By Clelia Sigaud, M.S.
bSci21 Contributing Writer
It’s hard to forget restraining someone. The exposure to intense aggression or self injury, along with screaming, struggling, threats and entreaties, possible injuries, and the myriad other manifestations of crisis behavior that are common during such procedures are far removed from what most of us have ever experienced in our lives outside of the field of human services.
When I first began working in special education, I attended a number of trainings and workshops related to the field, the content of most of which I have long since forgotten. I still vividly recall, however, one particular phrase from a training on restraint and seclusion legislation, “restraint and seclusion are indicative of treatment plan failure.”
To me, this phrase elegantly encapsulates why restraint and seclusion have no place in our treatment interventions. When we resort to physical means to forcefully control a client’s interfering behavior, our treatment plan has failed. When our treatment plan fails, then we, as behavior change agents, have failed. We have failed. Every time a restraint or seclusion happens, that is a failure, and should be recognized as such.
This is not to say that I am categorically opposed to all use of physical force in managing interfering behaviors. Although they are not and should not be classified or thought of as treatment tools, restraint and seclusion may sometimes be necessary. In the case of high-risk behaviors that are, in the moment, unresponsive to our interventions, it can become our duty to re-establish safety by utilizing a restraint or seclusion procedure. I am, however, strongly in favor of a model that conceptualizes restraint and seclusion as exactly what they are – red flags indicating that something about our services is inadequate or ineffective. Just as an engineer would analyze the causal links between her design and a subsequent vehicle malfunction, so should we use the debriefing process to examine what went wrong in our treatment planning or service delivery. Many workers in all kinds of roles are tasked with maintaining safety. We have a far more complex duty than the maintenance of safety – we need to create it.
As behavior analysts and supervisees, we are held to very high standards – standards to which many other professional conduct codes do not come close to aspiring. The potential burden of the standards are more than counteracted, however, by the amazing array of behavior change tools in which we are trained to use. We should not expect to be skilled in evidence-based interventions while simultaneously being permitted to habitually utilize very low skill, reactive procedures to temporarily address the very challenges that are inherently complex enough to warrant treatment to begin with. Below are five reasons to tread cautiously into the realm of restraints and seclusions:
Restraints and seclusions are not function-based interventions. They do not treat.
Restraints and seclusions break relationships down. They damage the all-important rapport that we work so hard to establish and maintain as the bedrock of our work with clients.
Using restraint and seclusion as problem-solving tools can shape our own behavior in very unhealthy ways. The relatively speedy attainment of a sense of re-established safety and control, albeit often a false one, can lead us to rely on such physical management techniques when they are not warranted. Restraining or secluding a client should be an aversive experience for us!
Restraint and seclusion frequently results in injuries, and restraints can kill. Even “proper” restraints have caused the death of both clients and staff members in the past.
Every time a restraint or seclusion happens, we lose something. We lose a piece of our integrity as behavior change agents. We lose the opportunity to truly intervene in a treatment oriented way. We risk the breakdown of relationships with clients, and possibly even other stakeholders, such as staff members and parents.
Anyone can restrain and seclude clients in order to render their interfering behavior less problematic in the moment. It takes a committed, ethically minded, and knowledgeable interventionist to engage in long term problem solving.
Note: Pritchard and D’Antin wrote a response to this article here.
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Clelia Sigaud, M.S. is a teacher to children with developmental disabilities in urban Maine (to the extent that “urban” and “Maine” can be used in the same sentence). She has several years of experience working with special needs individuals, from preschool through age 20, in a variety of settings. Outside of work, she is earning her doctorate in School Psychology from the University of Southern Maine. Her interests include functional communication training, interventions for sexualized aggression/sexually problematic behavior, treatment of self injury, paraprofessional training, and ethical practice within the field of ABA. In her spare time, she enjoys authoring her own social stories. You can contact her at firstname.lastname@example.org.