Professional Assault Response Training (PART ) program Evaluation Results - Executive Summary

Transcription

1 Professional Assault Response Training (PART ) program Evaluation Results - Executive Summary Introduction The purpose of this evaluation was to gather input, from SASWH members and other organizations that have implemented the PART program, to assist with determining the program s overall effectiveness and applicability. The method for gathering input included an opportunity for every level of worker to complete an evaluation form. There were 65 evaluations received either electronically, by fax or by posted mail and each was reviewed. Evaluation Results: Key Messages Evaluations suggested that PART is effective in some sites/areas and has proven to be successful to reduce and eliminate injuries. Evaluations recommended that the theory in PART Basic should focus more on communication. Also, by holding more frequent re-evaluation sessions with appropriate practice of techniques may assist with retention and proper application of principles. Evaluations identified concerns with limited or ineffective Code White* programs, suitability of staff and knowledge level, as well as the need for training/education on dementia and Alzheimer s disease. Home care incurs additional challenges as workers are often alone and the environment may be challenging. Common statements in the evaluation related to the importance of: being able to identify and appropriately respond to the potential of aggression/ violence; proper documentation and follow-up of incidents; using an effective and appropriate approach; increasing communication to the circle of care providers; as well as, developing and communicating effective care/treatment plans. What Does This Evaluation Suggest? Prior to selecting a training program of this nature, the diversity of individuals working in healthcare and of those receiving care must be taken into consideration. It is preferred to align the selection of the training program to best meet the needs of the environment/situation. For those who have invested in the PART program, additional education/training on dementia and Alzheimer s disease in some areas is encouraged. PART is a viable component of an employer s comprehensive program to address workplace injuries. It may be more effective when matched with the appropriate approach and attitude. This combination will support a decrease in injuries related to assaultive and abusive behaviours. *Code White: aggression. In healthcare, this code refers to an emergency (i.e. behavioural based aggression) where a trained team responds to resolve the situation and a protocol for workers is in place. SASWH: PART Evaluation Results, April

2 The Next Steps Comments from the evaluation were categorized into three sections; namely: program, process and people. SASWH is committed to address PART program and process concerns as follows: PART SASWH will develop the following working group with implementation completed by October PART Content and Delivery Working Group: The working group s goal is to enhance learning outcomes in the Basic program as it relates to identification, approach and communication. This group will also consider delivery methods to increase active participation during the classroom sessions with the goal to increase understanding. When considering amendments to the program based on comments received, SASWH will ensure that where PART is working well, that any changes to the program would not have an adverse effect in these areas. SASWH will review the current competency recommendations for PART Trainer and Instructor candidates as well as focus on following up with current PART trainers. SASWH is committed to assist current trainers with increasing their confidence with delivering program principles. SASWH has developed Safety Talks that can be utilized by members to remind employees to work safe, be aware and alert, to report incidents and to document and communicate. Safety Talks can be located on the SASWH website ( under Resources. Selection Based on the comments received, there may be a need to consider alternate programs that focus on specific needs, such as Alzheimer s disease. To address this, SASWH will invite various program vendors to contribute to a program matrix resource. The goal of the matrix is to provide employers with information to assist in program selection to address specific needs. The matrix will include elements such as learning outcome(s), focus audience (e.g., acute, long term care), levels (e.g., trainer, instructor), costs and testimonials if available. In addition, SASWH is committed to offer its members the Workplace Awareness Violence Education (W.A.V.E.) program developed by the Saskatoon Health Region. This program provides learners with principles related to awareness, appropriate approach and communication skills that are crucial elements to reduce and/or eliminate injuries related to violence. SASWH will continue to promote and offer various programs and supports, developed and available for healthcare, to assist any program s success in achieving its goals. The provincial Safety Management System (SMS) Evaluation Tool will assist in identifying workplace successes and areas for improvement. Training and education programs are available from SASWH to assist with increasing knowledge and understanding related to roles and responsibilities of leadership, supervisors and occupational health committees. Additional education is available from SASWH on completing effective workplace inspections and getting to the root cause of incidents. A complete SMS that is communicated and implemented by the employer, and supported through SASWH, would assist in creating and maintaining a safe workplace. SASWH: PART Evaluation Results, April

