The Methodist Home has been selected as a national demonstration
site to improve methods and training programs to reduce physical
restraints with youth in residential treatment. This program represents
our commitment to treatment where all youth and staff are safe.
In September 2001, as part of its focus on reducing and eventually
eliminating the use of restraint and seclusion, SAMHSA (Substance
Abuse and Mental Health Services Administration) funded the three
year Best Practices in Behavior Support and Intervention Project.
The project sought to identify best practices in preventing and
reducing the use of restraint and seclusion in facilities serving
children and youth. To achieve this goal, the grant provided financial
support for five demonstration sites and one coordinating center.
SAMHSA charged the demonstration sites with implementing model
training programs and shifting their organizational culture to
make their environments conducive to reducing the use of restraint
and seclusion. The coordinating center was responsible for providing
technical assistance to the sites, evaluating the outcomes of
the various interventions implemented at each site, and disseminating
the results of the project to promote best practices.
SAMHSA selected five demonstration sites based on their commitment
to the goals of the project and their distinct proposed method.
In each site, the project focused on improving the training and
supervision of staff that work directly with children and youth.
The five sites were:
• The University of Alabama Brewer Porch Children’s
Center, Tuscaloosa, Alabama;
• The Connecticut Collaboration for Training Excellence,
which divided funds among the Klingberg Family Centers, New Britain,
Connecticut; the Devereux Glenholme School, Washington, Connecticut;
and the Riverview Hospital, Middletown, Connecticut;
• Father Flanagan’s Girls and Boys’ Town, Boys
Town, Nebraska, which contracted to provide technical assistance
to the A.B. and Jessie Polinsky Children’s Center, San Diego,
California;
• Lakeside Treatment and Learning Center, Kalamazoo, Michigan;
and
• The Methodist Home for Children and Youth, Macon, Georgia.
As a result of the SAMHSA grant, The Methodist Home has undertaken
a number of important initiatives:
• Hiring practices have changed significantly to ensure
staff can actually perform a physical restraint if necessary.
Pre-employment screening is more rigorous than ever before in
the agency.
• Clinicians conduct structured preadmission risk assessments
on all children admitted into the agency. The clinicians share
these at staff meetings prior to the child entering placement.
• Each child has a “functional analysis” of
behavior completed by the cottage team during the initial placement
period focusing on challenging behavior that is part of the “script”
they come with.
• Staff and child debriefing protocols symbolize that both
parties need agency attention and support following a crisis.
• Monthly practice of all restraint techniques by both
staff and trainers is a critical component of skill retention.
• Agency trainers are also the supervisors, working in
the programs on a daily basis, and as such, they are the “occupational
experts” in the workplace, rather than being in the training
department.
• Building the training infrastructure by having trainers
in every cottage expands ownership of the techniques and philosophy
of the agency’s crisis management program.
• Independent verification of training competence in restraint
techniques give staff confidence that they truly are being judged
as competent at the end of training. In the new system, the trainer
who conducted the crisis management training is not allowed to
test his or her participants at the end of the training session.
• Annual reaccredidation of all staff and trainers is vital
to ongoing quality assurance efforts.
• Injury reporting to the training provider ensures continual
dialogue and feedback on the techniques and special situations
encountered during a restraint.
Most important, doing away with seclusion and eliminating the
use of PRN medications had no effect on the frequency of restraint
throughout the agency. In other words, The Methodist Home has
learned these two interventions are not necessary to managing
challenging behavior of our youth. |
