Addressing Day to Day Risk with the Team, Part 1 1...Addressing Day to Day Risk with the Team, Part...

Pennsylvania Department of Human ServicesOffice of Developmental Programs

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Course Number C-018-01

1Addressing Day to Day Risk with the Team, Part 1


This webcast includes spoken narration.

To adjust the volume, use the controls at the bottom of the screen. While viewing this webcast, there is a pause and reverse button that can be used throughout the presentation.

The written version of the narration appears to the right of the screen.




Certificates of Achievement will be available to Administrative Entity staff, Providers, Supports Coordinators, and SC Supervisors after completing all course requirements. Please view and then save or print your certificate in order to receive credit for this course.

For SCs and SC Supervisors, course requirements include successful completion of a pre‐test and post‐test. All parts of this series must be completed to earn credit.




Hello, my name is Amy Tomalinas. I am a Risk Management Specialist with the Office of Developmental Programs and will be presenting this training.

Welcome to Addressing Day to Day Risks with the Team, Part 1 ‐ Introduction, Key Terms and Guiding Principles

This webcast is the first in a series. All six parts of this webcast series will need to be completed in order to receive credit for this course.




Here are the overall objectives for this six‐part training series. The focus of the series is to provide the tools and strategies for teams to use to recognize and record risk; and to practice critical thinking skills in developing proactive person‐centered risk mitigation strategies to assure that risks are addressed.

In this webcast, Part 1, of the series, we will describe the team’s role in recognizing risk, consequences, need for support and alternatives that reduce the likelihood of harm; implement strategies that balance protection from harm with promoting growth and opportunity and utilize new tools in preparing for discussions on risk mitigation.

The tools, concepts and strategies presented throughout the series will help you to work collaboratively with teams to have person‐centered conversations on how to address risk.




In addressing day to day risk as a team, we are going to be considering – what is an acceptable level of risk and what supports does a person need to address the risk to be as safe and healthy as possible. Keep this in mind as I tell you about Adam. Adam’s Story is a supporting document to this webcast. If you have not already printed and read about Adam; please do so now.

Adam is in his mid‐twenties and lives in Central Pennsylvania with his parents. He and his family enjoy boating, fishing and hunting. Frequently Adam would accompany his father on hunting trips, but never used a rifle. One day Adam told his father that he actually would like to shoot when they were hunting. Like many fathers, Adam’s father saw the opportunity to hunt with his son, to teach him how to shoot a gun and to be with him for his first successful hunt as a cherished opportunity and a time honored tradition.

But the sport of hunting also has a lot of inherent risks and for Adam there were some additional challenges that needed to be considered. In the previous risk trainings, there has been a lot of focus on the negative aspects of risk. What we are focusing on in this training is that taking a risk can also have a positive result, if we take the time to understand the risks and get the right supports in place.




While you don’t know Adam, if you were part of his family, what do you guess would be your concerns about him hunting? Write your ideas in the text box. When you are finished, click Enter.




Here is what Adam’s family thought about as the risks for him.

‐ Adam gets hurt

‐ Someone else gets hurt

‐ If he fails the Hunter Safety test or cannot learn to shoot a gun safely, he may be greatly disappointed

‐ He might lose confidence in himself and

‐ Adam might choose not to accompany his father on future hunting trips

Take a moment to notice that this list includes both physical and emotional risks for Adam.




But while Adam’s family recognized and fully understood the safety and emotional risks for Adam, the family also recognized that Adam has many strengths and resources.

‐ Adam is very motivated to learn how to shoot

‐ He can learn the information needed to pass the Hunter’s Safety exam

‐ Adam has always shown his parents that he can do what other people can do. It just takes him longer

‐ He has determination when he wants to achieve something in his life and

‐ His family will support him to make this happen. In the words of Adam’s father, “Nothing ventured, nothing gained!”




And here’s what happened. Adam’s father started teaching him to shoot, starting with a BB gun and both parents helped him study for the Hunter Safety test. Adam reminded his parents when it was time to study because he was so motivated to pass the exam.

After a lot of effort from everyone, Adam passed the test and got his hunting license! He is now able to accompany his father on his hunting trips, but also to actually hunt with his father, shooting at game when the opportunity arose and even getting a turkey.

This is a picture of Adam with his father that was recently featured in an article in the Pennsylvania Game News, that was written by Adam’s father.

But that’s not the end of the story.




In addition to teaching Adam how to shoot and to pass the Hunter’s safety test, Adam’s father has put in place other supports to help keep Adam safe while hunting. Because Adam is unsteady on his feet, his father carries his gun into and out of the woods. He also makes sure that he and Adam can see each other at all times when they are hunting.

Addressing risks is not just about avoiding the negative experiences, but is also about helping to ensure the opportunity for the positive experiences, the opportunities for an Everyday Life, including being able to hunt with your father. And this ties in with ODP’s mission to “…support Pennsylvanians with developmental disabilities to achieve greater independence, choice and opportunity in their lives”; and their vision to “continuously improve an effective system of accessible services and supports that are flexible, innovative and person‐centered.




