CPI’s Nonviolent Crisis Intervention ®

Training Program General Information

and Empirical Support

10850 W. Park Place, Suite 600

Milwaukee, WI 53224 USA
800.558.8976
888.758.6048 TTY (Deaf, hard of hearing, or speech impaired)
[email protected]
crisisprevention.com

© 2009 CPI (reprinted 2014). All rights reserved. 14-CPI-INT-003 07/14

Table of Contents
Company Profile............................................................................................................................................................................. 3

Locations......................................................................................................................................................................................... 3

Program Philosophy...................................................................................................................................................................... 3

Program Summary and Methodologies...............................................................................................................................3–4

Promoting Best Practice.........................................................................................................................................................4–5

Global Professional Instructors.................................................................................................................................................. 5

International Professional References....................................................................................................................................... 5

Continuing Education Credit....................................................................................................................................................... 6

CPI Instructor Association...................................................................................................................................................... 7–8

Empirical Support and Research References................................................................................................................. 9–15

CPI’s Nonviolent Crisis Intervention® Training Program General Information and Empirical Support – © 2009 CPI (reprinted 2014). 2
Company Profile
CPI is the worldwide leader of professional development in crisis prevention and intervention. Since 1980, the
Nonviolent Crisis Intervention® training program has been attended by more than 8 million professionals, from
organizational leaders to direct care staff, spanning thousands of mental health facilities, hospitals, schools,
businesses, and other human service settings.

CPI training has been provided to professionals in the US (including Puerto Rico), Canada, the United
Kingdom, Ireland, Germany, Spain, Australia, and New Zealand who work in schools, hospitals, long-term care
facilities, care homes, and mental health settings. CPI’s training programs and support materials have been
made available in seven languages and dialects. Documentation of the effectiveness of Nonviolent Crisis
Intervention® training, as well as references, are available upon request and can be categorized by discipline,
governing body/association, and geographic area.

In addition to training programs, CPI creates and publishes print and electronic resources including the Journal
of Safe Management of Disruptive and Assaultive Behavior (JSM).

Locations
CPI offers over 300 regularly scheduled courses per year in cities throughout the world. Previously trained
Certified Instructors can join new participants in these courses to refresh their knowledge and skills at no cost.
Training is also conducted on site and tailored for the specific audience. On-site programs are currently taught
in English, Spanish, and French.

Program Philosophy
CPI’s cornerstone training program, the Nonviolent Crisis Intervention® program, espouses a philosophy that
focuses on providing the best possible Care, Welfare, Safety, and SecuritySM to staff members and those in
their care. The emphasis is on prevention, de-escalation, and the use of physical intervention only as a last
resort when an individual presents a danger to self or others.

Program Summary and Methodologies

The Nonviolent Crisis Intervention® training program is embraced worldwide by organizations committed to
providing quality care and services in a respectful, safe environment.

The strategies taught in the Nonviolent Crisis Intervention® training program provide staff members with an
effective framework for decision making and problem solving to prevent, de-escalate, and safely respond to
disruptive or assaultive behavior. The philosophy relating to Care, Welfare, Safety, and SecuritySM expands
throughout the continuum of interventions that are necessary when working toward reduction or elimination of
restraint use.

The Nonviolent Crisis Intervention® training program combines innovative concepts regarding violent behavior
into an educational system that gives staff at all knowledge and experience levels easy-to-understand models to
use when confronted with anxious, hostile, or violent behavior.

While inherent in any use of restraint is an element of risk for physical or emotional harm to everyone involved,
the physical interventions taught in the Nonviolent Crisis Intervention® training program are designed to
minimize these risks.

CPI’s Nonviolent Crisis Intervention® Training Program General Information and Empirical Support – © 2009 CPI (reprinted 2014). 3
Any physical intervention is to be utilized only as a last resort when an individual’s behavior presents an imminent
danger to self or others. The program realistically addresses physical intervention through careful assessment of
risks and further exploration of the “last resort” concept.

