HWC Q&A: How Does HWC Training Decrease The Need For Physical Intervention?

Question: Does training staff in both de-escalation and physical intervention, as opposed to de-escalation alone, lead to an increase restraints (after staff are trained) within an organization?

Answer:

The idea that training staff in physical intervention will lead them to use it excessively stems from a misunderstanding of human nature and the role of empowerment.

This is really a discussion about whether the personal empowerment of staff is good or bad. In the same way that empowering students with tools for self-regulation, resilience, and positive coping skills enables them to handle difficult situations without resorting to aggression or defiance, training staff in physical intervention is not about promoting its use but about giving them confidence and preparedness to maintain safety when a truly unsafe situation arises.

Safety Comes First

It is only by creating a physically and emotionally safe environment that organizations and schools can offer their clients and students a foundation from which they can learn, heal or grow.

Without the tools to ensure safety, teachers and staff are left vulnerable to situations that may compromise the well-being of both themselves and their students or clients. By limiting a person’s ability to respond effectively in situations where safety is at risk, the very foundation of the organization’s or school’s mission is undermined.

From healthcare clients who may be ill, in pain or scared to students who are neurodiverse, from different cultural or socioeconomic backgrounds, or who have experienced trauma, feeling safe and trusting their environment can be a significant challenge. If staff are not provided with the tools they need to ensure safety, clients and students may lose trust in them, feeling that the staff cannot protect them from the physical or emotional harm that might arise from a situation. Furthermore, when staff feel disempowered and fearful, it affects their ability to remain calm and regulated. A fearful or dysregulated staff member will struggle or be unable to effectively support or set appropriate limits for a dysregulated student or client.

From our experience, based on training many thousands of organizations and schools over four decades, trained or not, staff do not want to engage in physical interventions at all. There is almost always a reluctance to become physically engaged, even when safety necessitates it.

What is typically experienced post physical intervention training is an improvement in Staff’s ability de-escalate a situation using “Support” and “Limit Setting” interventions. Clients and students test the emotional solidity of the people (i.e. staff) around them by attempting to activate a response. When staff are equipped with the tools to ensure their own safety and the safety of others, they are not driven by fear. As a result, they are now able to remain calm, coherent, and emotionally regulated. In fact, the number of restraints after training should decrease, not increase.

Handle With Care. Everyone Deserves To Be Safe.

HWC’s Evidence Based Approach To Creating Trauma-Informed and Trauma-Responsive Organizations, Healthcare and Schools

Trauma-informed care and trauma-responsive care are two closely related but distinct concepts. While they share a common goal of promoting healing and well-being, they approach the implementation of that goal in different ways.

Trauma-Informed Care

Trauma-informed care creates an environment that understands trauma and promotes a universally safe, supportive environment that is sensitive to the needs of persons (i.e. students, clients, children, staff) who may have experienced trauma. Staff and teachers are trained to recognize signs of trauma and to provide a supportive and predictable environment, with a focus on safety, trust, and positive relationships.

Trauma-Responsive Care

Trauma-responsive care focuses on the unique needs, behaviors, triggers of those persons who have experienced and are affected by trauma. Here customized interventions like calming techniques, co-regulation, support, de-escalation strategies, trauma-focused therapy and individual educational or behavioral plans are used.

How Many Students Are Affected by Trauma?

Research suggests that one in four children experiences some form of trauma before the age of 18. According to studies such as the National Survey of Children’s Health, it is estimated that over 60% of children have experienced at least one type of traumatic event, with many students enduring multiple adverse experiences. Trauma may include physical, emotional, or sexual abuse, neglect, household dysfunction, bullying, community violence, and more.

Trauma Care Best Practices

Trauma-informed care is based on six core principles namely: safety, trustworthiness, choice, collaboration, empowerment and responsiveness.

Safety Comes First

People who have experienced trauma often have difficulty feeling safe or trusting their environment or other people. Those who have experienced a traumatic event often feel less safe than others. HWC understands the impact of trauma on the entire human organism, which is why safety (creating a safe physical and emotional space) is our number one priority. By creating a physically and emotionally safe environment, organizations and schools can offer their clients and students a foundation from which they can begin developing resilience and a secure sense of self and the world around them. There are two components to safety:

- Physical safety: Ensuring clients and students have a secure physical environment (e.g., no bullying, no violence, a safe space with no triggers).
- Emotional safety: Encouraging supportive interactions, allowing for emotional expression, development of self and resiliency and minimizing or providing an environment that minimizes retraumatizing experiences.