Today’s webcast builds on and is a follow up to several 2013 and 2014 trainings on risk including:

‐ Introduction to ISP Monitoring

‐ ISP Monitoring Course ‐ a multi‐part webcast series

‐ Foundations of Recognizing and Mitigating Risk

‐ SC Role in Mitigating Risk – originally a face to face training that is now available as a professional development webcast and

‐ Risk Management Roles for AEs and Providers

If you have not completed these webcasts or attended the face to face training, it is strongly recommended that you take the time to view all of the risk training in order to broaden your knowledge and understanding of risk mitigation.




To get an idea about the scope of this issue, here are two quizzes with HCSIS data about people with intellectual disabilities in Pennsylvania.

The first question is: How many people in Pennsylvania received ODP funded supports in 2015? Click on the response that you think is correct and then click the Enter button.




If you guessed – 52,000 people – you are correct. Approximately 52,000 people did receive ODP funded supports in 2015.




Here’s the next question ‐ how many incidents were reported in HCSIS in 2014 across all reporting categories?

After you have made your selection, click the Enter button.




There were over 58,000 incidents reported in HCSIS in 2014. It is important to note that this is not a 1:1 comparison. Similar to what you know from your own work, some people have no incidents and other people have multiple incidents.

Here is the breakdown of top categories for reported incidents.

Emergency Room Visits – 13,995

Medication Errors – 11,164

Individual to Individual Abuse – 7,054

Hospitalizations – 6,122

Thinking about the people represented by these incident numbers sets the stage for our discussion on risk. Teams need to work everyday to understand why and how people are at risk. Helping to keep people as safe and healthy as possible will work toward reducing the number of reported incidents.




The next few slides are a review to be sure we have a shared understanding of definition of terms and concepts related to risk.

First, here is our commonly shared definition of risk. Risk is the likelihood of some undesirable event or negative outcome occurring to an individual.




The severity of risk is broken down into two basic categories: Imminent and Non‐Urgent.

If there is an imminent risk, there is a need to act immediately in order to protect the person from the undesired event and when necessary taking action to first enlist the support of emergency services.

Non‐Urgent risk is defined as an undesirable event that is not likely to occur immediately, giving at least a little time to better assess the situation, seek out additional supports and develop a longer term plan to reduce the potential for that undesirable event.




In previous training, we introduced this graphic as a tool to help the team guide their actions, based on the severity of the risk (likelihood of harm to the person) and immediacy (when the risk might occur).

You’ll remember that the top left quadrant (red) is when severity is great and immediacy is now or very soon. These types of risks require immediate action.

The top right quadrant (orange) indicates great severity but the risk in not immediate, it will occur in the future. Action can be planned over time to reduce these risks.

The yellow quadrant (lower left) is a situation of lesser severity but something is going to happen soon. The action here is to monitor and take action to reduce the risk.

The green quadrant (lower right) identifies a risk that is less severe and is not likely to happen anytime soon. In this case, the team has time to plan to reduce or eliminate the risk.

The team’s conversation in determining the severity and immediacy of the risk is one step forward in establishing a shared understanding of the risk and supports needed.




Previous risk training focused on imminent risks with severe consequences. And while addressing imminent risk is crucial to protecting an individual’s health and safety; situations of imminent risk are more the exception than the rule.

Have you ever moved an electric cord out of the way to be sure not to fall? Just like for you and me ‐ the SC, service providers, family members, and the individual identify and mitigate various potential risks on a daily basis. These are the types of risks that we identified as top categories in HCSIS reporting.

Together the team works to recognize and assess everyday risk, develop effective mitigation strategies, and record and communicate this information so that non‐urgent risks are less likely to become more urgent or imminent.




Does this look familiar? This is the risk mitigation cycle that was introduced in the SC Role in Mitigating Risk training.

There are two important things to think about in addition to understanding the different parts of the cycle. Let’s start first with the fact that no ONE person has total responsibility for any one part of the cycle or the whole cycle!

Regardless of your role in supporting the person, everyone (the family, the DSPs, Providers, SCs, SCOs, AEs, ODP and even the person him or herself) all have responsibility to:

‐ Ensure that risks are recognized and assessed

‐ Develop, implement and routinely evaluate appropriate strategies to address the risk and

‐ Document and communicate to everyone involved in supporting the person.




So it requires attention from all team members to adequately address the on‐going nature of this risk mitigation cycle. And that leads me to the second point – that the risk mitigation cycle is continuously moving between the steps.

While in this diagram it looks like the movement is always clock‐wise, it may sometimes happen that the team will need to take a step back to understand why a risk mitigation strategy is not working as expected.

For example, if the evaluation identifies that the strategies are not working, the person is not safer or healthier, the team will look back at the implementation to see if the strategy is being put in place as designed. It may be that the strategy is being implemented as described so the team looks back further to development of the strategies and assessments to come up with another idea to try.