Physical interventions are only an option when the inherent risk in their use is eclipsed by the physical danger
that the acting-out individual demonstrates. Equally important, participants are taught to always be conscious
of their intent in a crisis situation: If intent is to maximize safety for clients and staff while employing the least
restrictive approach to intervention, never for convenience or punishment, then risk of injury is minimized for all
concerned.

The Nonviolent Crisis Intervention® program begins with CPI’s Crisis Development ModelSM to help organize
thinking about chaotic moments. Emphasis is on the prevention of aggressive acting-out behavior through
identifying individual behaviors that may escalate into dangerous situations. Defusing potentially violent
situations through nonverbal and verbal intervention strategies is the program’s main focus.

CPI’s ever-present goals include preventing and de-escalating hostile and potentially violent behaviors, being
aware of nonverbal communication, avoiding power struggles, and setting appropriate limits. These goals set
the tone in the Nonviolent Crisis Intervention® program to help staff maintain professionalism at all times. CPI’s
Personal Safety TechniquesSM, as well as emergency physical intervention skills to manage oneself and others
safely during a crisis situation, are demonstrated and practiced through role-play and interactive learning. CPI
Postvention strategies have always been a key component of the program (and debriefing strategies have
been recommended in both Joint Commission on Accreditation of Health Care Organizations and Center for
Medicare & Medicaid Services [CMS] seclusion and restraint standards). These strategies are taught to assist
staff in learning from and improving their interventions as well as enabling the personalization of intervention
strategies based on the distinctive behaviors exhibited by individual clients. The importance of incident
documentation is also stressed in this portion of the program.

CPI has learned what is crucial to incorporate into an ongoing Training Process through the unparalleled follow-
up support and services provided to organizations that have implemented the training over the past 30 years.
The Nonviolent Crisis Intervention® Training Process is best implemented through CPI’s Instructor Certification
Program, which allows for necessary tailoring and application of program content to evolving organizational
realities, while maintaining the integrity of the program content with the highest quality standards and services.
The Instructor Certification Program offers organizations a link to ongoing professional consultation, resources,
and examples of best practices through the CPI Instructor Association. CPI is dedicated to sharing exemplary
practice throughout the world and provides immeasurable value to organizations striving for excellence in
sustaining safe and respectful environments. The Nonviolent Crisis Intervention® training program can be
taught in one of two ways—in its entirety in a classroom setting or as a hybrid option. In the hybrid option,
participants receive much of the content in a web-based format, followed by a classroom session designed to
help apply that content to workplace situations.

Promoting Best Practice

Quantitative and qualitative evidence collected over the last three decades has demonstrated how the
Nonviolent Crisis Intervention® training program has been effectively implemented to provide for more positive
outcomes. Participants report that the program realistically approaches issues with long-term preventive
solutions rather than relying on staff to act appropriately when faced with aggression. Certified Instructors
repeatedly report the value of the program’s approach of viewing the crisis moment more holistically—as a
component of an individual’s behavior. The user-friendly principles of the Nonviolent Crisis Intervention® training
program give staff easy-to-understand behavior de-escalation tools to incorporate into their daily interactions
with clients at their organizations.

CPI’s Nonviolent Crisis Intervention® Training Program General Information and Empirical Support – © 2009 CPI (reprinted 2014). 4
To help ensure that all training is consistently delivered, the CPI Instructor Association has implemented a
comprehensive system involving clear and consistent standards, ongoing competency criteria, monitored
training, documentation, and one-on-one support via phone, email, and Internet. Certified Instructors are invited
to attend free, two-day refresher programs offered over 300 times per year in cities worldwide.

Global Professional Instructors

CPI currently employs full-time Global Professional Instructors who present the Nonviolent Crisis Intervention®
training program and are responsible for all Instructor Certification Programs. All have at least a bachelor’s
degree, several have a master’s degree or higher, and all have direct, professional experience in education, drug
and alcohol counseling, health care, mental health, social work, administration, residential care, corrections, or
working with youth and individuals with developmental delays.

