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Restraint II

As a Child and Youth Care student I had never seen restraints happen until I began my practicum. Now I usually see at least one per day. I have been struggling with the importance of restraints and when they are truly needed. I find that they are a form of control and strength and power but are needed in many scenarios. For almost all of the restraints I have seen I feel that they did need to happen.

 I do notice though that once you touch a child in that way he/she immediately escalates and the behavior becomes completely out of control. I think that it is important to first try and calm the child down before a person does a restraint. I understand that if the youth is going to hurt themselves or others then a restraint needs to happen immediately. But if a youth is saying "no" to something that they don't want to do of if they are acting up then I feel that a restraint should not happen. If anyone has feedback on this subject I would love to hear it.

Jocelyn Hull
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In response to the issue of restraint, many times the staff enter into power struggles with the children and when the child continues to be noncompliant, I have seen staff restrain a child in order to save face, to prove that they are the ones with the upper hand. We have been struggling with this issue for a long time.

Through extensive training about the emotional, psychological and physical effects of restraint and seclusion, staff begin to realize the effect this has on a child's life. I have created a focus group with the residents on the issues of restraints and it is very scary. Many of the residents would rather be restrained than watch another child be restrained. The children have experienced physical and emotional abuse in their past and to be exposed to this triggers past memories.

Working with at risk populations, I see a need for restraints only when the child is out of control and is a danger to themselves or others. If a child throws a chair, tears down some pictures or kicks his/her door, many times they need an outlet for their anger and I agree, restraint only escalates a child. The key to reducing the incidences of restraint and seclusion is the relationship between the staff and the child. The child needs to be able to convey to the staff when they are out of control and work on a way that will prevent further outbursts. There are too many deaths resulting in restraints and the answer to the problems is knowing your children and building open, positive relationships.

Matt Fox
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Jocelyn,

I have never seen a restraint happen before, but many of my colleagues and fellow students have. So I guess my question to you is : when is a child or youth at risk of hurting themselves or others? Who makes this judgment call? Many of the students in our practicum class have voiced the concerns they have about restraints. In our day and age I do not see why we must use such overbearing barbaric techniques to control our troubled children and youth. I understand that in a lot of cases using a restraint would be a last case scenario, but if they are happening on a daily basis I can not see how this would be beneficial to the client or to the staff. What happens to the relationship after they have been restrained? and if this is a regular occurrence than it is obviously not very effective.
 
Thanks.

 Sarah Wahl
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I too am a Child and Youth Care student in Toronto, and agree with Jocelyn. I am graduating in the spring, and do feel as though restraints are used unnecessarily depending on the staff. This can happen for a number of reasons. First and foremost, restraints should only be used if the child is at risk of hurting himself or other people, and de-escalating does not work.

 With that being said, Jocelyn pointed out about power and control. This is true. Perhaps workers become frustrated with the same child over and over again, and instead of de-escalating the behaviour they skip right to physical intervention. Some staff are improperly trained as well, and use restraints as their only form of intervention, even though it should be the last.
 
In some regards, children may use physical restraints as a way of feeling needed and get the attention they want. I know this from experience. Last year a child would purposely get into a restraint before bedtime so he could be close with the staff on shift. This was affection to him, because he never received it at home. In this circumstance, we as staff taught him the proper way to show affection and to feel wanted - rather than having a tantrum to get physically held.
 
I am all for physical restraints, especially in the hospital setting where I am, but other forms of intervention need to happen first before the child is physically restrained.
 
I would love to hear comments - feel free to e-mail me or post a message!
David Brennan
Toronto, Ontario
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Jocelyn,

I have never seen a restraint done either and even in practicum placement I have not seen one, must because the children in my placement are not a risk to themselves or others. I do however, understand what you are saying about how sometimes you feel that your placement is using them unnecessarily. I think that I would struggle with that as well, I feel that if a child feel threatened that they are going to act out and become more aggressive. The biggest thing that would concern me about your position is that from the sounds of it the workers at your placement are using restraints as the only way to deal with behaviors. I personally feel that a restraint should only be used in very selective situation when the child is at great risk of hurting themselves or someone else. Even then if it can be avoided it should be. I guess that is a question that you have to ask is why are they using them and are they really working, if it is not helping the child relax, what is it doing?

