General /

Individuals who are receiving services and service providers have rights that are established by laws and regulations. Individuals receiving services have:
• the right to receive appropriate and individualized services,
• the right to be free from abuse and neglect and
• the right to be involved in treatment decisions.

Service providers are protected by the Office of Safety and Health Administration (OSHA) which mandates that employers provide employees with a safe working environment.

Service providers sometimes perceive the rights of individuals receiving services to be in conflict with the employees’ right to a safe working environment, particularly when services are provided to individuals who sometimes exhibit challenging behaviors. These rights are not in conflict and in fact can complement each other. This is more likely to occur when the culture of the service environment promotes recognition that there are reasons why individuals are in their care and treatment and that the environment should provide a therapeutic milieu. When this occurs, the likelihood of physical altercations is lessened and the result is a safer environment.

Sometimes service providers, particularly direct care professionals, interpret their job as one of managing the environment by controlling the behavior of individuals receiving services. An interpretation more conducive to a safe environment for everyone is one where it is recognized that:
• behavior is communication.
• when service providers look behind the behavior to proactively meet the needs of service recipients, the need for individuals to use their behavior to meet their needs is lessened.
• challenging behaviors are often the result of stimuli, sometimes internal but also external, that cause the individual to perceive themselves to be at risk, physically, emotionally or psychologically.

When service providers create treatment environments that consistently treat individuals receiving services with respect and dignity, it is more likely that everyone will feel safe to trust each other. When there is trust, the frequency and intensity of challenging behaviors are lessened. When individuals receiving services perceive the goal of service providers as helping them to be and feel safe, they are more likely to trust the staff and engage in the treatment being offered.

There are some barriers to individuals receiving services perceiving the environment and/or staff as safe and caring rather than controlling.
• When individuals (either peers or individuals receiving services) fail to treat each other with respect and dignity, individuals receiving services have reason not to trust and feel that they must keep themselves safe.
• When the culture of the treatment environment creates an attitude of control or punishment, individuals receiving services will likely react negatively and more frequently use their behavior to demonstrate their anger and frustration.
• When individuals receiving services perceive (correctly or mistakenly) that their input into their care and/or treatment is unwelcome, unheard or disregarded, they are more likely to use their behavior to demonstrate their fear, frustration or anger.
• When individuals become agitated, service providers often move closer to the person and tell them to calm down rather than giving them space and time to regain control of themselves.

On occasion, service providers have initiated lawsuits when they have a physical injury caused by a person receiving services in the service environment. In March 2009, a court ruled that the irrational actions by a psychiatric patient are to be expected and what might call for punishment in a mentally stable patient does not justify punishment of a mentally deficient patient.

Service providers must consider that often the behaviors that are challenging are caused by traumatic experiences that resulted in the individual exhibiting poor impulse control. Part of the responsibility and hopefully goal of the service provider is to help the individual learn how to better manage their own behavior so they do not overreact or use behaviors that may become a physical threat. This teaching is more likely to be successful when staff consistently models those behaviors amongst themselves. This requires service providers to demonstrate patience, understanding and empathy with peers and individuals receiving services.

Individuals receiving services have rights, but also have responsibilities. All of us experience consequences for our behaviors, some positive and some not so much. There are logical consequences, e.g. if you don’t work, you don’t earn money and are less likely to eat. An important part of informed choice is for individuals to understand these consequences. That is part of personal responsibility. How and when that information is conveyed is critical and should not be conveyed as discipline or used as punishment. Consequences are not and should not be punishment. When people perceive themselves as being punished, it often results in feelings of anger, resentment and retaliation. When individuals perceive themselves to be controlled or punished, it can impact the perception of the roles and power, and conflict is more likely to occur.

It is more effective to teach individuals receiving services how to use their behavior more effectively in the future than to punish them for what they did in the past. That approach is more likely to develop the trusting relationship necessary for individuals to feel safe and not feel compelled to use their behavior to protect themselves.

When everyone feels safe in their environment, it is more likely that the rights of both service providers and individuals receiving services will be upheld. This is the approach we teach in The Mandt System.

Aaryce Hayes – COO Mandt System