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Evaluation of the SafetyCareTM Behavioral Crisis
Prevention & Management
Training by QBS, Inc.
University of Utah
Presented by Will Backner and Stacey Graziano
February 2010
Training School Psychologists to be Experts in Evidence Based Practices for Tertiary Students with
Serious Emotional Disturbance/Behavior Disorders
US Office of Education 84.325K
H325K080308
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Safety-Care Behavioral Safety Training is a
competency-based crisis prevention training
program developed for staff who work with
individuals with the potential for aggressive
behavior.
+ Philosophy of Program
Safety-Care procedures are based on research from applied
behavior analysis (ABA).
Utilizes concepts of behavior support including
reinforcement and functional assessment.
Focuses on identification and reinforcement of alternative
behaviors.
Safety-Care is taught using behavioral instruction methods.
+ Certification Requirements

The core Safety-Care course is two days in length (12–16
hours of training time) and basic trainer training is three
days.

Certification lasts for one year for both Trainer and Specialist
certification. Specialist recertification takes one day and
Trainer recertification is one day if conducted at the
customer’s site.
+ Certification Fees

Safety-Care Specialist Training (1½ day training by
certified QBS Master Trainer)

At customer's site—up to 10 participants
$3,600
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At customer's site—up to 16 participants
$5,760
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Attend open session at QBS
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Safety-Care Trainer Training (3 day training by certified
QBS Master Trainer)
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At customer's site—up to 10 participants
$7,000

At customer's site—up to 16 participants
$11,200

Attend open session at QBS
$360 per
person
$700 per
person
+ Certification Fees
Advanced Module Training by Certified QBS Master
Trainer

Half day—up to 10 participants
$1,150
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Full day—up to 10 participants
$2,300
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Curriculum customization
Free
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Curriculum development
$100 per hour
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Certification/Annual Recertification

Attend 2 day recertification during open session at QBS
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1 day recertification at customer’s site—up to 10 participants, 5 minimum
$200 per person

Specialist certificate cost (initial training or recertification) $4 per person

Transfer Safety-Care Trainer certificate to a new organization
$200 per person
$200
+ Training Outline

Introduction: general introduction to the course, causes and
conditions associated with challenging behavior, the
reinforcement model of behavior, and the inadvertent
reinforcement of challenging behavior.

Incident Prevention: provides methods for reducing the
likelihood of behavioral crises and improving staff safety.
Includes creating a safe and positive living environment,
dressing for safety, and safe interaction with potentially
aggressive individuals. Staff will also learn, practice, and
demonstrate competency in reinforcement and basic
preventative safety.

Incident Minimization: methods for identifying crises and
stopping or reducing their intensity. Includes detecting
antecedents (triggers and signals), predicting behavior, and
getting assistance. Trainees will also learn and practice
approaches to intervention with agitated individuals, deescalation, and reinforcement of non-crisis behaviors.
+ Training Outline

Incident Management: how to safely cope with a serious
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Post-Incident Procedures: recovery procedures following crises,
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Role-Plays: following the presentation of the Safety-Care
behavioral incident. Includes physical safety skills, releases,
management of weapons, leadership during behavioral crises,
procedures for safe holding, alternatives to holding, emergency
release, planned rapid release, and emergency release.
Organizations can choose not to use certain physical interventions if
they believe they are not appropriate to their setting and mission.
debriefing of staff, debriefing the individual.
curriculum, role-plays of increasing intensity are presented. Roleplays are tailored to the kinds of problems that trainees encounter in
their work settings. Role-plays are designed to teach staff how to use
the skills they’ve learned, and which approach to take.
+ Competencies

