Since the publication of the report released in January 2015, DRA has continued to monitor and review the use of restraint at the Booneville Human Development Center. DRA reviewed all restraint reports for a sixteen month period and all human development center reports on restraints submitted to the Developmental Disability Services Board.

“During our investigation we saw instances of residents being frequently restrained without evidence of meaningful review of the necessity of the restraint or ways to avoid the restraint in the future, “says Masseau.
In addition to reviewing restraint reports, DRA talked with facility staff and administrators to discern not only the extent and type of restraints used but also the effort to provide programming to reduce restraint incidents. DRA also consulted with an expert in facility practices, including the use of restraints in facilities.

DRA concluded that the restraint practices at Booneville HDC are both contrary to currently recognized best practices regarding restraints and puts residents and staff at risk of physical and emotional harm. Furthermore, DRA has concluded that the restraint practices at Booneville HDC will not be eliminated without serious scrutiny and comprehensive changes with the facility.

The full report is available at the organization's website.

Past criticism of the center has been downplayed by state officials who've claimed a bias in the reporting by the Rights group. I've sought a comment on the latest report.

UPDATE: Today, the state said it was taking positive steps in Booneville and would continue to look closely at the criticism. The following statement from DHS was also adopted by the board of the division that oversees the center.:

The Division of Developmental Disabilities Services (DDS) and its Interim Director Melissa Stone have received a copy of the DRA’s January 2016 report on the restraint practices at the Booneville Human Development Center (BHDC). That report mirrors complaints in a January 2015 report from DRA. It’s important to note up front that BHDC is licensed by the Office of Long-term Care, which completes annual on-site reviews of the facility and its practices. No deficiencies with the restraint practices have been identified in those reviews.

Though no deficiencies with regard to restraints have been discovered, DDS took the DRA’s 2015 concerns seriously and reviewed the restraint policies of all human development centers and ultimately changed policies at BHDC and another facility to ensure all were using the same restraint techniques.

BHDC began training in the new, nationally-recognized approach from the Crisis Prevention Institute in March 2015. More than 100 employees have been trained in the new techniques to date, and the remaining employees will complete training by the end of March. The new techniques provide staff with more non-physical de-escalation approaches and ways to set appropriate limits that help calm behaviors. These techniques are also in line with recommendations made in 2012 by an independent consultant who reviewed restraint practices at all HDCs. BHDC data through December 2015 shows that the use of emergency restraint techniques is less frequent than it was a year ago.

Unfortunately, emergency restraints and interventions are necessary at BHDC because of the number of residents who have a diagnosis of both a developmental disability and a mental illness that can be associated with aggressive or injurious behaviors or tendencies. Currently, more than 93% of our clients have dual diagnoses. Despite the assertions of the DRA that residents at BHDC have the same behaviors as other HDC residents, this is a unique population that requires intense treatment and emergency interventions. Many of our residents are directly admitted from the Arkansas State Hospital, other HDCs, or jail. Often admissions occur because the safety of the resident being admitted or others in the referring environment could not be ensured. BHDC employees are specially-trained to work with this high-need population. CMS recognizes that emergency situations arise in these populations and allows for the use of interventions, including the papoose board and chemical interventions.

While all residents meet HDC admission requirements, many are accepted with the awareness that they present a high-risk of danger to self or others, as predicted by their psychiatric diagnoses and history.

These residents will likely always need a closely-supervised, high-level of care due to their clinically-complicated needs. Despite the potential for dangerous behaviors, BHDC only uses restraint interventions in emergency situations, often only after other de-escalation techniques did not calm the resident. Emergency interventions are not used out of convenience or for punishment. It’s important to note that incidents involving emergency restraints and interventions are reviewed daily by BHDC residential staff and nurses and, when necessary, the treating psychiatrist. The treating physician will adjust and monitor medications and treatments in an effort to reduce or eliminate dangerous or self-injurious behaviors. Chemical interventions are only used when ordered by a doctor. The DDS assistant director for quality assurance also reviews restraint use monthly.

Though DDS Interim Director Stone is confident that BHDC staff only use restraints in emergency situations, she takes the new report seriously and plans to take an in-depth look at the practices, diagnoses and admissions at BHDC to see if there are ways to further reduce the use of these emergency interventions. She also plans to work with BHDC to ensure staff is re-trained, if necessary, on appropriately documenting client interactions and emergency interventions.

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