Excellent Article on Alternatives to Restraint
Excerpt:
"Children who are victims or witnesses to abuse experience significant changes in the way they regulate their emotions over time, creating all kinds of problems as they get older," Huckshorn says. And yet as these children escape violent, abusive surroundings, they are all too often subject to violence in a venue designed to protect them.
"I think we've confused what's therapeutic in terms of intervention," says Janice LeBel, Director of Program Management for the Child and Adolescent Division of Massachusetts's Department of Mental Health (DMH). "There was a tacit belief that containing children, setting harsh limits, and imposing a physical restraint or seclusion was somehow therapeutic. How we got the idea that meeting a child's history with violence was somehow going to be palliative and restorative, we don't know."
If a child's past is the powder keg that makes potential conflict so explosive, it's often the staff who provide the spark. "In reviewing restraint episodes involving children, we noticed a pattern," says Nan Stromberg, Director of Nursing and Licensing for Massachusetts DMH. "When kids were in trouble and in distress, the staff would set limits, and the kids would then become more agitated--a recipe for restraint."
"Research that looks at why restraint increases [stress] points to the phenomenon of counteraggression," says Paul Jones, Staff Development Coordinator at Home of the Innocents in Louisville, Kentucky. "When you feel like you're being attacked, there may be an [instinctive] reaction, and a staff member [may be contributing to that situation]. Counteraggression prevents people from being able to let those verbal assaults or other things go."
"Everyone [is vulnerable to counteraggression], whether they admit it or not," Jones warns, "but the extent to which it happens decreases with experience and training."
When Stromberg and LeBel decided to investigate the backgrounds of children involved in the most restraints, they found that more than 85% had significantly well-documented trauma histories.
"These kids weren't seeking out restraint, they were traumatized," Stromberg says, "and their needs were being expressed and being poorly met. Restraint was not only countertherapeutic, it was [repeating] the abuse they had already experienced. Once we understood that was a critical variable, we were forced to step back and do business in a different way."
At New York's Bellevue Hospital, where restraint is not used at all in the child unit, and only rarely in the adolescent unit, Stromberg and LeBel found a staff committed to doing whatever it took to see a child through a crisis by talking through the situation.
"In the adolescent unit, we saw a remarkable example where a girl was very out of control, pounding the wall," Stromberg says. "Instead of offering the usual 'You've got to lower your voice and get in control,' the nurse manager was validating her anger, saying, 'I know you're angry, and that makes sense--I'd be angry too.'" The staff were able to escort the other children from the room, and in that quieter setting, the situation was quickly diffused.
But to the DMH officials, it all seemed too simple. "We grilled the directors," LeBel says, "looking at numbers of staff and training and how much they paid their workers, figuring there had to be some big difference that allowed them to be restraint free, but there wasn't one. But there was crystal-clear, rock-solid leadership [committed to finding another way], and a group of people who understood they could negotiate any kind of crisis without resorting to restraint."
Entire Article at NoSpank:
http://nospank.net/kirkwd.htm