Case Study
NAPPI WORKS with children
“A lot of our kids crave negative attention. NAPPI helped us break that cycle.”
“A lot of our kids crave negative attention. NAPPI helped us break that cycle.”
Organization:
Children’s After School Program (CASP)
North Suffolk Mental Health Association
Greater Chelsea, Massachusetts
Population served:
Boys and girls aged 6-12 with special emotional, behavioral and/or psychiatric needs. CASP is an after school program that includes all school vacations. Participants are referred through the Department of Mental Health, Department of Social Services, family-based services, and other state and local social service agencies. Many of these children have multiple diagnoses and history of hospitalization(s). This high-acuity-based program is the last chance for them to remain at home with their parents. If they don’t succeed here, they often require re-hospitalization or another residential option.
The problem:
CASP was providing structured activities with consequences for inappropriate behavior. However, time-outs, expulsions and other consequences became time-consuming power struggles with staff. Therapeutic time decreased, resulting in a downward spiral of regression.
“NAPPI is one of the best things to happen to our agency in the past five years. We were using other training before, but we needed to change because it had no solutions for kids. Our Children’s After School Program really needed help – and NAPPI was the answer to their problems. Our staff are honored when they’re asked to become NAPPI trainers. And participants in the training sessions always get a lot more out of the training than they expected. By receiving NAPPI training, our staff members feel that the North Suffolk Mental Health Association is investing in them!”
Kristen Janjar, Training Director
North Suffolk Mental
Health Association
Many of these children had participated in similar programs and knew how to manipulate others and escalate situations. A predictable pattern developed: An out-of-control child would exhibit increasingly dangerous behaviors until staff felt they had no other option than to use restraints. CASP realized this approach wasn’t working. But, in order to eliminate restraints as an option while still maintaining a safe environment for everyone, they needed to learn a way to break the pattern – to prevent the precipitating factors from occurring in the first place. That’s when they contacted NAPPI.
Applying NAPPI (Non-Abusive Psychological & Physical Intervention):
NAPPI International was hired by North Suffolk Mental Health Association, CASP’s sponsoring organization, to conduct a 7-day Private Trainer Certification event. Two staff members from CASP were included. They became NAPPI Certified Trainers in order to train the entire CASP staff and serve as an internal resource. For two and a half days, CASP focused on learning the NAPPI 9 skills of Assessing and Preventing Escalating Behavior, Safely De-Escalating and Defusing, Reducing and Eliminating Restraint and Seclusion, and Developing Positive, Professional and Powerful Relationships. NAPPI also conducted a Skill Enhancement Day to concentrate on special strategic and tactical considerations when working with children.
After assessing their current situation, it became evident to CASP they needed to create a “greener” environment for the children using the NAPPI Green Behavior Scale. This Scale promotes three key components: High Quality Relaxation, Productivity, and Caring Community Connections.
NAPPI suggested CASP change their program’s dynamics to reward positive behavior – not punish negative behavior. Time-outs and expulsions were eliminated. Staff shifted to a giving model, rather than taking-away model: NAPPI helped CASP create a flexible system of choices, in a rich affirming environment which made it easier for a child to make a good choice over a bad one. Children now earn tokens for their positive behaviors, and staff write Positive Incident Reports.
| Fiscal Year |
Total Children Served |
Incidents When Restraints Were Required |
Rate of Restraints |
FY05
(before NAPPI) |
14 |
16 |
1.1 |
(with NAPPI:)
FY06 |
9 |
2 |
0.22 |
| FY07 |
16 |
3 |
0.19 |
FY08 to date
(Q1, Q2 & Q3) |
18 |
0 |
0 |
NAPPI’s measurable results:
CASP staff soon realized they were accomplishing significantly more when they applied NAPPI strategies than when a child was fighting a time-out. Now, with the opportunity to work more productively when children were at their best rather than their worst, everyone began to see progress.
Every month the children count the tokens they’ve earned and recite what they did to earn them. “Some start out actually embarrassed that they could be ‘this good,’” explains CASP Program Director Andrea Pasko. “Now this is something everyone looks forward to – and is an important affirmation that these kids are not ‘failures.’ By participating in this exercise they feel – sometimes for the first time in their lives – that they can be successful, and, most importantly, normal.”
“The psychological component of NAPPI prevents escalation and provides options,” reasons Pasko. “It’s easier to focus on the positive – with even the most difficult kids. NAPPI provided us with a different outlook on how we wanted our program to run. A lot of our kids crave negative attention. NAPPI helped us break that cycle.”
With three quarters of their 2008 fiscal year behind them – and more children currently enrolled than in the past ## years – CASP has successfully achieved and maintained a zero restraint environment. Gratefully, Pasko concludes, “NAPPI has helped us create a ‘Green Community,’ where restraints are unnecessary, assaults are unknown, and everyone feels safe. Clearly, NAPPI has drastically changed the way we serve our clients – in a positive way.”
“NAPPI is one of the best things to happen to our agency in the past five years. We were using other training before, but we needed to change because it had no solutions for kids. Our Children’s After School Program really needed help – and NAPPI was the answer to their problems. Our staff are honored when they’re asked to become NAPPI trainers. And participants in the training sessions always get a lot more out of the training than they expected. By receiving NAPPI training, our staff members feel that the North Suffolk Mental Health Association is investing in them!”
