Eliminating Restraint & Seclusion with Kendra Stea (Unrestrained Episode 1)

welcome to unrestrained the podcast series from CPI here you can enjoy conversations where professionals on all sides of crisis and behavior management relaxed and open up about themselves that workplace in their clients look at the latest tips and trends from the best in the business so tune in often to integrate their experiences with your own hello and welcome to the first episode of unrestrained the CPI podcast series this is your host tarifa tone and I’m joined today by Kendra’s TIA Kendra is a nationally certified counseling CPI’s director of client services hello and welcome Kendra thanks very thank you for joining us today today we’re going to talk with Kendra about her 13 plus years working with CPI as well as her own personal history and that brings me to our first question today on restrained Kendra in your article seven essential elements of health care excellence you wrote people enter the caring profession because they want to give back because they want to be a part of something bigger than themselves because they feel called to do so in light of those observations talk about your career path and personal experiences and kind of what brought you here today sure well you know as I was growing up you take all these career aptitude tests and everything told me I was either going to be a pastor or a farmer or a social worker and so at the end of the day I ended up kind of going to social worker out getting a bachelor’s degree in criminal justice and then eventually a master’s degree in counseling but B Wisconsin native yeah for the most part born and raised on a dairy farm in central Wisconsin hence the aptitude towards farming mercy yeah um and so right after college I went to work in an in a group home for youth my aspiration was to become a victim witness coordinator in the court system but the jobs are few and far between and they’re often filled internally by other county employees or things of that nature so how is that us that’s a support role for people that have been victimized in crimes correct helping them navigate the court system making sure they have the right resources they’re prepared to maybe be in a courtroom with the person who victimized to them just really being an advocate and support for people who are in their victims or witnesses of crime sounds like we can use more of those people yeah I think it’s a really critical role in the court system so um I started working at this group home for teenagers who’d been adjudicated or found guilty of certain crimes and removed from their home and I fell in love I didn’t mean to I didn’t even like the children that much and on my second day of employment in a group home somebody handed me a video and said you’re gonna get some training but this will get you started why don’t you watch this video and it was CPI’s the art of setting limits and it changed immediately the way I looked at how I was gonna interact with these teenagers who I was pretty sure I could make them do anything you know I was the adult right one in charge right so that’s kind of how it all got started it was quite by accident and you know over time through a series of jobs working with mostly youth and some adults in group care or residential treatment settings transitioning out of Corrections back into the community you remember the aha moment when you said oh this is me this is really what I want to do you know I don’t I I wish I could say all of a sudden it was clear to me but it felt right I think right away from the beginning it just was a good fit for me mm-hmm like I said I took the job because I needed a job and I wasn’t sure and immediately it was just the right fit was just the right fit it’s great yeah and so then you became aware of CPI through setting limits the the presentation and how did you eventually get to CPI from the home that you were counting it well that organization used CPI is nonviolent crisis intervention training program so eventually was trained in the in the program I left that organization and went to lutheran Social Services of Wisconsin in Upper Michigan and they too used CPI’s training program and there came a point in time during my tenure with them where they needed an instructor for the group homes that I was supervising at the time and so I volunteered to become a trainer because I liked the content and so I went through the instructor certification course I began training for the staff in our group homes and then we recognized that we had a group of staff that didn’t really have a duty to care or they they were working in partnership with schools but their job wasn’t really they weren’t the caregiver and so at the time CPI had an offering called street-smart from 9:00 to 5:00 which is since been kind of repackaged into our prepared training program and now it’s much more robust – than it was then so I went to get a dual certification

and it was at that program where I said to the instructor you know how do I get to be one of you how would I work for CPI because I really liked taking the knowledge the skills the you know the simple strategies and just passing those along to my staff and and then watching them and those crisis moments just completely resolved things in a way that was successful and so we never had to put our hands on anybody and she said send your resume and so I did was that 2001 yes 2000 or late 2000 I sent my resume we went through the interview process and started as a global professional instructor then did you take the teaching the role of a GPI yeah right away yeah it did so I trained actively for about three and a half years um but really felt called and compelled to some other things CPI was doing I miss training I loved being on the road I loved interacting with our clients and our customers and and watching those light bulb moments that they have but we your were growing company we’ve been growing and so there were so many other opportunities to get involved with that have really led to a place I feel like I can help people change their culture and that’s that’s a big impact and it’s been a very fulfilling shift to them well that’s and I’m glad you brought that up in the time that you’ve been here what’s the biggest sort of cultural turnaround that you’ve been involved with when you go well maybe we could talk a little bit more how national it becomes sort of evolve how your role of transition to director of client services sure may think over time and we recognized we had certain accounts at CPI that were very