Possible Psychological and Physical effects of restraining

 

 

Having performed hundreds of interventions and transports of adolescents over the last 8 years, along with implementing “no physical restraint device” policies for companies, I would like to share with you my opinion when it comes to policies and the possible negative impacts of physical restraints and physical restraint devices when intervening on and transporting “at risk” youths. As most of you know, the use of restraints of any kind has become controversial and is opposed on moral and ethical grounds, except where serious threats to safety are present. 

However, there seems to be a blind eye when it comes to intervention and transport companies in the therapeutic programs and schools industry (not all programs, schools, and education consultants share this opinion, and for those who do not, I applaud you).

 

 

 

 

 

It should be clear that few of the proponents of physical restraint have claimed that it has not any therapeutic value in itself.  Instead it is usually viewed as a physical safety mechanism that may permit continuation of other therapeutic interventions once the restraint is completed. Most educational textbooks dealing with aggressive or violent behavior or students with emotional or behavioral disorders suggest that physical restraint might be warranted for purposes of safety in spite of the lack of empirical research support.

 

 

We, in this industry, must be very careful in how we spell out our policies and practices for restraining children, and these policies and practices should detail that restraints will be used when and only when children are attempting to hurt themselves or hurt others. It is my strong opinion that maintaining a policy and practice of using physical restraint devices, such as handcuffing and leashing children, during an intervention or transport is not and never should be ok and is not in the best interest of the child, the family, the program, or the education consultant. Mental health professionals concur that maintaining a policy and practice such as this can cause adolescents psychological, emotional, and/or physical harm. Children, regardless of their status in society, have a right to be protected from being humiliated and psychologically harmed while receiving treatment. Furthermore, policies such as this could possibly undermine a program’s effort and the ultimate outcome in not only providing treatment, but in a child maintaining what they have learned.

 

Children, who have been restrained, with or without physical restraint devices, could react in many different ways. Two examples in this article are:

 

 

 

Some experts have said that any experience of profound humiliation will tear down, not build up these children, could impair a child’s development of their identity and morality, and ruptures their trust in authority. An experience like being physically restrained, with or without physical restraint devices, could increase the possibility of future misconduct and criminality for this particular population of children. The bottom line is…..are we willing to take the chance on how the reaction might be when it is possible from the onset to significantly decrease the odds entirely?

  

Identity is fragile; being physically restrained, with or without physical restraint devices, like a dangerous beast may cause the child to feel like a dangerous beast.

 

During adolescence, children develop a moral identity. Children become extremely sensitive to unfairness. Being physically restrained, with or without physical restraint devices, during an intervention/transport could make children doubt that the system presumes them innocent, and that the system aims to help them. They cannot trust the people who now control their lives. The apparent conflict between what the adults say and what they do is damaging to this phase of a child’s development. 

 

Physically restraining, with or without physical restraint devices, children without having conducted a full psychological assessment, or who because of qualifications, cannot properly interpret a psychological assessment such as emotional, physical and sexual abuse, school failure, family or friends failure, eating disorders, ODD, ADD, etc. can make them feel powerless and hopeless. “Any abuse of power by an adult can provoke in a traumatized young person a combination of self-blame and sense of betrayal that can lead to self-destructiveness or aggression.”  

 

“Emotional abuse includes restriction of movement” and what could possibly conceived to be punishment by parents and/or adults of adolescents is a known risk factor for depression, suicide, alcohol abuse, physical abuse of children, and domestic violence.”

 

Others have said that the harm of handcuffing or leashing children is anti-therapeutic and antithetical to the rehabilitative aims of therapeutic programs.

 

Indiscriminately physically restraining, with or without physical restraint devices, brands and stigmatizes children in ways that adversely affect how others regard them, and the manner in which they regard themselves.” This labeling may cause others to “act [in a manner] toward the branded [child] that confirms the label’s negative attributes” This may cause the branded and stigmatized child to act in accordance with the negative label. 

 

Physically restraining, with or without physical restraint devices, conveys the message to the handcuffed or leashed child that he/she is a dangerous person guilty of an alleged crime. 

Indiscriminately physically restraining, with or without physical restraint devices, children poses the risk of the child internalizing the stigmas they receive and can ultimately damage their self-esteem.

 

Indiscriminately physically restraining, with or without physical restraint devices, children with fragile self-esteems exacerbates their damaged self-esteem. 