The critical questions every client and student wants to know, “am I safe, do you care, will you help me, can I trust you”?

Connection: Strong, supportive relationships help to rebuild trust and promote positive behaviors. HWC’s Solid Object Relationship Model (SORM) teaches that the most effective way to de-escalate a situation is to be the person the client or student can trust and feel safe with.

SORM is a relationship-centered approach that teaches staff how to behave in a manner that provides clients with the emotional and environmental support needed to convey trust, security and safety. Clients and students test the emotional solidity of the people (i.e. staff) around them by attempting to activate a response. HWC teaches staff how to recognize the purpose of the ‘test’ and appeal to the healthy components of the client’s personality, which seeks stability or homeostasis, to form an alliance.

Strategies include

Being Affect Neutral
Being empathetic
Being trustworthy
Providing support
Giving choices and strategies to assist the client or student to calm down (breathing, slowing down, coping strategies, redirection)
Providing a safe space
Staying regulated (a dysregulated staff person will never be able to manage a dysregulated client or student).

As it relates to HWC’s SORM, the more positive the staff’s relationship with the student or client, the more likely they will allow you to support them during a time of dysregulation.

Some Of The Benefits of a Trauma-informed Organization or School

Improved Emotional and Psychological Well-being

Reduced Stress: Trauma-informed practices help create environments that minimize stressors and triggers for people who have experienced trauma. This can lead to decreased anxiety, depression, and emotional dysregulation.
Increased Resilience: By fostering physical and emotional safety and supportive relationships, trauma-informed organizations and organizations help clients and students build resilience and better cope with challenges.

Enhanced Academic and Behavioral Outcomes

Better Focus and Engagement: Students in a trauma-informed school are more likely to feel physically and emotionally safe, which can improve their concentration, participation, and academic performance.
Reduced Behavioral Issues: Trauma-informed approaches emphasize understanding the root causes of behaviors. This can lead to a pro-active approach to eliminate triggers (i.e. bright lights, loud noises, raised voices, finger pointing) and put into place customized education or behavioral intervention plans that address the underlying trauma.

Take-away

HWC’s program is easily adaptable to the spectrum of trauma and neurodiverse clients and students.

HWC’s program focuses on interventions that have flexibility so that the intervenor can intervene in a way that works with and maximizes the strengths of the person. The goal is to empower the client or student and give him/her/they tools to manage their own behavior.

To have a trauma-informed or trauma-responsive organization or school, safety comes first. Traumatized clients and students must learn that not all emotionally charged situations end badly, and that they can trust staff to protect them from the emotional and physical consequences of their and others behavior.

Handle With Care. Everyone Deserves To Be Safe.

The Science of Behavior Management

HWC’s Summer 2024 Newsletter

In this newsletter we will discuss how findings in neuroscience correlate to relationship-based crisis intervention behavior management models. Specifically, how HWC’s Solid Object Relationship Model (SORM) interacts with the nervous system to create a state of calm.

The Autonomic Nervous System (ANS)

The Nervous System acts as your control center. It is responsible for everything from your heartbeat and breathing to digestion, emotions and the way you feel. The Autonomic Nervous System is comprised of two main parts: the Parasympathetic Nervous System (PNS) and the Sympathetic Nervous System (SNS).

Think of the PNS as the brake and the SNS as the gas pedal.

The PNS is responsible for the “rest-and-digest” response that calms the body down. It allows us to relax, become calmer, more clear and focused.
The SNS is responsible for the “fight-or-flight” response which primes the body for action against a perceived or actual threat. It can also be activated in cases of imaginary threats or fears.

In a regulated state, the interaction between these two parts of the ANS keeps our body’s functions running smoothly and maintains our emotional well-being. In times of stress, our SNS protects us by activating bodily processes to increase arousal, alertness and activity. Once the danger has passed, the PNS carries signals to deactivate these processes returning the mind and body to a state of calmness.

Whereas an “acute” or brief state of stress is helpful and productive, a constant or “chronic” state of stress is unhealthy and can lead to exhaustion, irritability, depression, sleep disturbances, and over time, more severe issues like hypertension and compromised immunity.

