Safewards:
Model refresher

Safewards definition of conflict and containment
Task: How have you been using Safewards in practice?
Task: Name the six domains

Can you give examples from practice for the following?
•	Reducing or eradicating the conflict originating factors
•	Preventing flashpoints from arising
•	Cutting the link between the flashpoint and conflict
•	Choosing not to use containment when it would be counterproductive
•	Ensuring that the use of containment does not lead to further conflict
•	Patient modifier examples

Task: Spin the Safewards model
Task: Pin the intervention on the Safewards model
Overview of originating domains 
Staff team domain
Internal structure
Rules, routines, efficiency, clean/tidy, ideology, custom, practice

Staff modifiers
Staff anxiety and frustration, moral commitments (honesty), psychological understanding, teamwork and consistency, technical mastery, positive appreciation, education/training, clinical supervision, model skills, challenge each other, review care provided, focus on flashpoints, finding better ways to manage them (reduce number of rules, pre-empting needs) and set limits

Flashpoints
Denial of request, staff demand, limit setting, bad news, ignoring

Physical environment domain
Better quality environment versus complexity (observation/supervision)

Features 
Door locked, quality of environment, speedy repairs, complexity, seclusion rooms available, PICU, ICA, comfort/sensory rooms, ligature points

Staff modifiers 
Vigilant and inquisitive, checking routines, décor, maintenance, clean and tidy, alternative choices, respect 

Flashpoints 
Secrecy, solitude, admission shock, exit blocked 

Outside hospital domain
Stressors 
Visitors, relatives and family tensions and relationships, missing out, dependency and institutionalisation (absconding), demands and home 

Staff modifiers 
Carer/relative involvement, family therapy, active patient support, awareness, important factors from outside that can influence behaviour on the unit (financial circumstances, support to resolve issues with family and friends, accommodation-checked on/leave to visit)

Flashpoints 
Bad news, home crisis, loss of relationship or accommodation, argument 

Patient community domain
Patient-patient interaction 
Contagion and discord (copying behaviours, impact of others’ behaviour, living with others, meal times and medication times)

Patient modifiers 
Anxiety management, mutual support, moral commitments, psychological understanding, technical mastery

Staff modifiers 
Explanation/information, role modelling, patient education, removal of means, presence and presence+ (getting in early), conflict resolution, pre-emptive reassurance, managing level and fluctuation of activity on the unit

Flashpoints 
Assembly, crowding, activity queuing, waiting, noise, staff/patient turnover or change, bullying, stealing and property damage 

Patient characteristics domain
Symptoms and demography 
•	Symptoms: paranoia-defensive aggression/absconding, specific delusions, depression-suicide attempts/irritability, use of substances, irritability or disinhibition
•	Personality traits: features of ASPD, instrumental aggression
•	Demographic: particularly being younger and male

 Staff modifiers 
Pharmacotherapy, psychotherapy and functional analysis; nursing support and intervention; enhance choices, freedom and control over circumstances; develop mutually respectful partnership; therapeutic community; authoritarianism-counterproductive; CBT; social skills training; TIC responses; choices over how to respond.
Only a few people account for the majority of aggressive incidents, therefore:
•	change responses after the first event to avoid subsequent events
•	target therapeutic interventions

Flashpoints 
Exacerbations, independence, identity, acuity, severity

Regulatory framework domain
External structure 
Legal framework, national policy, complaints, appeals, prosecutions and hospital policy 

Staff modifiers 
With the exception of hospital policy, these modifiers are not under staff control (RRI); however, the way they are carried out can be. 
Procedural justice, respect for rights, hope, information giving, support to appeal, legitimacy, compensatory autonomy, consistent policy, flexibility, effective complaints process, policy targeted at RRI, choices (such as more activities, meals, snacks), intervene to address hopelessness and self-stigmatisation.

Flashpoints 
Compulsory detention, admission, appeal refusal, complaint denied, enforced treatment and exit refusal 

Task: Reviewing the Safewards model and concept

Task: Selling the Safewards model
Task: Selling the Safewards model
Task: Role play
Safewards feedback
Paste in some feedback from staff, patients and family here about the impact Safewards has had to date
Task: Fidelity comments to consider
Professor Len Bowers has made some comments in relation to Safewards 
- discuss these statements as a group 

•	If your intervention doesn’t alter any of the ‘staff modifiers’ identified in the Safewards model, then it isn’t a Safewards intervention, and it probably won’t do anything to make your ward a safer place, even though it might make it nicer in other ways. 

•	Although many Safewards interventions can be done creatively, that doesn’t mean anything creative or arty is a Safewards intervention.

•	None of the interventions will work if you and your team don’t actually do them!