Crisis

Training Institute

Western Psychiatric Institute & Clinic

of UPMC Presbyterian Shadyside

Office of Education & Regional Programming

Comprehensive Crisis Management Train the Trainer

January 25-29, 2010 8:00 am – 4:30 pm each day Program Code: PQ01 Four Points by Sheraton Pittsburgh International Airport One Industry Lane Pittsburgh, PA 15275
Presenters:
David V. Julian, MEd Program Coordinator, Crisis Management Training Programs Office of Education and Regional Programming Western Psychiatric Institute and Clinic		Michael J. Boland, MSEd Clinical Educator/Crisis Specialist Office of Education and Regional Programming Western Psychiatric Institute and Clinic
Program Description:
The Comprehensive Crisis Management Train the Trainer program is a 40-hour training designed to give individuals the knowledge, skills, and confidence to instruct the Comprehensive Crisis Management (CCM) training program. CCM is an 8-hour program consisting of two components: 1) The lecture and discussion component focuses on assessment and prevention techniques as well as crisis management skills. It helps employees to assess whether a potentially dangerous situation is developing and how to prevent a crisis. 2) A physical demonstration and practice component teaches physical techniques for movement, escape, and emergency safety interventions that are effective and safe for staff and the aggressor. These techniques do not rely on speed, strength or surprise; instead, participants learn to use natural body movement in effective ways.
Educational Objectives:
At the conclusion of this program, participants should be able to: 1. Identify a variety of reasons for challenging behaviors to occur 2. Understand the impact of emotional trauma and the importance of providing Trauma Informed Care. 3. Recognize the importance of ongoing self assessment 4. Understand the importance of developing a therapeutic relationship 5. Identify key factors in the prevention of crisis situations. 6. Discuss responsibilities necessary in the safe resolution of crisis situations. 7. Perform appropriate physical escape and emergency safety intervention techniques
Target Audience:
Individuals with significant clinical experience who will provide the physical and verbal CCM training to their staff members.
Continuing Education Credits:
PSYCHOLOGISTS – 35.0	NBCC – 35.0		CEU – 3.5
ACT 48 – 35.0	SW/LPC/LMFT – 35.0		CPRP – 35.0
Tuition: $875.00 Tuition includes all registration and workshop materials and continuing education credits. Full tuition must accompany the registration form. A $50.00 administrative fee will be deducted from any cancellation received less than two weeks before the session. No refunds can be issued once the program has begun.
To register: Please complete the attached registration form and contract information form and return them via fax, mail or email. For questions regarding this program, please contact Kyessa L. Brian by phone at 412-802-6905 or via email at briankl@upmc.edu.

Registration Form FOR THE CRISIS TRAINING INSTITUTE
Please duplicate this registration form as needed PLEASE NOTE: Pre-registration is REQUIRED Telephone registrations CANNOT be accepted. Please register NO LATER THAN TWO WEEKS BEFORE THE COURSE(S) YOU WISH TO ATTEND as space may be limited.				Please MAIL or FAX this registration form to: Kyessa L. Brian WPIC/OERP 4601 Baum Blvd, Room 178 3811 O’Hara Street Pittsburgh, PA 15213 FAX: (412) 802-6910 / Phone: (412) 802-6905
Registration forms and information on our upcoming programs are available on the WPIC/OERP website at: http://www.wpic.pitt.edu/oerp
Social Security# (last 5 digits):			DISCIPLINE 01 Psychology 02 Psychiatry 03 Professional/Technical 04 Medicine 05 Social Work 06 Nursing, RN 07 Nursing, LPN 08 Education 09 Related Therapies 10 Social Sciences 11 Administrative /Business 12 Other			DEGREE 01 High School 02 Associate Degree 03 Nursing Degree 04 Bachelor's Degree 05 Master's Degree 06 Doctoral Degree 07 M.D. 08 Other
Name (Last, First):
Agency:
Address:
City:
State:		Zip code:
County
Day Telephone: ( )			JOB TITLE 01 Executive Director 02 County MH/MR Admin 03 Unit/Program Director 04 Unit Program Coord 05 Clinical Supervisor 06 Team Leader 07 Psychologist-Supervisor 08 Psychiatrist-Supervisor 09 Physician-Supervisor 10 Accountant 11 Medical Records 12 Clerical 13 Psychotherapist 14 Therapist		15 Caseworker 16 Case Manager 17 Counselor 18 Consultant 19 Intake/Assessment 20 Residential Program 21 Aide 22 Psychologist 23 Psychiatrist 24 Other Physician 25 Clergy/Chaplain 26 Staff Nurse
Email:
FOR CONTINUING EDUCATION PURPOSES, PLEASE INDICATE YOUR CERTIFICATION NEEDS:
q NBCC COUNSELOR	NBCC NUMBER ____________
q NURSE	q PSYCHOLOGIST
q CPRP
q SW/LPC/LMFT	q ACT 48 ID NUMBER______________
Are you a WPIC employee? □ yes □ no
Crisis Training Institute
PLEASE INDICATE WITH AN “X” WHICH PROGRAM(S) YOU WISH TO ATTEND Comprehensive Crisis Management Train the Trainer (PQ01) January 25-29, 2010 – Pittsburgh, PA TUITION: Total Enclosed: $_____________ Method of Payment: o Check (Make payable to OERP/WPIC) Check #_____________ o American Express o MasterCard o Discover o Visa To be completed by credit card users only: Card Number:__________________________________________3 digit security code:_________ Expiration Date: _________________ Signature:__________________________________________________________ To be completed for UPMC account transfers only: Business Unit:___________ Account #:_____________ Dept. ID:__________ Administrator’s Signature_____________________________________________ PLEASE TURN TO NEXT PAGE FOR CONTRACT AND BILLING INFORMATION.