All Global Professional Instructors must complete a rigorous training process, annual competency testing, and
engage in continous learning and development. Global Professional Instructors are skilled at presenting and
customizing the Nonviolent Crisis Intervention® training and related special offerings to meet the needs of
market-specific audiences and individual program participants. Our Global Professional Instructors are based
at CPI’s international headquarters in Milwaukee, Wisconsin, as well our offices in Australia and Europe, which
allows CPI to maintain fidelity, continuity, and quality control of our services and support.

International Professional References

Dr. Larry Hardy Mr. Tony O’Donovan
Senior Psychologist/Department of Child Care Advisor
Family Services & Housing Department of Justice, Equality, and Law
Province of Manitoba Dublin, Ireland
Winnipeg, MB, Canada
Mr. Luke Perry
Mr. Leo Coughlin Behavioural Support Specialist
Director of Residential Services Voyage Care
Youth Village Center for Youth Oxfordshire, England
Bartlett, TN USA

Dr. Lisa Kuntz

Director
Connecticut Diagnostic and Evaluation
Center for Deaf and Hard of Hearing
Individuals and Children’s Center
West Hartford, CT USA

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Continuing Education Credit
CPI maintains a wide variety of program approvals, accreditations, and providerships through numerous
entities for continuing education. Each entity is governed by its own set of rules and policies and uses its
own terminology with respect to credits, hours, or units and how they are calculated. CPI itself does not
issue continuing education credits. We work with the various boards and licensing organizations so that they
have the appropriate information in order to recognize our training program as being in compliance with their
requirements.

CPI is glad to work with Certified Instructors interested in receiving continuing education credit for the hours
they attend the Nonviolent Crisis Intervention® training program.

Many professional organizations will accept the Certificate of Attendance that CPI issues to participants. In
some cases, the course outline and training objectives will also be requested.

The following is a sampling of organizations from which CPI has received approved
provider status:
Within the United States: National Association of School Psychologists (NASP)
American Board of Industrial Hygiene (ABIH) National Association of Social Workers (NASW)
Arizona Peace Officer Standards and Training Board National Board for Certified Counselors, Inc. (NBCC)
(POST) National Federation of Licensed Practical Nurses
California Board of Behavioral Sciences (NFLPN)
California Board of Registered Nursing New Jersey Department of Education
California Department of Social Services Ohio Counselor and Social Work Board
Illinois State Board of Education Pennsylvania Department of Education—Act 48
Indiana State Board of Health Facility Administrators Pennsylvania Department of Health
Massachusetts Department of Education State of Texas, State Board for Educator Certification
Michigan Department of Education—Kent Intermediate Texas State Board of Examiners of Professional
School District (ISD) Counselors (TSBEPC)
Missouri Peace Officer Standards and Training (POST) Washington State Board of Education, Puget Sound
National Association of Alcohol and Drug Education Service District
Abuse Counselors

International Recognition/Accreditation:
BILD (British Institute of Learning Disabilities)
Office for Health Management (Ireland)
Ontario Ministry of Community, Family and Children’s Services (MCFCS)

For a comprehensive list of all the organizations that have approved CPI to offer continuing education units,
please call toll-free 800.558.8976 in the US, Canada, and Latin America.

Augustana College Credits Available

Through an agreement with Augustana College, any new Certified Instructor who successfully completes the
Four-Day Instructor Certification Program may also earn from two to three undergraduate or graduate credits for
his or her efforts. A detailed brochure that outlines the application process is available from CPI and also at any
Nonviolent Crisis Intervention® training program.

