Safe and Realistic Role-Plays Critical to Instruction of Restraint

Unit 9 of the CPI Nonviolent Crisis Intervention Training allows participations to learn restraints that are to be used as a last resort when clients are demonstrating behaviors that put themselves or others at risk. While the majority of this training conveys that there are many options staff members have to deescalate a crisis situation before needing to restrain an individual, the need to know and understand restraints that are proportionate and as least invasive as possible is a very necessary practice. In an effort to help training participants recognize the range of behaviors that may require a restraint, it is important to structure trainings in a way that move from “classroom models” to real-life scenarios as soon as possible.

Classroom models help participants to understand the movements that go along with a restraint and help them to gain confidence that the restraints are designed in a way that will keep both clients and staff members safe. To do this, I typically move from teaching the classroom models step-by-step and then immediately into a “transitions” activity that allows participants to gain the muscle memory necessary to execute these restraints effectively. This activity allows me to say the words “low,” “medium,” or “high” to communicate the level of aggression the client is showing. I can say 6-8 of these words in a minute, while allowing participants to adjust as I do so; it also gives me an opportunity to evaluate our success.

After this, it is time to begin more dynamic practice. CPI Global Professional Manager Lesley Rynders agrees with this approach. “With holding skills, my goal is to get them confident with the classroom model as quickly as they can, so I can focus on the problem solving and drilling,” she said. This, she believes, is where real confidence is built.

To do this, I run activities that allow for increased activity and intensity on the part of the person playing the role of the person-in-crisis, without allowing that person to give the people playing the role of staff members more than they can handle. For instance, I begin by having the person-in-crisis move his or her hands and feet as much as one would like; however, these people need to stay in their chairs. We then progress to allowing this person to try to stand, but I tell the staff members that standing is dangerous.

After this, I begin taking chairs away from staff members. In our initial classroom model practice, three chairs are placed next to one another, with the person-in-crisis in the middle and staff members on both sides. But in reality, this convenient scenario will not always be the case. As a result, I take chairs away to – again – simulate a situation that is as real as possible. To close out my “seated hold” lesson, I tell the person-in-crisis to continue trying to stand, but I let staff members know it is now okay for people playing this role to stand. When the person-in-crisis stands and the same restraints used in our seated positions still work, it makes it very easy to teach the “standing” restraints.

After I finish teaching the remaining restraints, I move into running the aforementioned “problem solving and drilling” that I believe best help a person to be confident in their ability to manage a person who is a danger to him or herself, or others. To do this, I have three key role-play exercises:

1. I divide the large group into triads, and send one person from each triad to a location away from the rest of the group. First, I let the two remaining members of the triad know that the person who returns will make a request that they “cannot normally approve.” Therefore, they have to say “no.” I then help my separated participants come up with a request they will make (that cannot normally be approved) and tell them that they should first make their request, before becoming verbally and then physically aggressive. If the participants are put in a restraint, I tell them, they should yell things such as “you’re hurting me,” or “I can’t breathe!” I want those participants practicing as staff members to consider whether or not to maintain the hold when the person is saying things such as this. This activity leads to great discussion.
2. Next, I have the group in teams of four. Here, I ask two people to join me in a location away from the rest of the group. I let the remaining staff members know that they will serve as school leaders (for instance) who are managing a policy that prevents students with failing grades from going to school dances. I then tell the other two participants to approach the staff members, angry about this situation. They will only verbally aggress towards the staff members before turning on one another and becoming physically aggress towards each other. This leaves staff members with the responsibility of deciding how to handle two physically aggressive individuals at once, while most of our holds require two people to restrain one person. This, again, leads to a great deal of conversation.
3. Finally, I have people break into groups based on the tables where they are sitting. I have one person separate to a location away from the group. I tell the group that their job is to get that person back to his or her seat at the table. I tell the separate staff members that, when they return, their job is to do anything but sit at the table. I want them to “create an incident.” After about 90 seconds, I cut this role play and shift the people-in-crisis to new groups where they serve as “team leaders” who use the COPING Model (taught in the tenth unit of the Nonviolent Crisis Intervention Program) to debrief the incident that had occurred. Again, this leads to great conversation and learning.

My role-play scenarios may or may not appeal to you. However, if nothing else, I hope they inspire you to develop scenarios that are safe and realistic so your participants can gain confidence in their ability to manage a person-in-crisis.