What’s in Your Toolbox?

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“What’s in your wallet?” 
The actor Samuel L. Jackson asks this question in a commercial, suggesting that you should check your wallet, and if you're not in possession of a particular item (a specific credit card), then you have something of inferior quality that may not be accepted or may not meet your purchasing needs.  
So now I'm asking a question that requires you to examine whether or not you are equipped with the most important tool a care professional can have.

My question is, What’s in your tool box?
I ask this because we often refer to our interventions as “tools” in our tool boxes, and there’s one very important tool that’s necessary for your other tools to work.  
If you should be fortunate enough to have this in your tool box, but for some reason you don’t use it, you and your colleagues may never know the number of lives you can touch positively or the great many things you can helpfully change and constructively do.
A true culture change begins and sustains itself through the use of this one tool. With it, the possibilities for positive organizational growth and improvement are limited only by the ideas you don’t challenge.

The tool of which I speak is the complete buy-in, support, and backing of your administrative leadership.  

At Arizona State Hospital, we are fortunate to have an administrative leadership that’s both visible and active in their support of its employees and patients, promoting quality patient care and recognizing staff, programs, ideas, and systems that positively affect both our customers and their environment. 
Without believing in our administrative leadership, seeing things as they could be, sharing in their vision, and striving for improvement, we would not be able to do the kind of quality work we do, care for patients the way we do, and improve our performance in our ongoing effort to be and get better each and every day.

Our leadership encourages us to think and be creative, to problem solve, and to engage our patients.

Staff have accepted these challenges and more in preparing each patient for treatment successes as they work toward recovery.
Thinking outside the box at times, we collectively offer and promote opportunities for every patient to consider on their road to recovery, be it through treatment, insight development, symptom and behavior awareness and management, education, therapeutic work, or volunteerism. All of these are patient-engaging measures that offer us opportunities and interventions as caregivers, along with our being supported in our efforts as parts of a team and sharing in that sense of belonging with one another. 
These are the things that drive many of us, by helping to create something more than yesterday with the possible promise of a better tomorrow.

Many, if not all, of us have at least once felt supported through the acts of kindness, fairness, and genuine concern that was shown to us. We endeavor to recreate that feeling for those we provide service to. Being able to address situations in a timely and effective manner was not only a vision of ours, but an adopted standard and practice. 
Ensuring that patient and staff safety remain a critical focus during any verbal or physical engagement was an integral part of our selection to find a nonviolent crisis management and training program. Factoring in all of these variables, CPI was selected and is the crisis intervention training program we now provide for all staff. CPI incorporates many of the same ideas we wanted regarding patient and staff safety. Nonviolent Crisis Intervention® training provides principles and concepts with a comprehensive approach to crisis recognition, along with simple communication techniques and proportionate interventions and plans for crisis de-escalation and prevention. 
The program supports and uses a team approach when addressing crisis and instructs on personal safety techniques for the interventionist. The curriculum also focuses on crisis prevention and debriefing as methods to deter crisis and recognize early intervention and de-escalation opportunities. It can also be customized to address specific challenges faced by staff in working with specific persons and/or populations. Several of our Instructors now take more of a prevention approach in dealing with a potential crisis and conduct crisis drills and rehearsals to familiarize themselves with best practices for specific crisis scenarios.
Many things have changed over time, particularly in behavioral health. The search for the proper tools has followed much the same path, from an object to an intangible, from something we can touch and hold, to a way in which we think and act. It is something we can give and still have, something that is consistent, universally applicable, and over time has shown itself to be the very foundation that we as caregiver architects design performance and improvement processes around. It creates a culture where everyone can thrive. And having that type of administrative support is the most important tool any of us could have and use. 
Each and every day we hope to be better as a team by getting in front of crisis situations and averting them altogether.

With our administrative support:

  • Our goal to reduce seclusions and restraints has become more of a reality.
  • Our efforts to keep patients and staff safe has become more of a reality. 
  • And now with leadership buy-in, better employee training, new resources, and an emphasis on patient recovery, we have the opportunity to do our best and be the best we can be.
We take solace in the fact that we have committed to a crisis training program that has shown itself to be safe, effective, and something people can count on.

That’s what’s in my tool box. 
What's in yours?

DC-CI.JPGWith 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. 
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About the Author

“Every individual on this earth deserves to be treated with compassion, understanding, and the right to keep their dignity intact. This can be difficult to honor at times when someone loses control of their behavior, but that’s where Rational Detachment and not taking it personally really kicks in. What has helped me be able to do this well goes back to the first day I was introduced to Nonviolent Crisis Intervention® training. I was a participant before becoming a Certified Instructor (and before working for CPI), and over the years I have had so many opportunities to use what I learned way back then. Today, I live the skills automatically. It’s an honor to have been given those skills to live the philosophy of treating others the way I want to be treated.”