large-scale like expand nationwide how we typically sell is based on geography our account managers have a state they’re assigned to or province they’re assigned to but there are those organizations that tend to be large integrated health systems and or mental health systems that have locations in multiple states that were large utilizers of our offerings and so we’ve recognized there might be an opportunity for us to better support those types of organizations or even to try to speak with their corporate level to get a corporate level contract or some buy-in and support so that all facilities could freely use our offerings without having to go through a bunch of red tape or help consolidate buying efforts to save them time and money and they’ve really been open to that kind of relationship with CPI’s and so the more we started to do that we saw the effects of that kind of relationship with those organizations and so we decided we should needed to make a department or a couple positions really designated towards supporting those large nationwide accounts and so it’s really evolved into this really nice thing of a group of us who work not only at the individual facility level but also have these corporate relationships as well so we were bottom-up and down to shape their entire workplace violence prevention policy you know essentially across their health system right I want to talk about a specific client for that chore okay sure so as an example I’m probably now two years ago I started to have a dialogue with Ascension Health they are located out of st. Louis Missouri but they have about 120 hospitals across the nation and they do some long-term care homes as well as well and you know like most health systems they’re merging and consolidating and growing you know day by day and they’ve really really wanted to start to address this issue of violence in health care it’s it gets a lot of press but there’s not a lot of resources out there and so we started to dialogue about what would that look like to do a system-wide approach not just a formal training but of informal components so that everybody in the facility might get some level of an awareness about what workplace violence is and how to prevent it from occurring and so we’ve expanded our training presence from a formal capacity into many of their health ministries is what they’re called but we’re also working on some informal components with them to put out on their LMS so that every associate in their employment will have access to one is a very specific healthcare video that was actually filmed in one of their facilities using scenarios that they helped us create and write that is focusing on prevent X and then we did two e seminar series one is on workplace bullying and one is on domestic violence and how it impacts the workplace these are issues and concerns

they’ve identified are their highest risk areas patient to patient violence patient to staff violence visitor guest violence so you in your planning stage its director you go in and meet sort of partner with the the executive or the decision-makers there and say what’s hurting you or what’s you know and they then come back do you ever do do sometimes take an assessment and look and say well you could also write that’s exactly I mean some organizations when they when we come together as partners already have a really good feel for what they what they need or what they want to try to change in their culture and others really are starting from Ground Zero and they’re not sure and so the first step right is to sit down have a dialog kind of figure out what what their goals are and then how can we be a partner to them in achieving those outcomes and how long have we talked with the century it’s been two two and a half years now and it’s still kind of rolling out the e seminars in the preventive techniques video are all in pilot right now the training is you know slowly expanding across the health ministries so it’s been a really nice relationship and then they’ve had to make you know other changes that are you know connected but not necessarily related to us like an improved reporting system for incidents and so then there was an education piece of making sure associates to know the proper way to report and record workplace violence of all different kinds and they put together you know threat assessment protocols and risk assessment protocols so it’s been this really comprehensive workplace violence prevention approach that’s really been great to be a part of that’s in that that initiative was developed with in connection with CPI that is right through that’s and that’s and we I’ve read about weight point Center up in Canada that’s also could you do China light on that a little bit yeah so weight point Center for mental health is in Ontario and it’s the facility or its it’s huge right they’re having like 8,000 employees but the facility houses the provinces most chronically mentally ill individuals they serve individuals who have been adjudicated or found not guilty mental disease or defect these are individuals who cannot live in the community and a couple of years ago now as well they put out a request for proposal after dialoguing with some training vendors to really put together a comprehensive culture change plan that included training of formal and informal that included some consultation pieces and what was really interesting about this environment is that they’re very sure they’re very unique right they’re they’re unique no one else is like that and there’s some truth in that however what we really had to work to do is help them see how what we had really can work for them by their own admission they were using some fairly coercive practices when individuals were in crisis they were using the elements of pain compliance and physical coercion during crisis that just are no longer acceptable about the best practice who’s been the most dramatic sort of turnaround that you’ve seen that’s a fair question right it happens a lot but I mean I think a good example is the the folks at Waypoint in working with them I knew that it was going to be a challenging group for a lot of reasons and it had really little to do with the actual individuals and more to do with the culture that had developed at the organization and so the trainers that were so lucky can you describe that culture just a little bit yeah it it’s very paramilitary very they are the largest employer in a small community so it’s also very generational within families you know my grandmother worked at Waypoint and my uncle works at Waypoint and my cousins work there with me and it’s my job to and so as things would change you know there’s that pressure from family members or friends of all when I worked there we did it that way and you know and so there was it’s steeped in tradition it’s really what’s going on right it’s completely steeped in tradition and it’s also had a history of kind of you know what’s our soup of the day intervention we’re gonna try now or thing we’re gonna change now that for many staff they felt like never got staying power like they do something’s different and everybody’d say this how we’re gonna do it and then it would just go away so a treatment is your that no one really bought into it a practical though exactly exactly or just you know even things that staff wanted to see changed yes we’re gonna change them and then it just never really would wouldn’t stick so they really were concerned that this was just

