Risk Assessment, Safety Supervision, and Liability (RASSL):Research-Based Pilot Module
Mary Tellefson, Sarah Moreau, and William Koehler
Liability has been a concern for those providing orientation and mobility services, and the topic of many discussions. With the onset of COVID-19, coupled with critical and long-standing shortage of trained O&M Specialists, remote instruction via multiple technologies has raised new and serious questions about liability for the O&M Specialist. With learner safety as a prime responsibility of the O&M Specialist. Mary, Sarah, and Bill explore the tenets of risk assessment, safety supervision, and describe how scope of practice affects potential liability for that specialist. Ramifications for the O&M Specialist and the use of untested technology and devices will be discussed as well.
The Risk Assessment Matrix and training presentation is research based.
Contact us, for training and resources. You may also see our presentation at AERBVI.org e-learning site.
Column 1: Environment
When looking at environments for potential risk, consider these factors:
•Is the environment predictable, stable and/or controlled or are there changes that occur?
•What are the possible environmental variables and does the learner know to expect them?
•For example, a familiar indoor school environment would appear to be risk free most of the time. However, when there are scores of students in the hallway passing between classes during certain times of the day, there could be greater risk for the learner with emerging cane skills, or who uses auditory cues or time-distance awareness to locate the stairs.
•Therefore, a learner must be taught how to deal with those variables during the day.
•Even a fairly simple indoor environment has the potential for unexpected variables and the potential for injury. When you conduct a risk assessment you will take these into consideration.
•Have you specifically taught problem solving skills?
•During a risk assessment process, the learner’s familiarity with the environment plays a huge role in anticipating and planning for expected and unexpected hazards.
•This also speaks to the level of skill acquisition a learner demonstrates. For example, a learner who has an inconsistent arc when using touch technique may not pick up on an expected or unexpected drop-off (stair, curb, manhole, etc.)
•Unfamiliar environments require a higher level of safety supervision.
•Learners whose skills are “emerging” require a higher level of safety supervision.
•Proximal, on-site safety supervision is expected
•Levels of safety supervision and levels of skill acquisition are detailed in subsequent slides.
There isn’t an agreed upon definition of simple and complex environments, and surely, what may be simple to one learner may be complex to another. But it is worthy of consideration.
•Typically, we assume a familiar indoor environment is a “simple” environment and has less potential for bodily injury than an outdoor environment in which the features include streets and motor vehicles.
•To some degree, the kind of environmental variables that can occur helps us differentiate a simple environment from a complex environment.
•The level of cognitive function necessary to travel safely in any given environment must also be considered. Individual learner characteristics are taken into account when evaluating the risk for injury.
Column 2: Safety Supervision
Ensuring a Learner’s Safety during O&M Instruction or Monitoring
When deciding how close an O&M instructor needs to be to a learner in order to ensure safety, the following are considered:
•the recorded skill level the learner has demonstrated in the working environment
•the complexity of the route
•the environment (presence of hazards)
•likelihood for unexpected variables
We know that giving a more structured level of supervision than is needed on a regular basis can promote a dependency that facilitates learned helplessness.
These levels were created out of necessity at the Wisconsin School for the Blind and Visually Impaired back in the 1980’s and adapted for use in the O&M CCCR Standards document.
Levels of Safety Supervision Examples
Maximum Safety Supervision:
•Hands on contact (wheelchair, students who run)
•Within arm’s reach (physical proximity)
Moderate Safety Supervision:
•Line of sight
•Within voice response range (vocal proximity)
•Student needs to be able to respond to a verbal “stop” command or equivalent
•Needs prompts with situational observation
Minimal Safety Supervision:
•Situational age-appropriate supervision
•No observation necessary
**It is recognized that the field does not have a unified way of describing levels of safety supervision. We have adopted these from the O&M CCCR Standards document for use in this training module.
Levels of Risk Associated with Safety Supervision Considerations
Column 3: IEP Goal and Lesson Plans
•This factor is not so much related to learner risk of injury as it is to O&M negligence should an injury occur.