Here is an example to demonstrate the risk mitigation cycle.

Cathy attends pre‐vocational program and is supported by a staff person named Becky. One day Becky notices that Cathy becomes very drowsy and unsteady on her feet after lunch. Becky also knows that Cathy takes seizure medications with lunch. Becky identifies two potential risks for Cathy – she may fall and be injured during afternoon activities or she may become so sleepy that she cannot do what she likes to do during program time.

Becky documents her observations and concerns in Cathy’s Program book. She also contacts Cathy’s Supports Coordinator Richard to alert him of the situation and the need for the team to discuss the risks to Cathy.

As part of the team, Becky has already recognized, documented and communicated the risk. The team will now work through the next steps of the cycle – assess, develop strategies, implement and evaluate. Conducting a new assessment at this time is important. The cause of the change in Becky’s behavior could be related to the seizure medications but it might also be related to lack of sleep. Becky’s roommate has not been feeling well and has been up often at night; and so has Becky.




Are you familiar with the term sentinel event?

A sentinel event is something unexpected that may happen to only one person or be extremely rare, but it is so serious that prevention for everyone requires action to see if it could happen to someone else.

When a sentinel event is identified, an agency or an entire system of care will investigate to discover what has happened and what changes to services and practices may need to be put in place.




This chart shows some of the events that are tracked by the medical health care industry. From collecting data like this, sentinel events are used to identify the need for changes in policy and practice.




Have you heard about the patient who went in for surgery on her left foot and when she woke up found that her right foot was in a cast? How about the person who got an infection after surgery and after many days it was determined that a medical instrument was left in his body?

While we have heard these stories, in fact, these were sentinel events that only happened to a few people nationwide. But because the consequences were so serious, the entire medical healthcare system changed practice to be sure it would not happen to anyone else.

When you have surgery now, your body part is marked with a Sharpie pen and you are asked multiple times before anesthesia to confirm the type of surgery you are having done. Before and after surgery, all medical instruments are counted and cataloged to be sure that all are accounted for and nothing was left behind.

While these examples are from medical health care, identifying sentinel events, understanding the cause of the event and then creating new policies and practice toprevent the bad thing from happening again is an important part of risk mitigation in our field too.




While sentinel events are bad things that happen to people, milestone events are achievements or positive life events that are celebrated and happily anticipated. But with these positive milestones, there is also risk and the worry that something might go wrong.

Examples of Milestone Events include:

‐ Graduation

‐ Getting a driver’s license

‐ Obtaining and using an augmentative communication device for the first time

‐Moving away from family and a

‐ New job




For most of us, a major milestone was reached when we received our first driver’s license. We did not think primarily about the risk that all drivers face when they are behind the wheel. As parents, we teach our children safe driving and perhaps put other rules in place to reduce their risk as first‐time drivers. But still there is a risk.

For Adam, obtaining his hunter’s license was a huge milestone. There is still risk involved in his hunting but supports have been put in place to help reduce the risk while promoting the opportunity for personal growth, adventure and discovery.




Think about your own life…

‐What if you never learned to drive?

‐What if you never got married?

‐What if you never had children?

‐What if you never learned to swim?

‐What if you never got on an airplane or a train or a ship?

Everything on this list is a positive milestone event for most people. But all of these events also involve risk and might result in some kind of physical or emotional distress. But we all take these risks everyday. The questions are – what is an acceptable level of risk for me and what support (or thing you do) is in place or can be put in place to reduce the risk.

What are some risks that you take? Are there supports or things that you do to reduce the risk?




The goal of risk management is to balance the responsibility of keeping people safe while promoting independence, self determination, growth and opportunity.

Do you think it is possible to prevent all bad things from happening to people?




What if our bodies were rolled in bubble wrap? Would that eliminate all risks to us?




Use the text box to identify possible risks that might be created if we were rolled in bubble wrap.

When you are ready, click the Enter button to continue.




Here is a partial list of some potential risks that were identified by participants during the face to face training.

‐ Skin breakdown

‐ Suffocation

‐ Isolation

‐ Depression

Before we move on, take a moment to notice that this list includes both physical and emotional risks. Sometimes we don’t think about the emotional risk and that is equally important to help a person to be healthy and safe.

So the takeaway is that we cannot protect ourselves or the people we support against all the bad things that might happen. The goal of zero incidents or injuries in life is not realistic. It is not realistic for people with or without disabilities. In our work, we have to do our best to recognize risk and put supports in place to reduce the risk as much as possible while promoting new opportunities for growth and discovery.




This concludes Part 1 of the series, Addressing Day to Day Risks with the Team.

Part 2, Balancing Safety and Acceptable Levels of Risk, can be located in the course where you found this webcast.




This webcast has been developed and produced by the Pennsylvania Department of Human Services, Office of Developmental Programs in partnership with The Columbus Organization.

Thank you for participating in this lesson.



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