An interview with Recornect founder, Erik Kuijpers
A CoWin system in an acute psychiatry unit generally has a positive effect straight away. But how does that work exactly? What does it demand of a unit and the staff? ‘If the staff understand CoWin well and successfully integrate it into the existing de-escalation policy, the results are significant and without exception, positive.’
What does the implementation of CoWin demand of a unit?
‘At present, a critical look is being taken at the coercion and pressure policy at many acute psychiatry and forensic psychiatry units. In the west, there's a clear trend in reducing forced containment, due to its inhumane character. Recornect's CoWin is a natural extension of this need. However, CoWin is not a top-down solution. It's a powerful de-escalation tool that supports the care team in curbing forced containments.There is, however, one important precondition: maximum support among the staff. I know from my own experience as a psychiatric nurse that it's important to have a say in new policy. That's why we have preliminary discussions with the staff early on in the preparatory phase, to talk in detail about the whole system. Our experience is that implementation is much easier after this preparatory phase.’
Do you often experience resistance among care staff?
‘On the contrary. I almost always experience a huge relief among the staff after a demonstration. There's often a strong feeling of powerlessness present when imposing coercion and pressure measures. CoWin feels like a kind of missing link to the staff. So they welcome our system with open arms. The only thing pretty much everyone wants to know is: can CoWin be easily destroyed? No, it can't. CoWin has been developed to meet the highest forensic security requirements, so I always invite everyone to do their worst with the screen - try and break it.'
Are there misconceptions about CoWin?
‘The major misconception I hear now and then is that we mustn't make containment too enjoyable. I find this to be a bizarre assumption and it has a slightly punitive undertone. It rests on the premise that we shouldn't reward someone who is psychotic and displaying very rebellious behaviour with an overly comfortable stay. If you look at how austere isolation units often are, they are actually not in line with the needs of someone who has a high level of energy. On the contrary, there is often a need for safety, human contact and the possibility of being able to leave that space soon. CoWin meets this natural need which is why we see that everywhere CoWin has been implemented, the duration of forced containments has been significantly reduced, because clients de-escalate faster.’
Is the CoWin a magic solution?
‘That's taking it a bit far, of course, but for some people, it comes close. The CoWin system achieves the greatest benefits if it is backed by a thorough understanding among staff. In addition to good technical understanding, it's important that CoWin is well integrated in an existing de-escalation policy. This varies from one organisation to another. We're seeing a trend towards safe wards, where security in the unit is a shared responsibility of both care staff and clients. In this way of shared decision making, containment forms the very last step in a stepped care model of early de-escalation. CoWin ties in perfectly with this way of working, with powerful results.'
Is it difficult to learn how to work with CoWin?
'When you buy CoWin, the purchase includes a training session. In just forty-five minutes, I will have explained the basics and I count another forty-five for the staff members who are responsible for uploading the material, for example, or for the personalisation for the clients. Incidentally, I always get asked during training whether a CoWin screen has open Internet. Of course it hasn't. Everything can be allocated, switched on or configured at client level and the staff control that. Plus, it all works pretty intuitively, so anyone who can work with a tablet can also work with CoWin. After that, it's just a matter of a whole lot of practising and applying it in practice. In most cases, CoWin has a natural place in the unit and everyone can work with it blindfolded.’
CoWin as a basic tool in the de-escalation policy?
'We believe so, in acute psychiatric care. The cost of system is recovered in no time, thanks to the preventive effect. And if containment does turn out to be necessary, the duration is significantly shorter.Because it feels more pleasant and safe thanks to a feeling of having control, clients get back the contact with themselves and others more quickly. We are of the opinion that CoWin is not a luxury or a comfort, but rather a very welcome basic amenity in the unit. Take, for example, airbags in cars. They used to be regarded as a luxury. But nowadays, if you were to buy a new car and it didn't have standard airbags, that would be unacceptable.'
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