Transitioning to Safety-Care®

QBS has a number of recommendations about how to begin rolling out Safety-Care®. A systematic approach is important in order to limit miscommunication and minimize risk.

Male professional having a conversation with his colleagues

Organizational Support

To implement Safety-Care® with maximum effectiveness, it’s critical that administrators, managers, and supervisors be actively involved. Any medical professionals who might be involved in approving or oversee- ing the use of emergency physical management procedures should also participate. If possible, they should all be trained in the full curriculum. If that is not practical, they should, at a minimum, be oriented to Safety-Care®, including a demonstration of the physical procedures that might be used.

QBS staff member teaching crisis de-escalation techniques on female student

Training Plan

Most organizations choose to have their own in-house Safety-Care® trainers. This strategy is more cost effective than direct staff training by QBS, and it also ensures that the organization has trainers available to support staff, retrain, review, and practice.
Who should be sent to become trainers?

One of the most important decisions to be made in transitioning to Safety-Care® is choosing the right staff to send for trainer training. Candidates to become trainers should have these characteristics:

Program Benefits:

They want to be trainers. Staff who like the idea of being a trainer will usually be better at it than staff who are required to do so against their preference.

They are well respected by their peers.

They are comfortable presenting to an audience.

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They easily can read text written in high school level English and can fluently read short passages out loud in the language they will be training in.

Trainers who will be expected to teach all of the Safety-Care® physical procedures will need to have nor- mal agility, range of motion, and motor planning ability. They are able to kneel down on one knee from a standing position, then stand back up again without awkwardness or needing to support themselves with their hands. They should be able to do this on one knee, then the other, several times in a row.

They are able to do their jobs while devoting sufficient time for training and support of staff.

Staff Training Plan

When transitioning to Safety-Care®, is best to create a detailed written plan describing how training will be done. It should answer these questions:

  • Which parts of your organization will be trained, and in which order? It may be possible to train all at once, or it may be necessary to begin with one specific program component (classroom, school, residence, unit, campus, etc.). The plan should make it virtually impossible for staff with incompatible training to be called upon to try to work together. Roll out Safety-Care® in one component, conduct follow-up and problem solving sessions, then move on to the next component in a systematic manner. Be sure that staff who work in multiple locations always have sufficient training and a clear under- standing of policy.
  • What is the date by which all staff must be trained? Optimally, the core training happens over weeks, not months, for all staff. The less time between the start of training and the completion of training for all required staff, the better. If training is spread out over more than a couple of weeks, consider scheduling a refresher session for staff who may have the training and then not use it for a period of time
  • Who will do the training for which groups of staff? If you have two or more trainers, decide how they will be used. With new trainers, we recommend that they work in pairs for at least the first two or three sessions. Remember that a class can have up to 10 trainees (with one trainer) or 20 trainees (with two trainers). Larger numbers of trainees trained at the same time should be split into multiple groups.
  • Will training happen during regular staff shifts? If so, who will cover while training is being done? If not, then consider how staff will be scheduled for training. Will overtime be used to pay staff during train- ing or staff who are covering their shifts? It is best to estimate the payroll cost of training beforehand.
  • Where will the training be conducted? Make sure the training space is appropriate—not just as a lecture space but as a location for teaching physical procedures and conducting role-plays. The Safety-Care® Compliance Standards have a set of expected standards for the training space.
  • How will staff be assigned to particular trainings? How will they be informed of the training, told what to expect, and told what to wear?
  • Who will do the training for which groups of staff? If you have two or more trainers, decide how they will be used. With new trainers, we recommend that they work in pairs for at least the first two or three sessions. Remember that a class can have up to 10 trainees (with one trainer) or 20 trainees (with two trainers). Larger numbers of trainees trained at the same time should be split into multiple groups.
  • What is the plan for staff who miss the training?
  • What is the plan in the event that a staff person does not pass the Safety-Care® training?
  • What is the plan for reviewing Safety-Care® skills to ensure that staff retain them?
  • What is the plan for training newly hired staff?
  • What is the plan for re-certification?

How much time should be allotted for each class?

