Behavioural skills training for teaching safety skills to mental health clinicians: A protocol for a pragmatic randomized control trial. (Preprint)

Abstract

Workplace violence is an increasingly significant topic, particularly for staff working in mental health settings. The Centre for Addiction and Mental Health (CAMH), Canada’s largest mental health hospital, considers workplace safety a high priority and consequently has mandated staff safety training. For clinical staff, key components of this training are self-protection and team-control skills, which are a last resort when an individual is at an imminent risk of harm to self and/or others and other interventions are ineffective (e.g., verbal de-escalation). For the past 20 years, CAMH’s training-as-usual (TAU) has been based on a 3-D approach (description, demonstration, and doing), but without any competency-based assessment. Recent staff reports indicate that the acquisition and retention of these skills may be problematic and that staff are not always confident in their ability to effectively address workplace violence. The current literature lacks studies that evaluate how staff are trained to acquire these physical skills and consequently provides no recommendations or best-practice guidelines. To address these gaps described by the staff and in the literature, we have borrowed an evidence-based approach from the field of applied behaviour analysis known as behavioural skills training (BST) which requires trainees to actively execute targeted skills through an instruction, modeling, practice and feedback loop. As part of this method, competency checklists of skills are used with direct observation to determine successful mastery.

Our objectives are to evaluate the effectiveness of BST versus TAU in terms of staff confidence, their competence in self-protection and team-control physical skills, their level of mastery (predefined as 80% competence) in these skills, and d) their confidence, competency, and mastery at one-month post-training.

We are using a pragmatic randomized control trial design. New staff registering for their mandatory safety training are randomly assigned to sessions which are, in turn, randomly assigned to either the BST or TAU conditions. Attendees are informed and consented into the study at the beginning of training. Differences between those consenting and not consenting in terms of role and department are tracked to flag potential biases.

This study was internally funded and commenced in January 2021 after receiving ethics approval. As of May 2022, data collection is complete; half of the baseline, post-, and 1-month videotapes have been rated, and three-quarters of the interrater reliability checks have been completed. Analysis is expected to begin in late summer 2022 with results submitted for publication by fall 2022.

Findings from this study are expected to contribute to both the medical education literature as well as to the field of applied behavioral analysis where RCT designs are rare. More practically, results are also expected to inform the continuing development of our institutional staff safety training program.

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