A Pound of Prevention: Putting the 'P' in CPI

Have you ever heard the saying, “An ounce of prevention is worth a pound of cure”? 

Have you ever wondered what CPI training and that phrase have in common? 

Well, they share a common focal point, and that focus is prevention.  

Let me explain further by asking a few questions, which we will answer at the end.

• Would you rather be A) a firefighter or B) a fire preventionist?
• Would you rather A) manage risk or B) assess risk?
• What kinds of services might a home security specialist offer?
• What are some of the reasons for having evacuation drills and fire drills?
• If your home was burglarized, what recourse do you have or what are some of the things you might do? List 7 possibilities.
• What kinds of things can you do to deter your home from being burglarized? List 7 possibilities.
• Would you rather add or subtract, create or destroy, build or topple, give or remove?

Understanding the choices a person might make regarding these questions, one might say it’s better to deal with a potential problem or inflammatory situation before it can elevate to a crisis or worse. 

The CPI programs offer an array of possible responses, each giving the interventionist the ability to exercise a proportional intervention response to each particular situation. This allows for a more appropriate level of intervention to be used in addressing behaviors.

How we use CPI at Arizona State Hospital

At my organization, we are learning new ways to address old problems more effectively—particularly because of CPI’s enhancements. 

With our evolution in how we use the program, we now no longer wait for signs of anxiety before we act and/or become supportive. Here’s what we do instead:

• We now look for ways to get in front of potential issues.
• Rather than just addressing each and every problem, we look to create conditions that support healthy behaviors in a healthy environment.
• We now educate our staff on meaningful engagement opportunities and not just in prevention and intervention measures.
• We offer active and interactive opportunities and programing that’s recovery-oriented.

If we miss out on establishing any of our pre-crisis measures such as building rapport, we still have a variety of intervention tools left in our tool box. Before a crisis can evolve or goes south, we can interrupt many of the behaviors by simply asking a question and listening. Empathic Listening, next to rapport building, is one of the most impactful interventions and deceleration techniques I myself have used. 

In expanding our use of CPI, we have found that it is not just a reactionary set, or a series of go-by-the-number intervention measures to be used in crisis. Given closer examination, CPI is about prevention and preemption in a great many ways. 

As we began to gain a greater understanding of the fundamentals of the material, we found that a person can expand their thinking on the use of CPI concepts and principles and apply them to a number of everyday situations, while upholding the core philosophy of Care, Welfare, Safety, and Security℠. 

For instance, do you have to wait for Anxiety to be Supportive? In dealing with an individual in crisis, is it OK if your goal is to get him to Tension Reduction immediately? 

With our expanded application of CPI, now our staff can look for opportunities to work with individuals and design a plan or an environment that recognizes and encourages positive behaviors.

As we adopt these ideas and adjust our thinking, we now look to establish more pre-crisis opportunities for positive interaction and meaningful engagement. Staff can become more proactive rather than reactive, or always responding to crisis events. We can initiate contact and interaction and begin to create or shape the conditions that are acceptable and more desirable.

Daily prevention measures

I encourage staff to look for daily opportunities to positively affect their environment. Staff have been educated about using as many preemptive approaches and supportive interventions as possible prior to an individual experiencing a crisis, or presenting differently than normal.

We have educated staff on what I call “checking in.” Simply stated, this is a practice whereby we engage an individual first in conversation and simple banter as early in the day as possible, offering support where able, after which we then communicate any significant details to each other. 

We also encourage individuals to work with the personnel on their units to strengthen patient–staff relationships. In addition, I ask that the unit staff to do their best to welcome, encourage, and support this practice. Working with the different staff, we try to build communication bridges to foster a connectedness with our patients, enabling them to see the staff as a resource, ready to help them navigate their issues and concerns while in the hospital.

CPI touches on this idea in the Crisis Development Model℠ (which you can learn more about here). By building relationships with patients, staff have better insight into how to communicate with and help and support the individuals in their care—not only for the purpose of early intervention during crisis, but also in averting crisis altogether.

In a more supportive, empowering, and recovery-oriented environment, the patient can increase their chances of having a more positive experience and achieving some success at their endeavors. Staff can now begin to work with many individuals as they have now observed what has been effective and what works.

Results

From these cooperative ventures the number of conflicts, seclusions, and restraints should decrease measurably. Trust and reliance are also two outcomes we have experienced in making these changes and decisions. 

Another positive result has been the trust our employees demonstrate in the trainings and on the units. They believe and commit themselves to the fidelity of the instruction and support the philosophy, principles, and concepts of Nonviolent Crisis Intervention^® training.

Having personnel from various backgrounds, such as former police officers and military personnel, and their having been trained in other ways, one would think it might be difficult to introduce different crisis response intervention and prevention methods. The reality is, that has not been the case. I’m proud to say that our CPI trainings have been embraced by staff, resulting in an effective Team Crisis Response model. 

Recognizing negative behavioral cues provides us with the opportunity to set the conditions, and create the environment where unproductive cues cannot form, function, or exist. 

This is the basis for newer ideas like Safety Planning making its mark. CPI has and details a wealth of information on intervention and Postvention. CPI also has just as much information on prevention, however much it may be missed or go unnoticed by some.

Our trainings

While CPI’s philosophy of Care, Welfare, Safety, and Security℠ remains ever present and paramount in all the trainings we do, we must also remember how that aligns with our mission to provide quality care and service to the individuals in our hospital, helping them by supporting them in their efforts toward recovery. We also do this by providing needed structure, advocacy, and assistance whenever possible for everyone, including individuals who struggle at times and may be challenged by this opportunity.

In many of our drills we now discuss the following: Prevention, Intervention, and Postvention. 

In using and customizing the CPI curriculum to better address each patient’s needs, we use the Integrated Experience and the Crisis Development Model℠ as both a learning tool and a teaching tool. Our training Instructors have put more of a learning emphasis on understanding and using the CPI Verbal Escalation Continuum℠, de-escalation, and deceleration. These skills remain critical elements in defusing and lessening crisis. However, understanding how not to be in these situations or get in situations that can compromise staffs’ safety and, by extension, the safety of others, is where we still sometimes fall short.

Continuing to evolve

As we all learn better disengagement skills, we now include ways and demonstrations on how people can increase their safety quotient. We have expanded our CPI training to include more in-depth discussion on personal safety principles, concepts, and positions. In addition, we have included an emphasis on increased awareness, and avoiding or reducing staff exposure to unsafe, vulnerable situations, and recognizing potentially compromising events. 

In summary

During trainings and drills, I and our other CPI Instructors stress doing your work early, so as to be ahead of things, and to stay ready so you don’t have to get ready.

And that’s our ounce of prevention. If any of this works for you, consider it your pound of cure.

The answers

Now for the answer to the questions. Well, if you read this, I’m sure you know the right answers. Now you tell me—what are yours and why?

About the Author: With over 30 years of experience at the Arizona State Hospital in Phoenix, D.C. Foster is a Behavioral Health Intervention Specialist and Master Level CPI Instructor. D.C. works with individuals identified as Serious Mental Illness (SMI), Forensic, and Sexually Violent Persons (SVP). Since 2012, he has been using CPI training to create a more person-centered, trauma-informed, recovery-oriented therapeutic environment for patients. D.C. is also a leading member in the CPI Instructor Community, where he exchanges training strategies and professional development techniques with his fellow Instructors.