 Lisa Dempsey
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Jocelyn,
 
I myself have never seen a restraint happen before I started my practicum. I have heard about them lots, but to see one in my opinion, can be a frightening experience for the child. I also wonder if restraints can be form of control and power, but at the same time this can sometimes seem necessary. I think that restraints should only be used as the very last resort for a child. Sometimes children and adults need to express their anger. The children that we are working with need to be able to express their anger, but at the same time learn how to cope with these frustrations in a safe and positive manner.

It is always so important to remember why a restraint is being done, and to make sure that it is done in a safe and respectful way. I have watched it done a few times, and I have been pleased to see how safe and gentle the children are handled and spoken to. I also found it interesting to see that a child can go from having an extreme outburst of anger, to being restrained then being calm and happy again. I guess a good point to remember is that Marlene has taught us that children need and crave consequences, and if the consequences are done in a positive and safe manner, the child can benefit greatly from them.

Thank you for bringing up a concern that many of us, new to this topic, may have as well.
 
Candice Klebe
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Sometimes it seems there are additional risks to allowing children to attempt to vent an emotional state through an aggressive act. Having seen many self inflicted injuries by the youth in my care I question the safety of free physical aggression on inanimate objects. 400 stitches to put a child together after he jumped through a window or holding the arm while a co-worker held the other above the youths heart to slow the blood until we arrived at the emergency room come to mind. Packing innumerable toes in ice that broke when the door or wall refused to relent to the force of the venting also come to mind. I agree if they are smashing models or ripping paper that is one thing, but I feel it is safer to stop the youth from hurting themselves and try to hang on to the emotions for exploration.

 Passion and intensity in an immature individual can some times put our children at greater risk than being gently held and as Nancy Vogel taught me to blend with the movements of the resistance. In this rhythm sometimes all that show gives way to fear and vulnerability which are difficult issues when you know you are invincible like some of the people I have met over the years. In an environment where safety is the issue not power it is safer to restrain.

 Technique is interesting because it is usually those unwilling to dirty their hands that must spend their time criticizing those that do. But if you ever want to help a child walk through the opportunity and risk of a crisis be there when they can describe without hesitation why it is more valuable to be held and reassured than it is to destroy themselves. We work in an environment where we have to document the legalities of the situation. The pen is mightier than the sword. But the group of people in our care judge us and decide if we are safe. That is the judgement that matters. If you restrain with the best interest and safety of all involved a power struggle doesn't always need to be the cause.

 I know that it is and it is a shame. But I will never again stand by and allow self-injury to occur because I am afraid how I will be judged by casual observers. Remember as I often do that it is easier to untie the shoestring from the neck of a live person during conversation than it is if they were never discovered. Recently I had a client tell me as we where driving to the train station for his Thanksgiving home visit, that he remembers the day he stopped being suicidal. He was in a time out area for an extensive period of time. From what I have read it would be considered abusive to some. I eventually put my hands on him and told him as I am trying to tell you it is not okay for me to permit self-destructive behavior. He resisted and I stabilized him against the wall and put my arm across his face to prevent him hurting me although that was not one of my fears. It is then that he said if I wanted him to be safe he felt he should be safe. He went on to a state hospital for psychiatric evaluation. In time he returned to us. Eventually I was working in the group home he was in.

 Remember also, what we plant today is what we reap in the future. Not all power struggles are bad. Not all dangerous people are clearly a danger to themselves or others. sometimes going beyond the limits to meet the needs of the person are more important than how they will be judged by others.