Neurons That Fire Together, Wire Together

The brain hardwires everything that we repeatedly do. This principle can be summed up with the phrase “neurons that fire together, wire together.” Meaning, when one neuron repeatedly activates another via chemical messages, the connection between the two cells gets stronger. This is why it is important to stop bad behavior before the neuro-connections become “hardwired” or to interrupt the “hardwired” connection so that the connection lessens and new, more productive, neuropathways and behaviors can be established.

Regulation and Co-regulation

Behavioral or self-regulation refers to the ability to monitor, manage and regulate our own emotions and behavior. Co-regulation (or attachment) happens when two people help each other regulate their emotions. In the case of a teacher/student or parent/child, it can also mean teaching kids how to manage their behavior and emotions on their own.

Your stress can make another person feel stressed, your calm can make another person feel calm. The reverse is also true, another person or child’s stress can make you feel stressed. In order to assist in the regulation of another’s behavior, we have to be in control of our own behavior first.

Using the Solid Object Relationship Model (SORM) to Cultivate Attachment (Co-regulate).

SORM is based on the principle that a person in crisis will attach to a more solid object (co-regulator) to regain stability and homeostasis. Maintaining a calm emotional state by staff and faculty is absolutely critical to establishing an attachment where the student or child feels safe and they can trust you. Many students chronically misbehave not because they do not want to behave, but because they have not developed the tools to gain mastery over their behavior. Attachment is all about safety, protection and emotional regulation in times of perceived threat or danger. The student or child must feel that they are in a space that is both physically and emotionally safe from harm. The attachment with a Solid Object (You) has a positive regulatory effect on the physiological and psychological response to stress and the student’s return to a calm state.

A Solid Object does not respond to provocation or take things personally.

Qualities needed to be perceived as a Solid Object:

Calm ● Unafraid ● Centered ● Balanced

Fair ● Empathetic ● Understanding

Consistent ● Disciplined

Verbally Reassuring

HWC SUPINE HOLDING SAFETY ADVISORY

You are learning the PRT@ in its supine (face up) floor holding configuration, which requires two people to perform (from the “Settle Position” to our Two Person Supine floor hold).

This advisory is for supine (face up) holds. If you use, teach and are trained in prone holds, see Module 7 for the PRT® TRIPOD ADVISORY for the safeguards for the PRT in its prone or face-down configuration. If you, your organization/school, state etc. does not use or teach prone holds and YOU FIND YOURSELF IN A FACE-DOWN CONFIGURATION, REGARDLESS OF HOW YOU GOT THERE, you must either:

ASSIST HIM BACK TO AN UPRIGHT/SETTLE POSITION CONFIGURATION AND TRANSITION TO THE TWO PERSON SUPINE OR
LET GO OF HIM COMPLETELY

Supine floor Holding Safety Protocol:

Chest compression (placing sufficient weight or pressure on a client to restrict breathing), fatigue, client obesity, alcohol or drug use, heart conditions and/or other complicating medical and other factors (known and unknown to you) can all cause serious injury or death. HWC requires that you “continuously monitor the physical and emotional safety of the client” for any evidence of emotional and/or physical distress in all of the PRT’s holding configurations (Standing, Settle, Supine or Neutral/Prone) for the duration of the hold.

Whenever possible, there should be someone posted near the head of the client who is dedicated to CONTINUOUSLY MONITORING THE PHYSICAL AND EMOTIONAL SAFETY OF THE CLIENT.

Remain vigilant for any evidence of physical or emotional distress including, but not limited to, changes in or loss of consciousness, a sudden cessation of struggling, seizure, voiding of bladder or bowels, difficulty communicating, choking (indicating the possibility of aspiration), vomiting or heaving, changes in breath sounds, color, complaints of chest pain, difficulty breathing etc. Observe for food, gum or foreign objects in the mouth which may cause a choking incident. Consult with your organization’s medical staff if you have any question concerning the suitability of the PRT in any of its configurations for a particular client. HWC can also discuss any concerns with you or your medical staff and help you to make adjustments to the hold for specific clients, including modifications for casting of limbs, amputations, pregnancy, etc.

