Editor's Note: CPI's director of research & communications, Robert D. Rettmann, recently spoke with Certified Instructor Amy Kneisley, a vocational services coordinator from Riverside of Miami County/RT Industries in Ohio. Over a period of 12 months, Kneisley collected data on verbal incidents at her organization's production facility.
RDR: Hi Amy, for starters, talk a little bit about the project you put together.
AK: Over the last year, we conducted a research project to identify trends/patterns regarding verbal incidents and staff confidence in using verbal de-escalation techniques. First, data was compiled to identify trends/patterns between consumers at the production facility. Second, we looked at interactions between consumers and staff at the production facility. Finally, we hoped to identify how much of a relationship there is between verbal incidents during high and low production times.
RDR: What tools did you use to collect your data?
AK: Data was collected from November 2010 to October 2011 with the individual data collection template provided by CPI. Information was also gathered from incident reports and ABC charting. At the time of the data collection, there was one individual with a behavior support plan that included physical restraint as an option. Since physical restraint is used so infrequently, we wanted to focus more on verbal incidents.
RDR: Could you tell us a little about Riverside of Miami County and the population you serve?
AK: We provide vocational programming to adults with developmental disabilities. Ages range from 18 to 55. There are approximately 100 consumers served in the facility, and there are 11 support specialists/direct care staff. Staff to consumer ratios range from 1:3 to 1:12, with most falling into the 1:12 range.
RDR: So what prompted the project?
AK: The rationale of collecting this data was to strengthen staff confidence so that we are able to continue to decrease verbal incidents and continue to prevent physically acting-out episodes, which could result in restraint. In this way, we continue to provide the best Care, Welfare, Safety, and SecuritySM to consumers and staff. In the past 12 months, there were no incidents that resulted in the CPI Team Control PositionSM being used.
RDR: What did your project reveal?
AK: There were only three incidents between peers and they were easily redirected. There was no correlation between high or low production and the number of incidents. Most of the incidents over the past year related to one individual and the incidents were between him and staff.
RDR: So in a year's time, your data showed that even your verbal incidents were pretty sporadic, except for the one individual. Were you able to see any patterns emerge?
AK: This individual had come to our county from a developmental center, and his "cigarette schedule" was continued as a part of his plan. This type of schedule was carried over with his pop as well. This resulted in daily power struggles between the individual and staff, and often resulted in the individual borrowing cigarettes from other consumers. Staff allowed him to vent and attempted to redirect him back to work. This resulted in him becoming intimidating and hard to redirect. Some of his arguments were valid, such as "I bought the cigarettes with my own money. I should be able to take a smoke break like the others." So it was decided that empowering him through the right channels would be the most appropriate action.
RDR: Knowing this, what supports did you offer him?
AK: With the assistance of his team, we offered him a structure to manage his own cigarettes. At the core of this issue was not so much the ability to smoke, but to have the choice and to be empowered to self-manage. So, as I learned in the Enhancing Verbal Skills: Applications of Life Space Crisis InterventionSM course, it wasn't about the cigarettes.
RDR: What did you learn about staff confidence?
AK: In regard to working with the individual on the cigarette schedule, staff confidence was initially low because they felt they had no control over the plan. However, their confidence increased as staff felt more confident in the limits they were setting and when follow-through with those limits occurred.
RDR: How else did you use the data you collected?
AK: We also felt it was important to use the project tools to help recognize whether or not a plan includes a rights restriction. The Ohio Department of Developmental Disabilities has charged local county boards with reducing rights restrictions so that a positive culture of support can be obtained. We used the data from the project to look at behaviors and staff responses from each incident to ensure that we were on target for creating a positive culture.