Equip Your Staff: CPI Restraint Reduction and Training

Restraint reduction is a goal for schools, hospitals, and human services organizations that are:

• Committed to safely managing agitated behavior
• Dedicated to providing person-centered care
• Bound by policies, licensing requirements, or state or federal rules, laws, or standards

More and more states are passing legislation to reduce restraint use in schools, and in the healthcare realm, The Joint Commission has in place its Elements of Performance (EP) regarding the use of physical restraint. Additionally, the Centers for Medicare & Medicaid Services (CMS) has rules in place regarding the use of restraint in Medicare and Medicaid participating hospitals and community mental health settings.

The Only Truly Safe Restraint Is the One That Never Occurs.

CPI supports restraint reduction in schools, hospitals, community homes, long-term care facilities, residential treatment centers, and other organizations—and helps agencies around the globe balance safety for everyone. Whether you work in education, healthcare, or human services, CPI's training and resources can help you with restraint reduction.

Restraint Reduction in Schools

Laws, rules, and regulations about restraint in schools are designed to help prevent injury to both staff and students, and to protect the safety of everyone involved in a crisis situation. Though the standards vary from state to state, they typically require staff to be trained in:

• Recognizing the warning signs of escalating behavior.
• Verbal and nonverbal de-escalation techniques to prevent behaviors from progressing.
• Identifying triggers that cause a student to act out.
• Last-resort methods for intervening physically with as little potential for harm as possible.
• Recognizing signs of distress.
• Documenting incidents.
• Establishing and re-establishing strong and supportive relationships with students.

How CPI Training Can Help Your School

CPI's trauma-sensitive, person-centered Nonviolent Crisis Intervention^® training focuses on prevention and de-escalation techniques and other alternatives to the use of restraint. It also includes safer, less-restrictive physical interventions to be used only as a last resort when a student presents an immediate risk of harm to self or others.

Educators who use Nonviolent Crisis Intervention^® techniques in their schools say that the training opens new horizons for teaching their kids. From the program's philosophy of compassion and prevention to its alternatives to restraint, it helps staff handle behaviors more safely and more successfully—while bringing their focus back to teaching. Watch this video with Steve Canady from North Little Rock High School to learn more.

Meeting Your State's Requirements for Restraint Reduction

Visit our Legislation page to search for your state's rules and find out how CPI training can help you meet your state's requirements. Another helpful resource is My State's Seclusion and Restraint Laws from the Autism National Committee. Please note that not all states have statutes, regulations, laws, or guidelines on restraint use in schools.

Resources for Schools

"More Than Just the 'Restraint Class'" by Theresa Maez
While CPI's Nonviolent Crisis Intervention^® training includes last-resort physical intervention procedures to provide staff with skills and confidence to safely manage emergency situations, with its focus on prevention, it helps schools and districts decrease their need to use physical intervention at all. Find out what makes CPI training more than just the "restraint class."

PBIS Coordinator Cyndi Pitonyak's Testimony on Reducing Seclusion and Restraint in Schools
"For over two decades now, we have not found it necessary to use restraint or seclusion procedures to keep our schools safe, except in rare emergency situations," said Cyndi Pitonyak, PBIS Coordinator for Montgomery County Public Schools. Read an excerpt of the written testimony she presented at a Senate Committee on Health, Education, Labor, and Pensions hearing in 2012.

Restraint Reduction in Healthcare

Healthcare workers and hospital security staff deal with hostile, aggressive, and even violent patient and visitor behavior every day. In order to protect both staff and patients from harm and injury, CMS and The Joint Commission have regulations in place that require staff to be trained in:

• Using nonphysical skills for intervention.
• Identifying staff and patient behaviors, events, and environmental factors that may trigger circumstances that require the use of restraint or seclusion.
• Choosing the least restrictive intervention.
• Using restraints in a safer manner and only as a last resort.

How CPI Training Can Help Your Facility

With a focus on prevention, CPI's trauma-sensitive, person-centered Nonviolent Crisis Intervention^® training provides hospital staff with de-escalation techniques and other alternatives to the use of restraint. The program also offers safer, less-restrictive physical interventions to be used only as a last resort when a person poses an immediate threat of physical harm to self or others.

Hospital staff who are trained in CPI's techniques say that the program helps them balance their duty of care with making sure that everyone in their hospital is safe—from staff to patients to visitors.

Complying With Joint Commission and CMS Requirements
CPI's training programs correspond with the standards set forth by The Joint Commission and CMS. In fact, when the CMS calculated the cost of implementing training in a hospital setting, it used CPI's Nonviolent Crisis Intervention^® program as the model program.

Download details about how CPI training aligns with the CMS rules and the Joint Commission standards.

Resources for Hospitals

"Using Training in Verbal Skills to Reduce the Use of Seclusion and Restraint" by Linda Witte
"It's not possible to be seclusion/restraint-free with a mentally ill population." "Patients will rule the units and things will be out of control." "Staff will suffer more injuries." Sound familiar? Find out how, despite these fears, staff at Pine Rest Christian Mental Health Services decreased the use of restraint—without a rise in injuries.

"Reducing Seclusion and Restraint for Improved Patient and Staff Safety" by Randall LaFond
Discover how St. Charles Mercy Hospital achieved a 62.3 percent reduction in the use of seclusion and restraint.

Six Core Strategies to Prevent Conflict and Violence: Reducing the Use of Seclusion and Restraint (6CS)
Learn out how CPI training aligns with the strategies set by the National Association of State Mental Health Program Directors (NASMHPD) to help mental health professionals establish policies to reduce or eliminate restraint or seclusion in mental health treatment organizations.

Restraint Reduction in Human Services

Human services professionals who help children, adults, and families deal with abuse, neglect, addiction, and other serious issues frequently face aggressive behaviors that stem from fear and trauma.

When behaviors start to escalate or a client starts kicking or throwing things, it can be instinctive to use physical restraint to stop the behavior. While there may be times when an emergency situation warrants the use of physical intervention as a last resort, human services professionals who use verbal and paraverbal de-escalation techniques can often avoid restraint altogether. This not only reduces staff and client injuries and decreases workers' compensation liabilities, it strengthens the therapeutic relationship between staff and clients.

How CPI Training Can Help Your Human Services Organization

Focused on prevention, CPI's trauma-sensitive, person-centered Nonviolent Crisis Intervention^® training provides human services professionals with de-escalation techniques and other alternatives to the use of restraint, as well as safer, less-restrictive physical interventions to be used only as a last resort when a client presents an immediate threat of physical harm to self or others. Watch this video with social worker Angie Smith from the Family & Children's Center in La Crosse, WI to learn how CPI training helps her handle the situations that she and her coworkers deal with every day.

Resources for Human Services Organizations

"Changes in Attitudes, Changes in Outcomes" by Robert D. Rettmann
Find out how the crew at Pine Hills Youth Correctional Facility went from focusing on the use of force to control acting-out youths to an 80 percent decrease in staff injuries and a 90.5 percent decrease in workers' compensation liabilities.

"Expecting the Unexpected: Responding to Unpredictable Behavior" by Judith Schubert
"It is important for staff to understand not only the aspects of addiction that may impact behavior, but also how their own responses can help or hinder de-escalation and resolution," writes CPI president Judith Schubert. Read more and get 6 intervention strategies for dealing with anger, hostility, and unpredictable behavior associated with addiction.