HWC recommends that every staff member with direct care responsibility or who will foreseeably be involved in a restraint, receive CPR training.

If a client is in distress assess the situation and determine what actions are appropriate, including, but not limited to:

Releasing the client from restraint
Calling 911
Calling on-site or off-site medical staff
Calling for assistance
Implementing first aid
Commencing CPR
Physical examination
Medical examination

Additionally:

Limit the number of takedowns by taking advantage of the walls and other stable structures for support and stability whenever possible. For in-facing standing PRT wall restraints, always back yourself to the wall first then smoothly turn the client to face the wall on the tightest possible axis.
In an unassisted (solo) takedown to the settle or seated position, the PRT person is responsible for continuously observing and monitoring the client until someone else is in position to assume that responsibility.
The two staff involved in our Supine hold are responsible for continuously observing and monitoring the client until additional help arrives. The first person to arrive to assist should position himself or herself at to the client’s head in order to be completely dedicated to the task of continuously observing and monitoring the physical and emotional safety of the client.
Always protect the client’s head from contact injuries with the floor with the combination of an appropriate cushioning material and careful manual stabilization.
If either of the staff members performing the hold is fatigued or, for any reason, needs to be relieved, he/she can be replaced by transitioning someone else into position, as demonstrated during training.
It may be possible to avoid a Supine hold if you gain compliance (or policy dictates) by stopping at the “Settle Position”. Although the Settle Position is not as stable as our Supine hold, it can be additionally stabilized by changing to a “Modified Settle” (seated position), using the method described for pregnant females in Module 7. Use a wall, other stable objects or additional staff to help secure the hold and ensure that it remains upright and stable.
If the supine hold is required, you may then switch to “Two Person Supine Method”.
Initiate the physical “letting go process” (module 11) and take other appropriate steps as needed to transition the client out of the hold as soon possible i.e.as the client completes his or her “recovery arc” and returns to a calm mind state.

Download HWC Supine Holding Safety Advisory

HWC PRT® TRIPOD SAFETY ADVISORY

PRT® TRIPOD SAFETY ADVISORY

Chest compression (placing sufficient weight or pressure on a client to restrict breathing), fatigue, client obesity, alcohol or drug use, heart conditions and/or other complicating medical and other factors (known and unknown to you) can all cause serious injury or death. HWC requires that a Tripod Modification be used for every person placed in the “Neutral Position” and that you “continuously monitor the physical and emotional safety of the client” for any evidence of emotional and/or physical distress in any of the PRT’s holding configurations (Standing, Settle, Supine or Neutral/Prone) for the duration of the hold.

The “Tripod Modification” is a “weight bearing bridge” used to support 100% of the weight of the PRT person, as demonstrated by the PRT Tripod Exercise (Module 7)), where class participants lay on the floor simulating they have someone in the Neutral Position. Its purpose is to demonstrate that each person being trained is capable of supporting their entire upper body weight on their outside elbow. The “Tripod Modification” distinguishes a Neutral Position PRT from any other prone or floor restraint because the entire weight of the PRT person is supported to eliminate chest compression; consistent with any policy that prohibits placing weight on a person’s back. The PRT is the only physical technique ever granted a (US and International) Patent for “An Apparatus and Method for Safely Maintaining a Restraining Hold on a Person.”

Whenever possible, there should be someone posted near the head of the client who is dedicated to CONTINUOUSLY MONITORING PHYSICAL AND EMOTIONAL SAFETY OF THE CLIENT.

Remain vigilant for any evidence of physical or emotional distress including, but not limited to, changes in or loss of consciousness, a sudden cessation of struggling, seizure, voiding of bladder or bowels, difficulty communicating, choking (indicating the possibility of aspiration), vomiting or heaving, changes in breath sounds, color, complaints of chest pain, difficulty breathing etc. Observe for the presence of gum, food or foreign objects in the mouth which may cause a choking incident. Consult with your organization’s medical staff if you have any medical or orthopedic concerns about the suitability of the PRT® in any of its configurations with a particular client. Contact us to discuss any concerns that you or your medical staff have and to help you to make adjustments to a hold for specific clients, including modifications for the casting of limbs, amputations, pregnancy, etc. Call us at 845-255-4031 during regular business hours or for technical assistance call or text anytime, even during a hold, directly at: 845-380 7585.

