Consultation & Training

AWARE trainers refine H.E.L.P. course
Trademarked system teaches caregivers 'therapeutic attitude'

By Jim Tracy

As in judo and jitterbugging, its takes leverage and balance to master AWARE’s H.E.L.P. program "It’s not strength. It’s how you move," says Training Director Tim Hahn, who helped develop H.E.L.P. – AWARE’s trademarked system for relieving stressful situations.
"We place the emphasis on de-escalating stressful situations before they become a crisis," Hahn says. "In situations where individuals lose control and pose an immediate risk of physical harm to themselves or others, H.E.L.P. insures their safety until they can gain control of themselves."
AWARE first began using crisis prevention and intervention when it opened several children’s group homes in 1991. From then until 2003, trainers used a standard program developed by the Crisis Prevention Institute based in Brookfield, Wis.
That worked well enough, Hahn said, but AWARE wanted a system that would better fit its own needs.
"It was (CEO) Larry Noonan’s vision," Hahn said. "We’re a credible company, and he felt confident we could put together our own training program."

Advice from wrestling coach

In the summer of 2003, Noonan started looking for an expert outside AWARE and recruited retired Butte High School wrestling coach Jim Street. The hall of fame mat mentor knew a little about movement and balance after leading the Bulldogs to 13 straight state AA championships (1980-92). He came out of retirement in 2006 to coach the current crop of Butte High School wrestlers.

"We didn’t want to invent a new restraint system or new holds," Hahn said. "That’s where Jim came into the picture. His expertise with movement and balance fit in well with what we wanted."

Driving the need for a new system was passage of the Children’s Health Act of 2000, and with it, new restraint and seclusion rules for agencies receiving federal funds. The Act states that facilities such as group homes must guarantee children the right "to be free from physical or mental abuse, corporal punishment, and any restraints or involuntary seclusions imposed for purposes of discipline or convenience."

Restraint, for example, can be used only to ensure the physical safety of a group home resident, a staff member, or others. The Act also requires agencies like AWARE to provide "appropriate training."

"The Act listed a comprehensive set of skills and competencies that all staff needed to have," Hahn said. "That was our guideline. That was the outline we used to go by."
Hahn and fellow trainer Larris Allick waded into the project in the summer of 2003.
"We had to do a lot of research," Hahn said. "I spent hours on the Internet plugging in terms like 'de-escalation' and 'restraint.'"

It helped that he and Allick were certified as a trainers in the Mandt System of physical restraint, which is used by some juvenile corrections and behavioral health facilities."
"That gave us the foundation to get started," Hahn said. "We began mapping out both the physical skills required for a new system and started writing a manual."
They also moved furniture.

"We moved into new offices at Galen and made sure we had a room without any furniture," Hahn said. "And we started practicing."

For a while they split spent time between Galen and the wrestling room at Butte High School and started taking photographs. One of those, for example, shows step by step how to slip out of the grasp of someone who has grabbed your shirt, your wrist or your hair or placed you in a head lock.

"We also wanted to see how the steps would look formatted in our manual," Hahn said. "Our motto was to keep it simple. We didn’t want to get too technical."

Once they felt confident in their new system and had written a manual, they looked to the Montana Department of Public Health and Human Services for approval.

"They were skeptical of what we were trying to do," Hahn said. "It took four or five meetings and all of those meetings involved demonstrations in Helena. It was tough and stressful, but eventually they gave us the thumbs up. As far as we know, this is the only state-approved training curriculum."

Hahn credited Jeff Folsom, chief of operations, with winning over state regulators.
Today all AWARE direct care staff and case managers are required to pass the H.E.L.P. course, which is taught by Hahn, and training coordinators Allick and Scott Yebba. The course includes a 30-page manual complete with photos. AWARE also requires staff to take a yearly refresher course.

"We do local training at Galen, but we train in every community," Hahn said. "Once a month we’re in every community in Montana where AWARE has an office."

While the course teaches physical skills, it also emphasizes the need to develop a "therapeutic attitude," which meshes with AWARE’s philosophy of unconditional care.
A "therapeutic attitude" means you take care of yourself so you can be as calm, flexible, and effective as possible at work," Hahn said. "It also means that you uncritically accept the person you serve, which helps you be realistic about him (and yourself) and gives you some emotional distance from him or her. We want staff to understand their role as caregivers. We want them to be aware, be alert, but be 'cool.'

Restraint use reduced

The course takes six to eight hours. In order to get certified, trainees must show physical competency and pass a written test.

Since AWARE started using H.E.L.P., "We’ve seen a significant reduction in the use of restraint," Hahn said. "I attribute that to our staff and their managers buying into the program."

Word about H.E.L.P. has spread outside the corporation. AWARE trainers have taught the course to teachers and staff in the Butte School District, for example, and have conducted seminars on H.E.L.P. and the philosophy behind it to other groups.

While AWARE trainers continue to refine the H.E.L.P. program and manual, they have also teamed up as of Oct. 1 with the American Heart Association to certify training in CPR (cardiopulmonary resuscitation) and first aid. Hahn described the Heart Association Training as “more hands on” than what AWARE had been using.

Hahn, Allick and Yebba also double as CPR and first-aid trainers.

"We began
 mapping out both
 the physical skills
 required for a new
 system and started
 writing a manual."

"be alert,
 but be cool."