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Clients' role in fire prevention: a behavioral health organization discovers a missing piece in its fire prevention plan.

Most behavioral health organizations have a fire safety protocol, and many have routine fire safety training for staff. But how many actually assess and involve clients in the fire education and prevention process?

The Providence Center in Rhode Island has a fire safety program that empowers clients with mental illnesses to remain as independent as possible in the community and reduces the organization's risk of fire in its residential properties. Through education and by using an assessment tool, the organization assures its clients' safety in the kitchen and includes in their treatment plan a protocol for supervising their use of potentially hazardous equipment. The prevention program earned The Providence Center the 2006 Negley President's Award for Excellence in Risk Management, awarded by Negley Associates, underwriting managers of the Mental Health Risk Retention Group.

The Providence Center is a nonprofit, Joint Commission-accredited organization created to help adults and children affected by psychiatric illnesses, emotional problems, and addictions by providing treatment and supportive services within a community setting. The Providence Center serves more than 10,000 clients each year from Rhode Island and Southeastern Massachusetts. The Providence Center provides housing to those with persistent mental illness in eight group homes, transitional housing programs, and apartments throughout Rhode Island.

The Providence Center's responsibility to keep clients safe always has been paramount. The danger fire poses to disabled and mentally ill clients living in subsidized housing is very real. Recently, a fire caused by improper use and disposal of smoking materials killed a disabled veteran living in a rooming house in Rhode Island and injured another tenant and three firefighters. The Providence Center had its own experience with fire in May 2005 at its Nashua Street Supervised Apartment Program for persistently mentally ill adults. A fire started when a client left a pan unattended on a stove while he answered the telephone. The fire caused $10,000 in property damage, but thankfully there were no injuries or fatalities.

Following the fire, Providence Center management and staff performed a root-cause analysis. The subsequent report highlighted the organization's strong response plan and identified the weaker areas of its fire safety plan and staff training program. Although the analysis concluded that the staff was well-trained on what to do in the event of a fire, there was an important piece missing--client fire safety assessment and education.

The Providence Center's mentally ill clients living in group homes were well-versed on the fire-drill protocol, but they were not assessed for cooking and smoking safety or educated on how to prevent fires while using the stove. In addition, there was no plan in place to supervise clients who pose a fire risk (e.g., those tending to be forgetful while performing daily living tasks or not disposing lit cigarettes safely). These missing pieces were found to be contributing factors in the Nashua Street fire and identified as areas for improvement.

The root-cause analysis recommended steps to identify potential hazards:

* Screening clients' level of safety around potentially hazardous equipment

* Frequent training of staff and clients on fire prevention and reaction

* Establishing an education and supervision plan for clients prone to distraction or identified with unsafe cooking habits

* Assessing all properties for the presence of potential fire hazards

* Installing new smoke and carbon monoxide detectors

The analysis prompted The Providence Center to develop and implement a tool to ensure client and staff safety, reduce its exposure to liability, and increase the quality of client care. The client safety assessment tool is now used with all persistently mentally ill clients living in The Providence Center's housing programs. It includes the following assessments:

* Check each client's stove area to determine the presence of unsafe objects.

* Discuss with each client the importance of a clean stove and cooking area.

* Observe each client's cooking to gauge his/her food preparation habits.

* Give a hands-on quiz on safe ways to put out a fire.

* Demonstrate to each client the proper use of a fire extinguisher.

* Review with each client the building's smoking policy, including designated smoking areas, process for cigarette disposal, and do's and don'ts for safe smoking.

The strength of this assessment process is that it allows staff to gauge a client's level of safety and knowledge in a practical, hands-on format, rather than with the use of a formal, written questionnaire.

The Providence Center's group home, transitional, and independent living program staffs are educated on the use of this tool and the importance of accurately assessing client cooking safety. Supervisors inform their staffs of the risks posed by clients with known proclivities for forgetfulness and unsafe cooking or smoking habits. When clients are found to pose a fire risk, a protocol for supervising their use of potentially hazardous equipment is included in their treatment plan. Risk is reassessed after six months, and plans are updated if clients show a greater level of safety with the stove.

Since these new procedures have been in place, The Providence Center has not had a fire in any of its housing programs. Although the lack of a fire alone does not prove the program's efficacy, our methods and training data leave us confident that our comprehensive program has greatly reduced our exposure to organizational liability and is keeping everyone safer.

We needed surprisingly few resources to implement this quality improvement initiative: staff to undertake the root-cause analysis, develop the assessment tool and training materials, and hold trainings with other staff and clients. The program continues to require a commitment of staff resources for ongoing training and oversight. Despite this, the program is very cost-effective because all trainings are performed in-house by employees and training materials are inexpensive to reproduce.

Our field traditionally has not included clients in plans addressing environmental issues, but our program includes direct action steps for educating clients and developing a safety plan applicable to any housing placement. The Providence Center's program to engage clients in fire protection embraces the values of client independence and empowerment, values universally shared by all visionary organizations.

Sharon Morello previously was the administrator of substance abuse treatment for the Rhode Island Department of Mental Health, Retardation, and Hospitals' Division of Behavioral Healthcare. She has worked in behavioral healthcare with a concentration in addiction medicine since 1987.

For more information about the client safety assessment tool, contact Morello at (401) 727-6550,, or The Providence Center, 530 North Main St., Providence, RI 02904.


Sharon Morello is Director of Residential Services at The Providence Center in Rhode Island.

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Title Annotation:RISK MANAGEMENT
Author:Morello, Sharon
Publication:Behavioral Healthcare
Date:Apr 1, 2007
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