Roy T Bennett said, “You can’t always control the behaviors of others, but you can always choose how to respond to it.” Let’s dive in a little deeper on this and how this relates to Safety-Care.
I was first trained as a Safety-Care Specialist when I was working as a Direct Care Provider and I remember leaving training after two full days thinking, “I remember how to implement a wrist release, get out of a hair pull and a choke hold, and implement a one-person stability hold, but all of the preventative measures I learned on day one of training is now a blur.” Safety-Care promotes the use of least to most restrictive procedures and after leaving training, all I could remember were the most restrictive, hands-on techniques I learned on day two.
Being a Safety-Care Trainer now, it became clear that more hands-on and restrictive techniques were being used by our staff rather than the preventative techniques and de-escalation strategies emphasized in Safety-Care training. This was concerning given the psychological risks associated with using physical management. Specifically, one of our individuals who required physical management had psychological trauma due to a long-standing history of intense restraints prior to entering our services. Any time we implemented a hold, it was obvious this individual would experience re-traumatization; he would begin to withdraw from daily activities and other people, get easily startled and engage in more aggressive behaviors. Another individual found physical management highly reinforcing, and because of this, we started seeing an increase in his dangerous behaviors. In fact, after engaging in those behaviors, he would stand with his arms out, ready for staff to implement a two-person stability hold.
After looking at these scenarios, we wanted to try whatever we could to use more of a hands-off approach as long as it was safe to do so. I remember meeting with my supervisor and expressing my concerns and wondering how we could start using less physical management and more preventative techniques instead. The best way I could describe the variety of skills staff have after completing Safety-Care training was to compare it with a buffet. Am I a little food driven? Well, maybe. When you think of a buffet, we typically grab a standard-sized plate and start from left to right. We usually start at the salad bar, loading up on the salad, moving on to the fresh fruits and veggies and grabbing some appetizers and finger foods. We then dive into the main course, consisting of all the meats and potatoes, and of course those yummy rolls. Our plates are completely full – not leaving much room for anything else – but we can’t forget to pile that yummy dessert right on top. Because dessert is the last thing we have collected on our plates, that is the first thing we typically see and will probably start with when we sit down to start eating. We completely forget that we have salad at the bottom of all that, even though that was the first thing we added to our plate.
Looking now at teaching Safety-Care, I feel like it is a lot like that buffet. We teach all the preventative strategies early on, making our focus on least restrictive interventions first, but then we move on to teaching physical management. Day two of training is a full day of learning not only physical management but also testing the physical competencies. When staff were leaving training, they were in the same boat as I once was as a trainee; staff voiced that they remembered the last thing they were trained on, including hands-on, restrictive measures (the dessert) but less so the first thing they were trained on, including preventative measures (the salad). My supervisor requested that I run a report that pulled data on any physical management that was being used with our individuals. We were able to see how often it was being used, if it was being used correctly, and if it was even warranted in that specific situation. In a four-year span, we recognized that only two incidents of physical management were implemented. After looking a little deeper into these two incidents, both could have been handled with less restrictive techniques instead. We decided that moving forward, our company would no longer teach staff the physical management components of the training and focus on the prevention, minimization, and physical safety strategies only.
Since this shift was implemented over the last four years, there has been a dramatic decrease in dangerous and very dangerous behaviors exhibited by our clients. In fact, we have had zero incidents of physical management since the transition. Our staff have expressed they feel more confident in using their skills and tools and it truly shows with the data I have collected and continue to collect. The surveys we provide for staff following any Safety-Care training show that the staff really like focusing deeper on the preventative techniques and de-escalation strategies. I also created a challenging behavior scale that I use during our trainings. This is a great visual aid for our staff to utilize when dealing with any disruptive, dangerous, or very dangerous behaviors. The scale illustrates 0 being minimal and 10 being very dangerous behavior. Staff understand that depending on the type of challenging behavior, it might require further judgement in evaluating the risk to best categorize it on the scale. Staff report that the behavior scale has been extremely helpful; they can implement their tools and skills according to the type of challenging behavior they are observing at that specific time. Overall, what we have discovered as an agency and continue to discover, is that sometimes, less is truly more.
About the author
Katie Reyes is the Behavior Plan Implementation Specialist for Eastern Colorado Services for the Developmentally Disabled (ECS), located on the plains of northeast Colorado. ECS serves adults with developmental disabilities ranging from 18 years of age to end of life, providing support in residential group homes, day programs, and host homes. Katie has been a certified Safety-Care trainer for over 8 years.