Getting a Handle on a Hands-Off Policy

We have the pleasure of working with many organizations who have instituted hands-off policies. Restraint elimination is ultimately an excellent goal to achieve, and many organizations have been successful, for most organizations, restraint elimination 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.

Simply stated, at many organizations, staff has learned how to prevent behaviors from reaching a boiling point so well, that the need to consider physical restraint is not there. 

When implementing a hands-off policy, organization leaders should be aware that the decision to be restraint-free should not be taken lightly. A hands-off policy can work well, as long as efforts have been made up front to ensure that staff has the necessary training to make the policy work.

The policy should also dictate what staff should do if a client’s behavior becomes physically violent. 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 and 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.