CPI’s Nonviolent Crisis Intervention® Training Program General Information and Empirical Support – © 2009 CPI (reprinted 2014). 6
CPI Instructor Association
Attending a training program is just the beginning of the relationship with CPI. CPI continues to support your
training efforts after the initial training has ended through our network of Certified Instructors, the CPI Instructor
Association. The following standard and support services are offered to members of the CPI Instructor
Association:

Maintaining Standards
The CPI Instructor Association is an association established by CPI to formally validate the global standard
of providing high quality, meaningful training in the safe management of disruptive and assaultive behavior.
That standard has been set and maintained by Instructors and organizations from around the world committed
to excellence in providing training in the Nonviolent Crisis Intervention® program and providing for the best
possible outcomes for the consumers those organizations serve.

Instructor Excellence Renewal Process

The CPI Instructor Excellence Renewal Process ensures that all Certified Instructors receive the information and
support needed to maintain and improve their skills to instruct Nonviolent Crisis Intervention® training programs.
The process establishes the standard that training in the safe management of disruptive and assaultive behavior
should be an ongoing process rather than a one-time event. The Training Process includes the training Certified
Instructors receive to better equip them with the skills needed to deliver the training programs in a consistent
manner according to CPI standards. CPI standards and specific requirements of the Instructor Excellence
Renewal Process are clearly delineated within each Instructor Certification Program and reiterated during each
of the advanced and renewal programs.

Free Professional Consultation

For specific information and consultation on training issues, Certified Instructors can call Instructor Services
toll-free as often as they wish. Our Training Support Specialists are available between 7:30 a.m. and
6:00 p.m. (CT).

Training Resources
Instructors have free access to CPI’s Resource Center via phone or online. Our resource center includes
sample policy and procedure documents, an audio and video library, and regularly updated articles and data.

Documentation of Training Activities

CPI maintains a file of training records and provides Certified Instructors with program confirmation notices of
all training records submitted. If a question ever arises about who was trained when, Instructors can call toll-
free. Instructors can also easily access current training records through the CPI website.

In addition to the standard items listed above, CPI offers an array of customized support options
designed to fit individual training needs:

On-Site Refresher Courses

On a periodic basis, CPI can conduct review training courses at Instructors’ facilities for employees who
wish to refresh their skills. Refreshers also provide an excellent opportunity for CPI to further tailor training
to focus on an organization’s specific needs.

CPI’s Nonviolent Crisis Intervention® Training Program General Information and Empirical Support – © 2009 CPI (reprinted 2014). 7
 Customized Training Materials
Participant Workbooks and Leader’s Guides can be customized to incorporate actual scenarios as well as
organizational logos or other appropriate trademarks.

Advanced Training Programs

CPI offers Certified Instructors advanced training opportunities to enhance and strengthen their skills and to
fulfill the ongoing requirements of certification. The advanced training programs focus on physical intervention
skills, verbal intervention skills, training techniques and strategies, and specialized training for staff who support
individuals with autism spectrum disorders.

Research
The effectiveness of Nonviolent Crisis Intervention® training is well-documented and supported in the literature.
CPI is interested in working with organizations that wish to collect data to add to the existing body of evidence
of the effective implementation of the Nonviolent Crisis Intervention® program.

CPI’s Nonviolent Crisis Intervention® Training Program General Information and Empirical Support – © 2009 CPI (reprinted 2014). 8
 Empirical Support for the
Nonviolent Crisis Intervention® Training Program

CPI’s Nonviolent Crisis Intervention® training program has been approved as an Evidence-Based Practice
by the Oregon Department of Human Services Office of Mental Health and Addiction Services (OMHAS).
The following is a collection of resources which have examined the effectiveness of the Nonviolent Crisis
Intervention® training program:

Burnes Bolton, L., & Goodenough,

A. (2003). A magnet nursing service
approach to nursing’s role in quality
improvement. Nursing Administration
Quarterly, 27(4), 344–354.

Authors examined an overall effective

quality improvement program at a large
urban hospital. Improvement initiatives
included reducing seclusion and restraint
use. To help accomplish this, staff were
trained in Nonviolent Crisis Intervention®
techniques.

“The S&R team retrained all patient care

providers (not just nurses) and started
to aggressively analyze and scrutinize
every event. With this new training and
‘microscope approach,’ two significant trends evolved over time. One, staff learned how to recognize an
escalating event earlier, which would allow them to intervene earlier. Second, staff were collaboratively working
together to come up with less restrictive alternatives to seclusion and restraint.”

