by Robert D. Rettmann
CPI Research & Communications Services Coordinator

Many organizations have instituted a hands-off policy. While restraint elimination is ultimately an excellent goal to hope to achieve, it often takes time for restraint reduction efforts to be fruitful enough to realistically deem a facility restraint-free.

CPI believes strongly that training in verbal de-escalation techniques can be a very effective practice, and other proactive measures can be implemented in conjunction with an ongoing training process to help maximize the benefits of training.

When organizations look to implement a hands-off policy, it is often an attempt to minimize potential litigation, because inherent in all forms of physical restraint is an element of potential physical or psychological risk. A hands-off policy can work well, as long as efforts have been made up front to ensure that staff have the necessary training to make the policy work.

When a client’s behavior becomes physically violent, the organization’s hands-off policies often indicate that staff should call 9-1-1 to have the police handle the physical disruption. Unfortunately, police training in response to challenging behavior is geared toward use-of-force or response-to-resistance matrices, which are not always based on providing for the best Care, Welfare, Safety, and Security^SM of everyone involved.

These response matrices, understandably, are more typically based on the philosophy of providing safety for the officer and any possible bystanders. The matrices can include pain compliance techniques, OC/pepper spray, or even the use of guns if the officer deems that the individual is presenting a threat of deadly force.

In looking at a policy change to reduce (and perhaps eventually eliminate) restraint use, one organization’s administrator wrote about difficulties he had with staff buying into the policy change. In hearing that the facility wanted to eliminate restraint use, staff believed that administration had little concern for staff safety. The administration found that it needed to change its message about the policy.

The administrator found better results by communicating that the intention of the policy was not to forbid staff members from using restraint in the direst of circumstances, but rather to make restraint an unnecessary option as a wider array of less intrusive options were made available through ongoing training in the Nonviolent Crisis Intervention^® program.

Restraint was still an option, one that the hospital hoped would become less necessary over time as the administration provided more options for staff to learn better methods of de-escalating situations verbally, and as it advanced the culture of care within the organization to help prevent behaviors from escalating in the first place.

While adopting a hands-off policy is an admirable aspiration for a facility, administrators need to ask themselves a few basic questions before taking this major step:

• Do we have the supports we need in place for staff to implement this policy?
• How is the policy change being communicated to staff?
• How is staff included in the policy discussion?
• Have we done enough training to ensure the Care, Welfare, Safety, and Security^SM of everyone, including the clients, staff, and anyone else who might be present?
• What does the policy say about staff expectations to de-escalate a situation verbally?
• What goals are we trying to attain by eliminating restraint? Is a hands-off policy realistically going to achieve these goals?
• And, perhaps most significantly, what contingencies are in place if a client acts out physically?
• If calling 9-1-1 is how your staff is supposed to respond to a violent client, what instructions are given to staff to maximize safety until the police arrive?

CPI is glad to work with organizations considering the implementation of a restraint-free policy. In fact, the Nonviolent Crisis Intervention^® program can be taught utilizing Units I–VII & X, without the physical restraint components for facilities choosing to either adopt a hand-off policy or use a crisis response team to respond to physical violence.

CPI’s Instructor Services department (877.877.5390) is a great source for information on best practices whenever your facility is considering an update to policies geared toward violence prevention.

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