Evaluation of the Safety-CareTM Behavioral Crisis Prevention

1
Evaluation of the Safety-CareTM Behavioral Crisis
Prevention Management Training by QBS,
Inc.University of Utah

• Presented by Will Backner and Stacey Graziano
• February 2010
• Training School Psychologists to be Experts in
  Evidence Based Practices for Tertiary Students
  with Serious Emotional Disturbance/Behavior
  Disorders
• US Office of Education 84.325K
• H325K080308

2

• Safety-Care Behavioral Safety Training is a
  competency-based crisis prevention training
  program developed for staff who work with
  individuals with the potential for aggressive
  behavior.

3
Philosophy of Program

• Safety-Care procedures are based on research
  from applied behavior analysis (ABA).
• Utilizes concepts of behavior support including
  reinforcement and functional assessment.
• Focuses on identification and reinforcement of
  alternative behaviors.
• Safety-Care is taught using behavioral
  instruction methods.

4
Certification Requirements

• The core Safety-Care course is two days in length
  (1216 hours of training time) and basic trainer
  training is three days.
• Certification lasts for one year for both Trainer
  and Specialist certification. Specialist
  recertification takes one day and Trainer
  recertification is one day if conducted at the
  customers site.

5
Certification Fees

• Safety-Care Specialist Training (1½ day training
  by certified QBS Master Trainer)
• At customer's siteup to 10 participants 3,600
• At customer's siteup to 16 participants 5,760
• Attend open session at QBS 360 per
  person
• Safety-Care Trainer Training (3 day training by
  certified QBS Master Trainer)
• At customer's siteup to 10 participants 7,000
• At customer's siteup to 16 participants 11,200
• Attend open session at QBS 700 per
  person

6
Certification Fees

• Advanced Module Training by Certified QBS Master
  Trainer
• Half dayup to 10 participants 1,150
• Full dayup to 10 participants 2,300
• Curriculum customization Free
• Curriculum development 100 per hour
• Certification/Annual Recertification
• Attend 2 day recertification during open session
  at QBS 200 per person
• 1 day recertification at customers siteup to 10
  participants, 5 minimum 200 per
  person
• Specialist certificate cost (initial training or
  recertification) 4 per person
• Transfer Safety-Care Trainer certificate to a new
  organization 200 

7
Training Outline

• Introduction general introduction to the course,
  causes and conditions associated with challenging
  behavior, the reinforcement model of behavior,
  and the inadvertent reinforcement of challenging
  behavior.
• Incident Prevention provides methods for
  reducing the likelihood of behavioral crises and
  improving staff safety. Includes creating a safe
  and positive living environment, dressing for
  safety, and safe interaction with potentially
  aggressive individuals. Staff will also learn,
  practice, and demonstrate competency in
  reinforcement and basic preventative safety.
• Incident Minimization methods for identifying
  crises and stopping or reducing their intensity.
  Includes detecting antecedents (triggers and
  signals), predicting behavior, and getting
  assistance. Trainees will also learn and practice
  approaches to intervention with agitated
  individuals, de-escalation, and reinforcement of
  non-crisis behaviors.

8
Training Outline

• Incident Management how to safely cope with a
  serious behavioral incident. Includes physical
  safety skills, releases, management of weapons,
  leadership during behavioral crises, procedures
  for safe holding, alternatives to holding,
  emergency release, planned rapid release, and
  emergency release. Organizations can choose not
  to use certain physical interventions if they
  believe they are not appropriate to their setting
  and mission.
• Post-Incident Procedures recovery procedures
  following crises, debriefing of staff, debriefing
  the individual.
• Role-Plays following the presentation of the
  Safety-Care curriculum, role-plays of increasing
  intensity are presented. Role-plays are tailored
  to the kinds of problems that trainees encounter
  in their work settings. Role-plays are designed
  to teach staff how to use the skills theyve
  learned, and which approach to take.

9
Competencies

• Safety-Care has several goals
• Prevent behavioral crises.
• Reverse the escalation intensity of crisis
  behaviors.
• Teach strengthen behaviors that reduce crisis
  behaviors.
• Safely manage crises without injury or trauma.
• Terminate crises quickly.
• Reduce the likelihood of future behavioral crises.

10
Legal Liability

• Safety-Care is consistent and compatible with
  regulatory and accreditation standards, including
  JCAHO (Joint Commission on Accreditation of
  Hospital Organizations), CARF (Committee on
  Accreditation of Rehabilitation Facilities), COA
  (Council on Accreditation), and CMS (Centers for
  Medicare and Medicaid Services) and other
  relevant state regulations. It has been
  officially certified by the State of Maines
  Department of Health and Human Services, Division
  of Licensing and Regulatory Services and by the
  Department of Mental Retardation in
  Massachusetts. Safety-Care is also used in a
  number of other states where regulatory agencies
  do not specifically certify individual safety
  courses. QBS should be contacted regarding
  specific Safety-Care regulatory standards.

