Holds and Restraints
MONDAY, JULY 18TH, 2016
Holds and restraints are at the far end of the continuum of behavior management interventions. Students with challenging behaviors are among the population of students where holds and restraints are most common. The most basic rule of thumb in regard to holds and restraints is simple; avoid the use of them at all costs unless the safety of the student or those around him is in jeopardy. Iowa Code Chapter 103 details, among other things, the legal requirements all staff should be aware of regarding holds and restraints. Sections of the Code which deserve special note would include the following:
1. Training: Programs such as Mandt, TACT-2 and CPI are all popular evidenced-based training programs that serve as a great resource for staff challenged with the need to apply a hold or restraint. Initial training is a great place to start. But there is no substitute for recurrent training to help keep skills sharp. Additionally, a current, signed certificate of completion should be a mandatory component of any staff member's personnel file who works with special education students who have a behavioral disability.
2. Prone Restraints: Never. Ever. And in the event that a staff member finds himself in a prone restraint with a student when responding to an emergency, the staff member must take immediate action to end the prone restraint. Some of the most tragic stories under the heading "What's the worst thing that can happen?" involve the use of a prone restraint with a disabled student.
3. Paperwork: If a hold or restraint is employed, the required paperwork that must follow is substantial. And for good reason. Essentials include names of staff present during the restraint, time of day, behavior of the student, actions of staff before, during and after, and a description of injuries, if any. Additionally, copies of all related paperwork must be forwarded to parents/guardians within 24 hours of the occurrence.
4. Punishment: Never use a physical restraint as a form of punishment. One would think that principle would not even need to be mentioned. But it is in the Code for a reason. Staff dealing with a highly agitated student can sometimes leap frog to a hold or restraint as a "consequence" for bad behavior, when an appropriately implemented de-escalation technique would instead have been much more appropriate.
Holds and restraints are an unfortunate but necessary fact of life in working with students with challenging behaviors. The key is knowing what to do, when to do it, and how to ensure it fits appropriately in to the continuum of interventions that may be appropriate for.