CVPSD The Joint Commission R³ Report: New and Revised Restraint and Seclusion Requirements For Behavioral Health Care And Human Services

ALIGNMENT TO CENTER FOR VIOLENCE PREVENTION AND SELF DEFENSE (CVPSD) TRAINING PROGRAMS

Effective January 1, 2025, The Joint Commission has introduced new and revised requirements for behavioral health care and human services organizations that use restraint and seclusion. This fully revised and updated guidance fully replaces the previous standards, aiming to reduce redundancies, streamline processes, and remove the requirements around physical holding of children and youth in these settings.

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Additionally, The Joint Commission has refined its definition of restraint to make clear which practices do, and do not, meet the criteria for restraint. As a result, the revised restraint and seclusion requirements only apply to physical interventions covered under the updated definitions of restraint and seclusion.

UPDATED REQUIREMENTS	CVPSD ALIGNMENT
The Joint Commission R³ Report June 20, 2024 Effective Date: January 1, 2025 New and Revised Restraint and Seclusion Requirements for Behavioral Health Care and Human Services Organizations The new requirements, standards, and elements of performance (“EPs”) apply to behavioral health care and human services organizations that use restraint and seclusion.	Center For Violence Prevention And Self Defense (CVPSD) provides comprehensive crisis prevention training aligned to the new and revised Joint Commission standards for behavioral health care and human services organizations.
Standard CTS.05.05.05 Staff are trained and competent to minimize the use of restraint and seclusion and, when use is indicated, to use restraint or seclusion safely.	Center For Violence Prevention And Self Defense (CVPSD) utilizes a trauma-informed, person-centered approach that equips staff to recognize and evaluate potential workplace violence risks. This training emphasizes proactive strategies, including verbal de-escalation and escaping unwanted contact techniques, that are alternatives to more restrictive physical interventions. CVPSD also enables staff to address situations that may escalate beyond preventative measures. When necessary, physical holding skills are introduced as a last-resort intervention. CVPSD utilizes evidence-based curriculum to educate each participant on the risk of restraint and provides a framework to support safety-oriented thinking and decision-making. Each participant is required to complete learning checks to demonstrate competency in each module of the CVPSD curriculum.
EP1 The organization trains staff on the use of restraint and seclusion and assesses their competence prior to participating in the use of restraint and seclusion and on a periodic basis thereafter.	CVPSD does not include the use of seclusion in its instruction but recognizes seclusion is utilized in various settings as part of a comprehensive approach to mitigating workplace violence. CVPSD utilizes a Train-the-Trainer model as the primary delivery vehicle for in-person learning. Certified CVPSD Trainers are evaluated on their ability to apply physical skills safely and effectively. Rigorous performance-based standards are maintained. CVPSD Trainers also receive standardized performance-based resources to assess the competency of the staff they train, ensuring each team member can demonstrate these principles. Decisions regarding seclusion remain subject to each organization’s policies and procedures, and CVPSD Trainers are empowered to adjust the curriculum accordingly. CVPSD requires a refresher training every 6–12 months and strongly encourages more frequent ongoing practice to maintain skills and reinforce safe intervention strategies. Organizations are also encouraged to engage in less-formal practice of CVPSD physical techniques whenever the opportunity presents itself.
EP2 Any staff involved in the use of restraint or seclusion receive education and training and demonstrate knowledge focused on the following:	The following sub-elements detail how CVPSD training addresses each required area of knowledge:
•   Strategies to identify behaviors of staff and individuals served, events, and environmental factors that may trigger circumstances that require the use of restraint and seclusion	CVPSD examines the impact of trauma and the brain’s stress responses on individuals in crisis, as well as on the team members caring for them. By exploring activating events (antecedents), CVPSD training guides participants to better understand how these influences shape the behavior of both staff and the person in crisis.
•   Recognizing how factors such as age, developmental considerations, gender, ethnicity, history of abuse, etc. may affect the way in which an individual reacts to physical contact	CVPSD thoroughly addresses compassionate communication strategies, centered around applied empathy. CVPSD training emphasizes how factors such as an individual’s age, cognitive functioning, existing diagnosis, cultural background, environmental factors, and history of trauma can profoundly influence communication and must be taken into account.
•   Use of nonphysical intervention skills	CVPSD emphasizes identifying the earliest warning signs of distress and micro-escalations, which warrant a situation-appropriate response of providing immediate, supportive intervention. Team members learn to maintain applied empathy when setting limits, redirection to reduced-stimulus space, effective communication, and team coordination, as well as to adjust atmospherics to enhance the safety climate. There is clear focus on reflective listening and holding boundaries in ways that maintain the dignity and respect of individuals. A core theme is empowering professionals to work around power struggles.
