Raymond Cintrón, head of Crisis Intervention Team in Psychiatry Dept. of Elmhurst Hospital

When Hospital Peace Officer Raymond Cintrón began his work nine years ago, the goal was to maintain safety without today's focus on partnering with patients in their care. Cintrón used to break up fights to keep order but was exhausted and frustrated from what he says was a "mind-set of detachment" from patients. Then he did one thing to help bring more peace: he took off his uniform.

Cintrón's transformation was more than about changing clothes. It represented a broader effort to change the culture of HHC psychiatric services with the adoption of a number of patient-centered strategies: redesigning the role of hospital police, reducing the use of seclusion and restraint, and developing comprehensive crisis response with multi-disciplinary teams of doctors, nurses and behavioral health associates and technicians.

"Patients saw the uniform as a threat. As the person who was there to simply restrain them or enforce the rules," says Cintrón. "Now my approach is to show empathy, to be their ally. We talk a lot. We negotiate."

Cintrón is one of dozens of specially-trained staff, called Behavioral Health Associates, who have both clinical and security training, and have helped the psych departments at a number of HHC hospitals, including Elmhurst Hospital and Kings County Hospital, to radically change how crisis intervention is handled. Both hospitals have removed traditional hospital police from inside the psychiatric units and call on them only in rare cases.

The non-uniformed Behavioral Health Associates are part of Crisis Intervention Teams that are called upon to assist patients at the early signs of agitation. They work as part of the nursing divisions of Psychiatry and bring a balanced understanding of how to care for patients in highly volatile situations.

HHC's work to improve safety in psychiatry units was recently recognized by the National Association of Public Hospitals and Health Systems with a Safety Net Award for "Improving Patient-Centered Care…Reducing the Use of Seclusion and Restraint in Psychiatric Emergency and Adult Inpatient Services."

As a Behavioral Health Associate, Cintrón, learned about behavior modification and de-escalation techniques. He says he also learned to listen.

"Our patients get upset over things that could get anybody upset," says Cintrón. "Once, one of our patients was told he could not be discharged as he expected. He lost it. I talked to him and found out he was worried about his daughter. So I made contact with his daughter to make sure she was ok and I explained his discharge plan. That made a big difference."

In March 2009, Cintrón became Assistant Director in the Psychiatry Department at Elmhurst and head of the Crisis Intervention Team. The patient-centered care strategy practiced by these teams focuses on a more proactive approach to treating patients while maintaining the safety of staff and other patients and is the most compassionate care possible.

"Clearly, the team has had a significant impact on creating a safer inpatient service and has reduced the incidence of violence," said Dr. Charles Barron, Director of Psychiatry at Elmhurst Hospital Center. "The team has screened 2,010 patients and responded to 231 specific potentially violent situations. The team has responded to 665 requests for early intervention where the potential for violence existed. We are finding patients are more often gaining control with appropriate crisis intervention and can cooperate with their plan of care to form a better therapeutic bond."