How do you guys handle behavioral outbursts?

This week, Pomegranate holds another new team member orientation session. There is a lot of pre-employment training that takes place. One of the workshops is for CPI or Nonviolent Crisis Intervention training Program. Alongside CPR, it’s mandated of all direct care staff. This highly effective training is evidence based and practiced internationally.

Here’s an example: Jenna, 15, got in her foster mom’s face for ‘hassling her’ about being out way past curfew and hanging with the wrong crowd. After Jenna ‘went out of control’, mom locked herself in a safe place and called the cops. Jenna’s outbursts had escalated and her increasingly violent behavior was downright scary towards peers, even in a school setting. The cops took her to an ER. For her own safety and others, Jenna was referred to a residential treatment center for diagnostic evaluation and assessment. She was not happy going to a secure environment! Her very difficult early childhood in an abusive environment appeared to be contributing to the current outbursts. At the treatment center, Jenna might also exhibit a meltdown. How is the staff supposed to handle that? [The answer is, calmly, and in a well-trained manner.]

It is exactly for Jenna, and others like her that CPI was first developed in the 1970’s. Crisis Prevention Intervention is about the registered Nonviolent Crisis Intervention® training program designed to prevent physical or emotional harm and minimize risks. ‘Physical intervention is to be utilized only as a last resort when an individual’s behavior presents an imminent danger to self or others,’ according to the CPI course explanation.

The strategies ‘provide staff members with an effective framework for decision making and problem solving to prevent, de-escalate, and safely respond to disruptive or assaultive behavior,’ according to the program. The program is taught by experience professionals who undergo ‘rigorous training’ and ‘annual competency testing’ as part of their performance appraisal, as they teach the curriculum internationally.

From dementia patients in nursing homes to schools to detention centers to hospital environments, CPI is a highly effective, evidence based form of de-escalation and intervention education. The Joint Commission has a leadership standard for this type of training. According to the CPI website, “The Joint Commission named its July 9, 2008 Issue 40 Sentinel Event Alert “Behaviors that undermine a culture of safety.” It is clear that, through the undermining of employee safety, disruptive individuals threaten patient safety—the core mission of every accredited hospital or organization. In response to this safety threat, effective January 1, 2009, the Joint Commission promulgated a new Leadership Standard (LD.03.01.01) to address intimidating, disruptive, and inappropriate behaviors. The Joint Commission cited research ‘ . . . See:
http://www.crisisprevention.com/CPI/media/Media/Resources/alignments/Joint-Commission-Workplace-Bullying-Alignment-2013.pdf

Pomegranate does not use chemical or mechanical intervention or seclusion. “All Pomegranate staff is required to participate in pre-employment CPI training and ongoing refresher course modules. This is an investment in employee and patient safety and also a therapeutic response,” says April Turner, Pomegranate’s Compliance and QI Manager. “The program focuses on using less restrictive alternatives and verbal de-escalation techniques before the incident results in a physical hold, which gives the youth the responsibility of practicing self-control. As a result, the course has significantly decreased our restraints since implementation in 2010.”

April tells the staff to think about using CPI much like CPR. “You wouldn’t administer CPR to someone who is having trouble breathing. One only administers CPR if the person is not breathing at all.” This is much like the same concept she uses with CPI; the adolescent must be in immediate danger to themselves or someone else , and all less restrictive alternatives must have been utilized before applying a physical hold. “This is extremely important because we believe in safety first for our teens and our staff.” Following any incident is an opportunity for additional therapeutic intervention for teen, and staff to process and evaluate what happened to ensure better, more positive future outcomes. CPI is coupled with individual and group therapy as well as psychiatric care as necessary for symptom management.

[Photo credit: ‘Leave me alone’- girl by Franz Pfluegl Dreamstime 1107468]
(Please note: Since publication, QI manager April moved; we wish her well. Pomegranate’s new Quality Improvement Manager is RayShawn Wilson.)

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About Communications

Communications and Social Media @ Sequel-Pomegranate Health Systems
This entry was posted in adolescent psychiatry, behavioral health, behavioral health disorders, psychiatric care, residential treatment and tagged , , . Bookmark the permalink.

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