Physical Prompting
______ hands and _______hands should be used when Prompting clients to avoid harming them.
Barbie and Lego
If a bite breaks the skin, what do you do?
-Staff IR
-Recommend the staff go get seen at a medical clinic.
-Chat about antecedent strategies and how they can avoid it from happening again.
What are some ways we maintain a safe environment for our staff and clients?
-cleaning up before transitioning /chores
-organized pods/ groups
-being within arms reach of the client
-floor sup safety walks through the center
-Rules (no running, gym safety)
-Not being alone with clients in a room
-Walkies to call for assistance
Who do you send Staff IR's to and what forms do you complete?
-HR email group
-cc the CM and floor sup group
-note seeking or not seeking treatment in the subject line
Forms:
-Staff IR for all injuries
-Staff investigation report for staff who are SEEKING treatment
How would you advise a new staff member to prompt a client who is flopped on the floor?
-From behind
-Bend knees
-Remind them of reinforcement
-Lower them gently to the ground if you do not have a safe hold on them
What are the 2 types of bite releases?
-Jaw release
-Nose pinch
*Remind staff to feed the bite and not pull away
You have a staff member working through attending to art. They are writing their name with a pencil and there are water bottles, scissors, a bin of markers and glue, and a peer brought a big dump truck with him that is on the table.
The client begins to protest and the RBT is sitting level with the client.
What do you suggest to keep everyone SAFE?
-Potentially put the room on yellow or red
-Start clearing the area of dangerous items (truck, scissors, water bottles, iPads...)
-Have the RBT stand up out of reach from the client or give them a taller chair so they are not eye level with each other .
-Remove the pencil
-Remind them not to cross the mid-line
-Work through the bx plan
What is important to keep in mind when blocking a bite with your hand to their forehead?
The block should be an open palm on the clients forehead – HORIZONTAL to the ground
You should create space (and straighten your arm) by taking a step back
It is important that you are not pushing back on the client’s forehead to create space – doing so could injure the client’s neck
We have seen a trend in staff back injuries from physical prompting. What recommendations would you give to avoid this from happening in the future?
-Bend knees
-Precise movements
-Wide stance- Shoulder width apart for balance
-Lower them if it is not safe
-Call for extra support
-Be in dress code and have hair up
What is crossing the mid-line?
Why is "not crossing the mid-line" important?
-It is reaching in front of the client and crossing over their body.
-It is one of the most common bite injuries
-Crossing the mid-line gives the client easy and quick access to bite
You have a staff and client in the kitchen. The client is engaged in property destruction. They have poured out a few water bottles on the floor and are now using the kitchen sink to spray more water.
The floor is soaked.
How do you keep everyone SAFE?
-clear the room, reminding everyone to be careful of the wet floor and to walk
-block them from the sink/ remove the sink hose from them
-Remove them from the water soaked area
-Continue to follow the bx plan and work through the demand in a safe environment.
-Close the kitchen until it is mopped up
-Wet floor sign
Code blue is called and you can't open your medbox!
The medical plan says administer the seizure medication after 5 minutes and you are almost at 4 minutes.
What do you do?
-Call 911
-Continue to attempt prying open the box
What are your options if a staff member is completing multiple staff IR's throughout the month due to getting injured when physically prompting?
-Review Prompting basics
-Review blocking or have them attend the training again
-Loop in the CM and supervisor for goals if needed
-Review antecedent strategies
-observe and provide safety feedback in the moment
-Remind them that they can ask for help prior to physically prompting so you can assist them
Who is able to use the 2 different bite releases?
PCM staff
-all staff may use the bite blocking technique (hand to the client's forehead).
Clients are making slime and left out the Borax.
OHHH NOOO.... a client ate some Borax.
What do you do?
-Read the box warning label
-call poison control and follow their instructions
-notify parents
-IR completed, loop in supervisor and CM
-Check in with pod who left it out and remind them to clean up.
What is the serious injury protocol when needing to call EMS or parents for pick up?
If the incident is serious (client is unconscious, excessive bleeding or clear broken bones) we will call 911 immediately, then parents. If we are uncertain of the severity but require pick-up we will call parents and notify them of the injury and that we will call 911 if they are not able to pick up within 30 minutes. We will call again after 15 for an ETA and remind them if they are not at pick up in 15 minutes we will call 911 for medical assistance. The 30 minutes starts at the time of the injury.