The use of physical holds and secluded space has been a significant and challenging aspect of managing difficult and dangerous behaviors in many nearly all acute care settings. In recent years professionals have come to view these practices as ever more counter-productive in healing, as well as practically dangerous in and of themselves.
Cutchins Programs have been pioneers in practices which serve to reduce the need for these coercive types of interventions. The principles behind restraint reduction efforts are very similar to those involved developing trauma-informed care.
The field has identified 6 Core Strategies as guides for reducing the need for restraint.
- Leadership: The environment of care must provide vision, commitment, and resources to the entire culture.
- Workforce Development: Training of sufficient quality and quantity to caretakers. Hiring practices that select for exceptionally patient, kind and hopeful individuals. Supports for morale. Trainings typically will cover how traumatic experiences shape the brain; use of sensory approaches; preventive rather than reactive interventions; how to maximize influence and minimize power struggles; individualizing care.
- Tools: Provision of resources such sensory tools, supports for fun activities, and training in many specific techniques for prevention, de-escalation, repair, and review of dangerous situations.
- Consumer Voice: This points to the vast arena of partnering with and empowering the people we serve.
- Use of Data: Learning to use data to inform creativity. Looking for patterns with the data to help identify areas of weakness. The art is determining what to measure and then how to use the information to improve results.
- De-briefing: The art of reviewing incidents, both with and without the consumer involved, with the intention of learning how to disrupt the patterns that lead to violence.
Different environments may work with these principles in different ways. Commonly, a program focused on non-coercive care will highlight some of the following features:
- High interest activities.
- Willingness to individualize treatment and Individual plans to prevent escalations.
- Emphasis on early intervention
- Teaching of specific personal and social skills.
- Non-punitive, educational consequences for problem behaviors.
- Whole body approaches, such as sensory approaches and emphasis on soothing the whole person.
- Emphasis on care-takers staying kind and calm. Also, playful and hopeful.
- Strengthening motivation through having allies, and belief in the possibility of success more than through threats of consequences.
- Adapting the environment as much as is realistic so as not to expect more of people than they can do.
- Looking for ways to avoid power struggles, such as eliminating unnecessary rules.
- Provide experiences of belonging, competence, fun, and emotional security in order to build resilience.
- And conspicuous use of the 6 core strategies.