SECURITY POLICY Zumbro House, Inc. serves individuals with high behavior needs, including those with oppositional behavior, aggression, sexual acting out, elopement (running away), and other behaviors that place the client at risk or the community at large, at risk. It is our responsibility to ensure that we are doing everything within the scope of the clients’ risk management plans, our policies, and our license, to ensure the safety of our clients and those around them. Because of these overriding behavioral issues, staff assigned to supervise these clients are obligated to maintain supervision and security protocols as directed by supervisors or documented in the client’s risk management plan. The following supervision and security protocols must be followed for each and every client, unless an exception is specifically noted in that individual’s protocols or Risk Management Plan. Significant harm can occur to the client(s) and/or community if these protocols are not adhered to with the utmost vigilance. Staff assigned to supervise our clients will be spot checked to ensure seamless continuity with supervision and security protocols. Any staff person who is found not enforcing these mandated supervision and security protocols will incur an unpaid suspension of employment, ranging in length from 2-5 days/shifts. Some more severe infractions will result in immediate termination of employment. Severity of infraction will be determined by the Program Coordinator, and will be based on the level of risk that the client and/or community were placed in as a result of the supervision or security protocol infraction.
Again, the following protocols apply to every client, unless otherwise specified in their individual protocols or Risk Management Plan.
Clients may not wear shoes in the house and shoes must be kept in the designated cabinet or closet which will remain locked at all times.
Alarms on the exit doors and applicable bedroom windows will be armed whenever a client is in the facility. They will only be unarmed when someone is entering or exiting the house, and then will be re- armed immediately. This includes times when clients are frequently coming in or going out, such as when they are going out to smoke or arriving home from their day programs
Clients cannot, under any circumstances, be in other clients’ bedrooms.
Clients are not permitted to go into the community for any recreational activity when on Level 1. In addition, clients who attend certain day treatment programs will not attend activities that have not been approved by the treatment program, regardless of their current level.
Staff must never deviate from the activity schedule without prior approval from the Lead Counselor. Changes to the activity schedule will only be approved in circumstances such as inclement weather or safety-related situations – never based on the preference of the staff. Staff will not take clients anywhere that is not explicitly listed on the activity schedule. For example, stopping at Super America for a snack would not be acceptable unless it was part of the approved activity schedule. Staff will not do any personal errands, complete personal shopping or engage in any related personal activity during their shifts, as that would likely distract them from providing the required line of sight supervision.
Clients will not watch R rated or unrated movies at the house or in the theater.
Activities that primarily child-focused, such as water parks, carnivals, etc. will not be approved activities.
Client must be within line of sight supervision in the community. For example, while shopping at Walmart, the clients must remain in the same aisle as the staff and are not permitted to go around the corner or shop even one aisle away out of line of sight supervision.
Clients are not able to have personal computers, cell phones, or any devices that have internet capability. If a team has approved this type of device, staff must follow whatever process has been established to ensure the inability to access the internet.
At the library, clients are not allowed to access the internet unless approved by their interdisciplinary team. Clients who have been given approval must be directly supervised by staff while accessing the internet. This means that staff must be positioned immediately next to the client while he or she is accessing the internet so that staff are in direct view of the computer screen at ALL times. Staff cannot supervise more than one client at a time on the internet.
Clients are not able to access chat rooms or social networking sites such as Facebook, MySpace, etc.
Any items purchased, rented, or checked out (such as from the library), must be looked over by staff to ensure that they do not contain any material that is sexually provocative, photos of scantily clad individuals, or are child-focused. If there is any question about the appropriateness of an item, the client will not obtain the item at that time.
Visits to the mall must be on the activity schedule and must be for a specific purpose. Under no circumstances will clients enter stores that sell inappropriate items, such as stores that sell primarily women’s clothing/undergarments (with the exception of the female clients), that sell only children’s clothing, or that sell pornographic media of any kind.
The medication cabinet and any other locked cabinets or offices must remain locked when not in use. The medication cabinet must be secured if staffs are more than one arm’s length away from it. Keys must remain in a staff’s possession at all times. Staff may not hand keys (including staff keys, alarm keys, vehicle keys, etc.) over to a client for any reason.
