When an incident occurs that involves the use of a restraint technique, regulations often require that staff meet with designated staff and the individual receiving services and their legal representative to identify factors that led up to the restraint, and how to make changes that reduce or eliminate the need for restraint. This is referred to as debriefing or processing.
How: Debriefing should occur whenever an incident occurs that involves the use of any involuntary physical interaction to explore alternatives to de-escalating or gaining the person’s cooperation in the future. However there is also value in debriefing in situations where a serious incident was averted. Too often the focus is on what we could do better rather than on what we already do well so we can make increase that occurrence. If the process focuses on the positive as well as improvements, people are more likely to participate openly and voluntarily. When debriefing around incidents with positive endings occurs, staff are less likely to perceive it as a negative event in which blame is assessed.
When – Debriefing should occur as soon as possible after the event occurred, but it is also necessary to ensure that the discussion is not going to cause individuals to escalate again. If that begins to occur, the process should be discontinued, documented and another attempt scheduled.
What it is: The focus of debriefing should be on what went well as well as what we might do differently the next time to increase success. The focus is on fact finding, not placing blame. Everyone involved should be treated with respect and dignity. It might be helpful to process in terms of what would happen if “we tried” …. This is an effective way to invite people into the problem solving process. This is also a great opportunity to collect data on responses to various interventions increasing the possibility of a more proactive process in the future.
Where should it occur: Whenever possible the environment should be private and nonthreatening, particularly when it involves individuals receiving services. Which brings us to.
Who should participate: As stated it is not only a best practice but a requirement that staff meet with staff after a serious incident occurs, however in addition a debriefing should occur with the individual receiving services who was involved. Part of the goal of the service provider is to help the individuals in our care increase self-control. Processing can assist in identifying what led up to the event and what the individual and staff can do differently the next time. This helps develop neurological pathways that can enable the person to apply the problem solving information to situations in the future.
However, often service providers forget about individuals receiving services who may have witnessed the event. They may not have an appropriate context in which to put this and will project, “if they did that to that person, what would they do to me”. While there are HIPPA regulations around sharing confidential client information, there are ways to debrief very generally to help reassure everyone, the staffs intent is to keep everyone safe.
Most importantly – Why we do it
The goal of service providers should be to keep individuals in their care safe, physically, emotionally, and psychologically. They need to know that they are safe with us and can trust us. When service providers have to put their hands on someone involuntarily it can break that trust if the person does not understand the context and intent. It is extremely important that everyone have an opportunity to reconcile, re-establish that trusting relationship and share their perspectives of what happened and what can be done differently in the future to prevent such occurrences. The debriefing event can help to provide a therapeutic milieu… What is a therapeutic milieu??? That is information for a future blog…
Aaryce Hayes – Mandt COO & Faculty