SOUTH CAROLINA DEPARTMENT OF MENTAL HEALTH
Columbia, South Carolina
|OFFICE OF THE STATE DIRECTOR OF MENTAL HEALTH
DIRECTIVE NO. 892-09
TO: All Organizational Components
SUBJECT: “Behavioral Emergency Stabilization Training: BEST”
This directive establishes policy and outlines procedures to implement and maintain the training program entitled Behavioral Emergency Stabilization Training (BEST) for the South Carolina Department of Mental Health (SCDMH). The intent of the program is to provide training for all SCDMH employees working with clients and their families to ensure the delivery of quality mental health services in the least restrictive environment. This training will be made available to all SCDMH employees.
- It is the policy of SCDMH to develop a training program based on needs as identified by employees and clients in collaboration with SCDMH Quality Improvement and Risk Management data. The program and curriculum will be consistent with the SCDMH mission and priorities which facilitate recovery and promote resiliency.
- It is the policy of SCDMH that seclusion and restraint are never considered treatment interventions. They are always considered actions of last resort. In SCDMH, seclusion or restraint by trained and competent personnel is used only when other less restrictive measures have been found to be ineffective to protect the client or others from injury or serious harm. The use of seclusion and restraint must always be followed by a full review as part of the process to eliminate the use of these in the future.
- It is the policy of SCDMH to provide safe and humane treatment and a working environment which minimizes risks of harm to clients and employees while maintaining the dignity of clients. This obligation will be fulfilled in part by providing adequate training. All employees will be required to complete a minimum level of training. Employees involved in direct treatment and/or client contact will be required to complete online and in class training, demonstrating competency to utilize skills in behavioral emergencies.
- BEST training is designed to reduce the incidence and intensity of behavioral emergencies; to encourage dialogue between staff and clients; to use verbal de-escalation to minimize physical intervention and to promote a restraint free environment by:
- Introducing approved prevention and intervention skills and strategies for staff.
- Educating staff on the physical and psychological danger of physical intervention, including potential for death and injury, negative effects on treatment processes and the psychological harm to clients, especially those with trauma history.
- Recognition, Self Awareness and Early Intervention: BEST is designed to enhance the employee’s ability to evaluate and intervene therapeutically in the event of a behavioral emergency. The majority of the course content will be allocated primarily to verbal and non verbal skills, self-awareness, and safety principles. SCDMH supports the concept that most behavioral emergencies are preventable and that potential incidences are best handled by early recognition and intervention.
- Physical techniques training: The techniques taught in the BEST program are to be used only in cases of inevitable or spontaneous physical contact or where prevention and early intervention prove ineffective.
- Restraints: The restraints taught in the BEST training program are the only approved means of moving and /or physically retraining clients in SCDMH. They should be employed only as a last resort to clients presenting serious threat of extreme violence and with physical injury to self or others. (S.C. Code ANN. Section 44-22-150).
- The SCDMH Training Council will serve as the BEST Standards Committee to examine data, make recommendations for policy changes, and maintain and update the SCDMH BEST curriculum.
- There will be a subcommittee, comprised of staff from Client Advocacy, Client Affairs, inpatient facilities and Mental Health Centers. The subcommittee will periodically review a sampling of all cases involving seclusion/restraint and all cases of seclusion/restraint lasting more than 24 hours. On a quarterly basis, the subcommittee will look at the ORYX outcome reports by JCAHO and make recommendations to the Training Counsel based upon findings.
- It is the intent of this policy that all designated center and facility employees will complete BEST training. The amount of training to be received will depend upon the degree of client contact and job responsibilities.
- Initial training of new employees will be accomplished within the first 30 days of employment. No direct care employee shall employ physical interventions prior to the successful completion of this initial BEST training. Periodic updating of training will be conducted no less than every other year in class and every year through the online learning system. Special retraining of employees will occur as deemed needed by Quality Improvement and Risk Management findings, supervisory review findings and recommendations of the BEST subcommittee.
This Directive rescinds and supersedes Directives No. 883-06 entitled “The Behavioral Emergency Stabilization Training” (BEST) Program and No. 662-85 entitled “Seclusion/Restraint and Special Treatment Procedures for Psychiatric Facilities.”
John H. Magill
State Director of Mental Health
March 30, 2009
South Carolina Department of Mental Health
BEHAVIORAL EMERGENCY STABILIZATION TRAINING
CERTIFICATION OF COMPETENCIES
This evaluation reflects the competency testing of the employee listed above in his/her understanding of the course Content and/or ability to perform the protection, release and restraint skills according to the standards outlined in the program: “BEHAVIORAL EMERGENCY STABILIZATION TRAINING”.
Length of course instruction: ___ hours Written test: ____ satisfactory ____repeat training
SECTION I: PROTECTION SKILLS
- High Blow or Punch
- High Blow
- Pivot and Deflect Defense
SECTION II: RELEASE SKILLS
- One-Handed Wrist Grip
- Grip on Both Wrists
- Two-Handed Grip on One Wrist, Opposite Directions
- Grip pressure point
- Rear Choke – Standing
- Front Choke
- Rear Coke – Sitting
- Forearm Choke
- Hair Pulls
- Bear Hug
SECTION III: RESTRAINTS
- Basket Hold
- Straight Arm Restraint
- Bed or Floor Restraint
Skills Performance: _____ satisfactory _____ repeat training
Trainer Signature and Date
I understand the therapeutic intent and purpose of this training and will in no way abuse the techniques taught therein.
Employee Signature and Date
Revised: March 2009