Restraint Prevention Strategies

The effort to eliminate restraints includes three entirely different perspectives - primary, secondary, and tertiary prevention strategies.

Primary Prevention Strategies

These are organization-wide efforts to analyze and improve the way we interpret, respond to, guide, document, and discuss employee behavior and the behavior of the people we serve, and the facilities and systems that surround them. Primary strategies look at all aspects of the organization that might either increase or decrease the likelihood or severity of a restraint event, and then we create strategies that are most likely to improve those generic outcomes, and building a coercion-free, violence-free culture.

Success starts with committed leadership, policies and procedures that support influence rather than control, and includes the people served in treatment planning and advocacy. Your mission will succeed if you hire people that already support the recovery, strength-based and trauma-informed care and zero restraints, and then support them in their professional and personal goals and empower them throughout the organization. Your organization must create an environment that is not only physically safe, but conducive to the ‘people’ business–it must be attractive, welcoming, and flexible. We will help your group adopt new vocabulary to replace such terms as front line staff, crisis intervention, doctor’s orders, restraints, intervention, etc.

Secondary Prevention Strategies

The secondary prevention strategies alter the way we interact with individuals who may become involved in a restraint event, and we look for ways to minimize or eliminate the factors that might lead to a restraint event for that person.

While it is an improvement over previous knee-jerk reactions, we must move away from the concept of looking for the early warning signs of violence; instead, we must grow into the proactive concept of generating cooperation. Additionally, we must integrate the organization’s data on behavior, de-escalation preferences intake survey, and in-house education into a cultural norm that supports a non-coercive, influential, relationship-based service. Such concepts as the NAPPI Green Behavior Scale, that focus on developing a person’s rich, full life do far more to eliminate unwanted behavior than “effective behavior management” could ever do. It is also imperative that restraint avoidance techniques, scripts and strategies be documented in detail, conscientiously taught (and subsequently reinforced) and become required precursors to any hands-on technique.

Finally, people must be well-trained and frequently refreshed in hands-on procedures in such a way as to ensure a minimum impact (and a positive outcome) on the person served, the environment, and the staff.

Tertiary Prevention Strategies

These will focus on minimizing the length, severity and injury during the restraint, minimizing and evaluating the post-incident trauma, learning from our successes and failures thereby improving our responses. Tertiary strategies will also focus on providing a feedback mechanism to ensure continuous improvement, both in treatment and in day-to-day interactions.

We must minimize the harm that might be done by staff when they respond to unwanted behaviors. This is easier when staff members are taught to avoid such problems in the first place, and, if they must restrain, are taught to do so with attitudes and skills that epitomize the concept of minimum impact. However, even well-trained staff will be faced with unexpected events; so a satisfactory post-incident review will be one that supports staff to do the best they can, supports the people we serve to do the best they can, and uses the data gathered in this process to reduce the likelihood of an additional occurrence. Everyone must be involved in helping each other to ensure the quickest recovery from the trauma of the event, and to reduce its likelihood in the future.

We gratefully acknowledge the National Technical Assistance Center, SAMHSA and the faculty of the National Executive Training Institute for the efforts they have made in designing a viable intervention paradigm.