•   Methods of choosing the least restrictive intervention based on an assessment of the behavioral or medical status or condition of the individual served	With CVPSD, safety-oriented decision-making is to be maintained at all times. This considers the likelihood of a behavior and the potential severity of any harm. This systematic approach helps professionals remain objective, safeguarding from emotional overreaction or underreaction, and ensures that physical techniques are used only as a last resort. When evaluating behavior, staff assess the level of imminent harm and its probable outcomes. More restrictive interventions may only be employed when less restrictive interventions have been exhausted and there is clear evidence of imminent harm.
•   Safe application and use of all types of restraint or seclusion used in the organization, including training in how to recognize and respond to signs of physical and psychological distress	CVPSD interventions are engineered to reduce risk of injury to individuals and staff. They are minimally invasive and do not manipulate joints or utilize pain compliance. All CVPSD techniques have been independently reviewed by panels of doctors (kinesics review) to make an accurate determination of their level of risk to a person’s airway and physical injury. Independent review of the psychosocial risk has also been conducted and factored. No physical intervention is free from risk and CVPSD provides solutions that best mitigate the risk of physical intervention when the need is inescapable.
•   Identification of specific behavioral changes that indicate that restraint or seclusion is no longer necessary; Monitoring the physical and psychological well-being of the individual; Recognizing when to contact a medical professional	Certified CVPSD Trainers are coached and provided with framework for how to instruct CVPSD physical holds in a way that effectively transfers learning, anticipates incorrect application of technique, and supports performance-based assessment. This instruction includes when restraint is no longer necessary (Signs of De-escalation and Releasing) and specific guidelines for monitoring an incident of restraint. Specific guidelines for when to contact a medical professional and when to immediately discontinue the use of restraint are also included in CVPSD instruction and appear redundantly in all CVPSD trainer manuals, teaching guides, participant guides, and supporting documents. This portion of the CVPSD curriculum is written as policy and procedure.
EP3 Staff providing training in restraint and seclusion have education, training, and experience in the techniques used to address behaviors of individuals served that necessitate the use of restraint and seclusion.	CVPSD primarily uses a Train-the-Trainer (TtT) model for in-person learning. The CVPSD TtT model ensures the fidelity of the program that Certified CVPSD Trainers will deliver to the staff of their own organization. Through structured presentations, real-world examples, hands-on practice, and performance-based assessment, participants gain practical skills that are proven to prevent and mitigate workplace violence.
EP4 The organization documents in staff records that restraint & seclusion training and demonstration of competence were completed.	Found within the CVPSD Trainer Portal are staff training documents, certificate templates, and performance-based reviews that allow organizations to maintain accurate and defensible records of training and performance-based certification.
Standard CTS.05.05.07 The organization takes action to reduce the need for restraint and seclusion.	CVPSD’s training programs are designed to empower organizations with the proactive tools, communication strategies, and risk-assessment frameworks needed to minimize the use of restraint and seclusion. The elements below describe how CVPSD instruction addresses each performance element.
EP1 To minimize the use and impact of restraint and seclusion, the organization performs an initial assessment on an individual who is at risk of endangering themselves or others and identifies the following: •   Techniques and/or tools that would help the individual •   Signs of escalation, to prevent reaching the point of imminent risk •   Interventions that preserve the dignity of the individual if placed in restraint and seclusion •   Preexisting medical conditions or any physical, intellectual, developmental or cognitive disabilities and limitations that would place the individual at greater risk during restraint and seclusion •   History of sexual or physical abuse or other trauma that would place the individual at greater psychological risk during restraint and seclusion	CVPSD provides instruction that empowers participants to maintain person-centered communication, a nonjudgmental attitude, and a strength-based approach to all individuals. The intention is to provide solutions that help and support individuals on a day-to-day basis as well as when behaviors escalate. CVPSD provides instruction in recognizing micro-escalations (early warning signs) and provides intervention solutions at each stage along a continuum of behavioral escalation. Empowering professionals to recognize these early warning signs, thus triggering early intervention, enables co-regulation. This is what prevents escalation to the point of imminent risk. CVPSD maintains a trauma-informed approach to behavioral intervention (TRUST Model), which honors the reality of trauma survivors, and maintains this approach during acute crisis intervention. CVPSD’s commitment to applied empathy and the design of its physical intervention solutions makes any action that does not preserve the dignity of a person in crisis out-of-bounds per the CVPSD model. CVPSD publishes a formal zero-tolerance policy for any type of staff counter-aggression or abuse, be it physical, emotional, or psychological. CVPSD instructs participants to factor preexisting medical conditions, disabilities, and trauma history within safety-oriented decision-making. These factors are addressed with Person-Centered Planning as well as The Risk of Restraint and Safety Briefing components of the CVPSD curriculum.