HWC recommends that every staff member with direct care responsibility or who could foreseeably be involved in a restraint receive CPR training.

If a client is in distress, assess the situation and determine what actions are appropriate, including, but not limited to:

Releasing the client from the hold
Calling 911
Calling on-site or off-site medical staff
Calling for assistance
Implementing first aid
Commencing CPR
Physical examination
Medical examination

Additionally:

The “Tripod Modification” should be initiated immediately during all Neutral Position holds. Appropriate cushioning materials, like the PRT Tripod Stand™, can be placed under the weight-bearing (outside) elbow of the PRT person to extend the comfortable duration of the Tripod Modification.
During an unassisted (solo) takedown, the PRT person is responsible for continuously observing and monitoring the client until other staff arrive on scene.
Always protect the client’s head from contact injuries with the floor with the combination of an appropriate cushioning material (nothing that may cause suffocation or difficulty breathing), and careful manual stabilization.
In Two Person Takedowns to the “Neutral Position”, when additional staff are not available, the leg assist person should leave his/her position at the client’s legs and position themselves at the client’s head to be completely dedicated to the task of continuously observing and monitoring the safety of the client and ensuring that the “Tripod Modification” is performed properly.
If the PRT person is fatigued or, for any reason, unable to maintain a proper Tripod Modification, he/she can be relieved by transitioning someone else into the PRT position (as demonstrated during Module 7 Round-up conversation).
Limit the overall number of takedowns by taking advantage of the walls and other stable structures for support and stability whenever possible. For in-facing standing PRT wall restraints, always back yourself to the wall first, then smoothly turn the client to face the wall on the tightest possible axis.
It may be possible to avoid a Neutral Position if you gain compliance (or if policy dictates) by stopping at the “Settle Position”. Although the Settle Position is not as stable as a “Neutral Position” PRT, it can be additionally stabilized by changing to a “Modified Settle” (seated position), using the method described for pregnant females in Module 7. Use a wall, other stable objects or additional staff to help secure the hold and ensure that it remains upright and stable.
Initiate the physical “letting go process” (module 11) and take other appropriate steps as needed to transition the client out of the Neutral Position as soon as the client completes his or her “recovery arc” and returns to a calm mind state.

Download PRT Tripod Safety Advisory

Overview of Laws governing Restraint and Seclusion

Handle With Care has been providing training for school staff on how to manage student populations from pre-k12 since 1985.

There is generally a divide in schools between special education and general education with respect to behavior management and crisis intervention. The use of restraint in both general and special education are governed by 4 main bodies of law:

Self Defense Laws: Federal, Constitutional and State laws protecting the right to defend self and others. Ingram v. Wright (SCOTUS). The State does not have the right to limit a person’s right to defend themselves or another in any manner that is reasonable. Bowers v. DeVit. The Supreme Court of the United States (SCOTUS) ruled that the right to self-defense does not terminate when a teacher or student enters the schoolhouse gates. See also, Tinker v. Des Moines Ind. Community School Dist., 393 U.S. 503, 506 (1969)
Tort/Common Law: Courts have held that schools act in the place of parents (in loco parentis). As such, schools have a duty to maintain a safe environment conducive to education. Along with this doctrine comes a duty to train staff to handle foreseeable circumstances. It is foreseeable that children will lose their tempers and may engage in inappropriate behavior like fighting and throwing objects. There is a duty to train staff how to manage these foreseeable situations in a way that maintains a safe environment conducive to education.
Treatment and Behavioral Plans (IEPs/BPs). This is the duty to provide professional judgment in developing educational and treatment plans. The Supreme Court has held that the professional duty rests exclusively with the professionals working directly with the [students]. Youngberg v. Romeo. 457 U.S. 307 (1982).

In addition to the above, special education students have the additional Federal laws that must be complied with:

Americans with Disability Act (ADA), Individuals with Disabilities Education Act (IDEA), and the Rehabilitation Act Section 504 (504).
- The laws specific to special needs students protect their right not to be discriminated against because of their disability, and the right to a free and appropriate public education (FAPE) which includes IEPs.

How to Stop the School –> Prison –> Pipeline

Too many students are being diverted from school into the criminal justice system.

