Monday, 29 August 2011

To NVCI or not to NVCI, Part 2

Just to remind people...

DISCLAIMER:  I'm not in any way affiliated with the Crisis Prevention Institute or any of the training that it offers. I obviously have some strong opinions about the CPI's Non-Violent Crisis Intervention (NVCI) training, but they are my own.

NVCI Holds

I'd like to continue the discussion of NVCI training that I started yesterday by talking about NVCI holds, or bodily restraints. You've likely seen variations on them in movies, but the NVCI holds are generally less dramatic. They are used are used as a last resort, constantly monitoring the person in the hold, and only until the person has indicated that they've regained physical control.

I’ve never had to use an NVCI hold on anybody. I was lucky that I didn’t have to in any context before my stroke, and after my stroke using NVCI holds wasn't an option for me. Like the teacher in the Facebook conversation that I talked about in yesterday's post, I really hope that, even if I got to a point where I could safely use a NVCI hold, I never have to.

NVCI Holds and Inaccurate Connotations

When I hear the word ”hold” in the context that we learn in NVCI training, I think “restraint”, and I think of being tied to the bed in the hospital (See the blog entries entitled "Finger Spelling" and "Finger Spelling, Part 2" for the story about my restraint experiences). The NVCI holds are bodily, with a focus on comfort and safety for the person, but they are still restraints, and they still conjure up the image of restraint for me.

But I was not a person who should have been put in a restraint, according to the NVCI guidelines around restraint.I wasn’t out of control. I wasn’t at risk of putting myself or others at harm. When a person has genuinely reached that stage, when they’re no longer in control of their actions and they’re at risk of putting themselves or other people in danger (and agencies should have criteria even beyond that for whether or not use of a NVCI hold or any other restraint is appropriate in a given situation), it’s not a nice feeling for the person. No one likes being at that point. A NVCI hold, done properly, (which is physically safe for both the person or people doing it and the person who’s out of control) can bring about a measure of security that the out-of-control person needs to become calm. But NVCI holds are restraints, so they need to be used as last resorts.

And they need to be done safely, because the person or people doing doing the hold can also be hurt if it's done the wrong way.

I remember a situation several years ago in an airport where I believe a man died after being tasered by police. It astounds me that despite having the capacity through NVCI training and CPI-sanctioned means to safely and effectively restrain (and move an individual in restraint), more agencies don’t opt to make that part of the protocol. If the police were close enough to taser, they were close enough to do a safe, effective restraint until, if necessary, a chemical restraint was made available. The man could have lived.

No one wants to see people restrained. But if it must be done, as the last resort, agencies should take advantage of training that will ensure that staff can do it safely.

To sum up:

1) Agencies should have safety for both clients and staff as a priority in all matters, including those involving potential violence from any source.

2) NVCI is much more than the holds.

3) The verbal and non-verbal NVCI intervention strategies are good for anyone to learn, should they get the chance.

4) There’s no reason why staff working in sectors where clients take unpredictable action shouldn’t be taught the means to safely, for them and for clients, deflect any violence aimed at them.

5) NVCI Holds should be a last resort and have agency policy surrounding their administration, but can be done safely and with a minimum of trauma for everyone when done according to NCVI guidelines.

Obviously this is something about which I have strong feelings. This is another area where we have to balance respecting rights, responsibilities, and needs of the people we support, and that brings out strong feelings with anyone in this field.

More about CPI and NVCI:

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