Training and Staff Development
Stephen B. Goldberg, MD LLC
offers custom-designed specialized staff training in the areas of violence, suicidality, milieu management and professional development. We offer a variety of programs that include the management of violence within inpatient units, outpatient clinics and residential treatment facilities, suicide risk identification and risk reduction, milieu management and staff/professional development.
Each training is customized to the fit the specific needs of the target audience. Delivered in a variety of ways and devoid of unnecessary jargon, the information provided reflects the latest best practice, currently available knowledge and Dr. Goldberg’s life experience managing and teaching the management of violent, suicidal and difficult to manage patients/clients.
Information is presented in multiple formats and can include didactics, PowerPoint presentations, video vignettes and hands-on exercises.
All specialized staff training provided by Stephen B. Goldberg, MD LLC serves to educate, demonstrate and motivate for positive change.
STAFF TRAINING
All staff, from physicians and clinical staff to front-line technicians, are included in each of the phases of our process; from the assessment of the unit and its patients to the training and implementation of recommendations.
Clinical staff often receive ample training on the diagnosis and treatment of individual conditions during their core education, but rarely are given practical, real-world guidance on how to manage aggressive, violent and/or suicidal patients. This becomes even more relevant when dealing with patients in a “mixed unit” setting where there are patients of all types, including voluntary, involuntary, forensic or otherwise court involved with a variety of diagnoses, symptoms and secondary gain motivations.
It is the front-line staff who often are the lowest paid and least trained, but spend the most time with patients. Even the best-laid treatment plans are doomed to failure if the staff entrusted to implement, explain and support the plan are disenfranchised, afraid or underprepared to manage an acute population. When everyone on the treatment team is not a part of the management plan, the likelihood of success of that plan drops dramatically.
Ill-prepared and oppositional staff can antagonize patients, undermine staff and inadvertently contribute to aggravating rather than mitigating the risk of violence.
Staff of all backgrounds and levels of training have difficulty appreciating the impact of their actions on the milieu. An attempt to accommodate one patient can impact and empower others who are watching, observing and developing their own sense of what is and is not acceptable on the unit. Even the most impaired and disorganized patients can appreciate the unspoken culture of a unit and often will act based on that non-verbal understanding.
Fairness, consistency and a no-tolerance policy for violence (and threats of violence) can set the tone, even when not explicit, that the unit is a safe place where the staff is capable of managing the intensity of all patient needs and on the unit.
MILIEU MANAGEMENT
Milieu Management focusses on the importance of the inpatient community’s social environment (includes culture, norms and acuity of its residents) on an individual’s behavior and their ability/willingness to control their behavior. A well-structured milieu can help a patient contain negative behavior and provides an opportunity to remedy situations through staff and peer feedback, as well as an opportunity to model constructive behavior. When a milieu is functioning well, patients work with their peers and professional staff to take responsibility for the welfare of themselves, others in their community and the community as a whole.
The milieu should be a supportive environment in which the staff works with patients to provide safety and structure while allowing assessment of a patient’s relationships and behavior. A consistent routine needs to be maintained, which then fosters predictability and trust.
A milieu is considered therapeutic when the program’s community provides a sense of civility, membership, belonging, care and accountability.
When a milieu has high acuity, is understaffed, has high staff turnover, is unstructured and/or has aggressive/antisocial/psychopathic residents, the milieu becomes charged, counter-therapeutic and the likelihood of violence increases. Furthermore, when violence does occur, assessment of the root cause often fails to reveal a precipitating event and the focus is often concentrated on the patient’s medication management or the “untreatable” nature of their characterological flaws rather than the context in which the violence occurred.
Our approach to helping your agency reduce violence, suicidality and/or staff turnover involves a full assessment of the unit including, but not limited to:
Individual patient reviews, case conferences and staff meetings are also employed, when necessary, to allow for specific patient reviews and a comprehensive assessment that ultimately results in a set of recommendations that include specific patient management/treatment suggestions, staff training needs and potential policy revisions.
