Tag: prone restraint

We’re a hands off facility. What do we do when there is a fight?

Question:

We are a hands off facility but we have teenage boys in our group homes that are at times very aggressive/violent.  Our staff is working on deescalating the boys as soon as possible and developing relationships with them but what can we do when they start fighting with each other?

How can we break up the fight, keep everyone safe, and be hands off at the same time?

Answer:

The short answer is, you can’t; not if your client-combatants ignore your verbal instructions to stop.

The long answer is, while it may be nice to say you are a “hands off” facility, the fact is, your agency has a  responsibility to protect those in its care.

If you are going to take a population where it is foreseeable that there might be a physical altercation, you have to train staff to deal with that situation in a manner that is effective. It is not enough that you have “a” policy in place, the policy and training has to be effective to deal with the situation.  The other option is to call law enforcement, but if law enforcement does not get there quickly enough, your agency may still have to answer why it did not intervene.

There is a duty to train staff to deal with foreseeable circumstances.  There is also a duty to set up a safe environment capable of dealing with the population you serve. Again, “a” policy will not insulate you if the policy is not suitable for the needs of your facility.

If your agency is taking kids and there are fights and you know there are fights and the kids are not listening to verbal commands, and you can and should check with your agency attorney, but I don’t see how you can escape your duty to protect a client in your care who is a victim(s) of a battery by saying we didn’t intervene because we’re hands off.  The only possible way to minimize the duty to train staff to deal with violence is to only accept those clients who present zero risk of assaultive behavior into your program.  I am not sure that is possible.

Failing to take action can be just as abusive to a client as taking inappropriate action, under the right circumstances.

If the State is preventing you from restraining and forcing you to retreat and maintain a hands off policy, we would suggest that you bring the issue up with your State licensor and change the semantics of the discussion.  Frame the issue with respect to your state self defense and defense of others laws and the constitutional right to protect oneself (or another) from bodily harm.  Then address the issue of  your facility’s duty of care.  Frame the use of restraint as a least restrictive method of self-defense when retreat and verbal commands proved or were determined to be ineffective.

We do not want to place your agency at odds with your state licensing agency, but if you haven’t addressed the issue with them maybe you should ask for an advisory opinion or guidance.  A hands off policy where someone is in danger of being physically hurt is (in our opinion) illegal and ultimately unenforceable.  We have a position paper on this issue that we have provided links to.

Feel free to call us if you have any additional questions (845) 255-4031.

More Info

Additional Info

Restraining clients of the opposite sex

Question:

Does HWC have any resources supporting or not supporting the use of HWC by the opposite sex?  We are exploring the option of a mixed group home/residential facility and questions (many questions) have come up with regards to staff restraining clients of the opposite sex.

 

Answer:

Great question.

In order of priority:

1) Act for the client’s physical safety first and foremost.  Staff has a duty to protect a client’s physical safety without regard for gender or anything else.

2) Make whatever adjustments that are indicated to protect the client’s sense of emotional safety and well being.  HWC’s Module 7 includes how to transition another staff person to relieve you in a Neutral Position PRT or any PRT standing or seated, for that matter to account for the client’s emotional safety.  One of the five situations where a transition to another staff might be advisable is to accommodate any gender issues extant.

With respect to the PRT person, the issue is not necessarily to use someone who is the same sex of the child so much as it is the correct sex for a particular child.  Some girls have issues with men and do better with women.  Some girls have issues with woman and do better with men and, of course, there are some boys who do better with one gender or the other.  Whenever it is safe and feasible to do so, give consideration to the gender issues/wishes of the child and make whatever adjustments you can to help the child feel more comfortable and accessible.  Deal with whatever gender or other issues that may have occurred when you debrief the child post crisis.

When it comes to training, watch staff carefully to see if they are less comfortable restraining one gender or the other.  Most men will readily acknowledge that they do not feel comfortable restraining women and, especially, adolescent girls.  This is by far the biggest problem and the one with the most safety implications in mixed populations.  I would give them as many training repetitions as needed to help them get over it.  Transgender, gay and lesbian kids can present problems for some people, obviously.  They may need help making the necessary emotional compensations in order to become effective as treating personnel, much less someone who may need to perform an occasional restraint.

If you have any other questions or concerns, please do not hesitate to call me at (845) 255-4031.

Supine restraint for clients with exceptional athleticism

Question:

During our latest staff training we had the pleasure of a young flexible staff member who showed off his skills when restrained in a face up (supine) position.  The staff memberwas able to roll upward onto his upper back and shoulders and deliver knee strikes (with force) to our heads. Granted we would not elect to use this hold for someone like him who has no restrictions for the standard prone position but for demonstration and training we were at a loss for an answer.

Answer:

Most people do not have the flexibility to present the problem you describe, which is why it normally not necessary to have a leg person. In the scenario you present, you will need a person to control the client’s legs.

For his safety, make sure the person assigned to control the legs 1) stays low on the way in (using one of the people on the shoulders to block the resident’s view) and 2) he aims for the waist and works down to the legs.

HWC’s Empty-handed take down exercise

Question:

Is the empty hand take down going through the movements with out having someone in a PRT?

BTW: My staff said this is the best method that they have been trained in for handling clients.

Answer:

Yes. The empty hand take-down is the most important exercise you have your students do before you begin spotting for them with a live person. It is used to 1) establish the correct step sequence of the PRT takedown. 2) It can also be used any time you encounter confusion with a student about the correct sequence when you are spotting for them. Finally, 3) You use it to identify any student with a pre existing medical, orthopedic or some other issue that would preclude them from attempting a takedown with a live person.

Every HWC student performing a takedown with a person during training MUST be properly “spotted” for and the takedown count that you use with them MUST be the takedown count you were taught. It is in the Instructor Manual (“Deep Step Back” etc.)

In short, If they cannot do the Empty Handed Takedown Drill comfortably, they should not attempt a takedown with a person.

Daystar Residential Center Restraint

 The type of restraint used at this facility has not yet been released. However the last time Daystar got into a jam it was using the basket hold in the prone position. Even the Feds had the wherewithall to recognize that the basket hold in the prone position is a bad idea.

The GAO in its 1999 Report on Restraint Use in MH Facilities called the prone basket hold the prone wrap. The GAO probably named it this because that’s what NY was calling the restraint under NYS Office of Mental Hygiene. However to most people familiar with common restraint techniques, the technique GAO refers to as the “prone wrap” is the basket hold gone prone.

Putting a client in a basket hold and restraining them face down is a bad idea. As we have been saying, all prone restraints are not equal. Some can be used safely, others are simply not safe. The basket hold in the prone position is an example of a face down restraint that should be avoided at all costs.

The way the basket hold works is that a clients arms are criss crossed over their upper body, chest, torso, abdomen. Staff is positioned behind the client and grasps the client’s wrists. Some agencies like the basket hold because it contains the clients hands so they cannot pinch or grab. The problem with the basket hold is that it is not very stable because the staff’s connection is at an arms length holding the client’s wrists. This gives a lot of leeway to the client to struggle and fight against the restraint. As a result of this dynamic, the basket hold often destabilizes sideways. Now you have staff and the client on the floor on their sides, not very stable, not very comfortable and if the client continues to struggle the staff is going to want to get into a dominant (top) position. When this happens you have a client whose arms are now a criss crossed lever across their abdomen. You don’t even need the weight of the staff person to make this a very dangerous situation.

Moral of the story is, if you are going to use the basket hold make sure staff knows that they have to transition into a different restraint or release the restraint completely if the basket hold destabilizes and goes prone.

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