Listen to thisThe topic of physical intervention is an especially sensitive one right now in the United States. Public attention has been focused on deaths and injuries which have resulted from improper and out-of-control application of physical intervention by untrained or poorly trained personnel.
One of the workshops which we do is called PART
(Professional Assault Response Training). PART is a safety
enhancement/risk management program for agencies and personnel who work
with potentially volatile clients. It is research-based and is
continually updated on the base of current research and practice. I
thought I might share with you some of my thoughts, in response to your
questions.
1. Models of physical intervention
It is not wise to speak of training in physical intervention. We now
know that such training, offered without a wider context of
professionalism and alternative approaches, will lead to
over-application of the physical interventions. “If the only thing you
have is a hammer, everything else is a nail." Injuries which occur
within physical interventions are most often the result of loss of
control by the professionals applying the physical intervention, the
lack of training in critical thinking in a crisis to ensure application
of the safest and most effective intervention, and the lack of training
in a systematic model of intervention (along with regular supervision,
reinforcement of training, and well written and strictly enforced
policies regarding physical intervention).
2. There are many models or curriculawhich address this issue
PART is one of them, and, in my opinion, the best of the
models/curricula. The theme which I use in PART training is “Safety and
Dignity Through Problem Solving." If you would like more information
about PART, please send me your snail mail address, and I will forward
to you a brochure from the partnership. PART training is done in Canada
on a regular basis. Perhaps we could put you in touch with an agency
which has experience with it.
PART has been adopted in South Africa; the National
Association of Child Care Workers (South Africa) is the organization
authorized to deliver the training there. More than 5,000 persons have
been trained in PART in South Africa. The training is integrated into
the training for all Child and Youth Care workers there. PART is
becoming common in Germany and has been done in Russia; we may be doing
it in Sweden in the coming year. I do training in Germany at least once
a year. But PART is best known on the western coast of the United
States.
3. PART, and all of the models I know of,address the topic of
report-writing, againin the context of the intervention
Report-writing serves three functions:
review of the incident by the report writer(s),
a record for the team so that more can be learned about the client and about effective methods of intervention, and
a legal record of events, for the protection of staff and agency.
4. The philosophy of PART is: safety
anddignity through problem solving
PART is a systematic, team-centered approach which stresses
professionalism, preparation, skills in identification, good
decision-making in the selection of interventions,
SAFE-DIGNIFIED-EFFECTIVE physical interventions, and adequate recording
of the events. The principles of PART are based on the risks which are
posed. PART is a team-based, problem-solving, client-centered approach.
It is applied by asking critical questions, beginning with “IS THE
BEHAVIOR DANGEROUS?" Only immediate, imminent, potentially seriously
injurious behavior warrants physical restraint; this is especially true
when other, less intrusive methods could be applied, including verbal
interventions and evasion.
5. Seclusion rooms
The decision to use or not to use seclusion rooms arises from the
individual program's model and decisions made within that program as
well as external constraints on the use of such methods, e.g., state
regulations. Our observation, however, is that seclusion rooms tend to
be misused and overused, often for staff convenience or as retribution.
Sometimes, seclusion rooms are used when they are not needed because the
incident and the threat are past; they are used simply because there is
an agency policy that when such and such an incident occurs, the client
must go to seclusion for a pre-determined period of time. Current
legislation before our Congress is addressing both physical restraints
and the use of seclusion rooms. The legislation will put severe
constraints on the use of either method.
