Podcast: Eliminating Restraint & Seclusion

Guest Biography
Kendra L. Stea, MS, NCC, was a 13-year veteran of CPI and held the title of Director of Client Services from 2001–2015. A Wisconsin native with a background in behavioral health and social work, Kendra supported health care, education, and human services organizations in their implementation of Nonviolent Crisis Intervention® training and their staff development and violence prevention initiatives.

A Note From Your Host
We chose Kendra Stea as our first podcast subject because of her expertise and experience, as well as her personal warmth. “As I was growing up, you take all these career aptitude tests, and everything told me I was either going to be a pastor, a farmer, or a social worker.” This was one of Kendra’s first responses during the interview, and it was easy to feel through the patience and diligence of her manner that she would have been exceptional at any of them. How many of us, after all, would go to work fresh out of school into a place for deeply troubled teens and fall in love with the experience? So with polite regrets to the church and the dairy farm, kudos, Kendra, for applying the appreciable force of your person to the pressing matters of crisis prevention.

Podcast Highlights
Here are just a few of the highlights from my conversation with Kendra.

CPI training gives you effective strategies for crisis prevention (5:05)
“I really liked taking the knowledge, the skills, you know, the simple strategies, and passing those along to my staff—and then in those crisis moments to completely resolve things, in a way that was successful, so we never had to put our hands on anybody.”

On supporting national accounts (7:48)
"We decided we needed to make a department . . . designated toward supporting those large, nationwide accounts. And so it’s evolved into this really nice thing of a group of us who work not only at the individual facility level, but also have these corporate relationships as well, so we work bottom-up and top-down to shape their entire workplace violence prevention policy, essentially across their whole system."

"Some organizations, when we come together as partners, already have a really good feel for what they need, or what they want to try to change in their culture, and others really are starting from ground zero, and they’re not sure. And so the first step is to sit down, have a dialogue, and then figure out what their goals are and how we can be a partner to them in achieving those outcomes."

On training at the Waypoint Centre for Mental Health (11:52 – 22:06)

Host note: The Waypoint Centre for Mental Health is a locked psychiatric hospital located 90 miles north of Toronto in Ontario. Over 1,200 staff members serve patients adjudicated not guilty by reason of mental disease or defect. In 2012, Waypoint began a major strategic initiative including a commitment to restraint prevention and minimization training. After winning an RFP process, CPI began extensive training early in 2013 (1,200 training hours over more than 70 classes) to fulfill Waypoint’s commitment “to the enhancement of trauma-informed care in a culture of least restraint.” Despite significant staff pushback at the beginning of training, Waypoint is now showing a positive culture change evidenced by lowered incidences of restraint and seclusion as well as improvements in staff attitude.

On Waypoint culture prior to CPI training (13:52)
". . . it’s very paramilitary. They are the largest employer in a small community, so it’s also very generational in families: you know, my grandmother worked at Waypoint; my uncle works at Waypoint; my cousins work there with me, and it’s my job too. And so as things would change, you know, there’s that pressure from family members or friends: ‘When I worked there, we did it that way.’ and so it’s steeped in tradition, is really what’s going on there, right, completely steeped in tradition. And it’s also had a tradition of ‘What’s our soup of the day?’ intervention we’re going to try now, or thing we’re going to change now, that for many staff, they felt like never got staying power. Or like they’d do some things different, and everybody would say this is how we’re going to do it, and then it would just go away."

On the Waypoint Coaching Model (16:22)
“Waypoint took this really interesting approach which has been extremely effective for them, and I highly recommend it. They certified a group of trainers, then they also had us deliver training to a group of individuals that they hand-picked, that were called “coaches.” And the coaches role isn’t to teach or train, it’s to help be the eyes and ears of the trainers, so that during the implementation phase, as they’re rolling out this new strategy, they have a lot of people who can coach and help people remember, but they can also make little mental notes—you know, we need to practice something over here, do a refresher on limit setting, or we didn’t debrief this incident, and we should have—and so they can feed that information back to the trainers as part of a gap analysis.”

On changes at Waypoint after training (18:05)
“We first certified them, yeah, I want to say in February/March 2013. They started their training of their staff in April or May, and by mid-fall they had trained, already, about 700 staff. So it was intensive, intensive training in both our basic course and our Applied Physical TrainingSM course. And (a) trainer came up to me and he says ‘Kendra, I’m a changed person. I like to come to work now; I feel like I’m making a difference in people’s lives. I don’t know what’s happened to me! My wife doesn’t know what’s happened to me! . . . I used to always be number one or two in on the crisis . . . The other day we were standing there, and this gentlemen in the dayroom was getting really agitated and he was pacing around, and he was trying to pick stuff up to kind of throw it, and getting very loud and cursing and threatening, and the team kept saying ‘Well, let’s go! Let’s go!’ and I just said ‘No, we don’t have to do this.’ And we waited it out, because he wasn’t hurting anybody. And we didn’t have to restrain, and it resolved itself. Now I come to work, and I know I have a different way. I don’t have to put my hands on people to keep control in the unit.’”

On changes to coercive environments (23:12)
“Over the thirteen and a half years I’ve been with CPI, I’ve watched the awareness around the risks of restraint use grow, and with that has come this beautiful transition of care practices to be more person-centered and trauma-informed. Everything (is) being integrated in a way that has moved us from coercive environments into collaborative and cooperative environments, and that’s been across our markets, whether it’s schools or hospitals or mental health or human service organizations.”

On the need for training (24:40)
“I’ve been in that position where I’ve got a kid across from me, and the trash can comes flying, and the foot is next, and I’m expected to respond in a way that keeps him safe, that keeps me safe, that will help him calm down eventually, and keep everyone else safe in the meantime, and I’m the only worker at a group home. I mean, that is a challenge for any professional! And I was fortunate because the organization I worked for, by licensing requirements, but also by ethics, felt it was important and necessary to train me, and so they did. But every day at CPI we get calls from individuals who’ve never been trained.”

Coming Next on Unrestrained
Be sure to join us on July 30 for the second episode of Unrestrained, when our guest will be CPI’s Director of Curriculum Development, Susan Keith.

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