3 Professional Assault Response Training (PART ) program Evaluation Results Additional Information General Responses to the PART program evaluation identified challenges that extend beyond the content of the program. For any program to succeed and have its goals achieved, supports are a crucial component and should be directly aligned with commitment, communication, consistency and compliance. Commitment to reduce injuries starts with leadership and continues through to every worker, every day, every task. Communication top down, bottom up and straight across is key for understanding. Consistency in application of program elements or process steps is necessary for stability and effectiveness. Compliance may ultimately be the most important - compliance from every level within an organization - walking the talk; working safe; knowing and following safety rules. Responding A total 65 evaluations were received. Through self-identification, the following indicates the respondent s job position: 17 support staff 41 care-giving staff 42 supervisors (may also have self-identified as support or care-giving staff) 32 managers (may also have self-identified as support or care-giving staff) Also through self-identification respondent s indicated their area(s) of work. Of notable interest is that six respondents indicated they work in more than one area The following areas of work were also identified by 21 respondents: addiction services/counsellor administration community health community living service delivery detox facility supervisor education and training executive management health educator HR/safety leadership outpost population health primary care public health/inspector SASWH: PART Evaluation Results, April

4 Evaluation Results: Summary of Objective Responses For the questions aligned to the PART program objectives, responses were categorized into three primary areas: program, process and people. Similar responses are grouped together to assist with classification of responses and reduce repetition. 1. Treatment plans are in place and outcomes are understood it may be better stated in the program as a care plan rather than treatment plan needs to include information on why behaviours are occurring plans are always updated; plans are in place but not always communicated new information may not always be added plans should include client wishes; should include more detail on client workers insist plans are developed by managers/supervisors/educators some do not know or follow the treatment plan staff need to be able to assess day to day as situations change 2. Understanding Attitudes good reminder gets people really thinking about why they are in this career additional training is needed for some workers some care staff need to be provided with more client information than what s available staff are professionals and act accordingly all staff who may interact with clients need to be aware of their own attitude and approach - including lab, x-ray, porters, dietary, maintenance need to understand the impact of their attitudes and how that impacts others; some staff unable to control own emotions some workers are suited for the job while others are not; some take a permanent fulltime job due to seniority and not because they want to be there staff mature as they gain experience some lack ability due to age/mobility many staff are task orientated and get frustrated if they cannot get things done as per routine personal problems are often brought to work and spill over some staff trigger aggression in client some co-workers refuse to provide care to assaultive clients which leaves other coworkers and clients in unsafe conditions not all understand their job and role for resident/staff and for staff/staff relations staff acknowledge resident s needs and respect their requests - thus avoiding escalation SASWH: PART Evaluation Results, April

5 3. Physically and Mentally Prepared assists with staff being aware of potential for a dangerous situation useful reminder for all staff need to update the facility policy Code White is deficient extensive training in conflict resolution is provided safe work practices are followed and supported clients seem to be increasingly violent and staff are concerned they are not adequately prepared; staff are aware of agency policy and very conscious of dangers of working with residents with Alzheimer s disease some may not be comfortable with assessing violence in a mental health related patient new staff may not be aware of what will push a client s buttons staff s mental and physical abilities is a key issue; some staff become unfit over the years some staff have difficulty staying focused on their work staff need ongoing follow-up and reminders about hair, jewellery, footwear no preparation being made; too much sitting at a desk; too much irritability not well practiced observation skills; need more work around organized plan for selfcontrol some staff are unwilling to be educated or unwilling to accept education provided some staff dress inappropriately 4. Identification this area could be simplified as participants get lost and bored when information is provided on why escalation occurs better Code White training and response is required there is no mandatory de-briefing so learnings are lost concerns are reported; incident report filled out; plan is changed as a result many safety features have been installed (e.g., cameras in common areas; staff have cell phones; weekly conferences) time to develop treatment plans for complex residents not always are experienced staff available to help too often medications are offered/forced before trying to identify the issue and resolve it SASWH: PART Evaluation Results, April