 

“[w]hen physical restraints, with or without physical restraint devices, are used without an immediately precipitating event, the message given is that the youth is bad, untrustworthy, a criminal.”   

 

 

When: Physical restraints should only be used when and only when children are attempting to hurt themselves or hurt others. It is my strong opinion that Physical Restraint Devices (handcuffs, zip ties, leashes) should never be used while performing an intervention and transport. I firmly believe that if in the event that the adolescent is so out of control that he/she cannot be properly restrained by physical holds, then because of safety issues, law enforcement should be brought in. However, I do believe that under the right circumstances, with the right people (properly trained and tested), physical restraints themselves can and should be used, but only when the escalation of force has been followed and they are absolutely necessary. Physical restraints should not be used simply because an adolescent is showing opposition and/or refusing to cooperate in a manner that is not a safety danger.

 

 

 

 

Why: Children should be physically restrained when and only when attempting to hurt themselves or hurt others.

 

 

 

 

 

 

 

 

 

 

It is imperative that only thoroughly trained staff attempt physical restraint techniques. In addition to the techniques themselves, any and all companies that might at all have the need to physically restrain children, should have on file, written guidelines for their use, detailing that they are only to be used in an emergency situation which could result in serious safety threats.  Furthermore, yearly training does not suffice in regard to an employee becoming fluent in physical restraint. At a very minimum, quarterly training should be provided to all employees whose positions within the company would require them to physically restrain an adolescent.

 

 

The risks in using physical restraints are high. There is a very strong possibility of injury to the adolescent or employee(s) conducting the restraint, and possibly others in the environment.

 

Inappropriate use of physical restraint has resulted in serious injury and even death of the adolescent being held (Hartford Currant, 1998; Weiss, 1998).

 

Because there are always different interpretations of what is the appropriate amount of force necessary to restrain an adolescent, along with the fact that consistent and continuous training in physical restraints are not always followed properly, often there is an inappropriate amount of force used to physically restrain a child. This inappropriate amount of force can cause a great number of injuries, including death. Injuries resulting in inappropriate physical restraints are or could be:

 

 

Many programs have acknowledged the need for physical restraint procedures as a part of their overall efforts to be prepared to deal with violence and aggression in children under their care.  Often this entails training one or more staff members in a comprehensive set of procedures to physically restrain students, with related conflict de-escalation training, in order to attempt to prevent injury or property damage in the environment.  Unfortunately, intervention and transport companies are not held to the same standard. Yes, most intervention and transport companies can and will physically restrain an adolescent in an attempt to stop them from hurting themselves and/or others. However, they too will restrain an adolescent just based on the fact that the adolescent is in opposition as to complying with the transport itself. The lack of training, education, skills, etc. lead transport companies to inadvertently escalate situations to physical restraints long before restraints are needed.    I believe this to be, in part, because of miss-interpreted perceptions by the intervention and transport companies themselves as to their function, roles, and actual job within this industry. I believe, having worked in this industry for years, that intervention and transport companies, and many within the industry itself, do not feel as though the intervention and transport itself has any therapeutic value or is in and of itself, not therapeutic in any way, therefore resulting in standards and practices not equal to the rest of the industry. I believe that this is a very important time for change within this industry. I believe that intervention and transport companies owe it to the families, programs, and education consultants that they serve to increase the level of professionalism, and in doing so, also deserve the proper level of respect within the industry, knowing that we are all working towards the same goals. I further believe that referral sources should insist that the level of work performed by intervention and transport companies is of the same level of quality expected from programs and schools.

 

 

First and Foremost, Harmony Crisis Management Group acknowledges, understands, and agrees that physical restraints are needed and will be used within this industry. How and when physical restraints are used, however, is the question. We do not believe that physical restraint devices, such as handcuffs, zip ties, leashes, life lines, etc. should be used in any shape, matter, or form within the intervention and transport industry, and should not be accepted as far as a standard or practice by any referral source. Furthermore, restraining an adolescent without the proper training, proper education, and without the proper escalation of force could and would only be counter-therapeutic, leaving the individual victimized, stigmatized, and psychologically harmed. It is because of this, that we believe that this industry needs to make immediate adjustments to policies and procedures, and that handcuffing, zip tying, and leashing adolescents during an intervention and transport should cease.

 

No person should be subject to improper restraints that cause them to endure physical, mental, or emotional pain.

 

For responses to this article, please respond by sending email to info@harmonycmg.com