The Safewards model was introduced to Victoria as a trial across 7 services (18 unit) over one year. It was extensively evaluated by the Centre for Psychiatric Nursing, University of Melbourne with significant and positive results.
Safewards was associated with reduced seclusion events overall and improvement was especially evident in adult and youth wards. Also, Safewards had a highly favourable impact in terms of staff and consumer perceptions of increased safety and more positive inpatient environments.
Independent evaluation of the Victorian Safewards Trial was built on a program logic map and conducted across project phases of training, trial and sustainability. The evaluation provided project partners with clear findings regarding acceptability, effectiveness and impact of Safewards. The program-logic defined the objectives of the trial project. A mixed method design and multiple data sources were used. Data included: Safewards fidelity measures, based on observation by evaluators; several staff and consumer surveys; organisation-level diaries of project activity; and state wide data regarding seclusion events in all inpatient settings.
The Trial evaluation answered six major evaluation questions:
- Was Safewards effective in reducing containment (seclusion events) of consumers in the trial wards?
- How did Safewards impact on safety and conflict in participating wards?
- How acceptable was Safewards to consumers in the wards participating in the Victorian Safewards trial?
- How was Safewards implementation enabled and impeded?
- How acceptable and applicable was Safewards, according to staff participating in the Victorian Safewards trial?
- Did the participating wards achieve fidelity with the Safewards interventions, beyond the trial phase?
In terms of key objectives:
Effectiveness: Safewards was associated with a 36% reduction in seclusion rates, from baseline to follow-up.
Applicability: The Safewards model made sense to staff, most interventions were keenly taken up by staff (n=103), and consumers enthusiastically engaged with several interventions (n=72).
Acceptability: Safewards was highly acceptable to staff (n=103) and consumers (n= 72).
Sustainability: Fidelity was achieved to a very good standard in the trial period (n=18 X 3) and to an excellent standard by the end of the sustainability period (n=14 X 5).
The researchers concluded that further implementation should be supported by a refocused evaluation effort. The focus should be on four things:
- enhancing outcome evaluation for Safewards by developing feasible data collection for the primary outcome of conflict events
- measuring effects in wards where Safewards is continuing and where Safewards is newly implemented, via outcome measures and consumer feedback
- enabling ongoing monitoring of use of Safewards interventions across all wards, and via fidelity measurement
- reporting effectiveness of staff training via brief pre-and post- surveys and quizzes.
Reviewed 23 November 2021