Restraints

Question:

“I am looking for someone who can train my staff in the new techniques and laws for restraining.  Where do I seek out someone to do the training and certify my staff?”
 

Answer:

There are many different laws, policies and standards governing the use of restraint throughout the United States. Those that are set by governmental agencies typically only apply to organizations that receive public funding. Federal guidelines are very general, giving individual states the ability to determine specifically what they will allow. State laws and policies vary widely across the nation and there are different sets of requirements depending on the population (children, adults) and on the setting (schools, residential facilities, developmental services programs). Many states have different processes for setting standards and approving restraint training, although some states have no formal process or additional standards. State level decisions may be made by a department, appointed committee or sometimes a few specific individuals. In addition to state level requirements, there are sometimes local or district-wide polices that come into play. The result of all of this variability is that some schools (or other programs) are not allowed any physical restraint at all and some are allowed almost any kind of restraint. Some organizations or states may ban entire categories of procedures, e.g., floor procedures. Some states, such as Maryland, allow supine (upward facing) holds, but not prone (downward facing) holding. There is currently much debate about the adequacy of standards and many groups are calling for better and more standardized requirements. Standards and laws should be based on the recommendations of experienced and qualified practitioners, objective data, a consideration of both risks and benefits and an analysis of the effectiveness of practices, rather than on personal opinion or bias on the part of lawmakers.

 

Requirements

Requirements can often be confusing. Definitions of terms are not always clear and regulations can include procedures other than actual restraint. For example, many laws and regulations include seclusion in the same category as restraint, although they are quite different things. Most laws define restraint as restriction of movement by one person of another person that limits the individual's normal freedom of movement. There is both physical (also known as manual) and mechanical restraint (the restriction of movement by a device or object) and there are usually different laws regarding the two. Mechanical restraint is generally viewed as more restrictive and it is normally used in more restrictive settings.

Although regulatory language varies, there are some trends emerging as more standards are put into place. Most specify that restraint should not be used as a punishment, used for staff convenience, or used in place of behavioral programming. Most rules and laws use the language of "imminent harm to self or others" or the phrase "imminent death or serious bodily harm" to refer to appropriate criteria for initiating restraint. Restraints, in most states, can be used as part of a behavior program, but typically this requires approval of a local review committee and a human rights advocacy committee.

 

Choosing a Crisis Management Training System

Regarding the choice of a particular crisis management training system, again, different states have different rules. Some states require that crisis management training organizations meet very specific standards and submit their materials for review. These state approvals usually only apply to developmental services and not public education. Some states have a highly detailed and formal approval process, (such as Florida and Maryland) but many do not. Any system you choose should be staffed by highly credentialed individuals who understand all the intricacies and rules of different states and different organizations (schools versus developmental services). Also, it's very important that any crisis management system be flexible enough in the range of physical restraint procedures taught so that they can be used in your organization regardless of where your organization operates.
 

 Curriculum Content for a Crisis Management System 

Regarding the content of the curriculum for a crisis management system, there should not only be competency-based training, but it should include information on how to prevent crisis behaviors and de-escalate those behaviors that, if left unchecked, will lead to a crisis. The Professional Crisis Management (PCM) system of crisis management is more comprehensive than other systems which typically don't include prevention strategies. PCM is based on proven behavioral principles and positive behavior support strategies, but unlike other systems PCM applies learning principles such as shaping and fading even during the course of a physical intervention with an individual in crisis. Instead of using simple "restraint" the PCM system uses Dynamic Holding™, that changes in real time with moment to moment changes in the individual's behavior. This process results in the rapid stabilization of crisis behaviors and minimizes time in restraint.
 

Words of Wisdom

Whichever system your organization decides upon, make certain that the individuals who conduct training have expertise in behavior change, and not simply expertise in showing staff how to hold people. Try to find out if the training is a true certification overseen by a central organization or if the system just allows instructors to issue their own certificates to their participants. It's also a good idea to check out what kind of clinical support is available for issues that come up (and they always do) as your organization begins to use a new system. The PCM system of crisis management is led by behavior analysts with more than 70 years of combined experience working with children and adults with severe behavior problems.

   

For further information on any of the topics covered here, please contact us at www.pcma.com

About Merrill Winston, PhD, BCBA

Dr. Winston is a Board Certified Behavior Analyst with specialties in Developmental Disabilities & Behavior Disorders, Crisis Management Instructor Trainer & Consultant who specializes in the analysis and treatment of severe behavior disorders with special populations. His range of treatment experience includes feeding disorders, self-injury, severe aggression, language acquisition, and skill acquisition problems. Dr. Winston is a popular speaker at conferences and conducts presentations on a wide variety of topics in behavior analysis including psychotropic medication usage, mental illness, autism, exceptional student education, assessment and treatment of behavior problems, IEP goal selection and measurement, and a variety of conceptual issues as they relate to behavior.

 

About PCMA

The Professional Crisis Management Association (PCMA) has been providing crisis management and behavior analysis training, certification, consulting and technology-based solutions that help individuals and organizations since 1981. PCMA Board Certified Behavior Analysts are leaders in the field and have the skills and experience to help your organization and the people you serve succeed!

Professional Crisis Management (PCM), the flagship course offered by PCMA, is the most advanced, safe, ethical and effective crisis management system in existence.

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