Calabro, K., & Williams, S. (2002). Calabro et al.

Evaluation of training designed Summary of Pre- and Post-test Scores for Evaluation Variables (n=118)
to prevent and manage patient Variable Number Mean (SD) Mean (SD) Cronbach Alpha
violence. Issues in Mental Health of Items Time 1 Time 2 for the Scale
Nursing, 23, 3–15. Knowledge 9 6.1 (1.6) 7.3 (1.7)*
Attitude‡ 11 18.6 (4.7) 16.8 (4.5)* 0.68
Self-efficacy‡ 8 15.0 (4.0) 14.3 (3.3)** 0.77
This study was designed to
Behavioral Intention‡ 6 10.8 (3.2) 10.3 (3.2)*** 0.61
determine whether the test
responses of mental health care ‡ For attitude, self-efficacy, and behavioral intentions variables, a decrease in the mean indicates a
positive chance in the variables.
workers showed significant * p < 0.001; ** p < 0.01; *** p < 0.05
improvement after attending a
training session about managing
violence. The findings suggest that respondents who attended the training were positively influenced about
using the techniques for controlling and preventing inpatient violence.

The findings suggest that respondents who attended Nonviolent Crisis Intervention® training were
positively influenced about using the techniques for controlling and preventing inpatient violence.
Scores for the respondents showed a stronger intention to use the strategies.

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 Empirical Support for the
Nonviolent Crisis Intervention® Training Program

Jambunathan, J., & Bellaire, K. (1996). Evaluating staff use of crisis prevention
intervention techniques: A pilot study. Issues in Mental Health Nursing, 17, 541–558.

“The purpose of this pilot study was to evaluate staff use of crisis prevention
intervention (CPI) techniques in averting crisis episodes at the various levels (anxiety,
defensive, and acting out) of a crisis (resulting in reduction of seclusion and restraint
episodes and patient/staff injuries).” (541)

“The results of the study indicate that staff use of CPI training program
techniques was effective in resolving crises in 84.2% of the episodes observed
and over a wide variety of diagnostic and functional levels.” (541)

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.

An initiative is described to reduce the use of physical restraint on three psychiatric units of a university hospital.

Nonviolent Crisis Intervention® training was evaluated in conjunction with crisis management
components. Overall, a 97–99% reduction of restraints was noted.

Quarterly rates of restrainta among patients in three psychiatric units

before and after implementation of a restraint reduction program

Adolescent General Clinical

Psychiatry Unitb Psychiatry Unitb Research Unitc
July 2000–June 2001
First Quarter 0.05 3.85 0
Second Quarter 0.2 0.34 0.05
Third Quarter 2.44 1.05 0.76
Fourth Quarter 1.31 1.96 0.68
July 2001–June 2002
First Quarter 2.62 1.18 1.04
Second Quarter 3.78 1.36 0.51
Third Quarter 1.98 0.2 0.26
Fourth Quarter 0.08 0 0.01
July 2002–December 2002
First Quarter 0.05 0.02 0
Second Quarter 0.12 0.01 0

a The rate was defined as the total number of patient-hours in restraint that quarter, divided by the
number of patient-days (the daily patient census summed for all days of the quarter). This number
was then multiplied by 24 and then by 1,000.
b Advance crisis management training and nonviolent crisis intervention training were conducted in
the second quarter of 2002.
c Advance crisis management training was conducted in the first quarter of 2002, and nonviolent
crisis intervention training was conducted in the second quarter of 2002.

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 Empirical Support for the
Nonviolent Crisis Intervention® Training Program

McIntosh, D. (2003). Testing an intervention to increase

self-efficacy of staff in managing clients perceived as
violent. Unpublished doctoral dissertation, Division
of Research and Advanced Studies, University of
Cincinnati, Cincinnati, OH.

