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Opinion & Essays - Dec, 1999 Issue #64

When Restraints Are Necessary

By Christine Haggerty, 
Admissions Director
Cedar Ridge Residential Treatment Center
Roosevelt, UT 84066
(435) 353-4498

When parents consider placing a child in a residential treatment center, they might not contemplate that their childís behavior may require physical restriction or redirection (restraint). Even when parents do realize this possibility, they are often unfamiliar with the types of restraints used by various facilities, which might determine the appropriateness of such a placement for their child. Clarke Rossí article in the September (Issue #61) of Woodbury Reports suggests the following questions should be asked of potential facilities: 

Are physical and mechanical restraints used? 
At Cedar Ridge, we use a system of restraint, developed by David Mandt, who is experienced in psychological and physical intervention. The Mandt System emphasizes using an intervention that would initially avoid physical interaction. They would intervene using physical restraint only if it was deemed necessary in order to protect the student from either harming himself, other people or property. Cedar Ridge never uses mechanical or chemical restraints. 

Who authorizes the initial use of the restraint, terminates it, and authorizes its continuation? 
At Cedar Ridge, a staff supervisor or the senior staff on duty trained in the Mandt system determines the need for physical restraint when the studentís behavior threatens his or her own safety, that of others, or damage to property. Students are not restrained for being emotional or irrational, or for non-threatening physical movement. If a situation escalates so quickly that a senior staff or supervisor cannot respond before the crisis point, any other Mandt trained staff may initiate the restraint, and they may also continue or terminate the restraint after the student has been cycled to a point of no longer needing physical restriction or redirection. 

For what purposes are restraints used? 
There are three purposes for the use of restraint: 1) to protect the student from harming his or her self, 2) to prevent the student from harming others, or 3) to prevent the student from damaging significant property. Every effort is made to first handle the situation without physical intervention. 

What is the evidence-based peer-researched literature affirming the use of restraints? 
When possible Cedar Ridge uses the Mandt Manual in Training Restraint and as a guideline during a situation. Although every situation is unique, Cedar Ridge staff does their best to respond effectively to the situation and the student to minimize the necessity of physical intervention. 

Are people who apply restraints trained to attempt alternative methods prior to using restraints and are they trained in appropriately applying the restraint? 
All staff at Cedar Ridge are currently being trained according to the Mandt restraint system, which emphasizes dealing with situations non-physically before using physical restriction or redirection. Staff members use the minimum physical contact necessary to maintain control of the situation and discontinue the physical intervention as soon as it is no longer required. 

The Mandt system outlines several points of contact, such as pressure points and joints, which are to be avoided during a restraint. Cedar Ridge staff do their utmost to follow these guidelines. They are also trained in the correct positions/postures of contact when restraining the student in order to restrict them as little as possible and still maintain control of the situation. 

How many students during the past month and the past year have been placed in restraints? 
Cedar Ridge staff have restrained one out of twenty-six students in the past month and eleven students out of thirty-six students in the past year. 

Were there any deaths and serious physical injuries associated with restraints during the past month or year? 
During the three years Cedar Ridge has been therapeutically working with students, staff and students have nothing more serious than the minor discomfort of some bruising and scrapes. Cedar Ridge staff consider safety to be the first consideration in all situations. 

Are parents notified when their child is placed in restraint? 
Parents are notified in a timely manner by the staff, case manager, or therapist, after a student has been restrained. 

Are the children debriefed after the restraint episode has occurred? 
Feedback from their peers, staff, and therapist, we process all sides of the situation. We consider parents to be part of the debriefing process, and we work through any effect it has on them as well as on the student. 

We still encourage parents who are researching programs to ask questions concerning each oneís guidelines for the use of restraints, as programs may vary in their philosophy and procedures. We emphasize respect between the student and staff in situations where restraint may become necessary, and have found a quote from Haim Ginot adapted for the Mandt Manual which we apply to daily life at Cedar Ridge:

ďIíve come to the frightening conclusion that I am the decisive element in my _________. Itís my personal approach that creates the climate. Itís my daily mood that makes the weather. I possess tremendous power to make ____________ís life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humor, hurt or heal. In all situations, it is MY response that decides whether a crisis will be escalated or de-escalated and a person humanized or dehumanized.Ē

Copyright © 1999, Woodbury Reports, Inc. (This article may be reproduced without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)

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