Sectors

• Our Purpose
  The purpose of The Mandt System® is to build healthy relationships in the workplace. We have been doing this since 1975, giving us over three decades of experience which we have used to improve the work we do and the services we offer. All human services are provided in the context of relationships, and the first set of relationships we address are staff to staff relationships.
Of the approximately 2,000 organizations using The Mandt System® in the U.S. and Canada, over half work with people affected by developmental disabilities. Included in this are state operated developmental centers in Missouri, Nebraska, Illinois, Iowa, Delaware, Georgia, Washington, Montana, Wyoming, and large, multi-state private providers such as Res-Care and Mosaic. However, the vast majority of certified trainers work in community based programs for persons affected by developmental disabilities, including waiver funded residential and vocational services.
The evidence of our effectiveness is seen in the data from the above organizations, who report they have all experienced significant decreases in the frequency and duration of restraint, as well as in injuries to staff and individuals served.
Contrary to perceptions, we are not primarily a vendor of restraint training. Our focus is on building healthy relationships in the workplace, in order to help our customers improve the quality of work and quality of life of all concerned. We do teach restraint, although for every hour spent teaching restraint in The Mandt System® program, we spend 3 hours teaching how to prevent restraint, and an additional 2 hours teaching how to de-escalate a potentially aggressive situation so restraint again is not needed.
• Our Format
  We utilize a Train-the-Trainer model, certifying trainers for a period of 2 (two) years. Staff at the organizations in which the certified trainers provide training are certified for a period of one year. Annual re-certification is required.
We have had a great deal of experience helping organizations to transition from other types of restraint training approaches to The Mandt System®. Our approach is, in many ways, very different from most if not all other vendors, in the non-physical as well as the physical skills we teach. Corporate Culture Change program is a one day workshop for key administrative and supervisory staff that helps them to lay the groundwork for the culture change that is needed to fully implement The Mandt System®. In unionized settings, we also recommend that union leadership attend in order to minimize the miscommunication and misperception that often accompanies changes such as this.
• Our Programs
  As stated earlier, building healthy relationships in the workplace is our ultimate goal. We use information from the Canadian Policy Research Network (CPRN, 2002) to define the components of healthy workplace relationships. We also provide staff with a framework to understand the behaviors people use as they communicate their fear, frustration, anxiety and tension, which we believe are at the root of what many people term “challenging behaviors.”
We consciously focus on teaching people concepts prior to teaching them technique. We utilize an approach pioneered by the Cambridge Center for Behavioral Studies (http://www.behavior.org) that has 10 elements in a “Behavior Based Safety” approach which they teach to factory workers, retail employees, etc., to increase safety in the workplace. Teaching concepts before technique is important in that if staff only know techniques, they will probably encounter a situation for which the technique is not appropriate. Without knowledge of the underlying concepts, they will find themselves unable to respond appropriately.
We have built a framework within which we teach our program. It comes from an article by Robert L. Katz, first published in Harvard Business Review, in which he stated that businesses needed leaders with Relational, Conceptual, and Technical skills. We have organized The Mandt System® using this framework.

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
  • 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 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 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.
  • We recommend that the above 3 chapters be taught to students as a way of preparing them to become integrated into the community.
• CONCEPTUAL SKILLS
  • 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 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 6 – Liability and Legal Issues provides an overview of the legal issues surrounding the prevention and, if needed, use of restraint.
  • Chapter 7 – Medical Risks of Restraint is required to be taught prior to teaching chapter 10.
• TECHNICAL SKILLS
  • 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 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 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.
  • Advanced Technical Skills teaches how to prevent, and if needed, respond to severe aggression and violence. It may not be needed in unlocked settings.

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 people served. We know that if staff are in relationships with other staff where dignity and respect between the staff are evident that people supported feel safer. If staff feel and act safe with each other, then people supported 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 youth 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.

Teaching others, at all grade levels and even in colleges and universities, is a challenging task. In 1957, there was one physical assault on a teacher in New York City; in 2006 there were over 150. Educational standards and expectations have increased along with class sizes. It is estimated that the average teacher spends approximately $1,000.00 out of her or his own funds for classroom supplies.In spite of this, teachers continue to teach, students continue to learn, and the educational system struggles with decreased funds, increased federal and state outcome expectations, and in many cases increased acuity of need for those served in public and private schools. Emotional and behavioral disorders manifested by students continue to challenge the educational system, and safety of students and staff has become a major issue.

In his book “Characteristics of Emotional and Behavioral Disorders of Children and Youth” James Kauffman says:

“The most effective approaches to school-based prevention of anti-social behavior are proactive and instructive – planning ways to avoid failure and coercive struggles regarding both academic and social behavior and actively teaching students more adaptive, competent ways of behaving”

The Mandt System® provides a proactive and instructive approach which is based on interacting with people in non-coercive ways. Information from Northern Arizona University is used to define coercion and Positive Behavior Support.

