Nonviolent Crisis Intervention® Training Program

Scientific Rating:
NR
Not able to be Rated
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Nonviolent Crisis Intervention® Training Program has been reviewed by the CEBC in the area of: Behavioral Management Programs for Adolescents in Child Welfare, but lacks the necessary research evidence to be given a Scientific Rating.

Target Population: Staff working in child welfare settings as well as other human services settings

Brief Description

The Nonviolent Crisis Intervention® training program is a behavior management system for organizations committed to providing care and services in a respectful, safe environment. The training offers a foundation to structure prevention and intervention approaches based on a philosophy of providing the best possible Care, Welfare, Safety, and SecuritySM for staff and those they are responsible for, even during crisis situations. Strategies taught in the program provide staff members and/or staff teams with a framework for decision making and problem solving to prevent, de-escalate, and safely respond to disruptive or assaultive behavior. The program philosophy to promote the best Care, Welfare, Safety, and SecuritySM expands throughout the continuum of interventions necessary when working towards reduction or elimination of restraint use. The program addresses the serious issue of physical intervention through careful assessment of risks and an evaluation of what may constitute a last resort.

Program Goals:

The goals of the Nonviolent Crisis Intervention® Training Program are:

  • Teach staff members how to defuse potentially risky behavior before an incident escalates to a crisis situation
  • Reduce the risk of injury to staff and those served by decreasing the number of physical interventions
  • Improve communication among staff by establishing a common language
  • Increase staff confidence to intervene both verbally and physically
  • Alleviate the staff’s stress and anxiety associated with confusion or uncertainty in crisis moments
  • Help staff feel safer at work
  • Minimize the risk of potential liability
  • Improve staff retention by providing the skills necessary to manage difficult situations
  • Help an organization comply with legislative mandates and regulatory/accreditation guidelines
  • Create and maintain a safe, caring, and respectful environment for staff and those served
  • Help an organization demonstrate its commitment and contribution to a safer community

Essential Components

The essential components of Nonviolent Crisis Intervention® Training Program include:

  • The verbal and physical interventions described in the training program are intended for use with individuals experiencing a crisis moment. The techniques are not intended to be used as therapy.
  • The curriculum as noted below:
    • Introductions/Pretest
      • Establishes the scope of the program while organizing the experiences of staff during moments of crisis.
      • Professional and personal values of staff are linked to the purpose of the program, its concepts, and the approaches that will be taught.
    • Unit 1: CPI Crisis Development ModelSM
      • Provides a foundational model of Nonviolent Crisis Intervention® training to organize staff thinking about how crisis situations evolve.
      • Introduces the concept of an Integrated Experience to illustrate the significance of staff responses to various behavior.
    • Unit 2: Nonverbal Behavior
      • Raises awareness of nonverbal communication and how it may positively or negatively impact an individual’s behavior.
    • Unit 3: Paraverbal Communication
      • Examines the significance of how messages are conveyed by considering the vocal part of speech.
      • Demonstrates how you say what you say can influence the receiver’s perception of the message.
    • Unit 4: Verbal Intervention
      • Examines common verbal behaviors within the second level of the CPI Crisis Development ModelSM.
      • Highlights verbal intervention and empathic listening approaches that can help de-escalate a situation and decelerate an individual’s behavior.
    • Unit 5: Precipitating Factors, Rational Detachment, Integrated Experience
      • Examines antecedents that may influence behaviors while exploring how the attitudes and actions of staff may influence the person in crisis.
    • Unit 6: Staff Fear and Anxiety
      • Explores realities of staff fear and anxiety and what contributes to productive responses of staff during crisis situations.
    • Unit 7: Decision Making
      • Organizes thinking regarding the risks associated with different behaviors, encouraging critical analysis and rational reasoning in response decisions.
    • Unit 8: Physical Interventions — Disengagement Skills
      • Introduces principle-based skills for responding to various levels of physical risk behavior.
    • Unit 9: Physical Interventions — Holding Skills
      • Examines the risks of restraint use.
      • Expands upon learning from Unit 8 and explores progressive team responses to physical risk behaviors when a restrictive intervention is necessary for safety.
      • Explores decision making to discontinue restraint use.
    • Unit 10: Postvention
      • Provides a framework for a debriefing process aimed at establishing Therapeutic Rapport once an individual reaches Tension Reduction. Addresses emotions, antecedents, patterns, and behaviors associated with the crisis to prevent fueling another crisis.
    • Posttest/Evaluation
      • Assesses learning outcomes and gathers feedback via course evaluations.

