From Restraint Reduction to Creating Sanctuary

1. From Restraint Reduction to Creating Sanctuary Brian Farragher, LMSW, MBA Executive VP / COO Andrus Children’s Center http://www.andruschildren.org/

2. "If you don't change your beliefs, your life will be like this forever. Is that good news?" ~ Dr. Robert Anthony Educator & Writer

4. Myths About Restraint • Keeps Kids Safe • Keeps Staff Safe • Manages Agency Risk • It’s a Therapeutic Intervention

5. Features of Andrus Process to Reduce Restraints • Leadership Commitment & Vision • Staff Training • Staff Supervision • Maintaining a Focus • Documentation and Data Analysis • Clinical Review • Program Review and Performance Improvement • Understanding Trauma

6. Leadership Commitment & Vision • Clarifying Mission & Philosophy • It Starts With What You Believe • Restraint as Treatment Failure • Defining the Problem / Sharing Data • Setting Bold Goals • Staying Involved • Developing Effective Systems

7. Staff Training • Commit to an Approach • Thoroughly Train Formal & Informal Leaders • Watch Your In-House Trainers for Drift • Make Adjustments Based on Data

8. Staff Training Focused on… • Self Awareness and Affect Management • Understanding Trauma & Reenactment • Disengagement & Team Work • Faith in the Entire Process • Stay Back …Give Time & Space…Hands Off

9. Staff Supervision / Processing the Incident • Debrief All Incidents with Staff • Reinforce Training • Encourage Expression of Affect • Check Techniques • Explore Alternatives • Cultivate Values • Provide Perspective • Affirm Staff’s Best Efforts

10. Restraint a “BIG DEAL” What We Pay Attention to Flags What’s Important!!!

11. Documentation & Data Analysis • Incident Reporting • Supporting Documentation Follows: (Supervisory Review, Medical Review, Safety Plan Update) • Administrative Review of Specific & Aggregate Reports…Trends Inform Decision-Making • Behavioral Support Committee Review

12. Clinical Review • Identify & Manage Potential Risks • Individual Safety Plans Developed & Updated • De-escalation Preferences Assessed • Team Review of All Restraints • New Strategies Developed

13. Program Review & Performance Improvement • Data Analysis Flags Trouble Spots • Leadership Reviews Data & Encourages Problem Solving • Understanding the Social Context of Violence • Program Areas Develop Corrective Action Plans • Improvement in Performance Is Recognized and Celebrated

14. Understanding The Impact of Trauma & Creating Sanctuary • Impact of Stress on Our Systems - Parallel Process • Staff Training on Trauma • Identifying Traumatic Reenactment – Sins of Commission and Omission • Identifying Collective Disturbance • Understanding Vicarious Trauma

15. Understanding The Impact of Trauma & Creating Sanctuary • Building a Positive Culture – The Seven Commitments • Focus on SELF • Building in Protective Factors

16. Challenges • Connection and Engagement at All Levels is Key • Disregulated Adults Result in Disregulated Kids • Kids & Families as Partners Not Adversaries – Injury, Not Sick or Bad • Changing the Question from “What’s Wrong with You?” to “What’s Happened to You?” • Assessment • Anticipation • Setting Limits & Standards Without Fear • Are We Losing Control??

18. Major TCI Training Push Begins

19. Data Shared with Staff Consistently · Goal to reduce restraint articulated

20. Supervisory • Debriefing • Monthly Review • Parent Notification • Medical Review

21. Sanctuary Process Begins

22. New TCI Curriculum Training

23. Full Staff Trauma Training Begins

24. Agency Leadership Change

25. Implement Red Flag Reviews

26. School Leadership Change

27. Another School Leadership Change

28. One More School Leadership Change – For Good Measure

29. Leadership Sets Goals Develops Vision Maintains Focus on the Issue Through Training Clinical and Program Review Supervision Focus on Trauma Number of Restraint Incidents in Programs Data Collection Flags Problems Identifies Trends Affirms Progress

30. Andrus Children’s Center www.andruschildren.org Brian Farragher bfarragher@jdam.org