Practice Without Pressure

Practice Without Pressure (PWP) is a program developed to work with individuals with intellectual and physical disabilities who are unable to obtain medical, dental, or personal care services due to fear of the procedure, the use of sedation/anesthesia, or because of restraints. Providing these services without the use of restraint or sedation will result in less risk for the Member and more savings for the health plan.

Through specialized training and creating a supportive atmosphere, PWP aims to eliminate the need for sedation, anesthesia, and restraint in providing medical, dental, or personal care services to individuals with disabilities. If successful after testing the model, this is a possible benefit to be included in Medicaid state plans or waiver benefits to recoup the costs of the program.

PWP Quick Stats

Of 90 adults seen at PWP through a contract with Delaware Developmental Disabilities Services (DDDS), PWP achieved a 76.6% reduction in the use of sedation and zero use of restraint. The average number of practice sessions to achieve this outcome was 2.8
The investment will provide funding for The MAC training from Practice Without Pressure program to assist members with any hesitancy when seeking treatment.
The training can be used within the dental clinic, but also with women’s health, blood draws, haircuts, and pre-surgery assistance.
PWP will be piloted in The MAC but includes additional phases to expand these services throughout Texas and select regions of the United States.
PWP will develop a credentialing program for certified PWP programs throughout the US.

Changing Medical Care

Along with the goal of eliminating restraint practices in medical, dental, and personal care procedures, the PWP model also aims to make these changes to the healthcare experience that individuals with disabilities often run into. Here is a list of changes we want to see in medical care.

Less daily stress for patients, caregivers, and healthcare professionals
Decrease appointment time
Overall savings in cost
Decreased usage of emergency room visits, especially for oral health issues
Adding PWP as a Medicaid payable benefit in the future.

Why The MAC?

With PWP partnering at The MAC, it allows the program to directly tie into Social Determinants of Health. Both entities will work together to increase the ability of primary care and behavioral health professionals to provide more high-quality care to patients who need it. Since the program includes both caregivers and professionals, both MACers and MAC members will benefit.

History

Deborah Jastrebski, a mother of three, created PWP for her oldest, Marc, who has Down syndrome and significant heart issues. Marc became frightened of anything medical dental, even haircuts, in his personal space. This fear caused procedures to be very difficult for him, as well as his mother and the professionals that provided them. Providers often used restraint and sedation as methods to complete the procedures. Unfortunately, this only led to more trauma and continued the cycle of difficulties.

Ms. Jastrebski knew there was a better way. She not only wanted to better her son’s experience but also to help others within the disability community. By 2001 she had created the PWP from scratch and over time it has become the respected and nationally known entity that it is today.

Philosophy

In putting the person first and the procedure will follow
Everyone can learn, no matter their disability (cognitive, physical, emotional) age or past history
In building capacity in the individual, the caregiver/family, and the clinician/professional
In assuming competence
Behavior is communication
In meeting the individual where they are and bringing them forward
We must prepare, not force or restrain
Parents, caregivers, professionals, can and must learn how to interact, observe, coach, lead, rather than forcing care
The individual is PART OF THE TEAM, not an object to be worked on
In creating a cycle of success

Practice Without Pressure