Advice on Current Restraint Programs

Many organizations face a serious dilemma around restraints and, more specifically, restraint programs. Any restraint program you adopt should be thoroughly evaluated both for the skills it uses, and the philosophy it espouses. This philosophy must agree with your organizational values and the regulations you must operate under. However, before you can assess the fit – and fitness – of a restraint program, you must examine your own organization.

What is the overarching and cohesive philosophy under which your organization operates? Understanding this will form the basis for your thinking about improving the system – the system inside of which your staff members restrain the people you serve. Here are some elements to consider:

• Do we have a therapeutic goal?
• How do physical restraints, chemical restraints, mechanical restraints and seclusion fit in that goal?
• Do we have a mandate to keep people safe from themselves and each other?
• If those three elements collide, what guidance do we give our direct care staff and supervisors?

Before thinking about the physical portion of your course, step back and think about the entire spectrum of behavior you encounter. Not only do you need long, medium, and short term strategies in your plan, these strategies must be consistent.  You want the same message going out to all staff at all times. We recommend this message: "You must be both humane and effective – and have minimum impact on everyone and the environment at all times."

Here are some suggested strategies that may help you achieve your goals:

• Long term strategies:
  • Recognize and respond to the positive aspects in the lives of those you serve.
  • Develop positive, powerful relationships with them.
  • Find ways to help the people you serve to obtain, maintain, and enhance the richness of their own lives.

• Medium term strategies:
  •  Learn to assess and prevent aggressive behavior earlier with less effort and impact.
  • Create a daily environment where problems are less likely to happen.
  • Plan to respond safely when problems do occur.

• Short-term strategy: Develop, implement and enforce the use of safe and humane physical intervention practices and procedures in emergency situations.

Following these steps will put you on a path of fewer restraints. Strategies are nice, but you also need to look at some specific things in your procedures.

Any physical intervention should be a very last resort. You should have tried, and failed, at a number of less restrictive measures.

Many escort techniques are truly restraints - and any restraint should only be considered when less forceful methods have failed.

In order to reduce restraints, your people must be trained in a handful of specific restraint avoidance procedures.

You should have standard procedures and techniques that are appraised at each post-incident review; this requires staff to brainstorm, consider, and implement, less restrictive measures next time.

When choosing a method of restraint, keep in mind that staff control is not the top priority – the top priority is the physical and emotional safety of all concerned. In other words, is everyone safer – physically and emotionally – because we applied the restraint?

Well-done training and continuous practice is the only way to attain and maintain competence. Don't skimp on training and practice time. Staff members who put their hands on people should be well-trained and should frequently practice the skills they will use. Remember, this can be very dangerous!

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