The school-to-prison pipeline “is one of our nation’s most formidable challenges, states the report.” “It arises from low expectations; low academic achievement; incorrect referral or categorization in special education; and overly harsh discipline, including suspension, expulsion, referral to law enforcement, arrest and treatment in the juvenile justice system.” And, the report notes, “Throughout these causes runs evidence of implicitly biased discretionary decisions, which, unintentionally, bring about these results.”

What the report fails to mention is that the causes are not generally biased discretionary decisions, but policies imposed on schools by legislators, regulators and school boards. There has been a movement across the country that takes the authority away from individual schools. Individual schools often no longer have the authority to make discipline, safety, educational or treatment decisions as their discretion has been usurped by policy makers and people removed from the classroom.

The result, while, perhaps, unintentional, was absolutely foreseeable.

When you take the authority and ability to maintain a safe and effective educational environment away from the school and educators, and place the authority in the hands of law enforcement, there will be a rise in the number of students entering the school –> to –> prison pipeline.

HWC Facebook Page

HWC in the News: School Security Prepares to Handle Crisis Situations with Care

How to handle crisis situations with care: That is what the security team at the Monticello Central School District will soon be learning. Time Warner Cable News’ Jackson Wang has more on the training program.

MONTICELLO, N.Y. — Every day, disputes, disagreements, and conflicts are bound to develop between students in a school. While most are harmless, school officials are concerned about the few that get verbally or physically violent.

“You never can tell these days where a threat may come from,” said Tammy Mangus, Monticello School District superintendent.

To be prepared, the district will soon be training its security team on how to handle disruptive situations and prevent them from escalating.

Restraint in School – what the law says.

The press is finally starting to report the actual law governing restraint use. This is a breath of fresh air. In the past the press has lied to the public reporting that many or most states have no laws on the use of restraint. A statement which is entirely false, as every state has laws on the use of restraint either in their Constitution, case law or statute.

Handle With Care has been disseminating the law on restraint since 1999 when we presented in front of the Attorney General for the State of Virginia, the Virginia Poverty Law Center, Southern Poverty Law Center, a stream of advocate attorneys, newspaper reporters, and many other high powered persons.

Every person at our initial presentation agreed with our legal analysis.

Since that time we have disseminated the laws governing restraint to agencies and schools across the country. To every Federal legislator and the vast majority of State Legislators.

We are very proud that unlike the press, advocates, political hacks, and unelected bureaucrats running government agencies, we stood our ground, disseminated the law, and educated schools and other organizations about the law and their rights under the law.

The article appeared in a U.K. publication – Schools Week, and was written by an attorney. Here’s what she says:

“A member of staff may use such force as is reasonable in the circumstances to prevent a pupil from committing an offence, causing injury to a person or themselves, causing damage to property or prejudicing the maintenance of good order and discipline.”

U.S. law is the the same.

All we can say is, it is about time the press is starting to get it right.

Virginia. Schools drafting their own restraint policy and totally disregarding the inane law their legislators passed in March

In March 2015 the Virginia State Legislature passed a bill stating that schools could not physically intervene unless a student was in danger of serious bodily harm. “Serious Bodily Harm” has a widely understood legal definition that includes the amputation of limbs, the loss of an eye or permanent disfigurement.

At the time this bill was being passed, we sent out correspondence and comments informing the legislature and schools that the bill was illegal as it violated a person’s inherent and unwaivable right to defend self and others by all reasonable means.

According to this article, schools are drafting policy in accordance with actual law and disregarding the bills the Virginia legislature just passed.

For instance, Williamsburg-James City County schools are considering a policy outlining how and when trained teachers, faculty and staff can restrain or separate a child to keep the student from hurting themselves or others. An intervention threshold much lower than the one mandated by their legislature.

Instead of following the new restraint bill the legislature passed, schools are instead relying on Virginia Statute 22.1-279.1 that allows the use of physical intervention to maintain a safe educational environment.

Schools and educators should not have to wait until a student risks “physical injury that creates a substantial risk of death; extreme physical pain; or that causes protracted and obvious disfigurement, or protracted loss or impairment of the function of a bodily member, mental faculty or organ” before intervening.

HWC fully supports theses schools. We commend them for having the sense and fortitude to stand up and do what is morally and legally right.

Full Story

Why HWC

Training Types

Who We Train

More

Consulting

Resources

Author: Hilary