Participant Screen and Search

Each program is responsible for providing a therapeutic environment for participants. Staff training is essential to implement program policies and procedures effectively. Policies and Procedures must be written to ensure that the environment is physically safe from hazards and provides for the emotional safety of participants by utilizing a person-centered, strength-based, how to remove trauma-informed approach to treatment.

In a congregate residential setting, the community of participants is a rich source of the therapeutic experience, but it also provides unique challenges to the treatment staff. Participants should be made aware of the impact that items that may create an unsafe environment have on each participant in the community. Participants and staff who are aware of and support the reasons for policies prohibiting items that may create an unsafe environment are the best protectors of the community.

Therefore, Residential Programs’ Policies and Procedures should address the following:

• Creating strength-based environments and practices, which includes the use of strength-based language, that allow for the health and safety of all participants.
• Mobilizing and empowering participants within the facility to support efforts to reduce items that may create an unsafe environment. This includes providing pre-admission information to the participant, the participant’s family members/guardians and anyone who supports their recovery.
• Training staff to model and safeguard trauma-informed principles as they provide for the emotional safety of participants.
• Developing and implementing trauma-informed screening and search practices and protocols, including safe and person-centered alternatives to invasive searches when staff have suspicion of or concerns about the presence of items that may create an unsafe environment in the program. These alternatives may include (but are not limited to):
  • One-to-one staff to participant observation if the participant is suspected of having hidden items that were otherwise undetected.
  • Involvement of the whole community to address each instance when items that may create an unsafe environment are found with each participant responsible.
  • Limits on privileges for a participant or groups of participants who have brought items that may create an unsafe environment into the community or who have not reported the presence of such items, once it was known to them.
  • Individual and whole community rewards for supporting a safe environment –additional privileges, pizza parties, movie nights, certificates for individual and/or group achievements, additional time for out-of-residence passes, additional visitation time, etc.
• Developing a protocol for a community response to individual behaviors that may make the community unsafe in a way that is strength-based, trauma-informed, and supports participant inclusion in the community.
• Developing an intake protocol that educates participants and family members/guardians/anyone supportive of the participant’s recovery about the reasons for the safety rules and the importance of following them.
• Providing opportunities for participants to report concerns about community safety to residential staff confidentially.
• Conducting hourly room checks while the residence is occupied.
• Conducting grounds and perimeter checks at least two times per shift.
• Developing a protocol for staff and participants to have regular informal interactions as a part of the program intervention.

Staff training and supervision are key to transitioning to a new standard of monitoring, observation, assessment, and engagement that is strength-based and trauma-informed, which, in turn, will help create a safe refuge of  healing for all participants.

Staff training should include the following:

• Training about intake procedures from the first contact with the participant and referral source, including 
  providing information on allowable items, and prohibited items that may create an unsafe environment.
• Training in procedures for trauma-informed searches after a participant returns to the facility from an offsite location.
• Training in procedures for room monitoring, from everyday observation to specific searches for cause.
• Training in modeling and safeguarding trauma-informed principles as they provide for the emotional safety of participants.
• Training in behavioral and community interventions that staff are expected to utilize for all participants’ behavior, including the possession of items that may create an unsafe environment and are potentially harmful and/or potentially dangerous to the community.
• Training in the use of community as method, which means the:
  • Utilization of community rules and norms to address behavioral concerns.
  • Value of physical space as a sanctuary of healing.
  • Use of behavioral and community interventions to motivate participants to support the reduction 
    of items that create an unsafe environment.
  • Use of all participant behavior as opportunities for community intervention.
  • Use of staff within the community to build trust and help create a safe and comfortable 
    emotional tone through informal interactions with participants.
  • Use of staff within the community to model community norms; and
  • Use of active interventions to support the value of safety within the community.
• Training on the importance of behavioral modelling as a staff member, including a prohibition against possessing items that may create an unsafe environment.
• Training on the use of behavioral strategies to reward individual and/or group behavioral targets (such as one week with no safety incidents) and to deliver consequences with a therapeutic value that are graduated, directly connected to the behavior, and mixed with opportunities for rewards.

