Transporting Individuals with Disabilities Expert Article

Our behavioral health experts are frequently retained to investigate incidents where injuries and other incidents have occurred during the transport of individuals with disabilities to/from external care providers or community settings and their residence. These incidents include actions of the passengers that may relate to aggression towards the driver, care providers or peers; attempts to open the vehicle door; unbuckling seatbelts; and other behavioral concerns.

This article discusses the standard of care for transporting individuals with disabilities, with respect to appropriate behavior interventions and supervision considerations. 

Supervision Considerations for Transporting
Individuals with Disabilities

Agencies that provide services to individuals with disabilities must have proper staff to client ratios during transportation to ensure the safety of both passengers and driver.  Staff ratios are determined by each individual’s client-specific plan, and the overall support needs of all program participants. 

Often, individuals with disabilities receive services that require them to be transported by their support staff such as: to and from daily activities, doctor appointments, and community outings. 

Support staff can be employed by the residential provider, school/day program provider, or community based services. The vehicles used are typically owned and insured by the provider agency. 

Individual Care Plan/Behavior Support Plan

Individuals with developmental disabilities such as autism, pervasive developmental disorder, and intellectual disability can exhibit a variety of challenging behaviors including physical aggression, self-injurious behavior, or elopement. 

These behaviors may be in response to task demand, anxiety, a change in routine, or an environmental trigger and can occur in any setting. Individuals who exhibit dangerous or unsafe behaviors in the vehicle require specific behavioral programming to ensure they receive proper supervision during transport. 

The individual’s care plan and/or behavior support plan should include the necessary support and methods to ensure safe transportation. The behavior support plan is developed with a goal to reduce maladaptive and challenging behaviors through a prescribed method of proactive and reactive approaches. 

Behavioral Interventions

Support staff must be trained to properly implement the individual’s behavior plan, including all de-escalation techniques from least to most restrictive.    

For individuals with a documented history of unsafe behavior in vehicles, behavioral interventions may be necessary to ensure their safety, and the safety of others, in the vehicle during transportation.   

Prior to entering the vehicle, staff should be prepared to proactively address any potential concerns. This may include:

1. Adjusting the vehicle’s environment to reduce agitation or stress when applicable. Some individuals are sensitive to extreme temperatures, or loud music, therefore if appropriate, the vehicle should be a comfortable temperature and the radio at a low volume
2. Ensuring staff are trained to take necessary steps to reduce any known anxiety associated with the trip and exhibit competence with de-escalation strategies

For some individuals, more restrictive measures may be necessary to minimize risk of incidents during transportation. 

If applicable to the individual situation, restrictive interventions may include:

• 1:1 supervision in the vehicle to address aggressive, self-injurious, or other unsafe behaviors
• Designated seating to minimize access to doors, the driver or other passengers
• Buckle guards to prevent unbuckling of seatbelts; use of “child locks” to prevent opening the vehicle door
• Window padding to minimize injury or damage
• Partitions to prevent access to the driver

Communication Between Provider Agencies

Communication across provider agencies is critical for the continuity of care individuals receive, the chain of responsibility extends from one provider and setting to the next. 

Individuals with disabilities have a circle of support of the important people that play a role in their life, including residential providers, day program providers, care manager, service coordinator, and family. 

Each member of that circle is responsible for the overall health and safety of the individual when in their care. Discussions between providers occur at the regularly scheduled review meetings, however, it is important to share any change in status that the individual may experience with the treatment team to avoid negative behavioral outcomes. 

Providers that are responsible for transporting an individual should be aware of behavioral challenges that an individual may possess and how to implement the individual’s care plan and behavior plan to address those challenges.  

Behavioral Health Expert Witness Investigations

The supervision and behavioral health experts at Robson Forensic have hands on experience working in organized care settings, implementing and evaluating the processes and procedures used to ensure the safety of individuals receiving care. This includes, among others, effectively screening staff during the hiring process, training and retaining staff, and reporting/investigating incidents. 

For more information, submit an inquiry or call us at 800.813.6736.

Featured Expert

Danielle Dieterich, MA, JD

Supervised Care & Behavioral Health Expert

Danielle Dieterich is a Supervised Care & Behavioral Health Expert with two decades of experience in the management of clinical programs and residential care facilities including day habilitation,… read more.