5 Keys to Reducing Restraints

The Tale of Two Systems

In our pursuit of effective crisis management, many organizations fall into a trap. They pick systems that look great on paper and sound impressive in theory. But when we lift up the hood, these systems often miss the mark. Sure, these systems come loaded with words that hit the heartstrings, like compassion and trauma-informed. They promise quick fixes and easy training – who wouldn't be tempted? It's like buying a shiny, new sports car without checking under the hood.

Here's the kicker: when we take a closer look, we find gaps. Big ones. These systems kick in too late, starting at de-escalation and overlooking the crucial steps of prevention and skill-building. The training is more about ticking boxes than building real skills, leaving staff more like deer in headlights than skilled crisis managers. And the criteria for restraint? Let's just say it's as clear as mud.

So, what we're going to do now is lay out two different scenarios. One is the all-show-no-go approach we've just talked about. The other? A system that's got its boots on the ground, rooted in solid behavioral science and practical know-how. Let's dive in and see what really works and what doesn't in the world of crisis management.

Scenario One: The Reactive System

Imagine a setting where crisis management is akin to a band-aid applied to a wound that needed stitches. Here, the approach to crisis starts at de-escalation, with training that skims the surface but never delves deeper. This system, not fluency-based and lacking in proactive skill teaching, operates with vague criteria for restraints. Now, let's talk outcomes:

Short-Term: Initially, this approach might seem to manage the situation. But look closely. The staff, grappling with uncertainty, often hesitates, leading to escalated situations. Restraints become a common sight, breeding an environment of anxiety and mistrust.

Long-Term: Over time, this approach sows seeds of deeper issues. Staff turnover skyrockets – after all, who wants to stay in a high-stress, low-clarity job? Injuries, both to staff and those in care, become a grim statistic rather than rare occurrences. Litigation? Let's just say, lawyers find a fertile ground here. Relationships between staff and those in care are strained, often irreparably. And the financial costs? They balloon with the costs of recruitment, training, legal battles, and not to mention, the immeasurable cost of damaged reputations.

Scenario Two: The Proactive System

Now, let’s shift our gaze to a system where crisis management is an art form grounded in science, perfected with the brushstrokes of prevention, fluency in training, and crystal-clear criteria for restraints. What unfolds here?

Short-Term: The environment buzzes with a different energy. Confident staff move with purpose and are focused on strengthening relationships. Crises, when they do occur, are managed swiftly and with minimal fuss, as their fluency is evident. The use of restraints? It’s a rarity, not the norm.

Long-Term: This is where the magic happens. Staff turnover drops – people stay where they feel competent and valued. The rate of injuries plummets, and legal concerns? They become the stories of 'what used to happen'. Relationships flourish in this climate of trust and respect. Financially, the organization finds stability – lower costs in training, legal fees, and the priceless benefit of a sterling reputation.

When we dive into the complex and often contentious issue of restraints in behavior management, it's important to acknowledge a fundamental truth that is evident in our stories: Prevention is the cornerstone of effective strategy. Let's take a look at five pivotal keys to reducing restraints that are applied by the proactive sytem, emphasizing that the best way to handle a crisis is to prevent it from happening in the first place.

