“It Worked Again!” How CPI Techniques (and a Former Detective) Make a Difference at Yale-New Haven Hospital

Photo: fatihhoca / iStock
“A lot of people will stop me in the hall and say, ‘Don, I’ve got to tell you something. We used it today and it worked again! And everybody was safe.’ And that is such a positive thing. I get goose bumps thinking about it because it wasn't always like that.”
These are the words of Don Costa, a lieutenant and manager of the Protective Services Department at Yale-New Haven Hospital, referring to hospital staff using techniques from CPI’s Nonviolent Crisis Intervention® training to de-escalate challenging behavior. The quote is taken from Don’s interview on Unrestrained, the CPI podcast series.
And Don knows a thing or two about challenging behavior. Before joining the staff at Yale-New Haven, Don was a detective on the Waterbury police force, working in high-crime areas of the city. In addition to being decorated for bravery and valor, Don sadly lost his partner, who was shot in the line of duty in a drug-related crime. Don also found it necessary to draw and fire his weapon during a shootout with four homicide suspects.
  Lieutenant Don Costa

Transition to health care

Don’s transition to providing security in a health care setting happened 10 years ago, when he heard that Yale-New Haven Hospital was beefing up its security staff. The facility was stringent in their requirements to join their security force, hiring only former police officers that were nationally certified in Police Officer Standards Test and Training.
At the time he was hired, security staff at the hospital numbered about 45. The department is now 160 strong and planning to add 20 more officers.

Bringing CPI to Yale-New Haven Hospital

In 2008, the hospital realized that while they had an incredibly experienced and resourceful security staff, their professional backgrounds often did not include training in behavior management and de-escalation based on verbal skills. Enter CPI.
Don explains, “So, like I said, we're all trained, experienced officers, and we realized that the best skills are the verbal skills and not the hands-on. So the hospital decided we needed to search out a nonviolent intervention company like CPI. And after an extensive search, they decided CPI is nationally recognized.”

The impact of CPI training

After training, the benefits to staff and patients alike were dramatic. According to Don, “Almost immediately with the mind-set of just using our verbal skills, the adolescent psych unit experienced at least half the restraint application. So that was very noticeable. . . . and it was very recognizable and it was very positive.”

The team intervention approach

Another improvement that came along with CPI training was a team intervention approach to challenging behavior, which Don helped to define and implement. Don explains the change: “Well, what I was seeing when I first got here was medical people are very exact, and part of being exact is they would verbalize, right in front of the person that we're trying to have the interaction with, what their intentions were and what preparations they were going to do. So the time that I most recognized we needed to improve on this was when I was trying to de-escalate someone in the psych hospital, and behind me, I could hear a nurse telling the other staff to get the restraints, and who was going to have the left arm, who was going to have the right arm, etc. And I'm thinking, ‘I can hear you.’ [Laughter]
So that impressed me and I said, ‘Listen, for years on the police department, we had a code system, a hand signal system that was very nonchalant, and you would know, the other officer arriving, what direction they were going at.’ So I decided that a two- and a four-finger system would be fine. You don't use one finger because people point. So if someone just calmly puts out two fingers, and that means that ‘Let's start getting ready, start preparing and activate the team. I need another couple of people here to support what I'm doing verbally, maybe get the physical restraints over on the side. Someone clear the room. Someone speak to a doctor about possible meds.’ It just activates a whole, sort of preempting the situation.
Photo: shapecharge / iStock 

The issues and benefits of training other law enforcement officers  

Dave Vargas, a CPI Lead Global Professional Instructor and Don’s trainer for CPI’s Enhancing Verbal Skills course, also participates in the interview. Dave’s perspective as both a CPI trainer and a law enforcement professional lends valuable insight into how law enforcement officers can benefit from CPI training.
According to Dave, it can sometimes be daunting to CPI’s Global Professional Instructors to train individuals with military or law enforcement backgrounds. But the work really pays off because it gives professionals in law enforcement an opportunity to learn how de-escalation skills can be a powerful augmentation to their other skill sets. 
CPI Lead Global Professional Insructor Dave Vargas
According to Dave, “I think that when . . . most police officers are trained, when they go to the police academy, that they train the officers to take the enforcement action. It takes a few years of experience and being a more veteran officer, and maybe for some it takes a few more years than others, to realize that really it's not just about enforcement actionit's about taking that corrective action. How can we help the individual, that I'd much rather take a little bit of time now and use my verbal skills than go in basically ready to take physical action? I certainly do not wake up in the morning to go to work, especially as a police officer (even when I was working full-time as a police officer)—I don't want to go to work to throw down. I don't look forward to that. I want to go home safe!
Don is quick to second that emotion when he talks about training other law enforcement veterans. “I love during a week of training when you just see the change of the mind-set from just being maybe ‘Oh, this stuff is all lovey-dovey. This is great, but it's not going to work.’
But when they start realizing, ‘Wait a second. If I just put a little bit more effort in, if I actually take my time and think about the words that I say, think about my nonverbal presentation and how much of an impact just those first initial pieces can make, it might save me a whole lot of time later on with having to deal with someone who's physically agitated, with having to maybe potentially deal with a plethora of reports to write because of the action that I took. And frankly, it might save me from having to go and seek medical assistance for either myself, a colleague, or especially that person in crisis.’"

Tune in to the podcast to learn more

Be sure to listen to the podcast to enjoy more of the insights—and camaraderie—of these two CPI experts, including the importance of debriefing after every incident.
For more great information about calming upset patients and working with a team intervention approach, check out these blog posts:
Find Our Podcast