Frontline Initiative Documentation

Strong forces, in the form of liability concerns, funding constraints, Health Insurance Portability and Accountability Act (HIPAA) mandates, and ongoing workforce issues are testing human service providers. Smaller state budgets and bigger regulatory demands are leaving providers with fewer dollars and staff with which to manage risk at a time when the wisdom of expanding choice and opportunity has never been clearer.

At the same time, providers are striving to broaden the opportunities of individuals with disabilities to make decisions and participate in community life. Providers must strike a balance between choice and risk for individuals who long for more opportunities to make choices based on their personal preferences. The exposure to risk continues to grow, along with the provider’s duty to manage it.

A sound risk management process pursues quality outcomes while ensuring a reasonable degree of safety. It relies on competent Direct Support Professionals (DSPs), frontline staff, and self-advocates to minimize risk and educate the community. Together, they weigh options and make informed choices based on ability, desire, and degree of preparation. With this process, outcomes are more likely to be positive, leading to increased knowledge, competence, and self-esteem. These are the tools that DSPs and people who receive supports use to build bridges to the community and inclusion. Without them, outcomes can be disappointing or even disastrous.

When Bad Things Happen, the Community is the Jury

If members of the public were polled, many would agree with the idea that persons with mental health, cognitive, developmental, or a combination of disabilities have a right to be employed, have intimate relationships, vote, attend schools, shop in stores, use public transportation and join recreational clubs. When it comes to life situations, however, those same members of the public often decide that people with disabilities are best kept on a bland diet of limited activities and close supervision. They think that by keeping human service recipients “experience-poor,” they will also keep them safe. They overlook the fact that this would also bar such individuals from participating in most of the activities that society itself has identified as essential to making life worthwhile.

This contradiction is most apparent during a court trial that may follow an incident or accident involving a person with a disability. Jurors drawn from that uninformed public often find providers responsible for not providing a safe environment for individuals with disabilities. They may not realize that their decisions also promote more restrictions on activities and diminish community support for inclusion.

While we need to understand public perceptions, we must remember that they are indeed perceptions. With accurate information, the public, including jurors, lawyers, and judges, may ease their concerns and change their opinions. Efforts to deliver that information must be both coordinated and comprehensive if they are to succeed. The goals of such efforts are to discourage the use of judicial remedies that can restrict choices and opportunities, and to disperse the information that will promote safety, choice, self-determination, and the right to risk.

Steps Providers Should Consider

The task of educating an entire community sounds huge, but there are solutions. It begins with identifying risks and selecting the best options to manage them. In reducing the risks surrounding people and their activities, the most powerful tools are training and education. Plan to include staff, individuals being supported, and the public in your educational campaign.

The DSP’s Role

In addition to specialized training, the role of DSP and frontline staff demands high levels of stress tolerance, patience, and strength of character. Trained and empowered DSPs are more likely to be competent, motivated, and qualified for their complex tasks. Even in the face of smaller budgets, providers can do much to enhance DSP performance and morale —

• Schedule in-house sessions on stress management.
• Provide behavior support workshops, which can give staff alternatives to using restraints, etc. when working with individuals who have challenging behaviors.
• Offer brief talks by the Agency Safety Committee (OSHA requires providers of a certain size to have a Safety Committee in place) on topics relevant to your program and population.

Ongoing training, skill standards, a code of ethics and public relations and communications protocols are vital to a DSPs support system and should be in place to guide DSPs’ decisions and actions. DSPs must also understand the philosophy and mechanics of the Individual Risk Management Process (IRMP) if they are to effectively support individuals with disabilities in their pursuit of choice. It is important to convey staff appreciation and approval —

• Initiate a staff recognition day or employee-of-the-month program.
• Have a mentoring program to acknowledge senior DSPs and support less experienced staff.
• Recognize and support DSPs in an effort to enhance their status and image within your community.

All of these suggestions are low or no-cost ways to improve focus and tell staff that what they do matters, and that they do it well.

The Self-Advocates Role

Remember the old ad, “An educated customer is our best customer”? It might have well been written for human service providers. Educated individuals with disabilities are prepared and self-aware and therefore safer. Individuals who participate in personalized programs with suitable supports and realistic goals can succeed. Documenting each individual’s plan regarding abilities and preferences is a useful risk management practice. Here, again, providers can turn to in-house resources to boost safety awareness —

• Deliver reminder sessions on using public transportation, managing medications, job and household safety, etc.
• Sponsor discussions on choices, interpersonal relationship rights of the people being supported, and other topics.

All of these will reinforce formal training and help individuals with disabilities enjoy positive experiences and minimize the severity of any negative ones. Staff and the individuals being supported will also be better equipped to participate in the next step of the campaign.

Taking it to the Streets

A well-planned public relations campaign will show the community exactly what staff and individuals with disabilities have achieved with support. The only way to relieve public concerns and replace public perspectives with facts is to show the public the connections among right to risk, self-advocacy, bridges to the community, and ways in which people with disabilities can improve their own quality of life and that of the community. For example, maybe a local paper would write a news article about a person with a disability visiting residents at a local nursing home or helping to maintain a local park.

The more people who participate in community education, the better, but educated self-advocates and trained, motivated DSPs are your best ambassadors. They can carry first-hand information to schools, civic organizations, community leaders, the media, and special interest organizations. Among those groups are the judges, lawyers, jurors, teachers, and employers who have the power to affect your organization’s future and the lives of those you support. As the people you support educate the public, they will also gain experience and forge contacts that lead to inclusion and safety.

Through such grassroots activities your ambassadors can identify the community’s “Gatekeepers” and solicit their support. Gatekeepers are rich in social capital and often hold the keys to acceptance and risk reduction.

No provider can promise that people with disabilities and DSPs will not suffer harm or be harmed through their own or someone else’s actions or failure to act. No one expects them to make such a promise. What providers can do is use every available tool to reduce exposures, manage risks, protect individuals and DSPs, mitigate the negative effects of any untoward event, and investigate any event extensively and use the results to prevent future occurrences. Regardless of the people served, providers can use bridge building to achieve a variety of results.