HCBS Training

The evaluation plan is used to celebrate the progress made by teams. However, the evaluation plan will also uncover facts that can make team members feel uncomfortable. Quantitative data can help when topics are very stressful or emotional. 

For instance, incident reports are written documents that describe when something has gone wrong. Most organizations document incidents that reflect negative or unsafe interactions, injuries, medication errors, and other emergencies. Incident reports record negative social interactions that occurred between two or more people. If there are many incidents, people may feel defensive. Sharing visual summaries of incident report data without names or individual stories can be more objective and help take some of the emotion and conflict out of conversations.

Teams that stress the following values can change how incidents reports are viewed by everyone in HCBS:

• Incidents  are opportunities to learn, and to create a plan to prevent similar challenges in the future,
• The incident report is used for gathering information, not to punish staff for doing something wrong,
• Incidents are not meant to target someone as “having a problem behavior,”
• Negative interactions between people can be a sign that staff and people receiving supports both need to learn new skills, and
• Incidents between people receiving services suggest social and emotional skill-building could help.

Incident reports can teach us a lot about cultural differences within an organization. Each person tends to view disrespect or problematic behavior differently, based on how they were raised and the cultural values they hold. In families that value expressing emotions, slamming your hand down on the table while making a point can be seen as typical and accepted communication. A staff person from a different family background might feel threatened by this same behavior because it is not seen as typical or acceptable communication. Incident reports are an opportunity to teach about cultural differences, empathy, self-regulation, and self-awareness for everyone involved.

Provider Example

This graph shows all incidents in an organization in one year. De-identified numbers on this graph represent people who receive services. Each bar on the graph shows how many incidents occurred for each person involved in one or more incidents. The team used this information to create a plan for organizing Tier 1, Tier 2, and Tier 3 supports. If one or two reported incidents were associated with many people receiving services, the team knew that staff training was needed, and Tier 1 strategies were a priority. Three to five incidents might indicate Tier 2 strategies are needed.  A Tier 3 plan would be needed when six or more incidents are documented for one person. 

Visit Implementation Story #6 to see how one organization has started organize incident report data, and Module 7 Resources to learn more about how to use incident report data with staff and people supported.