Verbal De-Escalation Training for Staff at a Level One Psychiatric Hospital

Abstract

Purpose: Physical restraint is an intervention utilized when a patient poses an imminent threat to themselves or others. However, the use of restraint comes with physical and psychological risks, including post-traumatic stress disorder, physical injury, and death. Verbal de-escalation is an intervention designed to prevent physical restraint. A QI project was designed to assess whether an educational intervention would improve behavioral health technicians’ knowledge, confidence in skills, and attitude in verbal de-escalation at a level one psychiatric hospital in Tucson, Arizona. Background: Physical restraint is the restriction of an individual’s freedom of movement. Due to the inherent risks, physical restraint is a last resort and should be avoided when possible. As such, psychiatric hospitals are required to adopt a behavior management system to ensure safe restraints as well as ensure the implementation of interventions to minimize the use of restraints. Sonora Behavioral Health, a level-one psychiatric hospital in Tucson, Arizona, has adopted the Handle With Care Behavioral Management System, which includes theory and methods for verbal de-escalation. The hospital instructs employees on Handle With Care verbal de-escalation during new employee orientation. Methods: An educational intervention on verbal de-escalation was created in alignment with Handle With Care and presented at a bi-monthly meeting for behavioral health technicians at Sonora Behavioral Health. A pre-survey and post-survey were given to participants for data collection. The surveys assessed knowledge, confidence in skills, and attitude towards verbal de-escalation. Results: A total of 20 pre- and post-surveys were returned. Seven post-surveys were returned blank, while eight pre-surveys and five post-surveys were returned partially incomplete. Overall, pre-survey composite scores and confidence scores were higher than post-survey scores (p=.009 and p=.006 respectively). In the knowledge and attitude categories, there was no difference between pre- and post-survey scores (p=.25 and p=.06, respectively). Conclusions: The educational PowerPoint presentation did not improve knowledge, confidence, or attitude toward verbal de-escalation. Results were likely skewed by small sample sizes as well as blank and incomplete surveys. Future interventions should consider data collection in a format different than surveys.