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Office of Mental Health

Six Core Strategies for Reducing the Use of Restraint and Seclusion

The OMH Positive Alternatives to Restraint and Seclusion (PARS) initiative and the subsequent OMH Steering Committee to Promote Positive Therapeutic Environments have used and embraced NASMHPD’s The Six Core Strategies to Reduce the Use of Seclusion and Restraint.

In November 2012 the Substance Abuse and Mental Health Services Administration (SAMHSA) posted the Six Core Strategies for Reducing the Use of Seclusion and Restraint on its National Registry of Evidence-Based Programs and Practices (NREPP) Leaving OMH site.

The Six Core Strategies:
  1. Leadership Towards Organizational Change - emphasizing that efforts to create a violence free environment are most successful when facility executives provide guidance, direction, participation and ongoing review of the project, beginning with assuring that the facility’s mission, philosophy of care and guiding values are congruent with this initiative.
  2. Using Data to Inform Practice - monitoring performance and sharing data.
  3. Workforce Development - reshaping hiring, training and job performance practices to promote trauma informed, recovery-oriented, non-coercive care.
  4. Use of Seclusion/Restraint Reduction Tools - including trauma assessment, primary prevention and de-escalation strategies, and calming environments. Includes the use of:
  5. Consumer Roles in Inpatient Settings - providing full and formal inclusion of consumers and family members in a variety of decision-making roles in the organization.
  6. Debriefing Strategies - analyzing restraint/seclusion events to mitigate further trauma and to gain knowledge that informs policy, procedures and practices.

You can read a fuller summary in NASMHPD’s Consolidated Six Core Strategies Document PDF DocumentLeaving OMH site

The NASMHPD curriculum is designed as a two-day program of instruction. OMH has created a series of webinars based on the content of the NASMHPD program, along with two webinars on trauma and trauma-informed care.

Fundamental to implementing the Six Core Strategies is development of a comprehensive facility action plan. NASMHPD training in the Six Core Strategies culminates in the development by each participating provider of an action plan that addresses each of the Six Core Strategies. The action plan then guides the provider in implementing its various components. The second component in this toolkit, therefore, is a tool for developing a plan that addresses each of the Six Core Strategies.

This section is designed for providers who want to learn more about each of the individual elements of the Six Core Strategies.

Subsection 1 presents SAMHSA research on the Six Core Strategies as an evidence-based practice.

Subsection 2 provides an overview of the strategies.

Subsection 3 provides detailed information on each of the Six Core Strategies as well as on preparing an action plan that implements the core strategies. Materials presented here include webinars on each of the strategies, training modules developed by the NASMHPD NTAC/OTA faculty, PowerPoint presentations based on the NASMHPD material, and presentations by learning collaborative leaders and other experts.