Notice, Report, Escalate: Knowing When to Act

Respond proportionately using the person's normal presentation and agreed pathways.

Support workers are frequently involved when change first occurs, but it may not be clear whether to write it up, report to a supervisor, get same-day advice or use an emergency response.

Thresholds that are not clear can lead to hesitation. There can be distress when the person is over escalated and delay when they are under escalated. The more prepared the response, the calmer the reaction would be.

Why this matters for support workers

Support workers' quality is embodied in hundreds of tiny decisions they make in another person's home and community. The answer is consent, respectful language, accurate observation and the ability to be disciplined in the role, as well as having a clear plan. Consistency is not rigidity when workers grasp the function of a routine and are able to control the type of support given.

What better coordination looks like

Workers need a solid understanding of the rules, identifiable warning signs, and a clear pathway to help distinguish routine, urgent and emergency situations.

Know the baseline

Obtain information from approved sources about the person's normal patterns of communication, mobility, eating, mood, skin, sleep and so forth.

Record the difference

Explain the change, the time, the context and immediate response, but not the cause.

Follow the right pathway

Follow the person's plan and organisational procedure, check the message has been received and remain within your training.

Make the change last

A helpful change is one that is specific, and small enough to practise and easy to review. Determine who will initiate first, where the decision will be documented and when the person will be asked if it was a successful decision. If the approach requires multiple services, check each service individually, not assume readiness because of consensus in a meeting. Keep what works, change what doesn't and eliminate temporary solutions that are no longer meeting the desired goals.

Questions for the next review

What would “know the baseline” look like from the person's point of view?

What is fixed or what is still an assumption or a request?

What will the individual and team be able to see that will allow them to determine if this method is working?

Keep the boundary clear

In a life-threatening emergency, do NOT wait for administrative approval. However, never use emergency services as an everyday alternative to a support that is not urgent. Implement local emergency plans in accordance with the person's plan.

A practical example

One of the workers observed a participant was unusually winded as he walked a familiar distance. They ended the activity and followed the health escalation plan and made accurate observations. This allowed the appropriate clinician to make a timely decision.