This quasi-experimental study examined the effect of

the Nonviolent Crisis Intervention® training program on
the perceived self-efficacy of community mental health
center staff.

Nonviolent Crisis Intervention® training is credited for

increasing staff confidence, which in turn positively Means for crisis intervention self-efficacy scores of Experimental and
Control groups at Time 1, Time 2, Time 3.
affects intervention self-efficacy.

The omnibus mixed factorial ANOVA showed there was significant main effect for group (F [1,80] = .16, p <
.01, η = .15) and for time (F [1,80] = 10.17, p < .01. η=. 11). However, there was not a significant main effect
for interaction between group and time (F [1,80] = 2.72, p < .10). At Time 2 and Time 3 the experimental group
reported higher levels of perceived crisis intervention self-efficacy than the control group (see figure at right).
Post-hoc comparisons indicated that perceived crisis intervention self-efficacy significantly increased from Time
1 to Time 3 (M = .40, SE = .13) (p < .01). Thus, the hypothesis was supported.

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 Empirical Support for the
Nonviolent Crisis Intervention® Training Program

Smalls, Y. (2004). Utility of the implementation of A one-way repeated measures ANOVA was conducted in which
there was a significant overall decrease in restraint usage
programmatic systems to reduce and eliminate during the 7 recording periods as depicted in the graph below
restraint use for the treatment of problem behaviors F(1,6)=13.8, p< .05. As an aside, follow up data indicates that
restraint use continues to remain low to date.
with individuals with mental retardation. Unpublished
dissertation. Retrieved from etd.lsu.edu/docs/available/
ETD-01282004-145119/unrestricted/Smalls_dis.pdf

Dissertation examined restraint reduction efforts at

the Hammond Developmental Center in Hammond,
LA. Dissertation includes an extensive review of the
literature on reduction of physical restraints and the
risks associated with restraint usage. Independent
variable was a restraint reduction effort including 16
hours of training in the management of crisis situations
(Nonviolent Crisis Intervention® training), eight hours of
training in restraint theory and application, demonstration Centerwide Restraint and Injury Trend.
of correct application of physical restraint, training on
basic behavioral techniques, and a passing score of
90% on a written exam.

Study tested four hypotheses. The hypotheses and the results were:
1. Restraint use would decrease over 18-month duration of study (pre-test to 18-month snapshot): a 94%
overall reduction was noted.
2. Restraint use would steadily decrease over seven reporting periods during 18-month duration of study
(repeated measures): restraint use remained steady during the intervention period, but rapidly declined
in first three months following intervention period. Restraint use steadily declined throughout the
remainder of the study.
3. Psychotropic medication use would decrease over time: psychotropic medications experienced a 29%
overall decrease over the course of the study.
4. Overall injuries sustained due to restraint use would decline: hypothesis was not supported as no
restraint injuries were reported over the course of the study.

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Additional Resources Supporting the Effectiveness of the Nonviolent Crisis Intervention®
Training Program
Alegent Health Midlands Hospital. (2005). Nebraska Hospital Association Quest for Excellence Award
Application. Lincoln, NE: Nebraska Hospital Association. Retrieved from nebraskahospitals.org/quality_
and_safety/quality_initiatives/quest_for_excellence/questforexcellence_archive/questforexcellence_
archive_2005.html
Alegent staff documented their efforts to reduce seclusion rates at their hospital through the use of a
major initiative, including de-escalation training. The study was conducted over a six-year period, showing
excellent results in not only reducing seclusion rates, but also improving patient satisfaction scores, clinical
outcomes scores, employee turnover rates, and employee opinion scores. Nonviolent Crisis Intervention®
training was implemented in the second year of the initiative.

Bugaj, S. (2002). Improving the skills of special education paraprofessionals: A rural school district’s model for
staff development. Rural Special Education Quarterly, 21.
The article outlines a rural school district’s staff development program for special education teacher aides.
Following the first year of implementation, the plan received positive objective and subjective ratings. The
program included four components: basic instruction in behavior management, CPR training, instruction in
lifting, and Nonviolent Crisis Intervention® training. Measurement consisted of analysis of pre- and post-test
period questionnaires.