Clients may not be left in a vehicle for any period of time, for example, while the staff runs back into the house to grab something they have forgotten. The driver of the vehicle should never leave the vehicle without shutting off the engine and taking the keys with them, even if a second staff is present in the van.
Personal belongings should be left in employee cars if possible. If items are brought into the house, such as a purse, these items should be locked in the med cabinet and should never be left out in areas where they could be accessed by clients.
Staff must review and sign off on the Risk Management Plans, Protocols, and ISP for each individual they are supervising. Client Risk Management Plan supervision protocols must be followed and enforced without exception.
Kitchen knives must remain locked in a cabinet when not in use. When a client is using a knife or any other dangerous item, staff will remain within line of sight supervision.
Staff will carry the house phone on their person or lock it in the medication cabinet when not in use. If a client is on a level where he or she is able to answer the house phone, staff will hand it to them when it rings.
Clients are only able to make call to or receive calls from individuals on their approved call list, located in their Program Book. Individuals can only be added to the call list by the Program Coordinator. If an individual calls who is not on the approved list, staff will tell the caller that the client is unable to speak to them at that time, take their name and phone number, and report that information to the Lead Counselor or Program Coordinator. Although the level program indicates that clients are able to take calls in the privacy of their bedrooms on a specific level, that does not apply to those individuals who have call restrictions based on their behavioral history.
Staff must provide line of sight supervision when a client goes outside to smoke or for any other reason. It is not acceptable to periodically check on the client while he or she is alone outside of the house. Failure to provide this line of sight supervision could result in elopement or other behavioral challenges. If a staff is going outside with a client to smoke and clients are remaining inside, the door must be re-armed or the staff must stay within 10 feet of that door to ensure that another client is unable to go out the door unnoticed. Clients will be able to smoke once per hour at the designated time. Staff will not offer the availability to smoke any more or less often.
Borrowing or giving of any items between clients and staff or clients and their peers is not allowed. This includes borrowing of CD’s, games, movies, money, cigarettes, candy, or any other item. Clients are able to play games or listen to music together in the common area.
There are no minors allowed in any Zumbro House location or at any Zumbro House organized function. If staff are unsure of the age of an individual or if they appear under the age of 20, staff will ask the person to provide identification to verify their age.
Staff must remain awake and alert at all times. When clients are awake, staff must be engaged and interacting with them.
Clients should not be watching violent or sexually suggestive television shows, such as Cops, NCIS, CSI, etc. While clients are awake, the television should only be on if clients are watching it. Staff should not be watching television, as it can be a distraction which limits their ability to supervise and be aware of the clients.
Clients must be visually checked on at the specified intervals – no less than every 30 minutes at the houses and every two hours at the apartment programs.
Any changes to the staff schedule must be approved by the Lead Counselor. Leaving the house with one staff to four clients (or one staff to more than six clients in the apartment programs) without notifying the Program Coordinator will be considered a safety infraction.
Staff will never assume that something is approved or okay for a client based on their observation of other staff. Any exception to the protocols listed above must be communicated clearly in the individual protocol, Risk Management Plan, or directly from the Lead Counselor or Program Coordinator.
If a staff witnesses a violation of any of the above-mentioned protocols, they must report the violation to the Lead Counselor or Program Coordinator
Zumbro House Rules & Boundaries Appropriate Clothing
Clients must be dressed appropriately when in the common areas & when going from the bathroom to the bedroom after a bath/shower. Socks and/or soft soled slippers must be worn at all times when outside of the bedroom. Clean, unwrinkled, unstained, undamaged, well fitting clothes must be worn whenever going to work or into the community. Staff will assist clients to determine appropriate clothing combinations and outfits. Staff will not take a client into the community if the aforementioned qualifications are not met. “Sagging” pants is not permitted. Shoes may not be worn in the house.
Before You Go Outside…
Dress appropriately for the weather. Shorts should not be worn unless the temperature is 60 degrees or higher (at the time of departure). Let staff know before going outside and be respectful of the level of supervision that staff is required to maintain. Leaving the house property without staff permission will be considered elopement.