Items that are prohibited because of their potential to create an unsafe environment should be identified clearly in the program’s Policies and Procedures. The Policies and Procedures also should consider and incorporate the following principles:

Residential programs may restrict the use or possession of many items to create a therapeutic environment. Items that are prohibited because of their potential to create an unsafe environment should be identified specifically, as those that are potentially harmful or potentially dangerous and may cause harm to the participant or other individuals. These items include but are not limited to: psychoactive substances that are not prescribed and/or stored according to the program’s medication policies, weapons, and items that pose a fire hazard.

Policies and Procedures for screening participants on admission and when they return to the residence from an offsite location should include: 

• Specific procedures for meeting with and greeting participants, explaining the screening process, and obtaining permission for the search process.
• A specific script that allows the participant to self-disclose any items that are prohibited or are considered items that may create an unsafe environment. Procedures for searching for and collecting prohibited item or items that may create an unsafe environment, including a designated area for searches to be conducted that respects the privacy of the participant.
• Procedures for holding or disposing of items that may create an unsafe environment and holding other prohibited items that may be returned to the participant when they are discharged.
• Procedures for identifying prohibited items and items that may create an unsafe environment within the clothing and on the exterior body of an individual participant, while the person remains clothed, as well as ensuring that all such procedures are trauma-informed and allow for the least intrusive methods that will enable the participant the most privacy, autonomy, and dignity through the procedure.
• Prohibitions against conducting strip searches or searches of a participant’s body cavities: Programs should identify alternative approaches for ensuring immediate safety when a participant is thought to pose a level of harm to themselves or the community that may include finding a more suitable environment for a participant. These alternatives for immediately ensuring the community’s safety may include:
  • Increasing participant observation and monitoring.
  • Developing individualized safety plans with participants.
  • Utilizing multidisciplinary teams to develop a menu of clinically appropriate interventions.
  • Collaborating with the referring or mandating agency to formulate a comprehensive, individualized strategy that may include discharge from a congregate care environment with a referral to another treatment program.
    • A discharge for the possession of items that may create an unsafe environment should occur only after the program has utilized interventions to help the participant engage in the program in a manner consistent with the written standards of the facility.
  • Capitalizing on the therapeutic alliance to maximize the opportunities for disclosure and removal of items that may create an unsafe environment; and
  • Utilizing progressive behavioral interventions regarding items that may create an unsafe environment involving both incentives and trauma-informed consequences.

Policies and Procedures should identify progressive behavioral interventions regarding items that may create an unsafe environment that include opportunities for participants to self-disclose possession of such items with minimal consequences. While Policies and Procedures may also include immediate discharge for specific prohibited items that pose an immediate and potentially lethal threat to participants (e.g., lethal weapons), they should also include progressive behavioral interventions for that may create an unsafe environment but that do not pose an immediate safety threat.

Policies and Procedures for progressive behavioral interventions regarding participant possession of item that may create an unsafe environment should also include:

• A community intervention with the participant(s) in possession of such items that is strength-based and trauma-informed.
• An approach to processing the incident with other community members that is strength-based and trauma-informed.
• Opportunities for participants to process and discuss the safety of the community and to raise safety concerns in individual, group, or community forums with residential staff

Policies and Procedures, including staff training, for routine monitoring of the physical plant and perimeter safety should include:

• Daily monitoring of grounds by staff
• Daily room monitoring and facility walk-throughs.
• Search of facility vans after trips.
• Use of video and other surveillance of common areas.

Policies and Procedures for sessions and visits with family members/guardians/anyone supportive of the participant’s recovery should include: 

• An orientation to the facility and community norms, including rules about items that may create an unsafe environment.
• An explanation of the search procedures for visiting family members/guardians/anyone supportive of the participant’s recovery.
• Opportunities for family members/guardians/anyone supportive of the participant’s recovery to discuss requests from the participant for items that may create an unsafe environment.
• Screening of family members/guardians/anyone supportive of the participant’s recovery that may include searches of pockets and other items that are brought into the facility (e.g., packages).