6 some staff default to restraining as a means of treatment; these types of approach escalate the situation staff are very proactive in adjusting the treatment plan to meet the client needs staff can identify a threat but often do not assess the situation and change treatment plans without support and redirection sometimes it is a family member who is a threat some are task oriented and may not always use critical thinking 5. Match Level of Response use of role play when teaching is very beneficial material doesn t fit as well with smaller health centres very good information to share especially with public interest in caregiving activities learning program theory before learning the moves is important staffing levels and skills are often inadequate for sufficient protection the person teaching the program is key to ensuring staff understand this often staff response is excessive for the degree of danger (e.g., from small, frail, elderly woman) and results in injury to resident and staff staff are very aware and intervene at initial stage staff contact police for assistance if needed some staff overreact; some staff attitudes need to improve sometimes the situation gets more complicated if other residents or family are involved staff need information so they are not caught by surprise (e.g., phlebotomy staff taking blood, patient appears calm at first until the poke to the arm, the patient strikes out) 6. Reporting Incidents improve this area by including workplace policies the program has improved the reporting process this section of the program training brings the teachings back into play staff are good at detailing; however, there is limited assistance available and little discussion follows on how to prevent future violent incidents good process followed and OH&S staff report and chart unusual behaviours interventions could be documented better incident reports need to be filled out better communication needs to be put forward after an associative behaviour documentation could be done better more intensive investigations help with discussion of interventions used SASWH: PART Evaluation Results, April

7 a process and policy is in place need debriefing and follow-up so staff can know what happens after paperwork is done incident reports are not complete; no reports are filed; not reported to OH&S incident reports are completed and follow-up is provided individual teaching the program needs to be able to teach this effectively staff reluctant to admit their approach may have been wrong staff worried about being blamed most incidents reflect that staff tried to stop the behaviour rather than use the skills they have staff need reminders to complete the reports when incidents occur 7. Use of Evasion/Breakaway Techniques better guidance on who should receive these techniques is needed; not everyone should be taught the techniques should include safe positioning when performing tasks this is not effective if it is not practiced regularly; regular practice is needed staff need re-evaluation; we are behind in providing re-evaluation follow-up needs to happen after training so that staff are using skills correctly all other interventions need to be used first increase review as sometimes learned techniques will be forgotten in any program where techniques are taught, practice needs to take place after the classroom training session this is taught only in specific areas if not always used it takes people a while for them to come into play when an actual event occurs some are and some aren t using these techniques properly some staff only want to learn this and think it is exciting when they should be paying attention to the important parts of the program because staff don t remember or don t use techniques properly, PART is seen as not useful information the program focuses on identification and response - and if you use what you re taught in PART you probably won t need these techniques 8. Use of Manual Restraint Techniques the program needs to address situations when there are two workers or less and staff are not able to do these techniques SASWH: PART Evaluation Results, April

8 this is taught only in specific areas these are effective when staff are well trained and there are enough staff available these shouldn t be taught to everyone; should only be taught where needed need to be practiced regularly so information is retained these techniques are not used so therefore they are not taught staff don t always use what they learned staff don t use these techniques as they call security staff like to learn these techniques but they are not needed staff call RCMP/police when situation is out of control staff respond to situations where teamwork isn t known to them Evaluation Results: Summary of General Question Responses For the general evaluation questions, similar responses were grouped together. How Has The PART Helped You To Work Safe In Healthcare? felt more prepared to deal with situations taught me some basics in avoidance so not to escalate the situation has given me the confidence and ability to respond to any given situation it is no benefit for myself; I do not work in a high risk area and do not have contact with clients information on escalation and de-escalation is helpful how to treat clients fairly without being emotionally involved I had several injuries in the workplace prior to taking this program keeps me aware of potential of a dangerous situation and reminded me of what I should or could do - the repetition is great has helped with better understanding techniques for managing difficult staff has improved my communication skills and the theory behind why violence can occur my techniques were utilized fully to defuse a situation it has had little impact; it is not effective reminds everyone to be aware all the time taught me to always be alert, to position, exists and how to de-escalate there is a workplace attitude of being more competent if something does happen I can remain calmer and can recognize when someone is escalating principles have helped me tremendously in identifying signs of impending aggression as well as exploring possible reasons initial training was of value but the re-evaluations may not be as much value I put more thought into why the situation is occurring it has taught me to step back, mouth closed and soft talk - different approaches to situations has helped me to deal with irate clients in a manner that they tend to calm down and are no longer a threat in community care it hasn t helped as we need to have a program that addresses surveying the area prior to going into homes SASWH: PART Evaluation Results, April