EP2 Whenever possible, the organization uses nonphysical techniques based on the initial assessment in managing behaviors of individuals served. EP2 Note 1 Such techniques may include implementing a crisis response plan, redirecting focus, employing verbal de-escalation and positive behavioral support or using sensory modulation.	CVPSD utilizes a trauma-informed, person-centered approach that equips staff to recognize and evaluate potential workplace violence risks. This training emphasizes proactive strategies, including verbal de-escalation and escaping unwanted contact techniques, which are alternatives to more restrictive physical interventions. CVPSD enables staff to address situations that may escalate beyond preventative measures. When necessary, physical holding skills are introduced as a last-resort intervention. CVPSD emphasizes identifying the earliest warning signs of distress and micro-escalations, which warrant a situation-appropriate response of providing immediate, supportive intervention. Team members learn to apply empathy, redirection to reduced-stimulus space, effective communication, and team coordination, as well as to adjust atmospherics to enhance the safety climate. Verbal and nonverbal de-escalation skills are included throughout instruction.
Standard CTS.05.05.09 The organization assesses and monitors the individual in restraint or seclusion.	CVPSD instructs participants to factor these considerations within safety-oriented decision-making. These factors are addressed with Person-Centered Planning as well as The Risk of Restraint and Safety Briefing components of the CVPSD curriculum. A trauma-informed approach is maintained before, during, and after an incident of behavioral escalation. CVPSD instruction includes procedure for addressing hygienic concerns, such as evacuation of waste and signs of de-escalation and releasing from a CVPSD physical hold.
EP1 These assessments and interventions include the following, as relevant: •   Assessing for signs of injury •   Addressing nutrition and hydration status •   Assessing physical and psychological status and comfort •   Assessing hygiene and elimination needs •   Addressing readiness for discontinuation of the restraint and seclusion	CVPSD’s curriculum addresses all of these monitoring elements within its safety-oriented decision-making framework and Person-Centered Planning appendix. Specific guidance on monitoring during a restraint, addressing hygienic needs, and assessing readiness for discontinuation are included in CVPSD trainer and participant materials.
Standard CTS.05.05.015 Restraint and seclusion use are discontinued when the individual served meets the behavior criteria for discontinuation.	CVPSD instruction includes critical communication, specific considerations, and procedure for the duration of an incident, as well as how to intentionally release or discontinue a CVPSD hold. The CVPSD program provides guiding framework that addresses this standard and minimizes the risk of longer-than-necessary incident duration. CVPSD instructs and expects (by way of policy and procedure) for participating organizations to communicate the safety concern and criteria for discontinuation to the person held in restraint, in line with this standard.
EP1 As early as feasible in the restraint and seclusion process, the individual is made aware of the rationale for restraint and seclusion and the behavior criteria for its discontinuation. Restraint and seclusion are then discontinued as soon as the individual meets the criteria.	CVPSD’s guiding framework directly addresses this requirement. Participants are instructed to communicate the safety concern and behavioral criteria for release to the individual, and to discontinue the hold as soon as those criteria are met. This is written as policy and procedure within CVPSD instruction.
Standard CTS.05.05.017 The individual served and staff participate in a debriefing about the restraint or seclusion episode.	CVPSD stresses the importance of thorough post-incident debrief and documentation whenever physical intervention was used. Incident debriefs and documentation are included in CVPSD instruction in line with this standard.
EP2 The debriefing about each episode of restraint or seclusion is used to do the following: •   Identify what led to the incident and what could have been handled differently •   Ascertain that the physical well-being, psychological comfort, and right to privacy were addressed •   Counsel the individual served for any trauma that may have resulted from the incident •   Assess the impact of the restraint or seclusion episode on their behavioral functioning •   When indicated, modify the individual’s plan for care, treatment or services	CVPSD stresses the importance of thorough post-incident debrief and documentation whenever physical intervention was used. This process includes fostering a better understanding of the event from the individual’s perspective, providing the necessary support for the person held in restraint in the moment, and reestablishing rapport with the intention of avoiding future escalation.
Standard CTS.05.05.019 The organization documents the use of restraint or seclusion.	The CVPSD program provides instruction on post-incident procedure that includes documentation. Participants are coached on how to draft an objective record of the incident within a form that supports the aggregation of data for review and assessment. This supports a process of continual improvement and informs adjustments to individual behavior plans as well as organization-wide policy and procedure. CVPSD provides the necessary instruction and templates for incident documentation.

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