As a result of using our program, over 500 schools have been able to:

• Reduce the use of restraint
• Reduce behavioral referrals
• Increase time spent in the classroom
• Facilitate the educational experiences of all students

In some state educational standards, Positive Behavior Support is presented as an approach that “applies a behaviorally-based approach that enhances the capability of educators and parents to design effective environments that support student learning and behavior.”

The standards specific to Michigan education law go on to say that “PBS emphasizes behavior that encourages learning by building relationships” as well as by “creating routines, teaching skills/rules/expectations, identifying replacement behaviors that interfere with learning, making problem behaviors less effective, efficient and relevant, and making the desired behavior more functional and adaptive.”

The Mandt System® teaches the use of principles from an approach known as “Invitational Education” to facilitate building healthy relationships in the educational environment. Simply put:

Violence in schools is a major concern of all stakeholders in the educational environment. In an article appearing in Educational Leadership in 1995, Larry Brendtro and Nicholas Long state that:

“The most powerful restraints on violent behavior are healthy human attachments”

It is our belief that education occurs in the context of the relationships between all of the adults in the educational environment. When the relationship between and among all of the adults is positive, and all people experience dignity and respect as relational realities, education not only happens, it takes root and students do more than learn, they are educated. For more information, please see http://www.invitationaleducation.net.

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 students. We know that if staff are in relationships with other staff where dignity and respect between the staff are evident that students feel safer. If staff feel and act safe with each other, then students 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 students 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.

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
  • 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 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 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.
  • We recommend that the above 3 chapters be taught to students as a way of preparing them to become integrated into the community.
• CONCEPTUAL SKILLS
  • 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 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 6 – Liability and Legal Issues provides an overview of the legal issues surrounding the prevention and, if needed, use of restraint.
  • Chapter 7 – Medical Risks of Restraint is required to be taught prior to teaching chapter 10.
• TECHNICAL SKILLS
  • 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 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 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.
  • Advanced Technical Skills teaches how to prevent, and if needed, respond to severe aggression and violence. It may not be needed in unlocked settings.

• 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. 
Over 500 schools in the US and Canada use The Mandt System®, ranging from large cities such as Houston, Calgary, and Virginia Beach to smaller rural schools in Alaska, British Columbia, and Idaho. Following is a list of states and provinces in which schools utilize The Mandt System®:
  

  Alaska Alberta British Columbia California Colorado Georgia Hawaii Idaho Iowa Kansas Kentucky Maine Minnesota Mississippi

  Missouri Montana Nebraska New Hampshire New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania

  Rhode Island Saskatchewan South Carolina Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  
  Members of the Training Faculty of The Mandt System, Inc. have experience teaching at the local school level as well as at the university level. Four of our faculty members have published research based articles in peer reviewed journals, and have advanced degrees.

• When comparing our program with others, one of the factors will be cost. Please note that The Mandt System® does not charge for any training materials, student manuals, certificate, etc. There are no additional charges beyond the initial certification fee of $1,425.00 (US Funds). We provide, at no charge, each trainer with:

• • Access to Instructor Resource Center containing the Student Manual, a PowerPoint™ slide presentation with over 240 slides that can be used to teach all of the non-physical chapters (1 through 7) to students.
  • A Trainer Manual containing icons to tell the Trainer when to use the PowerPoint™ slides, when to do an activity, and trainer tips.
  • Access to the Trainer Support section of the Mandt System® web site, containing video clips of all physical skills to ensure training fidelity, update information on the manual, and a Trainer Forum to facilitate communication between the over 3,800 active trainers in the US and Canada.

The Mandt System® has been used in psychiatric hospitals for over 30 years, and in some of those hospitals, administrators and medical personnel realized that the principles taught in The Mandt System® could be utilized in Emergency Rooms and general medical-surgical floors, long-term care programs, and other health care settings to address issues of workplace violence.

The American Nurses Association reports that the Bureau of Labor statistics state an estimated 1.7 million workers are injured each year during workplace assaults (2005); violent workplace incidents account for 18% of all violent crime in the US (Bureau of Justice Statistics 2001). In its annual Workplace Safety Index, Liberty Mutual cites assaults and violent acts as the 10th leading cause of nonfatal occupational injury in 2002, representing about 1% of all workplace injuries and a cost of $400 million. (Liberty Mutual 2004). The incidence of injury resulting from violent acts is more than twice the incidence for health care workers, compared to other workers. (Bureau of Labor 2005).
The incidence of violence is likely far greater than that which is reported resulting from inadequate reporting mechanisms and victim fear of isolation, embarrassment, and reprisal.

