Wednesday, March 25, 2015

When you have to Restrain....

The issue of restraining individuals in ICF programs is a touchy one to discuss, plan for or to deal with especially when a surveyor is questioning you about your methods.  Many states, like Texas, do not have a standardized restraint or restraint training for facilities, so most are left up to their own devices to develop a program, seek out one offered by another provider, or just take the chance they will never have to do a restraint.  If you are lucky, you will have a good solid program that you rarely have to use.  Some places are not that lucky.

As some of you know I run a consulting company (My QIDP).  Naturally, I am usually hired when things are going bad.  I rarely get a call that says, "Hey, things are great, survey just left and didn't write any tags, but we were just wondering if you'd like to contract with us?"  No, I get the calls like, "State is in the building now!  We don't have a QIDP!" or "We're in major trouble, these tags are too long and our Q just left!"  Yes, that's when I'm called to try to help.   Recently I went into a program that had a restraint policy and even program they had adopted from another provider.  I wasn't too worried until the provider informed me of the number of "Take Downs" they were doing daily.

Please understand that when I say a "Take Down," I am actually talking about staff members having to physically take a person down to the ground and hold them there for a period of time.  I was surprised to see so many being used.   To further complicate things, the provider's administrator explained to me that he had watched some of these "Take Downs" and felt they were wrong for their facility.  I reviewed the training material, talked with staff, had staff demonstrate some of the maneuvers and returned to the administrator with a grim assessment.  To me it appeared many of these "Take Downs" were actually a form of modified Judo.  They seemed like they could easily become aggressive, and were obviously habit-forming.

After hearing my assessment, the provider asked me to develop a program.  I informed him that I had some information, training, and that I'd be happy to provide a program, but once it was developed I wanted to use it with other providers.  He immediately agreed that it sounded like a good idea so My QIDP set out to develop a program.

The first thing that I had to keep in mind was that complete a "Take Downs" should be the last resort.  This should happen close to the time you're calling 911 in other words.  There is a lot that can be done between the initial confrontation and a total "Take Down".

Because I had worked with several good organizations, served as the staff training coordinator for one, and taught their version of restraints as well as attended several different provider trainings on restraints, coupled with the fact that I have a black belt in Karate, I felt qualified to develop the program.  The goal became to keep restraints to a minimum and take downs to the last resort.

Out of this project was born "ARC".  ARC stands for "Assess," "Restrain" and finally "Contain".  The program is now offered through our website if someone would like to become a certified instructor (My QIDP).  The program breaks down on the three levels as follows:

A - Assess the situation.  Spend time talking to the individual, trying to determine what the problem is, and calming the person down through verbal cues without touching them.  Sometimes the person is mad and just wants to talk to someone.  There's no reason to restrain for that.  You have to talk to the person and try to learn what is bothering them to the point that they may require restraining.

R-Restrain next - If you do have to restrain a person this area should combine talking to the person and gentle restraining.  Several techniques are discussed in the class and demonstrated.

C- Containing a person is the last resort.  You should be close to calling 911 at this point.  A containment requires a full, and safe, take down of the person.  This is usually reserved for the most violent situations.

After we provided training to an initial set of trainers and they in turn trained their fellow staff, the facility saw a 95% drop in containment's in the first month!    Needless to say the administrator was very happy.  The staff were happy too because there were fewer incidents of restraining or containing the people served.

Bottom line, examine your form of restraints that your facility uses.  If they are harsh or you are using them too often, then assess them and determine where the problem is located.  It could be you need new behavior plans or approaches or it may be that you just need to wipe the slate clean and develop a new program that is less aggressive.  You could also contact us (My QIDP) for assistance or training in the ARC Program.  Whatever you decide to do, just remember that restraining someone or even containing someone on the floor should be the last thing you do before calling 911.   If restraints and containment's are use often, sooner or later a staff or individual served will end up hurt.

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