CPI Behavior Management Techniques Reduced Safety Interventions by 85%
Founded in 1888 in Atlanta, Georgia, Hillside provides specialized behavioral treatment and education to children and their families through residential and community mental health services. The residential program features seven cottages—five female and two male—with a population ranging from 12 to 18 years of age.
“A typical stay is four to six weeks, with 24/7 supervision, safety, and structure at all times,” says residential program director Eddie Dowdell. Fred Holmes, a program manager and CPI Certified Instructor, adds that “our clients all have mental health issues, mostly trauma, as well as borderline personality disorders. But they're here for hope and healing. Of course that’s a journey. We take each day as an opportunity to help them grow and learn, so when they're discharged from here, that they can cope in the community and have a healthy life.”
Prior to contacting CPI, Hillside’s crisis management program focused on reactive techniques. The result was that the 250-person staff experienced about 2,000 safety restraints, called Emergency Safety Interventions (ESIs), every year. Some of these ESIs led to clients and staff on the ground, which increased the risk of injuries.
Nonviolent Crisis Intervention® Introduces New Behavior Management Techniques
Eddie Dowdell says that the decision was made in 2019 to bring in CPI and its Nonviolent Crisis Intervention® Training, which he had been introduced to at another organization. “We just really wanted to go away from going down to the ground to prevent injuries to our staff and clients. Our CEO didn't like the fact that staff and clients would have to go to the ground with a crisis management technique. So, it was decided to go with Nonviolent Crisis Intervention®.”
Andrea Pierce, a program manager at Hillside and CPI Certified Instructor, was one of the first, along with fellow program manager Fred Holmes, to be introduced to the behavior management techniques in Nonviolent Crisis Intervention® training. “I was already the lead trainer for our old program, so it was just a matter of sending us off to get trained as instructors in the new program. And of course, it was a transition. It was very different.”
“Eddie introduced CPI to us and the whole agency, we just embraced it and we're getting better each month as trainers,” says Fred. “The continuity is there and we’re just trying to build confidence and competence with our employees. I was appreciative that Eddie selected me to be an instructor. I was learning something new, and I was excited about that, learning a new safety management program. Anything to do with training, I really enjoy. It was easy for me because I like training. We definitely want to try to maximize safety.”
It Comes Down to Safety
“When you talk about changing something that had been here for a long time, we just looked at the matter of safety,” says Eddie. “I mean, safety typically trumps anything when it comes to an environment like this. We just looked at the greater of two evils. It is safer to not go to the ground because you really can't predict where you're going to the ground. We would love for every time we had to go to the ground to have a mat to able to do it safely. But in the moment that you may have to go to the ground, it could be in the grass, it could be on the pavement, it could be on soft surface, hard surface. I mean, to prevent anybody from getting injured, we just wanted to just do away with it altogether.”
“[Nonviolent Crisis Intervention®] gives you the opportunity to be proactive instead of reactive. The crisis model, the defensive model, those things help the staff be able to recognize a crisis and deal with it accordingly without having to go hands on.”
— Eddie Dowdell, Residential Program Director, Hillside
Andrea noticed that “in this new program, it did appear to decrease the chance of injury to staff and clients. And it really emphasized that just because there is a crisis, it doesn't mean that the solution is going to be going hands on, because if you go hands on, that still doesn’t solve the root of the problem.”
The Power of Communication
Andrea believes the focus on nonverbal, paraverbal and verbal communication, as well as being able to understand where and how to intervene, was important. “Emphasizing communication over physical intervention, and modeling the communication as well, made it easier for us to get staff buy-in.”
To Andrea, part of the transition and the buy-in was also retraining the staff’s minds. “Certain techniques were very similar in the two programs. And so having people in the moment, one person possibly engaging one way and the other person engaging with the Nonviolent Crisis Intervention® way. We were all able to just continue to coach and train and laugh and recognize in the moment, ‘Hey, this is what we do.’ A lot of verbal, just coaching. And one day at a time, one crisis at a time, one moment at a time. Just doing one thing in that moment.
“We had to make sure that we were out there with the staff when they called for crisis assistance and be able to coach them through the moment to again, get them to see that you don't have to jump to the physical intervention. Exhaust the communication. Sometimes just silence will get you what you need. But emphasize that everything does not require a physical intervention. And when we do physically intervene, we're going in with the least restrictive and will work our way up if needed.”
