Show of Support
Previously, security came to the APTU as a show of force directed toward the patient. Now they come as a show of support directed toward APTU staff.
The process of “stat calling” security has also been changed. While the request may still be “Send two officers,” upon arrival, security is thoroughly briefed on the situation in progress and the counselor and staff’s plan for management of the patient. Changes in approach are communicated to security officers throughout the unfolding incident. Most importantly, when the problem is resolved, there is an immediate review of all actions, and feedback is solicited from all present. Everyone participating has an equal voice in expressing how everything went and what can be improved during the next incident.
Physical intervention by officers is not entirely off the table, but it is no longer the immediate response to a patient’s outburst of aggressive behavior. Officers receive training on nonagressive, nonthreatening postures and arrive prepared to wait as staff and counselors try to resolve the situation.
As part of the training, officers are shown recorded incidents where verbal intervention successfully deescalated patients’ outbursts. The psychiatric staff point out verbal techniques for the officers to use, including direct and clear limit setting, active listening, and the redirection of conversation to focus on the issue.
Officers physically intervene only to prevent an assault; they do not intervene in reaction to an assault that has already occurred. If an APTU staffer is physically attacked by a patient or that patient tries to injure him- or herself while security is present, officers will provide a quick and appropriate response.
Questionnaire. At the beginning and the end of the training program, security officers fill out a questionnaire that queries them on their feelings toward, and perceptions about, working with APTU. After the training is completed, officers fill out a second questionnaire, reporting on their changed perceptions as well as making suggestions or asking for more detailed information.
Thus far, the officers’ feedback on the program has been positive and encouraging. They write that the training has allowed them to feel more a part of the team. The questionnaires also reflect a subtle but important change in officers’ vocabulary that reflects their exposure to trauma-informed concerns and approaches to patients.
As a result of the program, security officers have developed a greater understanding of problems facing APTU patients and, by extension, patients with behavioral issues on other units and in the emergency department. The relationship between APTU and security has improved. There is a sense on both sides that relationships have improved and that each group now trusts the capabilities of the other.
Stat calls to security have not decreased—in fact, they have risen slightly as APTU staff use all the safety tools at hand to eliminate the need for patient restraint—but calls to the APTU are no longer seen as a waste of security’s time. Officers now understand how they are contributing to the hospital’s organizational objective to serve the patient and manage each incident in the safest, least traumatizing way.
Thomas F. Lynch is director of security at Baystate Health and chair of the ASIS International Council on Healthcare Security. Robert Horton is an RN-BC with the Department of Psychiatry at Baystate Medical Center. Monica M. Wynne is security manager of Baystate Medical Center. She is a member of ASIS International.