Focusing on Staff to Improve Safety

Posted by Kim Godfrey
August 18, 2016
Performance-based Standards (PbS) is proud to announce Luther Hall as the winner of the 2016 Barbara Allen-Hagen Award for Community Residential programs.
About two years ago, Luther Hall experienced a 93 percent turnover of staff because they were getting injured, using a lot of physical restraints and were exhausted. The residents were defiant and in control, and staff lacked a behavior management system to consistently and effectively manage the youths. The PbS October 2013 data showed 25 percent of the staff feared for their safety and 50 percent of youths were afraid. The leadership team developed an Improvement Plan that focused on employee investment and retention and giving staff the tools and support they need to hold youths accountable.
Luther Hall was selected as the 2016 PbS Barbara Allen-Hagen Award Winner for Community Residential programs because the emphasis on staff and a consistent behavior management system showed outstanding improvement in two years. The strategies resulted in more youths and staff feeling safe as well as more youths’ feelings that staff are fair, fewer restraints and the end of the overwhelming staff turnover. The youths’ fear dropped by about half to 21 percent and staff fear dropped to 13 percent  – both below the field average of PbS community residential programs. Youths reporting staff are fair about discipline issues increased from 50 percent in 2014 to 71 percent, physical restraints fell from 36 to three and staff turnover dropped to 21 percent.
Luther Hall is a co-educational residential psychiatric treatment facility for up to 16 boys and girls ages 10 - 18 years old who have been diagnosed with a psychiatric disorder and need 24-hour care and treatment. Youths stay an average of about nine months and are served by 45 staff. It is operated by Lutheran Social Services of North Dakota and located in a residential neighborhood in Fargo.
The starting point for the two-pronged approach to the improvement strategy was the development of the Refocus program, which offers youths the opportunity to reflect on their negative behavior right after it happens by processing with staff, completing a related assignment, role playing to discover other options for their behavior or cleaning up any damaged property. The program is designed not to punish youths but to help them learn alternative ways to express themselves when they feel overwhelmed by emotions. For staff, it provides a tool to hold youths accountable when they don’t follow the rules and a structure and guidelines for consistent staff responses that reinforce expectations and rules.
Next, Luther Hall addressed staff exhaustion. Residential supervisors’ 10-hour shifts were reduced to 8.5 hours, behavioral health specialists were given a steady rotating schedule rather than random, and weekend teams were created so the same staff worked together and a shift report was created to improve communication and ease transition from morning to evening staff. Regular celebrations, Employee Appreciation Day and fun events have been added to boost staff morale. 
Luther Hall looked to better understand the situations and behavior that preceded youths acting out to support the youths earlier. The youths and therapists together created coping boxes, one for each youth filled with items the youth finds comforting. 
Since the coping boxes have been used, Luther Hall has seen “drastic improvement in adolescents’ ability to independently cope with stressful situations, thereby de-escalating before crises transpire,” according to Tyler Holland, PbS Site Coordinator.
“By developing a stronger understanding of the preceding conduct, we have gained an educated understanding of ways in which we can proactively support our residents when poor conduct arises.”