Are You Using the 6 Core Strategies for Reducing Restraint and Seclusion?

February 16, 2022
Female counsellor talking to a female patient in an office

Need help reducing restraint and seclusion?

You can achieve your goals — with leadership, these Six Core Strategies and the right staff training.

If you follow best practices related to the use of restraint and seclusion in mental health or healthcare, you'll probably be aware of the Six Core Strategies for Reducing Seclusion and Restraint Use [PDF].

These strategies were set by the National Association of State Mental Health Program Directors (NASMHPD).

They outline a best practice approach to restraint and seclusion reduction by highlighting the need for organisational change, data-informed practices, workforce development, and honouring clients’ roles in their own care.

Consistent with our Safety Intervention training programme, the strategies call for the use of debriefing techniques as well as alternatives to the use of restraint and seclusion.

A principal champion of the Six Core Strategies (6CS) is Kevin Ann Huckshorn, past Delaware director for the Division of Substance Abuse and Mental Health (DSAMH) and an international thought leader on mental health and substance use treatment.

When leading the development of the 6CS, Kevin and her team talked to:

  • Leaders who had been involved in successful reduction efforts — to get their take on how they did their work
  • Service users — to get their perspectives on why they thought seclusion and restraint was being used and how it felt
  • Frontline staff — to find out how they felt about going hands-on and often getting injured

Kevin was a speaker at CPI's US International Instructors’ Conference in 2006 and, in the UK at the Restraint Reduction Network Conference in 2015. In this video from the 2015 conference, she details the Six Core Strategies as an evidence-based practice:

Kevin presented data from a study [PDF] in which hospitals “reduced the use of seclusion, restraint, forced medication administration, and injury rates by 65% or over.”

Want to implement the Six Core Strategies?

“CPI is the only organisation that has adopted the Six Core Strategies and strongly supported their implementation across the country, being a pioneer in that effort.” —Kevin Ann Huckshorn

Our Safety Intervention training programme can support you in implementing the Six Core Strategies in the following ways:

1. Leadership Toward Organisational Change

If you’re looking to drive positive change in your organisation, our industry-leading training and resources are designed to help you effectively promote a culture of safety.

We’ll help you ensure that your staff and your policies and procedures share a common language and that staff are empowered with tools to safely and effectively de-escalate crisis situations. Our philosophy of Care, Welfare, Safety, and SecuritySM becomes not just a programme philosophy, but a consistent daily practice for all staff to use when providing care - even in the most volatile moments.

2. Using Data to Inform Practice

We work closely with organisations to help them develop data collection tools to measure the effectiveness of their training and their efforts toward reducing restraint, seclusion, and violence.

3. Workforce Development

With CPI, you develop your own in-house crisis prevention experts. We call these your Certified Instructors — and when they deliver training to their colleagues, everyone develops critical skills for:

  • Preventing conflict
  • Recognising risk factors and warning signs of escalating behavior
  • Fostering collaboration and cooperation with service users
  • Identifying coping strategies to help service users manage their own behavior and make positive choices

Your CPI Certified Instructors become mentors who teach your staff to develop excellent prevention and de-escalation skills.

We also offer numerous tools and resources to enhance ongoing training and help you customise your trainings to your staff’s realities and your clients’ needs.

4. Use of Restraint and Seclusion Reduction Tools

The Safety Intervention training programme gives staff de-escalation tools and techniques that are focused on preventing the need for restraint.

  • Our Crisis Development ModelSM helps staff know which techniques to use and when.
  • Our Decision-Making Matrix gives them a further tool for objectively assessing risk behaviours and making decisions that reduce the likelihood of severe outcomes occurring.
  • Our debriefing model guides staff with tools for preventing difficult situations from happening again.

We teach that physical intervention should be used only as a last resort, and that the least restrictive intervention should be used at all times. We offer information on the risks of restraints, as well as resources on threat assessment. We’re also happy to aid your organisation with policy development and/or review.

The safest restraint is the one that's never used.

5. Consumer Roles in In-Patient Settings

You’ll find that our training and de-escalation strategies help you give patients and clients choices to help them manage their own behaviour.

6. Debriefing Techniques

Debriefing is a vital tool for restraint and seclusion reduction. Safety Intervention teaches the importance of re-establishing Therapeutic Rapport with an individual after a crisis. And our entire debriefing model is geared for use with both staff and consumers, and can be used for debriefing with bystanders as well.

Safety Intervention also helps you use Postvention for prevention — meaning that what you discover in an incident review can guide you in making changes to prevent similar situations from happening again.

Reducing seclusion and restraint is possible.

Organisations are doing it with success.

But it takes tremendous leadership, as well as dedication and motivation from everyone on your team.

To get started, Kevin recommends taking “a very serious look at how your staff interact with the people they serve and the skills they have” — which should include “excellent therapeutic communication skills.” 

As you know, nursing and other curriculums often equip people with no training in listening, communicating empathically, managing conflict, and averting volatile incidents.

Don’t wait to give your staff the skills they need to reduce the use of restraint AND stay safe.

If you’re ready to take the next step to put evidence-based strategies to work, contact us for a free consultation. We’ll help you design the training solution that fits your organisation so you can succeed at reducing restraint and seclusion.

Schedule a Consultation