•In the case that an O&M instructor has perhaps taken a detour after a lesson on the way back to the school or agency, maybe to return a library book or stop at the bank, thinking, “VI learners benefit from these real life experiences” and has a car accident in which the learner was injured, an investigator will look at the lesson plan and written goals to see if your “whereabouts” was justified.
•Be clear that if it isn’t in the written plan, you risk increased liability in such a case.
Column 4: ACVREP Scope of Practice
Importance of acting within your professional scope of practice
•As a result of an interview with a personal injury lawyer one of the first questions that would be asked in a claim of negligence lawsuit is whether or not the O& M instructor was working within the profession’s scope of practice.
•“If not, your professional liability insurance may be null and void.”
•(Personal communication with Insurance Carriers and Personal Injury Attorney, William Koehler, 2020)
•Since new innovations in the use of telepractice are being created as we speak and the needs of learners and O&M specialists are fluid as conditions evolve, it is essential that you review ACVREP Scope of Practice and the Subject Matter Expert committee’s guidance document to confirm the strategies/methods you use are upheld as a research-based intervention in the official documents.
• This will not only guide you in using preferred practice, research-based methodologies, but give you a rebuttal if asked to perform your job in a manner that is not acceptable.
Levels of Risk Associated with acting within the Professional Scope of Practice
Column 5: Student Characteristics
•It’s not a surprise to any teacher that learner characteristics drive the learning process.
•It is also a driving factor when assessing risk for bodily injury.
•Learner characteristics overlay all of the other factors that have been discussed in this training module, from the ability to problem solve variables in familiar or unfamiliar environments, whether they be simple or complex to the ability to control their own behaviors.
•The visual impairment itself is relevant when determining the skill set that is needed for travel in a given environment. But it does not predict the skill proficiency level that can be obtained. Therefore, using definitions of skill proficiency (emerging, applied, generalized) as defined in this module will define the risk based on skill rather than disability category.
Categories of Learner Characteristics that Affect Risk
•Among the many learner characteristics that teachers recognize as affecting an O&M learner's safety are:
•Predictable, controlled behavior
•Presence of other physical or cognitive concerns
•Whether or not these are characteristics are controlled through modifications or adaptions will help you determine the level of safety supervision that is necessary in any given environment and help you determine how much you must control the environment to prevent the potential for injury.
Using the O&M CCCR Standards to recognize increased risk
Five O&M CCCR Standard Domains gives us the framework to ensure we don’t miss an important component of O&M instruction.
•Standard One: Concept Development
•Inability to perceive and integrate space and time concepts; poor body image; inaccurate or inability to use environmental features and assign meaning for the purpose of knowing which technique to use or to anticipate danger.
•Standard Two: Sensory Development
•Underdeveloped sensory system, sensory systems at risk (poor balance or vestibular reactions), inability to perceive and integrate sensory input for each channel.
•Standard Three: Orientation and Mapping
•The inability to develop orientation and mapping skills could disallow a learner to recognize unfamiliar places, environments, or use landmarks. If a learner travels safely only in familiar environments, s/he may not be able to travel any place without maximum safety supervision.
•Standard Four: Formal and Travel Techniques:
•For learners with additional physical, behavioral or cognitive disabilities, the potential for getting beyond an emerging stage of skill development may be hindered. Accurate techniques provide safety and inaccurate techniques do not.
•Standard Five: Communication, Personal Safety and Advocacy
•Inability to communicate can lead to behavior challenges such as running off;
•Without the reasoning skills to problem solve, a learner may be at greater risk for injury when variable present themselves, if they get lost or decide to cross a street midblock to get to a destination they can see.
•Advocacy – the ability to communicate needs or wants can increase risk of asking for help when needed; indicating pain or the need to stop; increased fatigue could cause falls or decisions that increase safety risk if unable to advocate for self.
Levels of Risk Associated with Learner Characteristics