Safety-Care has several goals:
1) Prevent
2) Reverse
behavioral crises.
the escalation & intensity of crisis behaviors.
3) Teach
& strengthen behaviors that reduce crisis behaviors.
4) Safely
manage crises without injury or trauma.
5) Terminate
6) Reduce
crises quickly.
the likelihood of future behavioral crises.
+ Legal Liability
Safety-Care is consistent and compatible with regulatory and
accreditation standards, including JCAHO (Joint Commission on
Accreditation of Hospital Organizations), CARF (Committee on
Accreditation of Rehabilitation Facilities), COA (Council on
Accreditation), and CMS (Centers for Medicare and Medicaid
Services) and other relevant state regulations. It has been officially
certified by the State of Maine’s Department of Health and Human
Services, Division of Licensing and Regulatory Services and by the
Department of Mental Retardation in Massachusetts. Safety-Care is
also used in a number of other states where regulatory agencies do
not specifically certify individual safety courses. QBS should be
contacted regarding specific Safety-Care regulatory standards.
+ Website
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Types of Interventions Restraints
and Procedures
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Incident Prevention
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Create a Safe Environment
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Minimize disorganization, clutter, and excessive stimulation
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Dress for safety (No loose clothing)
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Modify environment (Remove dangerous objects)
Safety Habits
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Know where you are
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Manage your own behavior and emotional reactions
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What you say and how you say it
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Facial expressions
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Physical behavior
Differential Reinforcement
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Describes continuous, random, and scheduled DR
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Describes how to praise effectively
Elbow Check
1.
Stand to the side of the client (facing the same direction)
2.
Place nearest palm of hand on his or her arm right above the elbow with you fingers facing forward
3.
If the client struggles, keep your arm rigid to prevent the client from striking you
4.
Back off if there is significant resistance
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Incident Minimization
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Identify environmental antecedents
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Identify behavioral antecedents
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Allows you to intervene early before the client’s behavior escalates
The Safety Stance
1.
Place yourself in the client’s vision and stand to the side at a 45 degree angle
2.
Stand an arms length away plus a foot
3.
Stand in a thinking stance with the closer arm near the face
4.
Stand with feet shoulder width apart, front foot pointed toward the client and rear
foot pointed toward the side.
Safety sitting
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Eliminate them or help the client cope with them
How to sit and work with clients safely
Calling for assistance
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How to call for help in dealing with a client appropriately
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Leadership
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How to determine who is in charge during an emergency and what the leader should
do.
De-Escalation
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How to calm down an agitated person safely.
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Uses a step down model.
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Avoid power struggles
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The help strategy
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Helps the person understand that there are more appropriate ways to get the
same information. Based on assumption of a communication problem.
The prompt strategy
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Prompt the client what to do rather than the disruptive behavior.
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The wait strategy
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Prompt to do an incompatible behavior or high probability behavior.
Give the client time to calm down.
Management of weapons
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Can be any object that could cause harm.
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Remove potential weapons before a crisis escalates.
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No method to remove weapons from client.
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Call for assistance, protect clients and yourself, and contain the client
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Physical Safety
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The protective stance
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The safety shuffle
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Describes how to use arms to deflect hits and move away from clients.
Shoulder Check
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Shuffling back to maintain a safe distance without backing into a corner.
Moving and Deflecting
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Uses arms to protect from potential hits by client
A method to protect yourself from an aggressive client by moving behind
them and placing your hands on their arm and back so they cannot turn to
hit or grab you.
Supportive Guide
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A guiding procedure that uses a client’s own momentum to
quickly change the direction of movement without pulling
pushing or grabbing.
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Wrist Release/Grab Release
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Choke Release
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Procedure for keeping your airway open and releasing a head
lock.
Hair Pull Release
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Describes how to remove client’s hands from your neck if they are
attempting to choke you from the front or the rear.
Head lock release
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Technique for releasing a grab on your body or wrist without
hurting the client.
Describes how to stabilize your neck and release client’s grasp of
your hair.
Bites
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Describes way to avoid bites and release bites.
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Physical Management and
Restraint
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Emergency physical management
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1-Person Stability Hold
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Procedure for holding a client in place so that they cannot hurt themselves or others
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Also includes a method for dealing with the client sitting down during the hold
2-Person Stability Hold and Escort
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Method for two people to hold a client in place or
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Includes provision to escort them if they do not resist with them facing forward or an
escort where they are facing backwards if they do resist.
Chair Stability Hold
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Describes risk of physical interventions, when they should be used, and what to do.
Uses three staff members to hold a client in a chair with arms.
Releasing from physical intervention
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Includes signs of when to release a hold such as changes in the color of the client’s
face and labored breathing.
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Post-Incident Procedures
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Recovery
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How to set the environment until the client returns to normal
Debriefing
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Reviewing the incident with the client including their triggers and
what the client thought happened during the event.
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Reviewing the incident with staff to identify context of the event,
environmental antecedents, behavioral antecedents, and
interventions used to manage the client’s behavior. Also, review
interventions to make changes so they are more effective.
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Media and Research
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No media (DVDs, ect.). Only training manuals.
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Research
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Google Scholar was used to search for any research on the SafetyCare program. None was found.
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Books and journal articles that cover the use of Behavioral
Momentum and Restraint are listed as references for the program,
but none of them specifically examine the Safety-Care system.