Safe Management Group

(SMG)

Student Orientation

At Ontario Shores Centre for

Mental Health Sciences

Safe Management Group

• Safe Management Group (SMG)

Training Program offers generic skills &

techniques to support clinical staff in the

prevention & management of the crisis

continuum

SMG versus Other

Programs

• SMG, has a psychologically-based

philosophy with a prevention focus. It

was developed by psychologists and

behavioural therapists and looks at the

functions of behaviour. This aligns with

recovery and our mental health

approach to prevent and care for patient

who are experiencing crisis.

Role of Advanced Trainers

• Co-facilitates SMG Training for Ontario Shores

• Peer support for staff practice of SMG relationship management, de-escalation skills and safe physical techniques

• Works as a member of the team at Code Whites to support the team in promoting staff and client safety

Therapeutic

Relationship

Model

Therapeutic Relationship Model

• The model was created to focus on emphasizing working together in collaboration with patients which will positively impact staff and patient safety

• Evidence supports the development of multidimensional models for the management of aggression in mental health care settings (Duxbury, 2005)

Therapeutic Relationship

Model • Promote wellbeing and strengths

• Positive patient outcomes

• Promote least restraints and least intrusive

philosophy

Collaborative Recovery Model

• Guiding Principle 1 Recovery as an individual process

• Guiding Principle 2

• Collaboration and Autonomy Support

Components of the Therapeutic

Relationship Model

1~ Change Enhancement

2~ Collaborative Strengths and Values

Identification

3~ Collaborative Visioning and Goal

Striving

4 ~ Collaborative Action and Monitoring

What is the SMG Program

• Crisis Intervention Training

• Designed by Psychologists, Behaviour

Consultants & Physical Intervention

Specialists

• Approved for use with children & adults

by Ministry of Community & Social

Services in 2003

• Ontario Shores’ adopted SMG in 2008

to ensure staff are trained in a

CERTIFIED program to support best

practice

Approach

• Prevention of aggressive incidents

• Least intrusive

• Effective use of safe techniques

Risk Management

Summary of Risk

Management

• What is a Behavioural crisis

• Two types of behavioural crisis: Predictable vs. Unpredictable

• Effective Prevention of behaviour crises:

Plan for the predictable

Know the response to the unpredictable

Risk Management

Risk management includes:

• System Preparation

e.g. Policies and Procedures

• Preventative Planning

e.g. Plan of Care

• Functions of behaviour

i.e. What the patient needs or wants

Summary of Risk

Management

• Environmental preparation

– Enviroscan

• Staff preparation

– Aware of our own internal processes

– Stress management

Positive Feelings

Positive Behaviour Positive Outcomes

Positive Thoughts

Positive Self-Management

Relationship Management

Summary of Relationship

Management

• Power & equity

– Technique: Provide greater choices in

areas of insufficient self-determination

• Social Exchange & Reciprocity

– Technique: Create balance; plan more

positive experiences & reduce

unnecessary negative experiences

Summary of Relationship

Management

• Empathy, Caring, Acceptance

– Technique: Active listening, attention to

verbal & non-verbal cues, inclusion of

patient

• Genuineness & Openness

– Technique: Disclose appropriate feelings,

personal thoughts & information

Summary of Relationship

Management

• Responding to Emotions

– Technique: Allow patient to express

emotions instead of interrupting patient

during this process; use active listening

skills.

• “Meet the patient where the patient is

at present”

Summary of Relationship

Management

• Coercion

– Technique:

– Avoid giving in to coercion; redirect by active listening

& problem solving

– Avoid presenting coercive behaviours; Provide choices

and or make a plan ahead of time – empower the

service user.

• Interpersonal Boundaries

– Techniques: Discuss with other staff; Negotiate &

compromise with others on less important rules; Write

down limits & frequently review & communicate with

others

Managing Aggression

Summary of Managing

Aggression

• Aggression usually does not

happen suddenly & without warning

• Aggression often occurs over time

& through different phases

• There are NO set number of stages

a patient will go through

Code White Response:

Team Approach

Revised Code White Policy

• Code White responders will practice a least

restraint & least intrusive philosophy & ensure

alternative to restraints have been exhausted

first & whenever possible

• There will be an identified Code White Team

Leader at every Code White team response

who will assign roles & responsibilities

Revised Code White Policy

• Code White team leader responsible to ensure a Safety Occurrence Report & Code White Review will be completed following the event

• Emotional debriefing is available for staff through Critical Incident Stress Support Team (CISS) & Employee Assistance Program (EAP)