Fairchild, D. (1991). An evaluation of nonviolent crisis intervention training for personnel in educational and
residential treatment settings. Unpublished master’s thesis, Bemidji State University Library, Bemidji, MN.
Study evaluated the impact of the Nonviolent Crisis Intervention® training program by surveying 71
participants, including school administrators, special education and regular education teachers, school
psychologists, and residential treatment counselors. Participants were surveyed after at least one year on
the job after training. Participants reported a positive change in the learning climate, a reduction in the use
of physical restraint, and an increase in staff confidence levels and effectiveness on the job.

Godfrey, J. L., McGill, A. C., Tuomi Jones, N., Oxley, S. L., and Carr, R. M. (2014). Anatomy of a transformation:
A systematic effort to reduce mechanical restraints at a state psychiatric hospital. Psychiatric Services, (in
advance), p.1-4. doi: 10.1176/appi.ps.201300247
The authors from a state psychiatric hospital in North Carolina describe efforts to reduce mechanical
restraint use over three year using de-escalation training from CPI, response team implementation, and
policy changes. The article reported data from the Acute Adult Unit (AAU) and the Community Transition
Unit (CTU) at the hospital. Mechanical restraint was significantly reduced in the AAU (98% reduction) and
eliminated entirely (100% reduction) from the CTU.

Krop, J. (2002, Third Quarter). A lack of restraint: South Florida State Hospital’s new techniques bring results.
All Points Bulletin, 8, 7. Palm Beach Gardens, FL: Wackenhut Corrections Corporate.
This article outlines how South Florida State Hospital has successfully implemented the Nonviolent Crisis
Intervention® training program. It speaks to the importance of an ongoing Training Process, as well as
being as proactive as possible. Article includes data regarding the number of restraints when the hospital
first implemented the Nonviolent Crisis Intervention® training program and after having utilized it for
several years.
 ith an initial culture change and regular trainings once the program was implemented, the hospital
W
has noticed a dramatic decline in violent incidents.

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Additional Resources continued
McCue, R., Urcuyo, L., Lilu, Y., Tobias, T., & Chambers, M. (2004). Reducing restraint use in a public psychiatric
inpatient service. Journal of Behavioral Health Services and Research, 31(2), 217–224.

This project’s goal was to reduce restraint use in a public psychiatric inpatient service serving an
economically disadvantaged urban population. The six interventions used primarily involved changing
staff behavior.

 fter implementation of the six initiatives, one of which was Nonviolent Crisis Intervention® training,
A
restraint use was reduced by more than 50%, even though there was no reduction in patient-to-
patient or patient-to-staff assaults.

Petti, T., Somers, J., & Sims, L. (2003). A chronicle of seclusion and restraint in an intermediate-term care facility.
Annals of Adolescent Psychiatry, 27, 83–116.

Dr. Petti presents a case study showing an effective set of initiatives aimed at decreasing seclusion and
restraint use at the Youth Service of Larue D. Carter Memorial Hospital in Indianapolis.

The case study specifically cites CPI training as a major part of the seclusion and restraint
reduction effort. An overall reduction in “restrictive practices” was achieved over the course of the
seven-year study, although less emphasis is made on the numbers than on the journey the facility
took to get there.

Ryan, J., Peterson, R., Tetreault, G., & van der Hagen, E. (2008). Reducing the use of seclusion and restraint
in a day school program. In M. Nunno, D. Day, & L. Bullard (Eds.). For our own safety: Examining the safety of
high-risk interventions for children and young people (pp. 201–215). Washington, DC: Child Welfare League
of America.

The authors conducted a two-academic-year pilot study examining the use of seclusion time-out and
physical restraint at a public day school with students with emotional or behavioral disorders (EBD).
Following implementation of training in the Nonviolent Crisis Intervention® program, data were compared
from incident reports between the academic years immediately before and immediately following training.
Following training, the data showed a 39.4% reduction of seclusion time-out use and a 17.6% reduction in
physical restraint use.

