Calm in the Chaos: The Role of Mindfulness in De-escalation

by | Jan 7, 2025

In education, healthcare, and other human services settings, interactions between staff and service recipients often occur during moments of high stress and vulnerability. These situations can escalate quickly, sometimes leading to dangerous circumstances. When staff feel they have exhausted less restrictive strategies, they may resort to restraint—a practice that carries significant risks for everyone involved. For individuals receiving services, restraint can result in physical harm and emotional trauma. For staff, it increases the likelihood of injuries and contributes to burnout and turnover. Historically, these practices have also been overused, often as default responses to challenging behaviors. In response, many advocates and researchers have called for reductions or even the elimination of restraint as a means to deal with challenging behavior (Weiss, 1988).

While the negative effects of these practices are well-documented, this raises a critical question: How can we reduce their use while ensuring the safety of both staff and those they serve? What strategies can be implemented to decrease the use of restraint in human services settings?

Mindfulness in Human Services

In recent decades, research has increasingly focused on organizational interventions to reduce restraint and seclusion. Some efforts have involved changes in policies, mandatory behavioral consultations, or organization-wide change initiatives. While many of these approaches emphasize teaching skills to the individuals receiving services, others focus on changing staff behavior to create safer environments.

One promising area of research involves mindfulness training for staff. Mindfulness, the practice of maintaining present-moment awareness while calmly acknowledging and accepting thoughts, feelings, and bodily sensations, has shown significant potential in clinical and human services settings. For staff, mindfulness helps regulate emotions, reduce stress, and respond to challenging situations with clarity and empathy. By fostering these skills, mindfulness promotes more collaborative relationships with individuals served and reduces the likelihood of reactive or counterproductive behaviors.

Evidence for Mindfulness Training

A study by Singh et al. (2009) offers a compelling example of how mindfulness training can reduce the use of restraint and seclusion. The researchers conducted a 12-week training program for staff at a residential facility, which included two-hour weekly sessions on mindfulness concepts and skills. Here is a selection of key topics that were included:

  • Introduction to Mindfulness: Staff were introduced to mindfulness concepts, such as observing thoughts and recognizing instances of mindlessness in interactions.
  • Awareness of Arousal States: Staff explored how their physiological and emotional states influenced their interactions with residents.
  • Non-Judgmental Acceptance: Training included practices that encouraged acceptance and non-judgment during challenging situations.

The results of this study were striking. Following the training, the use of restraint dropped significantly. These outcomes align with a broader body of research summarized in a systematic review by Sturgeon (2023), which found that mindfulness training substantially reduced instances of restraint in residential group homes for individuals with intellectual disabilities.

Additional positive outcomes noted across studies include:

  • Significant decreases in the use of emergency (PRN) medications.
  • Lower rates of seclusion in facilities that tracked this outcome.
  • Increased positive interactions between staff and individuals served.
  • Reduced incidents of aggression.
  • Improved achievement of learning objectives.
  • Greater participation in social and community activities.
  • Enhanced subjective happiness observed in staff and individuals served.

These positive results were even found when mindfulness-based behavioral training was compared with training in traditional positive behavioral supports in a randomized controlled trial (Singh et al., 2020). Although the research is still emerging, these findings highlight the potential of mindfulness to significantly impact human services settings, fostering safer and more respectful environments for everyone involved.

Connections to Safety-Care

So how does this connect with Safety-Care?

At QBS, we emphasize the use of least-restrictive interventions to address challenging behaviors. Safety-Care is designed to ensure that physical management is used only when there is an immediate risk of serious injury and when all other less restrictive interventions would be ineffective to ensure the safety of everyone involved. Many of the strategies discussed and taught in Safety-Care align with the concepts expressed in the mindfulness training outlined above.

A key component of Safety-Care involves helping staff develop awareness of their own triggers (environmental events that provoke emotional or physiological reactions) and signals (behavioral responses to those triggers). By cultivating this self-awareness, staff are better equipped to respond effectively to clients’ behaviors, avoiding escalation and fostering positive interactions.

Mindfulness training often includes practices like mindful breathing and other coping strategies to help staff manage stress during incidents. Similarly, Safety-Care emphasizes building resilience—the capacity to adapt effectively to stress and adversity. Staff are encouraged to engage in resilience-building strategies, such as ensuring adequate rest and nutrition, seeking support when needed, and using personal coping mechanisms. These practices help staff maintain composure and effectiveness in challenging situations.

Prevention is another foundational principle of Safety-Care. Staff are taught that their behaviors should always communicate respect and promote the dignity of the individuals they serve. This includes being mindful of their communication style, posture, and physical interactions. Research by Singh and colleagues supports this focus, showing that mindfulness training helps staff behave in ways that are more positive, flexible, and less likely to trigger challenging behaviors.

Another notable finding from mindfulness studies is a reduction in power struggles between staff and individuals served. Staff trained in mindfulness were observed to intervene less frequently during verbal altercations, reflecting fewer attempts to control behavior through ineffective strategies. This aligns with Safety-Care’s emphasis on avoiding power struggles, which often escalate situations rather than resolving them. Instead, Safety-Care encourages staff to focus on support rather than control, creating a more respectful and collaborative environment.

The Path Forward

While more research is needed, the evidence so far underscores the transformative potential of mindfulness training in human services settings. By equipping staff with tools to manage their own stress and respond to challenging behaviors with empathy and clarity, organizations can reduce reliance on restraint and other more highly restrictive interventions while enhancing safety and well-being for everyone involved.

Mindfulness training, when integrated into frameworks like Safety-Care, offers a pathway to not only improve staff-client interactions but also to create environments rooted in respect, dignity, and mutual support. As the field continues to evolve, adopting evidence-based practices like mindfulness can help advance the shared goal of reducing harm and fostering positive outcomes for all.

References

Singh, N. N., Lancioni, G. E., Medvedev, O. N., Myers, R. E., Chan, J., McPherson, C. L., Jackman, M., & Kim, E. (2020). Comparative effectiveness of caregiver training in mindfulness-based positive behavior support (MBPBS) and positive behavior support (PBS) in a randomized controlled trial. Mindfulness, 11, 99–111.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, A. N., Adkins, A. D., & Singh, J. (2009). Mindful staff can reduce the use of physical restraint when providing care to individuals with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 22, 194–201.

Sturgeon, M. (2023). The impact of mindfulness interventions for staff on the care, treatment, and experiences of people with intellectual disabilities: A systematic review. Journal of Applied Research in Intellectual Disabilities, 36, 978-999.

Weiss, E. M., McDonnell, A., Easton, S., & Sturmey, P. (1988, October 11). Deadly restraint: a nationwide pattern of death. Hartford Courant, pp. A1–A11.

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