Overnight staff should not have to cue clients more than once to get up and get ready for the day. Clients must be ready to go when their transportation arrives to pick them up in the morning. This means that all morning hygiene tasks are completed adequately. Clients who miss their morning transportation due to not being ready will incur a level vote in community meeting.
Clients are expected to shower daily, unless contraindicated by a physician. Showers must be thorough and soap and shampoo must be used. Showers should last a minimum of 5 minutes. Clients are expected to attend to all other areas of hygiene also, including brushing teeth twice daily and using deodorant. Shaving daily and/or trimming beard, along with brushing/combing hair. Staff may cue a client to improve or re-do an area of hygiene that is deemed deficient or improperly done.
Community Meetings are a required component of ZH programming, and clients are expected to attend these meetings on a daily basis, which will be held in the house living room at a time designated on the program schedule. Clients demonstrating inappropriate group behavior, such as yelling or verbal aggression, may be asked to leave the community meeting.
Horse play, such as wrestling, tickling, poking, or play fighting is not tolerated.
Individuals may be asked to leave common areas such as the kitchen, living room, dining room if they are engaging in inappropriate behavior such as verbal threatening, posturing, cursing, name calling, spitting, hitting, kicking, etc. If another client is having these behaviors, and they refuse to leave the area, then the other clients must go to their respective bedrooms, to ensure the safety of all clients.
Clients will be asked to participate and assist with normal daily household chores, such as emptying the trash, cleaning the bathroom, shoveling the walk, mowing the grass, vacuuming, or dusting. Clients are expected to complete their chores to a reasonable quality standard and to the best of their ability.
Everyone living at ZH is expected to help with kitchen duties as well as other household chores. Clients must ask permission before taking food/drink from the kitchen cupboards or the refrigerator. Chore lists will be kept and posted at each house.
Loaning/Borrowing/Giving Personal Property or Money
Clients and staff may not loan or give personal property or money to other clients or staff.
Meal & Snack
3 Meals and 2 snacks are scheduled daily. Meals and snacks are served at the times posted on the program schedule at each house. Meals and snacks will only be served at the posted times. The USDA recommended portions/serving sizes will be served
Clients should use appropriate table manners. You may be asked to leave the table and finish your meal after everyone else is finished.
Clients may not go into peers bedrooms under any circumstances. Food or drink (other than water) is not permitted in client bedrooms.
Calls can be made and received on the house phone between 5pm and 9pm on weekdays and between noon and 9 pm on weekends. Calls must be made and taken in the common area, unless exempted by the client’s team or the ZH level program. Please refer to the ZH level program regarding amount of phone time for different levels. Long distance calls may be made with a calling card or by calling collect. Clients may not use the phone when they are visibly agitated or are demonstrating volatile or erratic behavior. Clients will be asked to take a 90 minute “cool down” period before they will be permitted to use the phone. If a client becomes agitated while on a phone call, staff will ask that the phone call end. The client may call back after the 90 minute “cool down” period.
Cell phone usage is strongly discouraged.
Handshakes, fist bumps and other hand to hand contact are the only form of physical contact allowed at ZH. Clients are not permitted to hug or otherwise touch other clients, staff, or other non-family individuals. This rule applies at the site and in the community. The exception to this is when physical contact is part of a staff approved game or sports activity, or if the client’s Risk Management Plan allows additional physical contact.
Personal TV’s and radios (except walkman’s) must be kept in bedrooms and set at a reasonable volume. Volume must be lowered when requested by staff. Zumbro House does not provide cable television or internet in client bedrooms. Clients may not play music with explicit lyrics, except with team approval, and then only with the use of head phones, so that nobody else can hear.
Rated R movies and video games with a rating of M or AO are not permitted in the common area of the house. Clients may watch rated R movies or play rated M or AO video games in their bedrooms upon team approval.
Treat others with the same respect you wish to be treated. Don’t yell, swear, tease, threaten, or call others (staff or clients) names. Physically aggressive or intimidating behavior is not tolerated.