Temple, T.O., Zgaljardic, D.J., Yancy, S., & Jaffray, S. (2007). Crisis intervention training program: Influence
on staff attitudes in a postacute residential brain injury rehabilitation setting. Rehabilitation Psychology, 52,
429–434.

Temple, et al. examined training effectiveness on staff participating in the Nonviolent Crisis Intervention®
training program in a residential rehabilitation program for individuals with acquired brain injuries.
Researchers utilized the Rehabilitations Situations Inventory before training, immediately after the training
program, and one month after training.

The study found that immediately after training, participants experienced greater comfort in facing a situation
with a client exhibiting behaviors associated with motivation and adherence, and aggression, as well as
when responding to other staff and client families. In one month follow-up, significant changes in comfort
level were maintained for staff responding to aggression and staff/staff interactions.

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Additional Resources continued
Thompson, R., Huefner, J., Vollmer, D., Davis, J., & Daly, D. (2008). A case study of an organizational intervention
to reduce physical interventions: Creating effective, harm-free environments. In M. Nunno, D. Day, & L. Bullard
(Eds.). For our own safety: Examining the safety of high-risk interventions for children and young people
(pp. 167–182). Washington, DC: Child Welfare League of America.

Authors of this study sought to advance harm-free care through the organization-wide implementation of
an intervention intended to change the culture at a large therapeutic group home for youth. The intervention
included initial and refresher staff training in the Nonviolent Crisis Intervention® program. As a result of their
efforts, the organization experienced significant reductions in physical restraints, physical assaults on staff
and peers, physical aggression, and property damage.

Tierney, E., Quinlan, D., & Hastings, R. (2007). Brief report: Impact of a 3-day training course on challenging
behaviour on staff cognitive and emotional responses. Journal of Applied Research in Intellectual Disabilities,
20, 58–63.

Authors examined the effect of perceived self-efficacy of staff in dealing with challenging behaviors after
attending a training program. The three-day training program consisted of two days of training in the
Nonviolent Crisis Intervention® training program and one day of training in defining challenging behavior and
addressing the use of functional behavioral assessments. Results of the study supported that staff (n=48)
had increased self-efficacy and confidence (p=.00) after a three-month follow-up.

Wakefield Gillam, S. (2014). Nonviolent Crisis Intervention® training and the incidence of violent events in
a large hospital emergency department: An observational quality improvement study. Advanced Emergency
Nursing Journal, 36, 177–188. doi: 10.1097/TME.0000000000000019.

Nonviolent Crisis Intervention® training was initiated to reduce the incidence of violence in an acute care

hospital ED with more than 75,000 annual visitors. Training intended to build skills to defuse potentially
violent situations and significantly decrease incidents in the ED requiring emergency security team
involvement (manifested as code purples). A quantitative quality improvement study evaluated the training
investment. The study collected ED code purple and staff training data from November 2012 to October
2013. A regression model determined incremental training impact. There was a negative correlation
between violence and Nonviolent Crisis Intervention® training in the previous 90–150 days; regression
determined a 23% decrease in code purples, pursuant to training. Risk mitigation justified the facility’s
investment to continue Nonviolent Crisis Intervention® training. Training reinforcement at 6-month intervals
shall be implemented for continued benefit.

Walsh, R. J. (2010). School response to violence: A case study in developing crisis response teams.
Unpublished dissertation. Retrieved from gradworks.umi.com/34/08/3408495.html.

The author evaluated the perceptions of participants’ effectiveness to respond to student violence following
training in the Nonviolent Crisis Intervention® program. Participants reported feeling more effective,
consistent, proactive, calm, and confident to respond to violence in schools.

CPI’s Nonviolent Crisis Intervention® Training Program General Information and Empirical Support – © 2009 CPI (reprinted 2014). 15