another one of those initiatives that would require them to put a lot of work in at the front end and would never be supportive do you know this going in yes Wow okay so that’s that’s gonna be a mental talk about steep yeah it’s tough because the instructors when they come to our program you know from any location are putting so much effort and energy into learning a new curriculum but also then preparing to go deliver it to a bunch of people and in this case they all knew that they were gonna be the pariahs right they were gonna come with this curriculum that was called nonviolent crisis intervention and they were gonna get nothing but resistance from their team members and frankly that’s where they started so I hand-picked some of our very best trainers you know that can handle that kind of resistance but I think my favorite example was one of the instructor candidates in the middle of the first day looked at Pam Sikorsky was one of our best gpi’s and said this is a bunch of hooey hooey yes sorry you know he totally used an explicit word that we won’t use here but he said this will never work for us Wow and Wow that’s how do you come back combat that sort of yeah it and and that was one of several people with that attitude when we took this really interesting approach which is really really been effective for them and you know I really highly recommend it and that they certified a group of trainers but then they also had us deliver training to a group of individuals that they hand-picked that were called coaches and these coaches role isn’t to teach or train but it’s to help be the eyes and ears of the trainer’s so that during the implementation phase as they’re rolling out this new strategy they have a lot of people that can coach and help people remember but they can also make little mental notes of you know we need to practice something over here and in this unit we need to do a refresher on limit setting and we didn’t debrief this incident and we should have and so they can feed that information back to the trainers that’s part of a gap analysis before planning next year’s training you know or to plan to come into a unit and do a drill or to do a review or to spend some extra time with some staff that needs some mentoring or coaching on de-escalation and limit settings so it really has been this nice model but so not only did Pam have these 12 trainers but then she had 25 coaches that were all of this Mike excuse me this mindset of this will never work for us I worked with Pam for a long time and she’s been at the organization just about a year or less than me and she said this was the hardest training she’s ever done but but within six months of them beginning the training anyway beginning was January 2013 um we first certified them I want to say yeah February March of 2013 they started their training of their staff in April or May and by you know mid fall they had trained already about 700 staff so it was intensive intensive training in both our basic course and our applied physical training course and that same trainer came up to me and he says Kendra I’m a changed person okay he said I like to come to work now I feel like I’m making a difference in people’s lives he said I don’t know what’s happened to me and my wife doesn’t know what’s happened to me and it was it was a profound changes huge hugely profound he said to me once he said you know I used to always be number one or two in on the crisis meaning they’d call a code he’d go he’d be one of the first two people to enter a new physical situation and he said the other day we were standing there and this gentleman in the date room was getting really agitated and he was pacing around and he was trying to pick stuff up to kind of throw it and be very loud and cursing and threatening and the team kept saying well let’s go let’s go and I just said no we don’t have to do this he said and we waited it out because he wasn’t hurting anybody he said and we didn’t have to restrain and it resolved itself he said now I come to work and I know I have a different way I don’t have to put my hands on people to keep control in the unit so to hear just those testimonies and just it strikes me that you know to put it back into this this lock up where the there are some you know there’s some tough cases there are some hard cases where anything and and and to imagine somebody after less than a year this dream is gone and said

let him go that’s that’s remarkable to turn around yeah it’s and have you seen that’s that they keep regarding restraint in solution um I am going up in a few weeks and hope to see a little bit more of that but the initial reports are that you know injuries are down restraint uses down you know I don’t have the percentages yet but you know by all accounts it’s been a very positive change it’s not still without resistance because on top of changing our kind of clinical programming and changing our behavior management programming they also built you know this very large brand-new state-of-the-art building that then they had to move into all these different bells and whistles and and quite frankly more space and a beautiful location where every patient will have a view of the Georgian Bay and just very much more warm and welcoming than the old building they were in but in that staff were concerned about giving up a level of environmental control than they experienced in their old building because it was tight quarters and you can find spaces so it gives this feel to staff of safety and control and now they were going to open that up and have more space for people to roam around or more places for people to go cool off or more options