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News & Views - Nov  2000 Issue #75

The Use Of Force And Restraint In
Wilderness Therapy Treatment Programs

By Michael Conner, Psy.D Mentor Research Institute
(541) 388-5660

[Dr. Conner, a clinical psychologist and former trainer for Oregon Law Enforcement, authored “Attack Risk” and “Communication Tactics to Manage and Diffuse Angry, Aggressive and Violent Behavior”, used nationally. He is consulting and developing training for Horizon Airlines to deal with “Air Rage.” Dr. Conner has National Board Certifications in Emergency Crisis Response, Emergency School Response, Traumatic Stress and Sports Psychology. Related articles by Conner appear on Woodbury Reports Online Opinion Section]

Justification For The Use Of Force

The public is rightfully concerned with the use of force or restraint, which may be necessary in the following roles:

·Emergency medical and rescue service
·Medical and mental health services
·Law enforcement
·Corrections, parole and probation

Wilderness therapy guides and instructors may also face oppositional, self-destructive and sometimes violent students. However, the risk of harm, injury or death can be very high in a wilderness program when employees use force in poorly designed interventions.

Though force and restraint are legitimate tools used by health care workers and public servants to maintain order, protect lives and insure public safety, its use in such settings is regulated. Many wilderness programs are not fully regulated, are not licensed, and their use of licensed, certified and qualified professionals can vary greatly. Ethical and professional standards of practice, including responsibility and liability for students’ well-being, are higher for professionals than unlicensed employees. Licensed and certified programs also have a higher level of accountability than unlicensed and uncertified programs.

In order to ensure accountability, there must be clear lines of authority, policies and procedures, and responsibility for the use of restraint or force in any program where employees presume to have the authority and responsibility of parents or legal guardians. Non-professional wilderness therapy staff have less authority to use force and restraint than parents, physicians and law enforcement. Wilderness therapy programs do not have the same disciplinary prerogatives and authority as parents.

Standards Of Practice In The Use Of Force And Restraint

I have worked in law enforcement, emergency rooms, medical hospitals, psychiatric hospitals, residential treatment programs, wilderness therapy programs and now the airline industry. I have been trained in the use of force and restraint as well as the personal, professional and legal consequences for the misuse of that authority. I have been involved in the use of force, and have crafted training in alternatives to its use. In all cases, the use of force and restraint must be necessary and justified by public policy and professional consensus. More importantly, licensed professionals are expected to act with compassion and to consider less dangerous or restrictive alternatives when ever possible.

Wilderness programs must legally and professionally articulate the basis of their use of force if used in response to staff claims that a student was acting in an unsafe or dangerous manner. Three critical questions are at the heart of this issue:

1. Did the student pose an immediate danger, risk of self-harm, attack or violence?

2. Can the evaluation of that threat or risk be articulated?

3. Were actions taken by employees valid, necessary and reasonable?

The answers to these questions are critical to managing personal and program liability, safeguarding a child’s health and emotional wellbeing, and ensuring that an employee’s career and life is not ruined. If not adequately answered, public opinions are formed based on appearances and incomplete information, potentially successful programs can fail, and criminal charges and civil law suits against employees and programs can ensue. The actual cause of injury is not necessarily limited to the staff who took action. Responsibility and accountability may rest with program managers and supervisors. And while the use of force may not be criminal, the misuse of force can be negligent, unwarranted and a dereliction of duty.

Law Enforcement and Corrections 

The behavior of law enforcement falls within the highest legal scrutiny and consideration of individual civil rights. Law enforcement can only restrain or use force to the degree necessary to address a clear and immediate danger, insure the safety of citizens, or enforce public policy, the law or legally authorized actions. Police officers cannot use their authority to limit the freedoms of children or adults without a basis in law, department policy and public policy. Law enforcement professionals are subject to internal reviews, checks and controls by public officials and citizens. Students in wilderness therapy programs are not automatically prisoners by virtue of their admission, nor are they under arrest. They have the same rights and freedoms as any child.

Medical and Mental Health Care. Medical and health care professionals, empowered by professional licensure and standards of practice, have the authority to use force as a medical necessity to insure safety, protect and save lives. Such actions are authorized with the same due diligence and responsibility as emergency surgery.

The use of force and restraint without public sanction or a legal basis is a violation of law and raises the matter of our constitutional rights. Just like law enforcement, medical and mental health professionals are subject to review procedures and they must be able to articulate, document and defend their actions. Children in a wilderness therapy program are patients who have rights. Admission to a wilderness therapy treatment program does not diminish those rights.

