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Safety Planning

There are multiple tools and approaches which may be helpful to those who choose ID/DD services. One such tool is a safety plan, which is designed to help a person during the earliest stages of escalation before crisis erupts. A safety plan differs from a crisis plan, in that a safety plan is proactive and a crisis plan outlines strategies to implement during a crisis situation. Safety plans are typically developed with people who have experienced trauma, however they can be used for anyone depending on individual needs.


Medical Versus Behavioral

Up to 85% of the time, when a person with an intellectual disability has behavioral symptoms, they are actually due to an underlying medical condition. Below are resources which can help supporters identify possible medical causes to rule out with the PCP.

Download file from Amy Tobolsky at Northwest Health Connections

DD Tools Matrix

This list can be used at the AE/SCO/Provider level to determine appropriate tools and supports based on a person’s concerns. The tools listed are best practice tools that should be implemented when we are struggling to understand the needs of those who choose our services. The tools/resources listed are often recommended through various processes to assist with specific identified concerns. This matrix is designed to assist in identifying potentially helpful approaches for various concerns.


Psychiatric Hospitalization Discharge Planning

Administrative Entities, Supports Coordination, Provider Organizations, Families and Individuals should be aware that Discharge Planning for a patient with an Intellectual Disability and a Mental Health Disorder should begin immediately following admission to the hospital.

Following are action steps and a checklist to serve as a guideline to aid in assuring the most appropriate support is available for a person following a psychiatric hospitalization.  Discharge planning is a critical part of the person’s treatment and is typically handled by a designated staff at the hospital; this could be a social worker, nurse, case manager etc… To offer the most appropriate support upon discharge there are critical pieces of information we must ensure we have. A member of the person’s team should be responsible for communicating with the hospital on a regular basis and the team should ensure that this information is captured throughout the course of the hospital stay.



Risk Reduction Plan

People with intellectual disabilities can be at risk for multiple reasons. The risk reduction plan was developed specifically to address individual to individual abuse, however the basic plan could be used for any risk, from Pica to problematic sexual behaviors.

Risk Reduction Plan

Essential Lifestyle Plan

revisedELPtemplate2 10 14

Individual to Individual Abuse

Central Region PPC has been kind enough to share a toolbox they developed. Below is a description of thier activities, followed by the tools they would like to share.



The incidence of I to I abuse is a reportable event to ODP through HCSIS (Home and Community Services and Information System). 

I to I abuse occurs when an individual perceives intent by another individual to inflict injury; intimidation, punishment, mental anguish, sexual abuse, and/or exploitation.

Categories of Abuse include physical, verbal, sexual, or psychological

ODP and HCQU have initiatives around identifying, reporting and decreasing the incidence of I to I abuse.

A workgroup formed out of the Central Region Positive Practices Committee upon recommendation by ODP Central Region Dual Diagnosis Coordinator.

Our first meeting occurred 4/22/14 with 18 participants from the HCQU, provider agencies, county, vocational and day programs.  We started with training developed by the HCQU on Individual to Individual Abuse Reduction. This was followed by discussion about what our goals and objectives were going to be.  We also had a presentation by a Risk Management Specialist from ODP that provided us statistics for counties in the Central Region over a 5 year period. There was a huge variation in numbers indicating a possible lack of consistency in reporting.

Our group’s objectives included the following:

  • Sharing strategies that focus on prevention
  • Learning how to effectively debrief after the incident with involved individuals and their caregivers
  • Accessing resources such as tools that are proactive and focus on prevention
  • Finding information that may include noticeable correlations between diagnoses and etiologies i.e. Autism, Fetal Alcohol Syndrome Disorder, ADHD, etc.
  • Developing critical thinking for effective corrective actions to reduce I to I in repeated situations
  • To educated through posting articles in the HCQU newsletter

Our next meeting occurred 6/17/14, again with 18 participants, where we shared resources and talked about some other things we would like to do which included:

  • Establishing a tool box of resources – OPTIMA, Risk Reduction Plan, Post Incident Debriefing tool, HCQU trainings for staff and consumers, websites
  • Obtaining a schematic from Theresa Toombs on Identifying I to I abuse
  • Utilize HCQU newsletter to share info around I to I
  • Mini focus group of individuals to help us develop proactive strategies to address

Our next meeting on 8/26/14, with 14 people, was productive as we began to identify what we wanted to put in our toolbox.  We also learned of the following initiatives:

  • Clinton County Community Connections, Inc. has formed a focus group of consumers to discuss abuse between individuals which they will have a report on at our final meeting in October
  • Suncom Industries, Inc. began a training program that promotes positive workplace interactions and appropriate workplace actions to the prevocational population. The program is called The Professional Development Plan and it includes person who have been involved in I to I abuse incidents or situations with the potential to lead to an incident of I to I abuse.  Connie Smith, Director of Compliance for Suncom will provide the committee with a report on the program at our final meeting in October.

Our final meeting occurred 10/28/14 and 19 people attended.  Each received a toolbox (folder) of the tools we had gathered.  Also we had a presentation by Clinton County Community Connections on the success of the peer group they conducted.  That was followed by a power point presentation on the overwhelming success of The Professional Development Plan by Suncom.  Both of these are included in the attached tool box

 Safety Risk Assessment and Planning Tool Top Ten Strategies of All Time for Promoting Positive Behaviour Staff Trainings List on Abuse Risk-Reduction-Plan Risk Screening for Best Practice – FINAL – March142014 Project Sarah Post Incident Debriefing Optima Assessment I to I document Individual to Individual Abuse Reduction HO Identifying I2I Abuse I to I Focus Group overview Health Care Quality Units HCQU Newsletter FBA BSP Info to Consider Handout DD Roll Out DD course descriptions Consumer Training related to I to I Abuse.





Dual Diagnosis Tips for Families
Western Region Positive Practices


Eligible Human Service Definitions


Pamphlet Talking to Psychiatrists


Toolbox for Direct Support Professionals


Tips for Clinicians on Counseling People Intellectual Disabilities


Intellectual Disability Services Acquisition information for Behavioral Health Providers




Understanding Risk

Robert Perske said in 1972, “there can be such a thing as human dignity in risk. And there can be a dehumanizing indignity in safety!”
What is this discussion of risk all about, really?Download

This article discusses the question of risk in the lives of people who are supported by human services. It responds to the way in which risk, as it has traditionally been approached by these services, imposes a barrier to social inclusion and to an interesting and productive life. The article proposes an alternative
person-centred risk process. We argue that, by beginning with a focus on who the person is, their gifts and skills, and offering a positive vision of success, it could be possible to avoid the implied aversion to any form of risk embedded in the traditional approaches and attitudes.Download

Smull-Thinking About Risk