Northstar History

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  • Journey to the

    North Star2006 - 2013

    Transforming behavior support in Hamilton County, Ohio

  • Building Relationships, Changing CultureIn August 2006, an extensive review began at Hamilton County Developmental Disabilities Services (HCDDS) of the ways in which individuals with disabilities are supported in interacting positively with others.

    This review started a transformation of the traditionally aversive* beliefs and methods surrounding interactions with individuals who exhibit challenging behavior. The emerging structure driving this transformation a classic cultural shift - became known as The North Star Initiative.

    To start the transformation, several staff joined together to collect and discuss data from customer satisfaction sur-veys, accreditation reviews, incidents, behavior support plans, and observations of those who work most closely with individuals.

    Staff who participated in this review represented several departments within Hamilton County DD Services, including Adult and Childrens Services, Quality Assurance, Major Unusual Incidents and Prevention, and Behavior Support.

    The need for this review was driven by: Common knowledge among some staff that individuals with aversive plans were not successfully transitioning off of them and methods in the plans were not positively impacting behavior Unapproved behavior support techniques happened frequently The Ohio Department of DD accreditation review in 2006 cited behavior support procedures as needing improvement A new Superintendent and Adult Services Director at HCDDS had great interest in supporting people with disabilities positively and encouraging increased interaction with their communities

    * In 2012, restrictive became the standard behavior support term, replacing aversive. Since the word aversive was operative in the period of time documented by this publication, it will be used throughout this publication.

    Building Relationships,

  • Building Relationships, Conclusions from the review led the group to the primary objec-tives of reducing aversive plans and building positive relationships between people with disabilities and those who support them.

    Since 2006, The North Star Initiative has grown into a dynamic movement, infusing not only HCDDS but also partner agencies with the philosophy, resources and tools to promote positive behavior support.

    As of 2012, 20 agencies supporting more than 500 people have joined with HCDDS in developing and implementing positive be-havior support philosophy and methods.

    It takes a long time to make a cultural shift. It was the first time we took on a project with people who crossed so many departments. It took a long time to

    get it off the ground because we had to get so many people together. Peggy Kurz

    Director of Community Services, HCDDS Former Director of Adult Services

  • Reducing Restrictive PlansReducing Restrictive Aversive (restrictive) plans are defined by the Ohio Department of Developmental Disabilities as the use of manual, mechanical or chemical restraints and/or the seclusion or restriction of rights. At the time of the initial data reviews in 2006, 88 aversive plans were in place, with seven of those using time out/seclusion.

    Plans that included time out/seclusion were prioritized for elimi-nation. To accomplish this, staff who worked with the individuals and had been using restrictive techniques were re-trained and coached about more positive approaches and implementing them.

    Success in aversive plans came gradually over the next two years. Time out/seclusion was soon eliminated from all aversive plans,

    and the number of aversive plans in general dropped in half.

    The state average for aversive plans is 2.6% of people served per county. HCDDSs average is .005%.

    From data collection and review in 2009 by statewide behavior support advisory committee affiliated with The Ohio Department of Developmental Disabilities

  • Developing Training Developing Training Materials and ResourcesOne of the first tasks of the North Star Initiative was to develop training materials and resources for staff to drive a cultural shift away from aversive techniques and toward building positive relationships. Resources included TIP SHEETS and teaching curriculums called TRY THIS and NOW I GET IT.

    The TIP SHEETS and TRY THIS provide information about specific mental health and developmental disability di-agnoses and how those co-occurring diagnoses impact how staff respond to individuals.

    The Now I Get It curriculum uses video clips to share successful teaching strategies for direct line staff. The curriculum was presented at state and national confer-ences for the National Association of Developmental Disabilities and TASH, an international advocacy and best practice association.

  • Promoting PositivePromoting Positive Behavior SupportIn August 2008, partner agencies that support individ-uals throughout the community in residential, work, and other settings were invited to join the North Star movement at Hamilton County DD Services. This pro-gram was named The North Star Advantage.

    Provider partner staff spend a majority of time with individuals. Consistent, well-qualified staff are vital to building positive relationships. Embracing positive be-havior support and changing the culture system-wide required offering the most comprehensive training and support to program managers and direct support professionals employed by provider partners.

    Key components of North Star Advantage Prescreening o viewing a DVD of daily interactions o on-site visits Training before Direct Support Specialists offer direct support o individual rights o Major Unusual Incident reporting o developing positive relationships o crisis prevention o first aid/CPR o support guidelines for the individual Additional training within the first 90 days o self-determination o overview of positive supports o tips for success o formal crisis prevention Ongoing training as requested by the agency Mentoring

    33% of unapproved behavior supports at HCDDS are not health and safety related but occurred be-

    cause staff did something that escalated behavior

    70% of these occurred with residential providers

    data collection and review in 2009 by statewide behavior support advisory committee affiliated with The Ohio Department of Developmental Disabilities

  • The video component depicts a realistic day in the life of a direct service provider. It has helped potential employ-ees decide if the job is a good match for them. The tours allow individuals to give input as to their likes and dislikes of a prospective employee. This process has helped participating agencies hire better-suited candidates and has contributed to reducing turnover rates.

    The training components are vital to start new employees with important information that helps them be successful with the people they are working with. Assigning a mentor to each new employee has also helped in retaining new staff. Behavior Support Specialists at HCDDS host sessions to train partner agency trainers on all aspects of positive behavior supports. Partner agency trainers take this information back to their agencies to change their own cul-tures.

    The average cost of staff replacement is estimated at 50-150 % of the salary of that staff. Through North Star Advan-tage regular meetings, training and mentoring, agencies are guided in reducing staff turnover and accessing HCDDS resources like behavior support consultation and mentoring.

    Second year North Star Participant Keith Hammond of Easter Seals TriState (formerly Jewish Vocational Service) credits North Star with inspiring his agency to reorganize processes that have positively impacted behavior support. Keith said that the work floor has been reorganized in ways that support people in performing their work better, and that the agency has seen a decrease in incident reports because of this.

    When the first group of North Star Advantage participants completed their work in 2008, members wanted to continue regularly meeting because of the benefits from interactions with peers and colleagues. Now, North Star Advantage groups from all of the combined years meet as a separate group from the current years group for addi-tional training.

  • Journey to the North StarJourney to the North Training is an important part of North Star Advantage. It is extensive and ongoing support for provider agen-cies. A series of trainings began in 2010 to teach new and existing Direct Support Staff at each adult center operated by HCDDS about the principles of positive behavior support. This series is called Journey to the North Star.

    This value-based training series was designed to initiate conversation with staff to develop empathy for indi-viduals served. Videos, biographical time lines, PATH Plans, and Life Boxes are used.

    Timelines guide a persons team in talking through a persons life history and capturing it on paper using high-lights and dates. This tool helps show the changes and patterns in a persons life that impact his or her behav-ior, and often pinpoints where a team needs to change its standards for that person to support them better.

    PATH (Planning Alternatives for Tomorrow with Hope) is a team-facilitated planning process that was devel-oped by Marsha Forest, Jack Pearpoint and John OBrien. PATH is one of the most useful tools for listening, planning and discovering what a person with disabilities wants for his or her future. The plan