The recommended time to teach the full Safety-Care® core curriculum is 12–16 hours of active training time (except for very small classes). That time should be adjusted to the number of trainees in the class. This table provides a general guideline:

One Trainer

1-2 Trainees: 10-12 hours

3-4 Trainees: 11-12 hours

5-6 Trainees: 12-13 hours

7-8 Trainees: 13-14 hours

9-10 Trainees: 14-16 hours>

Two or more trainers

1-4 Trainees: 10-12 hours

5-8 Trainees: 11-12 hours

9-12 Trainees: 12-13 hours

13-16 Trainees: 13-14 hours

17-20 Trainees: 14-16 hours

These times can be adusted proportionally downward if the curriculum is abbreviated.
For the first one or two classes that a new trainer teaches, it can be best to keep class sizes a bit smaller (6–8 for one trainer or 12–16 for two trainers) or provide a little extra time. If you have access to more experi- enced Safety-Care® trainers, we recommend that, whenever possible, they assist and mentor new trainers.

Starting from scratch

If your organization has no previous behavioral safety system in place and is starting with Safety-Care® from scratch, it is important to develop and implement a training plan. If possible, identify specific teams of staff who work together and roll out the training one team at a time. That way, they can work with and support each other with new procedures and concepts. Make sure that Trainers are available to answer questions and provide quick review of specific skills.

female teacher demonstrating de-escalation techniques on female student
healthcare professionals discussing notes on patient injury numbers

Transitioning from Another Crisis Prevention System

If your organization currently uses another crisis prevention training system and you plan to replace it with Safety-Care®, it will require careful planning to safely manage the transition. Here are some considerations that the plan should address:

Identify a rollout date. There can be one date for the entire organization. In other cases, however, it is more practical to have a separate date for each specific team of staff who work on a particular unit, building, classroom, etc.

They are well respected by their peers.

Develop a training plan leading up to the rollout date. Tell staff that they are not to use Safety-Care® until the rollout day. Make sure the time from when training starts to when the rollout day isn’t so long that the first set of trainees won’t remember Safety-Care® by the time they are expected to use it. It’s best not to spread training out over more than a month. If that isn’t possible, make sure that review sessions are conducted in the week or so leading up to rollout.

It is inevitable that some staff will be resistant to change. They may prefer the old course, in part because they have used it many times and know exactly how to make it work. They may just not be happy with the burden of change on top of everything else they are expected to do. Those concerns are understandable, and Trainers should be available to answer questions, respond to concerns, and role- play potentially challenging scenarios. It’s important to state unequivocally that, as of the rollout day, Safety-Care® will be the only approved procedure for prevention, minimization, and management of behavioral crises. Everyone will be less safe if there is any belief that it is OK to mix and match between the old course and the new one.

Once the program has been rolled out, make sure that Trainers are available to answer staff questions and provide quick review of specific skills as needed.

QBS team debriefing after an in-person training

Coexisting with Another Behavioral Safety System

Although Safety-Care® is comprehensive and designed to be consistent with a wide range of populations and treatment approaches, some organizations may choose to train some staff in Safety-Care® and other staff in some other crisis prevention course. QBS does not recommend this. If you do choose to use such an approach, however, we have certain cautions and suggestions.
The biggest concern is that a serious crisis could occur and staff who are trained in two different courses must figure out how to work together. If it is necessary for multiple staff to implement a physical hold, differences in procedures can create a particularly dangerous situation. Less dangerous, but also potentially problematic, is if staff who are training in two different courses are trying to work together to prevent or manage a behavioral crisis. There is the possibility that they might work at cross-purposes, enhancing the likelihood of injury or a serious behavioral incident.
Therefore, it is best to separate programs that use Safety-Care® from programs that use another interven- tion method. Staff in one location, and those they will call for assistance, should all be trained in a common set of concepts, skills, and procedures. Staff who are not trained in Safety-Care® who arrive to assist should be instructed (in advance) to help manage other individuals, remove dangerous items, etc., but should avoid intervention if possible.

