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 K
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 (12–16 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 customer’s site.

5. Certification Fees
Safety-Care Specialist Training (1½ day training by certified QBS Master Trainer)
At customer's site—up to 10 participants $3,600
At customer's site—up 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 site—up to 10 participants $7,000
At customer's site—up to 16 participants $11,200
Attend open session at QBS $700 per person

6. Advanced Module Training by Certified QBS Master Trainer
Certification Fees
Advanced Module Training by Certified QBS Master Trainer
Half day—up to 10 participants $1,150
Full day—up 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 customer’s site—up 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 they’ve 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 Maine’s 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 Safety Habits
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 client’s behavior escalates
The Safety Stance
Place yourself in the client’s 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 De-Escalation Management of weapons
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 Supportive Guide 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 client’s 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 client’s 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 client’s 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 client’s 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 client’s behavior. Also, review interventions to make changes so they are more effective.

20. Media and Research No media (DVDs, ect.). Only training manuals.
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.