When faced with aggressive behavior or potential violence, staff can react based on the emotions of the moment, or they can react based on their training. Proper training in crisis response and de-escalation skills enables staff to respond appropriately to crises and avoid the need for restraint and seclusion.
Reducing Seclusion and Restraint for Improved Patient and Staff Safety
Our Nonviolent Crisis Intervention® training program teaches skills that help reduce the need for restraint and seclusion. It emphasizes that physical intervention should be used only as a last resort, and only by staff who are trained in safe, nonharmful techniques that preserve safety and dignity. The program centers on the importance of preventing disruptive behavior and communicating with compassion and respect.
Our free eBook, Risks of Restraints, defines restraint-related positional asphyxia, the positions that are most likely to cause it, and the best way to avoid it. Download this useful resource and ensure care and safety for both staff and service users.
This page also offers 15 Resources for Reducing Restraint and Seclusion to assist you in your aim to boost safety in your school or facility. Please note that while CPI does not endorse the offsite resources, we believe that they may be helpful to you in your efforts to reduce or eliminate restraints and seclusion, increasing safety for each person involved in a crisis situation.
Additionally, this page features two informative articles that offer inside looks at organizations that have experienced a significant reduction in restraint and seclusion episodes. Along with before-and-after scenarios and tables of hard data, there are some very useful insights and tips.
“Reducing Seclusion and Restraint for Improved Patient and Staff Safety” by Randall LaFond discusses the positive outcomes achieved by a hospital psychiatric department.
“Using Training in Verbal Skills to Reduce the Use of Seclusion and Restraint” by Linda Witte outlines the success of a leader in mental health care.
By Randall LaFond
The reduction of seclusion and restraint has been a quality indicator in psychiatric services for many years. This project tracks a four-year effort at a five-unit, 65-bed psychiatric department operating within St. Charles Mercy Hospital, a 385-bed medical/surgical hospital, to improve patient and staff safety through efforts to reduce the use of seclusion and restraint.
Historically, the hospital’s efforts to address seclusion and restraint had primarily focused on ways to train staff to use seclusion and restraint more efficiently. Addressing calls to improve staff and patient safety from the Ohio Department of Mental Health, the Joint Commission on the Accreditation of Health Care Organizations, consumer groups, and staff, the facility administrators made a commitment to reduce seclusion and restraint.
Download this restraint and seclusion article [PDF]
Using Training in Verbal Skills to Reduce the Use of Seclusion and Restraint
By Linda Witte
“It’s not possible to be seclusion/restraint free with a mentally ill population.”
“The patients will rule the units and things will be out of control if we don’t use seclusion and restraint.”
“Staff will suffer more injuries.”
“We don’t have time within our shifts to spend on increased verbal interactions.”
Sound familiar? Those same concerns were expressed by Pine Rest staff last winter when rumors of a change in practice were circulating throughout the organization.
Pine Rest Christian Mental Health Services (PRCMHS) is a recognized leader in mental health care and is one of Michigan’s largest organizations providing a continuum of services for all ages. First established in 1910, PRCMHS currently serves approximately 187,000 annual patient visits for outpatient care and 5,600 inpatient admissions. In addition, PRCMHS maintains a census of 79 residents in a residential program for people with Developmental Disabilities, 66 residents in an Adolescent Residential Care program, and 135 residents in an Addiction Services Residential program. PRCMHS has dedicated itself to expressing the healing ministry of Jesus Christ through professional excellence, Christian integrity, and compassion. It has always been recognized for high standards of treatment, but the organization knew it could improve in the area of reducing rates of seclusion and restraint.
Download this seclusion and restraint article [PDF]
Children Call for Training for Care Professionals
In 2004, children and young people in England were asked for their views about physical restraint, and as a result raised concerns about restraint. This 2012 report, which is a follow-up consultation involving 90 young people across England to find out their current views and concerns about restraint, identifies that those people involved in the consultation all agreed that adults should give children in their care a chance to calm before resorting to physical intervention.
Based on this feedback, the report calls on children's services professionals to view restraint as a last resort, and says that professionals should make suitable choices regarding nonphysical preventive approaches before restraint is used.
With regard to physical techniques, children and young people are calling for professional staff to learn a range of techniques that do not obstruct breathing or cause pain—and to avoid physical restraint altogether for those young people who have experienced sexual abuse, those with asthma, and those with disabilities.
The report was compiled through a series of discussion groups held with children in care across different local authorities where participants described how physical measures could often escalate a tense situation. The consultation also identified that where staff had been properly trained, less restraint occurred because training gave staff skills in helping children to calm.
Download a PDF of “Children’s Views on Restraint.”
The following restraint and seclusion reduction resources are ranked alphabetically.
- 10 Tips for Crisis Prevention
Prevent crisis situations before they can become dangerous.
- Adverse Effects Associated With Physical Restraint [PDF]
Read about the dangers of restraint.
- CPI’s Nonviolent Crisis Intervention® Training Program General Information and Empirical Support
Read empirical data about the effectiveness of the Nonviolent Crisis Intervention® program in a variety of settings.
- Difficult Patients?
Download our free eBook, Creating a Safe and Caring Hospital.
- Effective Classroom Management Techniques
Get tips for effective verbal intervention.
- Effective Student Management Techniques
Learn about integrating Nonviolent Crisis Intervention® training with school-wide positive behavior support (SW-PBIS) strategies.
- Leaving the Door Open: Alternatives to Seclusion and Restraint
Watch a free video from the Substance Abuse and Mental Health Services Administration (SAMHSA) about reducing and eliminating physical restraint and seclusion.
- More Than Just the "Restraint Class"
Learn how Academy School District #20 shifted perceptions and kept the focus on prevention.
- Restraint Reduction and CPI Training
Learn how our program centers on ways to reduce restraint.
- The Nonviolent Crisis Intervention® training program
Our prevention-focused program is available through our open venues or hosting.
- PBIS and the Nonviolent Crisis Intervention® Training Program
Get more information about the connections between our program and PBIS, as well as links to the top 10 PBIS online resources.
- Positive Behavioral Interventions and Supports (PBIS) and the Nonviolent Crisis Intervention® Training Program alignment [PDF]
Discover how our program parallels PBIS concepts.
- Problem Student Behavior?
Access our free eBook, Creating a Safe and Caring School.
- Roadmap to Seclusion and Restraint Free Mental Health Services [PDF]
View a free document released by SAMHSA and the US Department of Health and Human Services that supports strategies for the prevention and elimination of seclusion and restraint.
- Six Core Strategies to Reduce the Use of Seclusion and Restraint Planning Tool [PDF]
Browse a helpful resource intended to guide the creation of a seclusion and restraint reduction plan that highlights a preventive approach.