Legal and Regulatory Compliance

Review applicable laws, regulations, survey standards, etc. How do those rules govern the manner in which your organization conducts behavioral safety training, safety interventions, and (if needed) physical restraint? While Safety-Care® is generally designed to be compatible with applicable laws and regulations, there are may be specific procedures that must be followed in order to be in compliance. If there is any conflict between the Safety-Care® curriculum and applicable laws or regulations, you should follow those rules, not the recommendations in Safety-Care®. Be sure to communicate to staff what they must do to be in compliance.

person reading behavioral news on their laptop computer

Download the PDF guide for Transitioning to Safety-Care™

Support From QBS

QBS recommends that organizations develop comprehensive policies to guide decision making and help manage risk. Make sure that policies and procedures accurately describe the organization’s philosophy and approach to behavioral safety. Although the specific items in a policy depend on the nature of the organization and the regulatory environment in which it operates, policies should generally address at least the following issues:

  1. The organization’s overall philosophy regarding behavioral support, prevention of crises, avoidance of restraint, and emergency use of restraint.
  2. Procedures and standards for staff training:
    a. Categories of staff who are required to be trained in Safety-Care®. If some staff will be trained in an abbreviated version of the course, specify which staff are trained in which parts of the course.
    b. Some staff may not be able to perform all procedures in the couse. These individuals may have an overall certification in Safety-Care®, but have documented restrictions on their use of those specific procedures. Are restrictions inconsistent with certain job roles or work in certain set- tings? What is the policy on staff with restrictions? Is that policy consistent with employment laws in your state or province?
    c. Timeframes for training following hire. Identify staff categories, if any, that must be trained in Safety-Care® before they can work independently.
    d. Additional training required beyond Safety-Care® to support crisis prevention (e.g., regulatory requirements, characteristics of population, types of treatment provided, behavior support procedures).
    e. Safety-Care® re-certification requirements and training plan.
  3. Procedures for how individuals at risk for dangerous behavior are identified and provided with support interventions designed to prevent or minimize crises.
  4. Procedures that govern implementation of physical intervention and restraint (if used), including (at least) the following:
    a. A description of approved Safety-Care® physical intervention procedures and a statement prohib- iting the use of procedures that have not been specifically authorized.
    b. Specific criteria for use of restraint. How does the organization define restraint? Under what circumstances can it be used? Under what circumstances is it prohibited?
    c. Who may initiate use of restraint.
    d. Who must be contacted when restraint is initiated. If authorization must be obtained when restraint is used, the policy should describe this process.
    e. Procedures for involving medical professionals (if applicable) in monitoring and documenting the individual’s condition during or after the restraint.
    f. Procedures that staff who are not medical professionals should follow to monitor and document the individual’s condition during or after the restraint.
    g. If a restraint continues for longer than a specified duration (15 minutes, for example), who must be contacted.
    h. If restraint is used more than a specified number of times in a specified period (more than three times in 24 hours, for example), who must be contacted.
  5. Procedures for ensuring the privacy and dignity of the individual being restrained, as well as the clini- cal appropriateness of procedures designed to assist that person to become calmer.
  6. Procedures for determining when to release from restraint.
  7. Procedures for managing particularly severe or extended crisis episodes that may present unusually high levels of risk. These procedures could include methods for getting more staff to the crisis location; involving staff with additional authority, experience, or clinical expertise; or procedures for requesting outside agencies to assist with safety or to provide for transportation of the individual to a more appropriate setting.
  8. Following a restraint, the procedures to be used to monitor the individual and help him or her safely return to baseline.
  9. Following a restraint, procedures for documentation of the incident.
  10. Following a restraint, procedures for notification of guardians, administrative staff, and (if required) regulatory agencies.
  11. Following a serious behavioral incident, restraint, or near miss, procedures for debriefing and plan- ning how to prevent such occurrences in the future, including documentation of the debriefing process (separate from documentation of the incident itself).
  12. Following any serious behavioral incident, procedures for supervising staff, supporting them, and helping them to manage stress and trauma.
  13. Procedures for tracking restraints, assaults, injuries, and other serious events, as well as procedures for regular review by a team of direct staff, supervisors, clinicians, and administrators designed to identify patterns and intervene to correct problems.

Support from QBS

QBS provides unlimited support for Safety-Care™ Trainers and organizations that use Safety-Care™, as well as videos, documents, and other resources available to trainers online. Please make use of these resources to assist you as needed in implementing and using Safety-Care™.

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