Suminski
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In regards to restraints this is my experience:
 
In one of my classes this semester I did a group project on restraints. Well as part of our presentation I got restrained. I can tell you that it was one of the most degrading experiences of my life. It was so horrible that it just reinforced to me that restraint will be the last choice for me when dealing with youth at risk. I work in a group home and in the seven months that I have been there there has not been a restraint. Our policy is that restraint is the last resort. I believe that working for an agency with that philosophy and also being restrained myself has shown me that there are other ways to deal with out of control youth. I am also grateful for my education because it has taught me other ways to deal with a crisis. I suggest to anyone who is restraining youth on a regular basis to try getting restrained first. Walk a mile in the youth's shoes it just might inspire you to find alternatives to restraint.
 
Lilah Lawson
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Jocelyn,

I agree that I never saw a restraint until going to my practicum. The first time I saw one it was quite overwhelming, as it turns out I see them daily as well. I find that in all the cases that I've seen they were necessary. In my cases the child would be at such a high point already that it would be that they were going to be in danger or that they were putting others at risk. I think that restraints are needed in some situation, and agree that they probably get taken advantage of as well.

Leigh-Ann Augustyn
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Hi all,
 
Here's my 2 cents worth on this subject:
 
As a restraint trainer and a veteran child and youth counsellor I have been able to witness (unfortunately) and be a part of a great many restraints. There is always the possiblity of abuse of such a controlling method to ensure youth compliance. Many workers will state they hate restraints but I have seen many use it as a very quick method of establishing control in a group home. These people have a tendency to have power and control issues and often engage in power struggles, personalize client behaviours and generally are the authors of many restraints in which they find themselves.

All the more reason to make sure people are fully trained in all aspects of restraints. True, the majority of restraints are unneccessary. Here are some key elements that we have put into place in a number of group homes I have worked at:

1. A proactive approach is always best. Having a team discussion the first week of a youth's placement should focus not only on goals to be set but also on the potential of the youth to be a danger to himself and others. Under what circumstances would you restrain this youth? What is considered unsafe behaviour for this youth? What has worked in the past with this youth (this may involve actually picking up the phone to speak with his last placement to get a handle on how he deals with crisis---speaking to his old worker is key---don't just wait for the report).
2. Non compliance is NEVER grounds for restraint. If a youth refuses to move..."I'm gonna make you move" is never an appropriate staff response.
3. After restraints are key times to process with a kid. The gains made here can often ensure you don't have to do a restraint with the youth ever again (this is one of the most neglected areas of restraints)
4. Supervisors should be walking through each and every incident with their staff after the fact. Relection and analysis of the situation is key to developing new techniques in dealing with the youth.
5. Every restraint can teach you something!!! about limitations of yourself, the client and your program. A residential team should never be afraid to examine itself and change things.
6. Safety above all is key. The word safety is thrown around in residential service like no one's business. It can be "safer" not to restrain. Physical damage to property is just that....to property...it's not that important. Sometimes more damage (psychologically and phsycially) can be done to a client by doing a restraint rather than letting it alone.
7. Far too much pressure to "be in control" or "on top of things" is placed on residential workers. A home without some crisis is a home that is not helping. These are disturbed kids we're talking about. If they are behaving like angels, we are controling too much. Through the resolution of crisis we can help these youth learn to take control of themselves, problem solve and grow.

Stephen Hendriks
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Jocelyn wrote: But if a youth is saying "no" to something that they don't want to do, or if they are acting up then I feel that a restraint should not happen ...

I agree ... some children, for instance, those with Asperger Syndrome or Tactile defensiveness, will often have an automatic "no" response, or will "explode" on being touched. Rather than giving an ultimatum, let the youth know they have a choice ... for instance, they need a bath, and they need their homework done ... and they want to watch a show. So ask them ... you need your bath, and to get your homework done first, which are you going to do now? That wee bit of control ... they are STILL doing what you expect of them, but they feel as if they have some control of WHEN they've done it. As if it's their choice ... works wonders!  

Tammbrey
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