How do you respond when a patient gets agitated or violent? And better yet, how do you prevent agitation and violence from happening at all?

It boils down to building rapport, says D.C. Foster, Behavioral Health Intervention Specialist at Arizona State Hospital (ASH).

D.C. is a CPI Certified Instructor who teaches his coworkers Nonviolent Crisis Intervention® prevention and de-escalation techniques. Since 2012, he and the staff at ASH have been using CPI training as part of their efforts to create a better therapeutic environment for their patients. D.C. wrote the following piece about how understanding what patients have been through and where they’re coming from can help them cope and heal.

Establishing Rapport Is Being Trauma-Informed
by D.C. Foster

When teaching a CPI training, I was asked about the real value of establishing rapport with our population here at the hospital. I paused for a moment and answered the question with one of my own: “What is the real value of knowing yourself?”

A litany of positive responses ensued, and I suggested that when I establish rapport with patients, I’m able to become more trauma-informed and subsequently better able to provide specific and individualized needed care.
Over the next few weeks, several participants from the training came to my office and asked, “What is trauma-informed care?” And, perhaps more importantly, this question came up during my explanation: “So what can we do?”
I thought about all the complicated suggestions and answers I could give, including the wordy descriptors and definitions I could offer. With this in the back of my mind, I asked, “What’s happened for you since our last training? And what’s happened for each person that you told me about as they get to know how the unit operates?”
As the staff considered individuals and situations, I urged them to begin spending time on the unit floor, in the environment, with the unit population.
“Introduce yourselves, ask questions, have conversations, get their perspective on things, find out who they are, what they like, what their hobbies or interests are,” I said. ”Be mindful and aware of your surroundings and the environment you’re in—but there’s also more to it than just that.”
I then explained that each of them have the ability to shape their environment, and it's as simple as knowing your population and specific individual persons.  
I find the building of rapport and being trauma-informed synonymous, and inextricably tied together, resulting in healthier and more positive outcomes for our population.
But specifically what do you do to achieve this? Let these actions become second nature to you and a part of your everyday interactions:
  1. Greet everyone you see and/or pass.
  2. Learn the names of the individuals in your care.
  3. Ask how their day is or went.
  4. Say hello, good morning, good afternoon, good evening.
  5. Ask if you can be of assistance in any way.
  6. Be visible and available to your consumers.
  7. Exchange pleasantries and have conversations.
  8. Have meaningful engagements and activities.
  9. LISTEN!
  10. Find opportunities to partner and work together.
  11. Build trust.
  12. Promote empowerment.
  13. Encourage their voice and choice.
  14. Educate.
  15. Respect one another.
  16. Acknowledge effort.
  17. Celebrate differences and accomplishments.
  18. Support each other through understanding. 

I've found and learned that getting to know a person and their life experiences affords me and others the opportunity to better provide needed care, offer more specific and tailored services, and have more successful interventions should they be needed.
I hope this helps you, and that you share it with others it can help, especially as a new year is upon us and our challenges—and abilities to succeed—continue.

Learn more about Improving Outcomes at AZ State Hospital.