but that was some more territory to police yeah absolutely more territory to monitor to watch for those signs of anxiety and they were just very concerned about how that would all go but the move went really well and one of the VP’s told me the other day they’ve already just experienced another shift in that reduction of incidents and you know disruptive moments because of the new environment that immediately people were just like reading the big sigh relief and and that’s been good that’s more space for them as well everywhere right well maybe you’ll talk to us again when you come back yeah very what do you see out there that makes you more or less optimistic that that the models that CPR I can catch on in a greater degree and you know accomplish more less restraint and seclusion and just a more peaceful and productive work spaces for people I think one of the more promising things in my tenure here at CPI has been to watch the amount of legislative activity around the issue when I first started for CPI you know it was just the beginning of people recognizing the real dangers of restraint use it was unregulated it was underreported or not reported at all and you know Erik Weisz had just broken the news in his hartford courant you know series called deadly restraint about the issue and where the general Accountability Office had done some research and figured there were 150 deaths that were related to restraint each year and those were just those that kind of got reported as such all over the last you know 13 and a half years that I’ve been at CPI and watched the awareness around the wrists of restraint use grow and with that has come this beautiful transition of care practices to be more person-centered trauma-informed just positive behavior supports everything being integrated in a way that has moved us from coercive environments into collaborative and cooperative environments and that’s been across our markets whether it’s schools or hospitals or mental health or human service organizations the advocacy groups standing up and fighting for the rights have been do individuals that are in care the legislative transitions that are now requiring a higher level of monitoring and reporting and training and for staff so kind of an age of an Enlightenment so far as people who might be subject to restraint and seclusion yeah it really has been and I mean and I think also for a long time we did a disservice to employees in these high-risk environments because they weren’t trained in what to do and none of crisis intervention is really intuitive you know it is not intuitive for me to stay calm professional rational when somebody’s swearing at me threatening me throwing stuff at me or trying to kick me or hit me and I’ve been in that position you know where I’ve got a kid across for me and the trash can comes flying but is next and and I’m expected to respond in a way that keeps him safe that keeps me safe that will help him calm down eventually and and keep everyone else safe in the meantime and I’m the only worker at a

group home and that isn’t Challenge for any professional and I was fortunate because the organization I work for by licensing requirements but also by ethics felt it was important and necessary to train me and so they did but every day that CPI we get calls from individuals who’ve never been trained did you did you take to the model soon immediately when you were presented with it just means yeah it’s simple it’s easy to digest and easy to quickly apply and that’s I mean that’s one thing what I really like about our curriculums is that it’s it’s just so practical it’s not complicated to do or to use it’s a principle based so I can take the concept and apply it in any situation so whether I’m in a school classroom whether I’m in a mental health unit sounds like once people internalize the models they can become almost intuitive yeah is there some element of our coursework that cpf coursework that you wish that you continually wish people did maybe we dug a little deeper or some aspect or any-any observation really that you’d like to share about the program that you find similar to interesting I am often talking with people about changing the culture I mean we can train staff and we can check a box and say we’ve done it but that won’t necessarily impact our outcomes and I’ve had the great fortune to work with several institutions who have completely eliminated restraint or seclusion and in every success story there’s one common variable I mean you can change up a lot of things and get there but the one thing that has to be present if you are going to eliminate or significantly reduce your restraint and seclusion it’s a commitment to debriefing every single incident incident that occurs I think we are good about debriefing with the individual in our care that was in crisis and we want to reintegrate them into the mili or get them back into the classroom so we talk about what happened and we help them think of different strategies on how they might behave next time and we look for the patterns and we do functional behavioral assessment and try to make new behavior plans but as a group of staff that are called to intervene daily in those situations we too need to sit down and say what worked for us what didn’t because otherwise we get stuck in this pattern of doing the same thing day after day and expecting a different result fairly confident is the definition of insanity yes and how do we inspect the individuals in our care to change their behavior if we don’t change ours if we’re not willing to take a look at our own behaviors and how they might have influenced both positively and negatively that situation so that we’re better tomorrow – and so that element of our curriculum you know it’s the last unit it gets shortchanged because time energy and it’s a commitment that you have to make as an organization to take the time to do it but when you do that’s how you prevent it you know in the future close to mention because revenge mmm-hmm do you have anything else you should go over you think in are we on time we’re about a half an hour think it’s about right well that concludes this episode of unrestrained I’d like to thank our guest Kendra Steve she’s the director of client services here at CPI and we thank you for listening in Kendra thanks thank you thank you for listening to unrestrained tuning again on July 30th for our second episode featuring Susan key intrepid CPI veteran and director of curriculum development until then this is your host Terry ketone hoping your intention is prevention