11
Website
12
Types of Interventions Restraints and Procedures
13
Incident Prevention

• Create a Safe Environment
• Minimize disorganization, clutter, and excessive
  stimulation
• Dress for safety (No loose clothing)
• Modify environment (Remove dangerous objects)
• Safety Habits
• Know where you are
• Manage your own behavior and emotional reactions
• What you say and how you say it
• Facial expressions
• Physical behavior
• Differential Reinforcement
• Describes continuous, random, and scheduled DR
• Describes how to praise effectively
• Elbow Check
• Stand to the side of the client (facing the same
  direction)
• Place nearest palm of hand on his or her arm
  right above the elbow with you fingers facing
  forward
• If the client struggles, keep your arm rigid to
  prevent the client from striking you
• Back off if there is significant resistance

14
Incident Minimization

• Identify environmental antecedents
• Eliminate them or help the client cope with them
• Identify behavioral antecedents
• Allows you to intervene early before the clients
  behavior escalates
• The Safety Stance
• Place yourself in the clients vision and stand
  to the side at a 45 degree angle
• Stand an arms length away plus a foot
• Stand in a thinking stance with the closer arm
  near the face
• Stand with feet shoulder width apart, front foot
  pointed toward the client and rear foot pointed
  toward the side.
• Safety sitting
• How to sit and work with clients safely
• Calling for assistance
• How to call for help in dealing with a client
  appropriately

15

• Leadership
• How to determine who is in charge during an
  emergency and what the leader should do.
• De-Escalation
• How to calm down an agitated person safely.
• Uses a step down model.
• Avoid power struggles
• The help strategy
• Helps the person understand that there are more
  appropriate ways to get the same information.
  Based on assumption of a communication problem.
• The prompt strategy
• Prompt the client what to do rather than the
  disruptive behavior.
• Prompt to do an incompatible behavior or high
  probability behavior.
• The wait strategy
• Give the client time to calm down.
• Management of weapons
• Can be any object that could cause harm.
• Remove potential weapons before a crisis
  escalates.
• No method to remove weapons from client.
• Call for assistance, protect clients and
  yourself, and contain the client

16
Physical Safety

• The protective stance
• Uses arms to protect from potential hits by
  client
• The safety shuffle
• Shuffling back to maintain a safe distance
  without backing into a corner.
• Moving and Deflecting
• Describes how to use arms to deflect hits and
  move away from clients.
• Shoulder Check
• A method to protect yourself from an aggressive
  client by moving behind them and placing your
  hands on their arm and back so they cannot turn
  to hit or grab you.
• Supportive Guide
• A guiding procedure that uses a clients own
  momentum to quickly change the direction of
  movement without pulling pushing or grabbing.

17

• Wrist Release/Grab Release
• Technique for releasing a grab on your body or
  wrist without hurting the client.
• Choke Release
• Describes how to remove clients hands from your
  neck if they are attempting to choke you from the
  front or the rear.
• Head lock release
• Procedure for keeping your airway open and
  releasing a head lock.
• Hair Pull Release
• Describes how to stabilize your neck and release
  clients grasp of your hair.
• Bites
• Describes way to avoid bites and release bites.

18
Physical Management and Restraint

• Emergency physical management
• Describes risk of physical interventions, when
  they should be used, and what to do.
• 1-Person Stability Hold
• Procedure for holding a client in place so that
  they cannot hurt themselves or others
• Also includes a method for dealing with the
  client sitting down during the hold
• 2-Person Stability Hold and Escort
• Method for two people to hold a client in place
  or
• Includes provision to escort them if they do not
  resist with them facing forward or an escort
  where they are facing backwards if they do
  resist.
• Chair Stability Hold
• Uses three staff members to hold a client in a
  chair with arms.
• Releasing from physical intervention
• Includes signs of when to release a hold such as
  changes in the color of the clients face and
  labored breathing.

19
Post-Incident Procedures

• Recovery
• How to set the environment until the client
  returns to normal
• Debriefing
• Reviewing the incident with the client including
  their triggers and what the client thought
  happened during the event.
• Reviewing the incident with staff to identify
  context of the event, environmental antecedents,
  behavioral antecedents, and interventions used to
  manage the clients behavior. Also, review
  interventions to make changes so they are more
  effective.

20
Media and Research

• No media (DVDs, ect.). Only training manuals.
• Research
• Google Scholar was used to search for any
  research on the Safety-Care program. None was
  found.
• Books and journal articles that cover the use of
  Behavioral Momentum and Restraint are listed as
  references for the program, but none of them
  specifically examine the Safety-Care system.