Clients will be expected to be in their rooms and lights out at different times depending on their level & according to the house program schedule. Although some alone time is healthy and appropriate, excessive alone time or isolation is discouraged. Clients will be asked to balance their alone/bedroom time with interacting in the common areas. Staff will prompt clients to come out of their rooms if the client is isolating excessively.
Clients will have the opportunity to select and participate in community activities at least 6 out of the 7 days during the week, when on level 2 or higher. While occasional non-participation in activities is appropriate, clients will be asked to participate in at least ¾ of available community activities, which promotes community integration. Client bedrooms must be picked up and tidy prior to leaving on a community activity. Staff will check client rooms for cleanliness prior to leaving on all community activities.
Clients will be permitted to smoke per team approval, but no more frequently than once per hour, and never during community meeting or meal time. Smoking will be permitted outside of the house in the designated location. Clients must remain in the designated smoking area. All cigarette butts must be placed in the receptacle located in the smoking area. Tobacco chewing or dipping is not permitted.
Clients and staff will be expected to comply with the client supervision protocols approved by their team, at all times. Unless otherwise documented, clients will remain within direct line-of-sight supervision at all times in the community.
Clients are not to loiter in the hallways, as this blocks access to those who need to pass through. Further, no more than two clients should be in the kitchen at given time.
Off-site visits are discouraged in the client’s first 45 days following admission. On-site visits are permitted following the first 14 days following admission. Unless otherwise decided by the client’s team, visitors are welcome with 7 days advanced notice to arrange for staffing (when indicated) and to plan around community activities, mealtimes, medication times, etc. Visits should be coordinated with the house Lead. ZH discourages visits when clients are on Level 1, due to safety concerns.
Bipolar disorder, previously called manic depressive disorder, is associated with mood swings that range from the lows of depression to the highs of mania. The depression phase is characterized by feelings of hopelessness, sadness, or loss of interest or pleasure in most activities. During a manic phase, the individual may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.
Although bipolar disorder is a disruptive, long-term condition, it can be managed through treatment with medications and psychological counseling (psychotherapy).
What are the symptoms of Bipolar Disorder?
Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:
Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in one’s job, school or relationships. Manic episodes can be severe and dangerous.
Bipolar II disorder. Bipolar II is less severe than bipolar I. Individuals may have an elevated mood, irritability and some changes in functioning, but can generally carry on with a normal daily routine. Instead of full-blown mania, individuals have hypomania — a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania.
Bipolar disorder symptoms reflect a range of moods.
The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.
Manic phase of bipolar disorder Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:
Depressive phase of bipolar disorder Signs and symptoms of the depressive phase of bipolar disorder can include:
Suicidal thoughts or behavior
Low appetite or increased appetite
Loss of interest in activities once considered enjoyable
Chronic pain without a known cause
Frequent absences from work or school
Poor performance at work or school
Other signs and symptoms of bipolar disorder Signs and symptoms of bipolar disorder can also include:
Seasonal changes in mood. As with seasonal affective disorder (SAD), some people with bipolar disorder have moods that change with the seasons. Some people become manic or hypomanic in the spring or summer and then become depressed in the fall or winter. For other people, this cycle is reversed — they become depressed in the spring or summer and manic or hypomanic in the fall or winter.
Rapid cycling bipolar disorder. Some people with bipolar disorder have rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people mood shifts occur much more quickly, sometimes within just hours.
Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren't there (hallucinations).
What causes Bipolar Disorder?
The exact cause of bipolar disorder is unknown, but several factors seem to be involved in causing and triggering bipolar episodes:
Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
Hormones. Imbalanced hormones may be involved in causing or triggering bipolar disorder.
Inherited traits. Bipolar disorder is more common in people who have a blood relative (such as a sibling or parent) with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.
Environment. Stress, abuse, significant loss or other traumatic experiences may play a role in bipolar disorder.
How is Bipolar Disorder treated?
Bipolar disorder requires lifelong treatment, even during periods when one feels better. Treatment is usually guided by a psychiatrist skilled in treating the condition. Individuals may have a treatment team that also includes psychologists, social workers and psychiatric nurses. The primary treatments for bipolar disorder include medications; individual, group or family psychological counseling (psychotherapy); or education and support groups.