1. Establishing a Robust Prevention FrameworkIt's been said, and rightly so, that an ounce of prevention is worth a pound of cure. In behavior management, this translates to establishing environments and interactions that significantly lower the risk of escalations. How? By fostering positive relationships, understanding and addressing triggers, and maintaining a consistent, predictable environment. This approach doesn't just reduce the need for restraints; it creates a culture of respect and safety.
2. Prioritizing De-escalation Techniques: Now, let's talk about de-escalation. It's not just a reactive strategy; it's a proactive one. De-escalation begins long before a crisis looms on the horizon. It involves ongoing efforts to understand and meet individual needs, effective communication skills, and the ability to recognize and respond to early signs of distress. By honing these skills, staff can often circumvent the pathway to restraint.
3. Assessing and Teaching Critical Skills: Here's a crucial point: Training shouldn't just be about ticking boxes. It needs to be fluency-based. Why? Because when responses are automatic and confident, staff are more equipped to focus on prevention rather than being caught in the maelstrom of an escalating situation. This training should cover not only physical techniques but also decision-making skills, emotional regulation, and the ability to recognize and respond to both verbal and non-verbal cues of distress.
4. Implementing Fluency-Based Training: Speaking of training, let's dive deeper. Fluency-based training ensures that staff responses are not only effective but also automatic. This kind of training moves beyond rote memorization to real-world application. It's about building muscle memory – both mental and physical – so that in moments of high stress, staff aren't paralyzed by indecision or driven by emotion. They have the skills, and just as importantly, the confidence, to handle situations effectively and empathetically.
5. Setting Precise Criteria for Restraint Use: Finally, let's address the elephant in the room: the criteria for restraint. "A danger to self or others" is a phrase that's as vague as it is common. This ambiguity can lead to misuse or overuse of restraints. We need clear, precise, and objective criteria. This doesn’t just protect the individuals in our care; it also provides clear guidance to staff, ensuring that restraints are a last resort, not a first response.

Reducing restraints isn't just about changing policies; it's a commitment to understanding that every individual in our care is just that – an individual. It's about equipping our staff not just with tools, but with confidence and compassion. By embracing these five keys, we can move towards a more ethical, effective, and humane approach to behavior management. Let's not just aim to reduce restraints; let's aim to create environments where the need for them becomes increasingly rare. If you are interested in bringing the greatest fluency and science-based crisis management system in the world for preventing and safely managing behavioral challenges to your facility, reach out to [email protected]. Our behavior analysts are standing by.

By the way, if you truly want a trauma-informed environment, check out this video with step-by-step procedures and a downloadable worksheet to guide you through it!

About the Author

Specializing in human performance, coaching, and organizational leadership, Dr. Paul "Paulie" Gavoni is a behavior scientist and educator who has worked across education and human services for almost three decades. In this capacity, he has served the needs of children and adults through various positions, including COO, Vice President, Director of School Improvement, Leadership Director, Professor, Assistant Principal, School Turnaround Manager, Clinical Coordinator, Therapist, District Behavior Analyst, and Director of Progam Development and Public Relations at PCMA. Dr. Gavoni is passionate about applying Organizational Behavior Management (OBM), or the science of human behavior, to make a positive difference in establishing safe, productive, and engaging environments that bring out the best in faculty and staff so they can bring out the best in the learners they serve. He is an active board member of the Opioid Awareness Foundation and World Behavior Analysis Day Alliance.

Known for his authenticity and practical approaches, Dr. Gavoni is the host of the Top 1.5% globally ranked Crisis in Education Podcast and a sought-out speaker at various Educational and Behavior Analytic Conferences Internationally. He a the Wall Street Journal and USA Today best-selling co-author of The Scientific Laws of Life & Leadership: Behavioral Karma; Quick Wins! Accelerating School Transformation through Science, Engagement, and Leadership; Deliberate Coaching: A Toolbox for Accelerating Teacher Performance; and MMA Science: A Training, Coaching, and Belt Ranking Guide. Dr. Gavoni is proud to introduce OBM and Applied Behavior Analysis to worldwide audiences through his numerous publications and his work with PCMA to create productive, safe, and positive cultures.

Beyond his work in education and human services, Dr. Gavoni is also a former Golden Gloves Heavyweight Champion and a highly respected striking coach in combat sports. Coach “Paulie Gloves,” as he is known in the Mixed Martial Arts (MMA) community, has trained world champions and UFC vets using technologies rooted in the behavioral sciences. Coach Paulie has been featured in the books Beast: Blood, Struggle, and Dreams a the Heart of Mixed Martial Arts, A Fighter’s Way, and the featured article Ring to Cage: How four former boxers help mold MMA’s finest. He is also an author who has written extensively for various online magazines such as Scifighting, Last Word on Sports, and Bloody Elbow, where his Fight Science series continues to bring behavioral science to MMA. Finally, Paulie was also a featured fighter in FX’s highest-rated show at the time, The Toughman, and as an MMA coach in the Lifetime reality series Leave it to Geege.