by Max Brantley
The number of times restraints are used at Booneville tends to trend higher than other HDCs, and we believe that relates to the fact that Booneville specializes in serving only intellectually or developmental disabled, ambulatory individuals with severe behavioral challenges, including behavior that has resulted in interaction with the criminal justice system or previous hospitalizations.In a prepared release today, the state praised a "dedicated staff" that treated residents "like family" and said use of restraints had been declining. "But we also found inconsistent documentation and a need for some changes that I think the staff and the family of clients will embrace,” said Melissa Stone, director of the Division of Developmental Disasbilities Services. Disabilities Rights has called for closure of the Booneville Center for a variety of reasons, including poor condition of buildings.
A team with experienced clinicians has completed its review of behavioral interventions at the Booneville Human Development Center (BHDC) and found a need for enhanced training, more rigorous documentation, additional reviews of the use of emergency restraint techniques and a streamlining of policies for all five human development centers in Arkansas.
The Arkansas Department of Human Services (DHS) Division of Developmental Disability Services (DDS), which operates all five centers, conducted the review with the help of clinicians from an outside organization that serves people with intellectual and developmental disabilities.
Melissa Stone, DDS Director, has asked BHDC to comply with the directives outlined in the report within 30 to 45 days. She also noted that the facility will be monitored closely and more changes may be made, if needed.
“It’s important that we are continuously improving and monitoring all of the centers and this review is a big step in that direction,” said DDS Director Melissa Stone. “While at Booneville, we found a very dedicated staff that treats clients like family. But we also found inconsistent documentation and a need for some changes that I think the staff and the family of clients will embrace.”
The seven-member team included a psychologist, a psychological examiner, a behavioral interventions trainer, a nurse and DDS staff. They reviewed files and documentation for 22 clients who had an emergency restraint during the previous six months as well as historical center data on the use of emergency restraint techniques. BHDC staff uses a nationally-recognized behavior intervention approach from the Crisis Prevention Institute (CPI) that focuses on de-escalation techniques to avoid further restraints.
The team found that the use of emergency restraint techniques is less frequent than in previous years, and that psychological staff wants to find ways to continue to reduce the use. To that end, the team outlined the following changes:
• Implementing quarterly psychology peer review of emergency restraints for all five human development centers;
• Changing behavior plans so that they clearly outline positive, non-restraint interventions as well as a detailed safety plan that could be implemented in emergencies;
• Re-training staff on how to properly and completely document clients’ behavior and modify forms, if necessary;
• Documenting daily incident review team meetings that include a review of all behavior and restraint reports.
• Creating a behavioral intervention training program for Qualified Intellectual Disability Professionals, who authorize the use of an emergency restraint technique;
• Ensuring the newly created Positive Behavior and Safety Plans (bullet two) are easily understood by the staff and can be followed without much difficulty;
• Providing continuous and ongoing CPI training; and
• Ceasing use of the “safe room.”
The team acknowledged that BHDC has been and continues to be in compliance with state and federal law and regulations and is licensed and certified by the Office of Long-Term Care, which completes annual on-site reviews of the facilities and its practices.
No deficiencies with the restraint practices have been identified during those reviews. DDS will continue to review all Human Development Centers to ensure the best practices are being instituted.