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“Reducing Workplace Violence means Increasing Workplace Safety through Positive Behavior Supports” |
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Providing mental health services for children, adolescents, and adults is a challenging task. A study done by the Centers for Disease Control and Kaiser-Permanente Insurance called the Adverse Childhood Effects (ACE) study found that over one-third of adults had experienced some form of abuse or neglect as children. In mental health services, most studies indicate that almost all people who receive in-patient or residential mental health services have experienced some form of abuse or neglect.
Working with people who have been wounded requires that mental health services strive to provide services in ways that are “hospitable and engaging to survivors” to use a phrase from Roger Fallot, an expert in the field of trauma informed services. All people who have been wounded want to recover from those wounds, and that is why the word used to describe people in service is “survivors.” They have survived abuse and neglect, they have survived the attacks caused in some cases by neurological and biological “differences” that underlie some mental health diagnoses.
In 1998, the National Association of State Mental Health Program Directors (NASMHPD) issued their first position paper on the use of seclusion and restraint, in which they said that the use of seclusion and restraint was not treatment, but rather an indication of “treatment failure.” (http://www.nasmhpd.org). In 2006 NASMHPD issued “Seclusion and Restraint - a Risk Management Guide” in which they focus on how to reduce the use of seclusion and restraint with an emphasis on eventual elimination of these interventions.
The mental health service sector has emphasized the reduction and eventual elimination of seclusion and restraint longer than other service sectors. As a result, there is impressive data from many psychiatric hospitals and residential treatment centers across the country. Valley Mental Health is Morgantown, WV, serves over 1,000 persons per year in a combination of out-patient, in-patient, and emergency placements. Since 2000, they have done a total of 2 restraints. Cedars Youth Services in Omaha, Nebraska, has eliminated the use of restraint in two of their programs, and significantly reduced the use of restraint in others. Psychiatric hospitals in New Jersey, Illinois, Texas, Florida and other states have had similar experiences.
Practice Based Evidence is an approach developed by Scott Miller, Ph.D., emphasizing outcome based evidence in “real world” settings, and these and other organizations have achieved significant reductions in the use of restraint in mental health settings. By using The Mandt System® organizations have been able to focus on prevention instead of intervention in reducing the use of restraint.
The Mandt System® has three components in our training; Relational Skills, Conceptual Skills, and Technical Skills. Known as the “RCT” program, it is taught in a Train-the-Trainer format which takes 5 full days of training, from 8:00am to 5:00pm Monday through Friday. The components of the course are:
RELATIONAL SKILLS |
CONCEPTUAL SKILLS |
TECHNICAL SKILLS |
Chapter 1 – Building Healthy Relationships focuses on understanding how to Recognize, Assess, Decide, Act and Review (use your RADAR) to prevent incidents from occurring. It also looks at the needs of people (Maslow´s Hierarchy of Needs) and understanding how people respond to stress. |
Chapter 4 – Trauma Informed Services is a sub-clinical training that gives staff an awareness of the effects of trauma on human beings. The chapter was written with the input of the National Technical Assistance Center and strives to help organizations create environments that do not re-traumatize individuals served. |
Chapter 8 – Assisting and Supporting lays down the foundations for all of the physical skills utilized in The Mandt System®. The three components of all physical skills are: Stance and Balance, Body Mechanics and Movement, and Body Positioning. A reasonable ability to maintain balance under physical duress is required. |
Chapter 2 – Building Healthy Communication Skills provides training on how to more effectively communicate to (a) build health relationships, (b) prevent incidents, and (c) de-escalate incidents if they occur. Skills for de-escalating incidents are taught. |
Chapter 5 – Positive Behavior Support teaches staff how to implement behavior support strategies. It does not teach people how to write these plans. The primary source of information is Northern Arizona University. |
Chapter 9 – Separating (Escape and Evasion Techniques) addresses situations where people have been grabbed (hair, clothing, arm, attempted choke, bite) and teaches how to gain release while de-escalating and preventing injury. |
Chapter 3 – Building Healthy Conflict Resolution Skills teaches how to resolve conflict by communicating and building healthy relationships with each other. Skills for defusing conflicts and de-escalating situations are taught. |
Chapter 6 – Liability and Legal Issues provides an overview of the legal issues surrounding the prevention and, if needed, use of restraint. |
Chapter 10 – Restraining – this chapter teaches how to restrain an individual if their behavior rises to the legal threshold whereby restraint is required and justified. The legal thresholds are discussed and presented. |
We recommend that the above 3 chapters be taught to the people supported as a way of preparing them to become skilled at self management. |
Chapter 7 – Medical Risks of Restraint is required to be taught prior to teaching chapter 10. |
Advanced Technical Skills teaches how to prevent, and if needed, respond to severe aggression and violence. It may not be needed for staff working in community based homes, office settings, etc. |
For every hour that we teach restraint, we spend three hours on prevention and two hours on de-escalation. If we can prevent an interaction between people from becoming an incident, we have increased the safety of all staff and all people in care. We know that if staff are in relationships with other staff where dignity and respect between the staff are evident that juveniles feel safer. If staff feel and act safe with each other, then people in care are more likely to feel safe with the staff.
In order to “calm down” people must feel safe. If people do not feel safe, they will not calm down. Our program focuses first on building healthy relationships between staff at all levels of the organization, and then on being role models so the people we serve can learn from us. They will learn much more from how we as staff behave towards each other and them than from what we teach in any curriculum.
