Reasons to Reduce the Use of Restraint

The theme “Restraint Reduction” couldn’t come at a better time for Michigan school employees. In December 2006, the Michigan State Board of Education enacted a new law “Supporting Student Behavior: Standard for the Emergency use of Seclusion and Restraint.” As a school social worker for the past 27 years and a Crisis Prevention Institute (CPI) Certified Instructor since 1997, I am always seeking out avenues to advocate for the decrease of restraint in our schools and other service organizations. The road to change has been a
challenging one.

The practice of using restraint has been an integral part of programming in residential and public school settings for many years. In the 1970s, staff were commonly instructed by our mental health community, as well as private and public institutions, to implement restraint as an approved technique to gain compliance from a client. It was not at all unusual for a child to be “physically managed” and removed to a “time-out room” for simply refusing to get up from a chair. In one setting where I worked, those rooms even had locking doors. The outcome was devastating with a list of physical injuries, emotional damage, and destruction of property. Yet, despite its ineffectiveness, professionals continued to use this type of intervention for many years. During the evolution of school discipline interventions in the 1980s, it was evident that some small advances in restraint reduction were edging into our modes of treatment.

School employees were starting to use new vocabulary terms including “positive behavior support” and “behavior intervention plan.” Prior to the implementation of the Michigan seclusion and restraint law, our school district made the move and had a team of instructors trained in the Nonviolent Crisis Intervention^® training program. We started to ask questions of our participants to provoke a creative thought process in order to encourage staff to be more cognizant of how to intervene without resorting to physical intervention. A few of our favorites are:

• What would you do if you were physically incapable of performing a “hands-on” intervention?
• What would you do if your school/facility had a policy which allowed no physical interventions?
• How would you feel if someone did a physical intervention with your child?
• How would you feel if the intervention resulted in a physical injury, or much worse, death? 

We must start to think about reduction in restraints not only because it is the law, but also because of the potentially harmful and ineffective outcomes following such interventions. One invaluable resource to consider is Risks of Restraints: Understanding Restraint-Related Positional Asphyxia by CPI, which has become a mandated part of our training. I had the opportunity to attend a workshop discussing the risks of physical restraints at the International Association of Nonviolent Crisis Intervention^® Certified Instructors (IANCICI) Regional Conference in Toronto, Canada in 2004. This is an essential experience for anyone who has ever been part of providing physical restraint or has witnessed such. The information concerning the dangers of physical intervention should be shared with anyone involved.

Our team came up with an extensive list of alternatives to Nonviolent Physical Crisis Intervention^SM. Here are just a few:

• Humor
• Distraction
• Evacuate the area (objects can be replaced, not people)
• Peer-to-peer support
• Prevention
• Develop a positive rapport
• Active listening

Let’s all share ideas, learn the dangers of restraint, and reduce or eliminate these incidents. Let’s do this, not just because it’s the law, but because it’s the right thing to do.

Reprint from Journal of Safe Management of Disruptive and Assaultive Behavior (JSM) September 2007

About the Author

Rebecca Ducham has worked in the field of school social work for 27 years. She has experience in the area of working in a private residential setting for emotionally impaired children, public school service, and currently, works at Tuscola Intermediate School District. She has been the Crisis Prevention coordinator for Tuscola County during the past 11 years, is an instructor for “Becoming a Love and Logic” teacher/parent, and teaches Nonviolent Crisis Intervention^® training as a Crisis Prevention Institute Certified Instructor.