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Community Daily Living Settings
  • Foster/Kinship Care
  • Group Home
  • Hospital
  • Jail
  • Outpatient Clinic
  • Prison or pre-release center
  • Residential Care Facility
  • School

Homework

This program does not include a homework component.

Languages

Nonviolent Crisis Intervention® Training Program has materials available in languages other than English:

Arabic, Braille, French, German, Inukitut, Italian, Japanese, Spanish, Turkish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Staff needs to be trained in the techniques (see training section for more details).
  • Techniques can be performed anywhere, no additional room requirements or resources are needed.

Minimum Provider Qualifications

The program is open to all staff members regardless of degree, who work within a Certified Instructor's Base of Employment.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

The program is taught using a train-the-trainer model. Individuals from organizations interested in using the program send prospective Instructors to be certified during a four-day Instructor Certification Program. CPI offers over 300 regularly scheduled courses per year in cities throughout the world. Training is also conducted onsite and customized for specific audiences. Program availability is continuously updated at www.crisisprevention.com.

Number of days/hours:

One-Day Introductory Seminar:
Learn to organize your thinking about how behavior escalates and how to respond appropriately during moments of chaos.

Two-Day Comprehensive Workshop:
Build on content from the Introductory Seminar by reinforcing preventive techniques and practicing the principles of nonharmful physical intervention.

Four-Day Instructor Certification Program:
Gain the skills and confidence to teach the program to staff at your facility. Instructor Certification is the premier choice of most organizations.

The Certified Instructor would then, in turn, be able to deliver the program to others within the organization in a format that is typically between 8-12 hours over one or two days. They would follow these guidelines when training staff at their organization:

  • Only active Certified Instructors certified by CPI teach the program.
  • Only authorized participants from the Certified Instructor's Base of Employment attend the program.
  • No more than three Certified Instructors team teach the same program.
  • Only original CPI training materials are used.
  • Units I – VII are adequately covered prior to teaching any physical interventions.
  • Only CPI's Classroom Models are used without substitutions of outside physical techniques.
  • All units of the program are taught in sequence.
  • Due Care is provided to participants by following the Procedural Safety Outline on pages 1 – 2 of the Instructor Manual.
  • Adequate space is used for training. (For 15 – 25 participants, a minimum of 1500 square feet is recommended.)
  • Every participant uses a program training workbook.
  • Class size must not exceed 40 participants.

An Electronic Presentation and other training aids that Instructors may choose to use with the program are available at crisisprevention.com.

The program is best implemented utilizing an ongoing training process, and as such, outside of initial training and formal refresher training, it is recommended that Certified Instructors implement a training cycle that includes Situational Applications, Policy Discussions, Reviews, Practices, and Rehearsals.

Organizations using the training program have the option of implementing the course in a blended learning (partially via computer, partially via classroom) version. The blended learning version allows staff to learn many of the basic elements of the program from the comfort of their computers outside of a class via the internet, then learning how to apply the information in a classroom environment.

Additional Resources:

There currently are additional qualified resources for training:

All training must be conducted through the Certified Instructor's Base of Employment; therefore the only source of training for organizations without a currently active Certified Instructor is through CPI.

Relevant Published, Peer-Reviewed Research

This program has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for a scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated." It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR - Not able to be Rated" classification, please see the Scientific Rating Scale.