9 every time I take and train PART I am reminded to be prepared and aware of my surroundings evasion has helped emphasis on observational skills, talking to the client to alter behaviour, changing activities, eliminating or minimizing fear in individuals I didn t do everything right the first time, but I certainly learned and improved on same with debriefings held after an incident and practicing some of the strategies and techniques made me more aware of myself, my surroundings and my client helped with understanding of skills needed and applied to observe a situation, react in a situation and the effectiveness for both staff as well as patient What One Change Would You Want, Why and How Would You Change It? supervisors and managers need to be able to help staff use what they were taught more emphasis on Alzheimer s disease and brain injury; add a section on Alzheimer s disease less theory as it is a long day, but it is all relevant so I m not sure how to decrease theory have a refresher every year we need other videos and newer ones to supplement Drawing the Line more staff should receive the hands on techniques - all staff come in contact with clients and they should be able to learn and understand appropriate situations for these techniques better step by step instructions for evasion and restraint techniques use GPA for long term care and PART for acute care when class size is small, the ability to reduce the time would be valuable make the course less wordy offer it more and have it in every facility; offer the full course to all workers expand the program to Code White areas; offer workers a broad scope of techniques to protect themselves implement a mandatory hazard alert system that could warn any worker of heightened potential for violence the length of the program; some pieces are applicable to all staff but not everyone needs it all make it a modular program; use home study or pre-class work the program should be taught once a year and not once a decade it should be more than a 2 hour program and taught by someone with knowledge and experience in self-defence it is good the way it is; don t change anything at this time teach staff behavior management skills instead of PART make it more department specific more emphasis on communication and documentation; with more communication you could take out the techniques change the hours needed to teach it some of the techniques as they may cause breathing suppression in restraint not applicable to a supervisor working in an office more examples and a focus on a variety of clients; how does a video on seniors apply in pediatrics decrease the reading and increase the role-play; use actual cases SASWH: PART Evaluation Results, April

10 educate management on debriefing and making staff feel supported make the approach a bigger part of the program re-evaluation should be optional and based on the discretion of the manager; should consider how staff reacted in previous situations not sure if it is the most appropriate program; other programs have been developed; may be time for a total change instructors should be qualified more mental health training add more about what the staff bring to any situation remove the program as it should be taken if you need it more verbal skills and observational skills training simplify the wording and include some fun, educational tools right now the program is perfect with just enough book, just enough hands-on and just enough demonstration everything in the program is necessary tailor the program specific to the area emphasize prevention more than evasion and breakaway segments as leaving the situation is better than getting to the point where techniques are necessary add stimulus change and strategic capitulation training What Would You Not Change, And Why? staff attitudes and responses and how that impacts the outcomes of encounters go toward the individual in the moves taught - this reduces the chance of a second assault and would reduce injuries techniques because it is good for people to know what to do and be reminded core information is well grounded in theory and applicable generally to practice identification - understanding why the individual is acting aggressively is critical to deescalation of the situation the whole program is important the discussion about why you became a caregiver complete Intermediate in 8 hour program techniques are good; first part when we get to reflect on ourselves and how we work communication and types of people is important; helps you to understand the dynamic in your building and co-workers more than what we see in our residents in LTC mandatory training release and restraints as they do work and are well taught modules on different triggers as this is very informative the Crisis Cycle - this is the PART program in a nutshell all people in healthcare need to learn how to read a client s approach, recognize frustration or aggression, manage it appropriately situational awareness - workers should be aware of what is going on around them it all needs to be overhauled Other Comments A variety of comments were received and those related to information already captured in the points above are not repeated. A summary of comments are: still one of the better programs for violence management taking the class with staff from other departments can give some great learning opportunities SASWH: PART Evaluation Results, April

11 when principles are understood and adopted they are instrumental in reducing aggressive and assaultive behaviours majority of workers do not see it as useful as they tend to remember the hands-on techniques security services utilizes different training that is not congruent with PART - so the same language and same mandate isn t being shared when it comes to controlling a situation. This makes for conflict at times it is generally very difficult to have one program to fit every need. It would be much better to have basic modules done by everyone with additional ones for higher risk units SASWH gratefully acknowledges the time taken by those who completed this evaluation. SASWH trusts that you find value in the report as well as the next steps in place to address the program concerns expressed. SASWH: PART Evaluation Results, April