Need help reducing restraint and seclusion? You can achieve your goals — with leadership, these Six Core Strategies, and the right staff training.

If you follow best practices related to the use of restraint and seclusion in mental health or healthcare, you’re likely aware of the Six Core Strategies for Reducing Seclusion and Restraint Use.

These strategies were set by the National Association of State Mental Health Program Directors (NASMHPD). They outline a best-practices approach to restraint and seclusion reduction by highlighting the need for organizational change, data-informed practices, workforce development, and honoring clients’ roles in their own care.

Consistent with our Nonviolent Crisis Intervention^® training program, the strategies call for the use of debriefing techniques as well as alternatives to the use of restraint and seclusion. They’ve been guiding state and private hospitals and agencies in the US and abroad since 2003.

A principal champion of the Six Core Strategies (6CS) is Kevin Ann Huckshorn, past Delaware director for the Division of Substance Abuse and Mental Health (DSAMH) and an international thought leader on mental health and substance use treatment.

When leading the development of the 6CS, Kevin and her team talked to:

• Leaders who had been involved in successful reduction efforts — to get their take on how they did their work
• Service users — to get their perspectives on why they thought seclusion and restraint was being used and how it felt
• Frontline staff — to find out how they felt about going hands-on and often getting injured

Kevin was a speaker at our International Instructors’ Conference in 2006 and at the Restraint Reduction Network™ Conference in 2015. In this video from the 2015 conference, she details the Six Core Strategies as an evidence-based practice:

We applaud Kevin for her work in developing the strategies and ensuring that they’re available to professionals who are committed to providing care that’s trauma-informed and person-centered.

Like Kevin, we also understand that a concern of many who support individuals who display violent or potentially violent behavior is that restraint reduction efforts would prevent them from being able to do what’s necessary to protect the individuals in their care from harming self or others.

What we are so proud of about our training — and what we love about the 6CS — is that the focus of both is on keeping service users AND staff safe.

And as you’ll see in the second strategy below, we agree with Kevin that data is the key to helping staff overcome the misconception that the less hands-on they are, the more people get hurt. Data shows that the reverse is true.

That is, data shows that with restraint reduction, “many less people get hurt,” as Kevin put it at the 2015 conference.

For example, Kevin presented data from a study in which hospitals “reduced the use of seclusion, restraint, forced medication administration, and injury rates by 65% or over.”

Separately but similarly, facilities that use our training have admirable results to share.

Many organizations have reduced or eliminated the use of restraint and seclusion and injuries by evolving their cultures of care and implementing our training and support. It’s this type of culture change that improves safety for staff and clients.

Want to implement the Six Core Strategies?

“CPI is the only organization that has adopted the Six Core Strategies and strongly supported their implementation across the country, being a pioneer in that effort.” —Kevin Ann Huckshorn

Our Nonviolent Crisis Intervention^® training program can support you in implementing the Six Core Strategies in the following ways:

1. Leadership Toward Organizational Change

If you’re looking to drive positive change in your organization, our industry-leading training and resources are designed to help you effectively promote a culture of safety and nonviolence.

We’ll help you ensure that your staff and your policies and procedures share a common language and that staff are empowered with tools to safely and effectively de-escalate crisis situations. Our philosophy of Care, Welfare, Safety, and Security^SM becomes not just a program philosophy, but a consistent daily practice for all staff to use when providing care — even in the most volatile moments.

2. Using Data to Inform Practice

We work closely with organizations to help them develop data collection tools to measure the effectiveness of their training and their efforts toward reducing restraint, seclusion, and violence.

3. Workforce Development

With CPI, you develop your own in-house crisis prevention experts. We call these your Certified Instructors — and when they teach our Nonviolent Crisis Intervention^® training to their colleagues, everyone develops critical skills for:

• Preventing conflict
• Recognizing risk factors and warning signs of escalating behavior
• Fostering collaboration and cooperation with service users
• Identifying coping strategies to help service users manage their own behavior and make positive choices

Your CPI Certified Instructors become mentors who teach your staff to develop excellent prevention and de-escalation skills.

We also offer numerous tools and resources to enhance ongoing training and help you customize your trainings to your staff’s realities and your clients’ needs.

4. Use of Restraint and Seclusion Reduction Tools

The Nonviolent Crisis Intervention^® training program gives staff de-escalation tools and techniques that are focused on preventing the need for restraint.

• Our Crisis Development Model^SM helps staff know which techniques to use and when.
• Our Decision-Making Matrix gives them a further tool for objectively assessing risk behaviors and making decisions that reduce the likelihood of severe outcomes occurring.
• Our debriefing model guides staff with tools for preventing difficult situations from happening again.

We teach that physical intervention should be used only as a last resort, and that the least restrictive intervention should be used at all times. We offer information on the risks of restraints, as well as resources on threat assessment. We’re also happy to aid your organization with policy development and/or review.

The safest restraint is the one that's never used.

5. Consumer Roles in In-Patient Settings

You’ll find that our training and de-escalation strategies help you give patients and clients choices to help them manage their own behavior.

6. Debriefing Techniques

Debriefing is a vital tool for restraint and seclusion reduction. The Nonviolent Crisis Intervention^® program teaches the importance of re-establishing Therapeutic Rapport with an individual after a crisis. And our entire debriefing model is geared for use with both staff and consumers, and can be used for debriefing with bystanders as well.

Nonviolent Crisis Intervention^® training also helps you use Postvention for prevention — meaning that what you discover in an incident review can guide you in making changes to prevent similar situations from happening again.

Reducing seclusion and restraint is possible. Organizations are doing it with success.

But it takes tremendous leadership, as well as dedication and motivation from everyone on your team.

To get started, Kevin recommends taking “a very serious look at how your staff interact with the people they serve and the skills they have” — which should include “excellent therapeutic communication skills.” 

As you know, nursing and other curriculums often equip people with no training in listening, communicating empathically, managing conflict, and averting volatile incidents (though when they do include such training, the results are impressive).