Reducing workplace violence means more, though, than reducing threats of harm. Creating a culture of safety is required to create long lasting change that will maintain the safety of all people in health care settings. The Mandt System® has been used effectively in a wide variety of health care settings in which violent behavior may occur. Special consideration for training in The Mandt System® should be given to Emergency Room personnel as well as psychiatric units. For more information on the effectiveness of The Mandt System® go to Reducing Workplace Violence.

Working with adolescents who have been either charged or charged and convicted of criminal activity is a challenging task. In the past, the “Retributive Justice” model has been used to punish people and make them pay for what they have done, in the hopes this would change their behavior.

The National Institute of Corrections has studied what works and what does not work, and published a study where they found:

• Not a single reviewer of studies of official punishment has found consistent evidence of reduced re-offense by the offender;
• Incarceration does not work to reduce future criminal conduct and there is evidence that it makes the offender worse in terms of recidivism
• In most published reviews, at least 40% and up to 80% of the studies of treatment services reported reduced numbers of re-offense by the offender. Not only does treatment work if delivered appropriately but the evidence also shows that punishment and inappropriate interventions will actually make the offender more likely to re-offend.

The Mandt System, Inc. is also committed to the application of the principles of Applied Behavior Analysis in an approach known as Positive Behavior Support. The information provided by Jeff Wells in a ten course review of the principles of Applied Behavior Analysis is consistent with the teaching of The Mandt System®.

The combination of the principles of Restorative Justice and Positive Behavior Support has resulted in an approach that is consistent with John Haley´s definition of Restorative Justice as “a process in which remorseful offenders accept responsibility for their misconduct to those injured and to the community that, in response, allows the reintegration of the offender into the community. The emphasis is on restoration – restoration of the offender in terms or his or her self-respect, restoration of the relationship between offender and victims, as well as the restoration of offenders and victims within the community.” (http://www.restorativejustice.org)

The approach of The Mandt System® is to understand that the conceptual skills of Restorative Justice and Positive Behavior Support and understanding the impact of Trauma on people can only be accessed when people have established healthy relationships with each other, and these relationships can only be established when safety has been established for all people.

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
  • 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 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 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.
  • We recommend that the above 3 chapters be taught to students as a way of preparing them to become integrated into the community.
• CONCEPTUAL SKILLS
  • 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 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 6 – Liability and Legal Issues provides an overview of the legal issues surrounding the prevention and, if needed, use of restraint.
  • Chapter 7 – Medical Risks of Restraint is required to be taught prior to teaching chapter 10.
• TECHNICAL SKILLS
  • 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 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 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.
  • Advanced Technical Skills teaches how to prevent, and if needed, respond to severe aggression and violence. It may not be needed in unlocked settings.

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 juveniles. 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 juveniles 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 youth 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 Restorative Justice to be effective. One of the comments made in the April 2008 DJJS newsletter was that “reinforcement was more effective than punishment” and we fully agree with this statement. We will work with DJJS to ensure that the Quality Assurance processes measure not just the absence of a negative (restraint) but also the presence of positive, pro-social behaviors that demonstrate competence on the part of youth to make different choices. We will also work with DJJS to review the programs, policies, and places so they are viewed as beneficial and not toxic by individuals served and staff.

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 Three decades of experience in the provision of training to empower organizations to prevent and, if needed, use restraint to ensure the safety of all individuals. Secure programs for pre-and post-adjudicatory youth in Texas, Nebraska, Oklahoma, New Mexico, Nevada, Minnesota, Iowa, Maryland, Georgia and Missouri utilize The Mandt System®. We are providing training the week of August 18, 2008 in Texas, and the Bexar County Juvenile Detention Center reported a decrease of over 70% in the frequency of restraint use during the past year. 
The primary Training Faculty members responsible for training in Juvenile Detention Centers is Mr. Randel Goad, who worked at a Juvenile Detention facility in Oklahoma as a shift supervisor for over 15 years. The Mandt System® is used in secure mental health facilities for juveniles, as well as forensic programs for adults in over 15 states. 
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. Please see section “D” for more information.

• 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 37 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.

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
  • 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 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 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.
  • We recommend that the above 3 chapters be taught to students as a way of preparing them to become integrated into the community.
• CONCEPTUAL SKILLS
  • 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 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 6 – Liability and Legal Issues provides an overview of the legal issues surrounding the prevention and, if needed, use of restraint.
  • Chapter 7 – Medical Risks of Restraint is required to be taught prior to teaching chapter 10.
• TECHNICAL SKILLS
  • 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 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 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.
  • Advanced Technical Skills teaches how to prevent, and if needed, respond to severe aggression and violence. It may not be needed in unlocked settings.

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 since 1975, 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 years of work since 1975 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.