Child Welfare Outcomes: Not Specified

Show relevant research...

Jonikas, J., Cook, J., Rosen, C., Laris, A., & Kim, J. (2004). A program to reduce use of physical restraint in psychiatric inpatient facilities. Psychiatric Services, 55, 818–820.

Type of Study: One group pretest/posttest design
Number of Participants: 227

Population:

  • Age — 12-17 years
  • Race/Ethnicity — 62% African American (remaining not specified)
  • Gender — 66% Female and 44% Male
  • Status — Participants were adolescents in an adolescent psychiatric ward with a diagnosis of major depression or other depressive disorders, adjustment disorders, conduct disorders, schizophrenia or psychotic disorders.

Location/Institution: Adolescent psychiatric unit at a university hospital

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated whether training staff members in crisis de-escalation and nonviolent intervention (Nonviolent Crisis Intervention® Training Program) would decrease adolescent patients’ self-reported stress triggers and personal crisis management strategies. Staff studied a comprehensive training manual, viewed a 90-minute training video part of a seclusion and restraint reduction toolkit, and participated in a one-day training session. Staff members conducted brief interviews at intake or within the first 24 hours of admission to elicit patients’ crisis triggers and to determine de-escalation strategies. Patients’ restraint histories were elicited along with their medication preferences. Each plan was reviewed on a weekly basis. The adolescent unit experienced a 48 percent decrease in the restraint rate one quarter after training occurred and a 98 percent decrease two quarters after the training and remained low throughout the final two quarters of the year. The primary limitation is the lack of a control group.

Length of postintervention follow-up: 1 year.

Ryan, J. B., Peterson, R. L., Tetreault, G., & Van der Hagen, E. (2007). Reducing seclusion timeout and restraint procedures with at-risk youth. Journal of At-Risk Issues, 13, 7-12.

Type of Study: One group pretest/posttest design
Number of Participants: 42

Population:

  • Age — 7-15 years
  • Race/Ethnicity — 37 Caucasian, 3 American Indian, and 2 African American
  • Gender — 40 Male and 2 Female
  • Status — Participants were students from the surrounding public school districts and a local residential facility on both a short- and long-term basis due to inappropriate behaviors.

Location/Institution: Minnesota public day school

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this pilot study was to review the effects of professional staff training in crisis management (Nonviolent Crisis Intervention® Training Program) and de-escalation techniques on the use of seclusion timeout and restraint procedures with at-risk students in a K-12 special day school. Measures utilized include a teacher self-questionnaire, incident reports, and staff surveys. Results indicated professional staff training was effective in reducing (a) seclusion timeout procedures by more than one-third (39.4%) and (b) physical restraints (17.6%). This study also found staff members were not initiating seclusion timeout procedures primarily for the reasons they were trained (e.g., physical aggression) but rather for nonviolent behaviors such as leaving an assigned area and disrupting the classroom environment. Limitations included the use of a convenience sample, lack of control group, and concerns about generalizability to other ethnic populations.

Length of postintervention follow-up: Unclear – training occurred throughout the school year.

References

Chau, C. (2010). Restraint use: A culture of assumptions. Retrieved from http://www.crisisprevention.com/Blog/January-2012/Restraint-Use-Culture-of-Assumptions

CPI. (2005). Instructor manual for the Nonviolent Crisis Intervention training program. Milwaukee, WI: Author.

Lafond, R. (2009). Reducing seclusion and restraint for improved patient and staff safety. Retrieved from https://www.crisisprevention.com/CPI/media/Media/Blogs/Reducing-Seclusion-and-Restraint-for-Improved-Patient-and-Staff-Safety.pdf

Contact Information

Name: Robert D. Rettmann, MS Ed
Website: www.crisisprevention.com
Email:
Phone: (800) 558-8976

Date Research Evidence Last Reviewed by CEBC: February 2015

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: January 2011