Continuing Education Credit

Each program is offered for the designated number of continuing education credits

COUNSELORS: NBCC

Western Psychiatric Institute and Clinic is recognized by the National Board for Certified Counselors to offer continuing education for National Certified Counselors. Western Psychiatric Institute and Clinic adheres to the NBCC Continuing Education Guidelines.

EDUCATORS: ACT 48

Western Psychiatric Institute and Clinic is recognized by the Pennsylvania Department of Education to offer continuing education credits under Act 48 guidelines. Western Psychiatric Institute and Clinic adheres to the Act 48 Continuing Education Guidelines.

MENTAL HEALTH PROFESSIONALS: CEU

Nurses and other health care professionals are awarded the designated number of Continuing Education Units (CEU). One CEU is equal to 10 contact hours.

PSYCHOLOGISTS:

Western Psychiatric Institute and Clinic is approved by the American Psychological Association to offer continuing education for psychologists. Western Psychiatric Institute and Clinic maintains responsibility for these programs and their content. Please see each flyer for the number of credit hours being offered.

CERTIFIED PSYCHIATRIC REHABILITATION PRACTITIONERS: CPRP

The announced credit hours for each program can be applied to your training hours for the Certified Psychiatric Rehabilitation Practitioners (CPRP).

LICENSED/CLINICAL SOCIAL WORKERS, LICENSED PROFESSIONAL COUNSELORS, LICENSED MARRIAGE AND FAMILY THERAPISTS: LSW/LCSW/LPC/LMFT
The indicated number of clock hours of continuing education is provided through co-sponsorship of the University of Pittsburgh School of Social Work, a PA-approved provider of social work continuing education in accordance with all the applicable educational and professional standards of the Council on Social Work Education.  These clock hours satisfy requirements for LSW/LCSW, LPC and LMFT renewal.  For information of social work continuing education, call (412) 624-3711.

DIRECTIONS:

Four Points by Sheraton Pittsburgh Airport

One Industry Lane

Pittsburgh, PA 15275

724-695-0002

From Pittsburgh International Airport:

Take State Route 60 South towards Pittsburgh for approximately 2 miles. Take the McClaren Road Exit, Exit 4 and at the traffic light continue straight. Follow the signs to the hotel approximately 1 mile. The hotel will be on the left side.

From East:

Take the Pennsylvania Turnpike to Exit 57 and follow Interstate 376 West to Pittsburgh. Go through the Fort Pitt Tunnel and follow the signs for the airport. Follow I-279 South which becomes Rt. 22-30 then US 60 North and take Exit 4, McClaren Road. Turn left at the end of the ramp and turn left onto Industry Drive.

From West:

Follow the Ohio Turnpike to the Pennsylvania Turnpike and take Exit 10, Rt. 60 South. Continue past the airport to Exit 4, McClaren Road and go straight onto Industry Drive. Proceed for approximately one mile and the hotel is on the left.

From South:

Take Interstate 79 North to Exit 59B, Route 22-30 West/Airport. Rt. 22-30 W becomes Rt. 60. Follow 60 North towards the airport and take Exit 4, McClaren Road. Turn left at the end of the ramp and turn left onto Industry Drive.

OVERNIGHT ACCOMMODATIONS:

A block of rooms has been reserved at the Four Points by Sheraton at the rate of $109.00 per night plus tax. To receive this special rate, reservations must be made by January, 10, 2010. When making your reservation please give the following code: (not available yet).

DRESS:

Please plan to dress casual for the entire week (jeans, sweats, etc).  Each day of the week will be divided between the lecture and physical portions of the program, so please be comfortable.  It is also a good idea to bring a sweatshirt or light jacket as the rooms tend to be a little on the chilly side.  Also, the restrictive procedures portion of the program does require spending some time on the floor so it is advisable to bring a small towel or handkerchief as well.

CCM TRAIN THE TRAINER PROGRAM REQUIREMENT:

Prior to attending the Comprehensive Crisis Management trainer program, a memorandum of understanding must be agreed to and signed by both Western Psychiatric Institute and Clinic, and a representative of the participant’s agency. This understanding will outline the terms and agreements that must be accepted by the participant’s agency. The memorandum of understanding must be returned to The Office of Education and Regional Programming of the Western Psychiatric Institute and Clinic prior to the start of the program.

Course Requirements:

□ Trainee must have sufficient clinical experience and be physically capable to become a competent trainer.

□ Training must be performed in teams of at least two trainers.

□ Training can only be given to members of your agency.

□ Trainers must be recertified by Western Psychiatric Institute and Clinic annually.

□ A contract provided by Western Psychiatric Institute and Clinic must be signed by the appropriate designee from your agency and returned to the address provided before the training begins.

□ Payment must be received within 30 days from the Train the Trainer course ending date.

□ Trainers must follow the program and instructor requirements which will be distributed during the training.

Please provide the following information:

Agency designee who will be responsible for signing contract of understanding:

Name:

Mailing Address:

Telephone Number:

Fax Number:

E-mail Address:

The contract will be mailed to you within one week of receipt of this document.

Agency designee who will be responsible for processing payment:

Name:

Mailing Address:

Telephone Number:

Fax Number:

E-mail Address:

An invoice will be mailed to you within one week of receipt of this document.

How many individuals from your agency will be attending this training session (please provide their names)? ________________________________________________________________________

________________________________________________________________________

The tuition for all registrants can be billed separately or together. Please indicate which you would prefer.

________________________________________________________________________

Total Cost: Number of attendees _____ X $875 = ____________

If you have any questions, please contact Kyessa L. Brian at 412-802-6905 or briankl@upmc.edu. Thank you for choosing the Crisis Training Institute of Western Psychiatric Institute and Clinic.