Medications A number of medications are used to treat bipolar disorder. If one doesn't work well, there are a number of others to try. Some doctors may suggest combining medications for maximum effect. Medications for bipolar disorder include those that prevent the extreme highs and lows that can occur with bipolar disorder (mood stabilizers) and medications that help with depression or anxiety.
Medications for bipolar disorder include:
Lithium. Lithium (Lithobid, others) is effective at stabilizing mood and preventing the extreme highs and lows of certain categories of bipolar disorder and has been used for many years. Periodic blood tests are required, since lithium can cause thyroid and kidney problems. Common side effects include restlessness, dry mouth and digestive issues.
Anticonvulsants. These mood-stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal). The medication asenapine (Saphris) may be helpful in treating mixed episodes. Depending on the medication you take, side effects can vary. Common side effects include weight gain, dizziness and drowsiness. Rarely, certain anticonvulsants cause more serious problems, such as skin rashes, blood disorders or liver problems.
Antipsychotics. Certain antipsychotic medications, such as aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), may help people who don't benefit from anticonvulsants. The only antipsychotic that's specifically approved by the U.S. Food and Drug Administration (FDA) for treating bipolar disorder is quetiapine. However, doctors can still prescribe other medications for bipolar disorder. This is known as off-label use. Side effects depend on the medication, but can include weight gain, sleepiness, tremors, blurred vision and rapid heartbeat. Weight gain in children is a significant concern. Antipsychotic use may also affect memory and attention and cause involuntary facial or body movements.
Antidepressants. Depending on symptoms, doctors may recommend individuals take an antidepressant. In some people with bipolar disorder, antidepressants can trigger manic episodes, but may be OK if taken along with a mood stabilizer. The most common antidepressant side effects include reduced sexual desire. Older antidepressants, which include tricyclics and MAO inhibitors, can cause a number of potentially dangerous side effects and require careful monitoring.
Symbyax. This medication combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the FDA specifically for the treatment of bipolar disorder. Side effects can include weight gain, drowsiness and increased appetite. This medication may also cause sexual problems similar to those caused by antidepressants.
Benzodiazepines. These anti-anxiety medications may help with anxiety and improve sleep. Examples include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). Benzodiazepines are generally used for relieving anxiety only on a short-term basis. Side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory.
Psychotherapy Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful. These include:
Cognitive behavioral therapy. This is a common form of individual therapy for bipolar disorder. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers bipolar episodes. One can also learn effective strategies to manage stress and to cope with upsetting situations.
Psychoeducation. Counseling to help one learn about bipolar disorder (psychoeducation) can help individuals understand bipolar disorder. Knowing what's going on can help individuals get the best support and treatment, and help one recognize warning signs of mood swings.
Family therapy. Family therapy involves seeing a psychologist or other mental health provider along with family members. Family therapy can help identify and reduce stress within the family. It can help families learn how to communicate better, solve problems and resolve conflicts.
Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship skills.
Support for those suffering from Bipolar Disorder
Get regular exercise. Moderate, regular exercise can help steady one’s mood. Working out releases brain chemicals that make one feel good (endorphins), can improve sleep, along with a number of other benefits.
Get plenty of sleep. Getting enough sleep plays a vital role in managing one’s mood. Individuals who have trouble sleeping should talk to their doctor or mental health provider about options to improve sleep.
Stay focused on goals. Recovery from bipolar disorder can take time. Help individuals stay motivated by encouraging them to keep focus on their goals. Stay positive and encourage them to talk about what they are struggling with, either in group therapy, individual therapy, or just one to one with you.
Find healthy outlets. Explore healthy ways to channel energy, such as hobbies, exercise and recreational activities.
Learn ways to relax and manage stress. Yoga, meditation or other relaxation techniques can be helpful.
**Please remember that any specific interventions or plans for addressing behavior for a client must be discussed with the team prior to implementation. None of the above suggestions are meant to replace any plans that are agreed upon and in place for any client. If you have ideas for how to support someone that you work with, please voice those ideas to the Lead Counselor, the Program Coordinator, or bring them up at the next staff meeting.
Information adapted from Mayo Clinic online source