We use a model from Invitational Education (http://www.invitationaleducation.net) to understand that the People, Places, Policies, Programs, and Processes used by an organization must work together to create a therapeutic, healing environment for in which mental health services can be effectively utilized. The Mandt System® is not a clinical program, it is a sub-clinical program that lays down the foundations needed for healing the take place. That foundation is the relationships between staff in the organization, the places themselves, the policies guiding staff to staff interaction through personnel policies and human resources, the programs selected to teach people new skills, and the processes used to measure success. The Mandt System® seeks to help organization integrate all their services into a cohesive approach to support people, not just their behaviors.
An optional program to teach managers and supervisors how to support the full implementation of The Mandt System® through effective supervision and managerial support is also available. Known as Mandt for Managers™, this three day training program teaches specific skills to supervise staff using the approach of Positive Behavior Support to teach replacement behaviors to staff. A set of Policies and Procedures that are consistent with the principles of Positive Behavior Support and which meet employment law standards is presented in the class. Information on how teams can be developed and maintained is an integral part of the program. The topic of conflict resolution is explored in much more depth, as well as the presentation of a tool to measure our personal approach to conflict resolution.
A second tool, known as Uniquely You, was developed for The Mandt System® by Dr. Mels Carbonnel along with staff from The Mandt System, Inc.. The tool utilizes the Personal Profile System™, also known as The DISC approach, to understand how to more effectively build teamwork with each other.
- Experience
The Mandt System® has over 33 years of experience in the provision of training to empower organizations to prevent and, if needed, use restraint to ensure the safety of all individuals. Psychiatric hospitals and residential treatment centers in the following states utilize The Mandt System®:
Maine Connecticut New Hampshire New York New Jersey Delaware Maryland Virginia West Virginia North Carolina South Carolina Florida Mississippi Indiana Illinois Wisconsin Minnesota Iowa Missouri Arkansas Texas Oklahoma Kansas Nebraska South Dakota Wyoming Montana Colorado New Mexico California Oregon Alaska Hawaii The primary Training Faculty members responsible for training in mental health programs have worked in psychiatric hospitals and have experience in clinical work, administrative and supervisory positions, and with a Protection and Advocacy organization.
The Mandt System® is a generic program used primarily in four human service sectors: Juvenile Justice Services, Developmental Disability services, Mental Health services, and Educational services. It is our belief that the neurological and physiological principles that underlie aggression and violence are common to all human beings and that a generic approach, adapted to specific environments, is the most effective way to teach staff how to prevent violence from occurring. As a result, it will not be necessary to individualize the training material for the Utah DJJS.
The Mandt System® is applicable to both community based programs as well as facility based programs. There are community based programs for adolescents in over 25 states that have successfully utilized The Mandt System® to reduce the use of restraint and increase the safety of all people.
- History
The Mandt System® is the most experienced program in the world in teaching the prevention and, if needed, use of restraint. In addition to our 33 years of work in this field, staff associated with The Mandt System, Inc. have:
- Provided testimony in state legislatures in Alaska, Texas, New Mexico, Ohio, Maryland, and Georgia on issues affecting juveniles
- Served as members of committees in developing best practice standards for national organizations such as the Child Welfare League of America
- Provided keynote addresses at conferences throughout the United States
- Served as technical advisors to states in the promulgation of regulations
- Presented technical papers at international conferences in Florida, Britain, and the Netherlands
In our work, we have over 3,800 currently certified trainers in The Mandt System® in the US and Canada. We provide over 100 workshops annually throughout the US and Canada, and have consistently received excellent evaluations from participants in our programs. Our training faculty members have the combination of education, experience, and passion to provide training that meets the needs of thousands of organizations.
Within 60 days of notification that The Mandt System® has been selected as the training program we will provide training in a one day session entitled Corporate Culture Change. It is our belief that leadership cannot simply be behind an effort to reduce the use of restraint and reduce injuries; they must be in front of this change process. We have provided this training in many different settings with excellent outcomes in achieving meaningful reductions in the use of restraint and increases in safety for staff and juveniles alike. Corporate Culture Change is required for programs with more than 250 employees.
Within 30 days of the Corporate Culture Change training we will provide training in The Mandt System® Relational, Conceptual, and Technical training to persons identified by the organization to become certified trainers in The Mandt System®. They will, in turn, provide training to the staff within the organization.
- Prevention, De-escalation, and Intervention for Safety
The focus of The Mandt System® is primarily on prevention. As stated earlier, for every hour we teach restraint, we spend three hours on prevention, and two hours on de-escalation.
Another way of conceptualizing our approach is that we want to:
- Keep interactions between people going!
- Prevent interactions from becoming incidents
- De-escalate incidents so they do not become crisis events
- If a crisis occurs, we want to use the least amount of external management to maintain the safety of all concerned
- Safety for All People
We believe that all people have an equal right to safety. Whether people are staff or individuals served, the right to physical, psychological and emotional safety is an inherent human right. We focus on this within our training in all of the chapters, with an emphasis on the need for staff to model safe behavior psychologically and emotionally with each other in order to teach individuals served how to interact.
We have also included an ergonomic assessment of each of the physical skills taught in The Mandt System® that provides information on how the techniques provide for the safety of individuals served and staff. We believe and teach that there is no such thing as a “safe” restraint. Any time human beings have any type of physical contact with each other, there is a risk of harm. While we can not guarantee safety, our track record of helping to reduce injuries at correctional programs across the country is evidence of the effectiveness of our program.
