The Correctional Safety Learning System® (CSLS) Collaborative is a developing community of Canadian and USA correctional, mental, and behavioral health systems moving beyond root cause analysis, focusing on individual suicides and tertiary interventions. Instead, CSLS Collaborative members are defining, measuring, and improving the process and system vulnerabilities that contribute to the suffering and harm of our inmates, clients, and staff.
Our CSLS Collaborative has directed its initial focus to examine the process and system vulnerabilities that contribute to suicide frequency and triggers among inmates and mental health clients. Collaborative members are given full education, coaching, and training on our Safety Learning System® and Continuous Organizational Innovation, Improvement, and Learning (COI2L™️) along with community support, research, and publication opportunities.
Our Safety Learning System®, along with our Continuous Organizational Innovation, Improvement, and Learning (COI2L™️) framework, will allow your organization to:
Where your organization can improve in care by discovering and classifying Opportunities for Improvement (OFIs).
From identified Opportunities for Improvement to develop meaningful, right-size, and cost-effective quality improvement projects.
Lessons learned from case review and MultiLens Discussion as broadly as possible to help frontline staff improve care in daily practice.
Suicide is the third leading cause of death in U.S. prisons (Patterson and Hughes, 2008). Most prevention efforts are focused on tertiary interventions, which prioritize training guards in CPR or patient rescue – efforts that help after the attempt of a suicide and not before (Hanson, 2010). It is also assumed that suicide risks go down as inmates become more comfortable. However, this assumption “is far too simplistic and ignores both the process and individual stressors of prison life” (U.S. Dept. of Justice, 1995).
Suicide is a “never event” meaning it can be classified as an adverse event that is serious and usually preventable. Despite the ‘preventability’ of suicide, “the actual incidence nationally is poorly understood” as “there are no reliable estimates of hospital inpatient suicides in the United States” (William, Schmaltz, Castro, and Baker, 2018).
Members will receive training on our proven 7-step case review method and system engineering approaches for implementing lasting change.
Members will receive customized access to our web-based central registry (Healthcare Safeware®) to gain actionable insights on their case review findings.
Members have the opportunity to receive annual benchmarking reports on collaborative learning and participate in monthly webinars with other members.
Members will receive coaching to complete the Continuous Organizational Innovation, Improvement, and Learning (COI2L™️) lifecycle for change.
Members have the opportunity to share data and improvement projects within scientific publications and collaborative presentations.
Members have the option to provide personal resiliency training through our partnership with Hope & Healing to find purpose and value in their work.
The CDCR has been a leading figure in suicide reduction within correctional facilities. Their mission is to “facilitate the successful reintegration of the individuals in our care back to their communities equipped with the tools to be drug-free, healthy, and employable members of society by providing education, treatment, rehabilitative, and restorative justice programs, all in a safe and humane environment.” We aspire to elevate this mission through our systems engineering and organizational learning techniques rooted in high reliability.