Wilderness Therapy vs. Boot Camp Programs 

The philosophy of wilderness therapy is to allow children to experience the force of nature as their teacher and to avoid staff use of force and restraint. Boot camp programs are designed and run with a high degree of interpersonal confrontation as well as physical and psychological aggression toward students.

Wilderness therapy programs are designed to create therapeutic opportunities and choices when students are confronted with nature and inevitable realities. The need to gather wood and build a fire to cook (i.e. wilderness) is different than screaming and intimidating a child if they don’t do what they are told (i.e. a boot camp). Obtaining control and compliance through the use of intimidation and coercion is characteristic of a boot camp program. Wilderness therapy and boot camps are distinctly different and incompatible approaches to working with youth. Programs that attempt to do both are on uncertain therapeutic ground or they are potentially dangerous. Interpersonal confrontation requires control, containment and medical contingencies.

Policy and procedures in wilderness programs are often vague and lack accountability. Wilderness program staff may lack the authority and ability to establish as well as enforce appropriate standards of practice. Although referred to as counselors, employees in programs might not be professionals or truly qualified for their duties. Those who are professionals may not be responsible and empowered to supervise therapeutic activities conducted by counselors, including the use of force.

The use of force and restraint in wilderness programs has become justified in some programs as a response to student defiance. Employees may become involved a use of force based on a rationalization that it was for “student safety.” The use of force for “student safety” could mean a student did not do what they were told and that a student’s refusal or argument represented some potential danger or future danger in the estimation of staff. Evidence and reason are crucial. If a student refuses to follow directives when there is a clear and immediate danger, one could be justified in taking steps to protect that child.

Force is a tempting response by staff in a wilderness camp when students are testing staff and increasing their defiance. The use of force fosters rapid compliance in behavior through a climate of coercion in which students fear the prospect of punishment, humiliation, loss of relationship, injury or pain. The use of force for behavior modification is a high-risk intervention and can result in an escalation of violence.

Escorting a child by force and then restraining that child because they choose to struggle against what they considered an assault by staff is not necessarily justified. Many children and students with behavioral problems will respond with force if they are feeling threatened, out of control, helpless, trapped or angry. These are predictable responses from children in wilderness and residential programs that carry tremendous responsibility when force is initiated by staff. There are first line alternatives far less threatening and dangerous than the use of force or restraint when students are defiant and oppositional.

Why Do Programs Use Force and Restraint? 

Programs rarely have policies and procedures that prescribe the use of force. But there are reasons for the use of force that are inferred from and supported by the observations of professionals and field staff.

-- The use of force fosters rapid compliance through coercion. Students who face the prospect of punishment, humiliation, injury, pain, as well the loss of freedom or relationship, will make different choices when in an environment from which there is no escape. But this is a boot camp response, not wilderness therapy.

-- The use of force can shorten the length of a student’s wilderness therapy program. Control and compliance by threats and force can be quicker than allowing the wilderness experience and program structure to change student behavior. Conflicts with nature are never personal and nature cannot be manipulated. Programs that are inpatient, poorly designed, have inexperienced staff or may not be qualified to work with more serious behavior problems are more likely to resort to force and restraint.

-- The use of force to manage inappropriate behavior is more cost effective in the short run than increasing the number of staff and the skill level of staff. Training in alternatives to force and restraint requires intensive education, practice and supervision.

-- The use of force can result from the frustration, fear and anger that builds in staff when working with youth at risk in remote wilderness environments. Staff burnout and emotional trauma is higher in programs that are immature, under-funded, poorly staffed and inadequately supervised. Stress, high staff turnover, financial problems, unclear treatment focus, as well as changing philosophy and management within a program are serious warning signs.

In Summary, the philosophy of wilderness therapy is to allow children to experience the force of nature as their teacher under the mentorship of wilderness guides and to avoid unnecessary confrontations that result in staff use of force and restraint.

Appropriate force and restraint can be used in a wilderness therapy treatment program in a clearly prescribed manner when there is a clear and immediate danger, for self-defense, and for insuring student safety and the safety of others.

The use of  force for behavior modification is a high-risk intervention and can result in an escalation of violence. Force should not be used as a “treatment option” or behavioral modification procedure without a specific order given by a responsible, qualified and licensed professional, who is adhering to policies based on behavioral, social and clinical science as well as professional consensus and public policy.

The use of force as a punishment or to gain compliance when there is no immediate danger and no treatment plan is not medically, legally or professionally justified. Financial decisions that affect training and supervision, as well as lack of funding, can increase the risk that force will be used.

The role of force in parenting is a decision that should be left to parents who will bear the personal and legal consequence for any abuse. There are alternatives to the use of force for defiance in wilderness therapy programs. But they are more expensive, sophisticated and labor intensive to develop and train staff to implement.

Copyright 2000, Michael G. Conner

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