Learning from Experience
“We're big on postvention and post crisis, looking at the coping model,” adds Fred. “We invested in a camera system, so all the crises that take place, we go back and review them. And when we see that staff need coaching, we go back, we debrief, and see how we can improve. Whatever training they need, we're going to make sure that they're trained properly.
“We want to maximize safety and minimize harm. For a lot of our staff, this is new for them, doing restraints and even trying to use the verbal de-escalation. So we go back and come up with real case studies or experiences that we've had here at Hillside. We ask staff questions to see what knowledge they have and for the Crisis Development ModelSM, what interventions they will use, whether it's directive or physical interventions.
“Some of our staff come here with precipitating factors. And when you're talking about hands-on, sometimes they'll freeze up and you have to meet them where they are, empower them and give them that one-on-one training until they build confidence. We just try to meet them where they are and recognize where they need extra work. And we just keep training. Andrea and I, we can kind of get intense at times, but we make sure we put on the training wheels first and as they learn and grow, we intensify the training.”
Helping Staff Help Clients
Eddie supports the work that Andrea and Fred have done as CPI Certified Instructors. “I'm very proud of them because I know what it's supposed to look like. And I know initially how difficult it can be when somebody asks me to come in and change something. Of course, nobody wants to change something that they're already comfortable with, but to actually take into consideration, go through it, own it, and realize and see the impact that it can have on the organization, that's what makes me proud, because like Andrea says, you have real live results. And results don't lie when you look at the emergency safety interventions that you have throughout the course of the year. And then you realize, the people giving the information to get those results are here. We didn't bring people in to train the staff, they’re already here. We trained them up, gave them all the tools they needed. Now they're doing what they have to do to make everybody successful in these behavior management techniques.
“In the role that I'm in now, it is definitely wonderful watching everybody else do the work and I assist when needed, and sometimes when they let me. But just to watch other people come in and be fresh, we consider green, and just watch them turn into individuals who really can flourish in this environment. And you’re helping people, you're helping them and you're also letting them know that I can help you without having to put my hands on you. I can talk to you and still get you to be safe. And that's what our staff and clients are like. And then just to watch the trainers do their job and do it well, I mean, it makes me happy.”
The Positive Impact of Nonviolent Crisis Intervention®
Incorporating Nonviolent Crisis Intervention® behavior management techniques have had a profound impact: a 60% drop in ESIs in the first year, and an 85% reduction in three years.
In 2018, the last year under the old training program, there were 1,928 ESIs. In 2021, there were just 290.
“A year passed, and we got 290,” says Eddie. “I think that was the blessing of it all. And it was huge. And again, I personally don't think as an organization we realize how big it is and you really have to be in positions like this, speak to people and just share those numbers for people to be like, ‘Oh my goodness, 290, that's it?’ And then people are realizing that's a big deal.
“It just became one of those things that, you know what I mean, you start showing pride in making sure that your name isn’t on the [ESI] list. You want that clap at the end of the week and then that week turned into months and those months turn into a year. And then the ESIs just became minimal, but it still was crisis situations happening, of course we had to go hands on, we did it 290 times. But just from having that coaching and just having trainers to be able to say, ‘Hey, look, going hands on, that's the last resort. And if we are going to go hands on, then that's when we really need to do it, but if we don't need to do it, we don't need to do it. We need to talk about it, we need to verbally deescalate. You need to have crisis plans.’”
“It feels very validating as an instructor when you see numbers go down,” says Andrea. “When you see a person actually can just sit there and communicate with this kid and exhaust communication in defensive level behavior, instead of making it into a physical intervention and making it be perceived as a risk behavior when it was really just defensive level behavior. That's why I do this.”
Adds Fred: “That's what brings me here every day. Knowing I can make a difference in someone's life, whether it's my coworkers or the clients I serve.”
Andrea has some words of advice for organizations that are considering training staff in Nonviolent Crisis Intervention®. “I would just tell somebody to give it a chance. It's a great program that is less taxing on the body, it's a program that accommodates any body type.
“It works, that's the honest truth. It works.”