Advocates for Children in Therapy, attachment disorder, behavior management, Crisis Management, Monica Pignotti, PCMA Inc., Prone Restraint, Reactive Attachment Disorder, restraint directives, restraint guidelines, Ronald Federici
State of Connecticut Directive on Prone Restraints
Prone restraints have been completely banned in several states. In other states, they are still legal but even those states, such as Connecticut, have developed strict guidelines for their usage because the dangers of improperly done prone restraint are widely recognized, even by those who still favor its usage and work for various state agencies.
Here is a directive from the State of Connecticut. Here are some points especially relevant to the discussion and criticism on this blog about recommendations for prone restraint by certain therapists who work with adopted children.
The Planning and Support Team (including guardian) recommends the use of the prone restraint procedure based on a written summary that clearly documents “risk/benefit” factors (i.e., that all less risky intervention procedures have been unsuccessfully attempted, that the individual’s behavior
justifies the risks associated with using prone restraint, or an existing medical/behavioral condition that contraindicates supine (face-up) restraint).
No prone technique shall allow staff to straddle or bear weight on the individual’s torso while applying the restraint (no downward pressure may be applied that may compromise the individual’s ability to breath).
No soft device (such as a pillow) shall be used to cushion the client’s head, since such a device may restrict the individual’s ability to breath.
All staff who will implement the restraint procedure have been trained in the individualized prone restraint plan by a trainer certified in an approved crisis management curriculum who is qualified to teach the use of prone restraint techniques.
The individualized prone restraint plan shall include monitoring techniques to ensure safety and identify early signs of distress, and shall specify clear criteria for releasing the individual if any sign of distress occurs.
Note that these guidelines are also in agreement with the white paper from a Florida-based organization. PCMA, Inc. that trains in crisis management and prone restraint and most importantly, trains people in behavior management skills that can prevent its use altogether in the vast majority of cases. Readers can compare and contrast these guidelines with some of the recommended restraint procedures I have criticized and discussed on this blog (click on the “restraints” heading on this blog to view them all). Recognize, however, that the difference is that these guidelines pertain to people who are working under highly supervised, institutional settings whereas the procedures I have criticized are presumably being carried out in private homes.
So yes, there is controversy over whether prone restraints should be used at all, but some points, such as not putting weight over or even straddling the person’s torso, never putting a pillow under a person’s head and using them strictly for safety (not for therapy and not to show the child who is boss) appear to be widely agreed upon, even by proponents of prone restraint.
In any case, this directive, which comes from a state, should put to rest any notions arising from the smear campaign propaganda against me that my criticisms and those or my colleagues are “fringe” and “Scientology backed.” The fact is that I am a well known, outspoken critic of Scientology and have been for more than 20 years and I would never be on the advisory board of any Scientology-backed organization. Advocates for Children in Therapy (ACT) is run by two people who have a longstanding history of being skeptics and a third who is a tenured Professor Emerita of Psychology, who have have never had any affiliation whatsoever with Scientology (I am on ACT’s professional advisory board, but not an officer of ACT). I am only quoting from guidelines that are today very much accepted by mainstream practices. Believe it or not, there are valid reasons to criticize certain licensed mental health professionals that have nothing whatsoever to do with Scientology and the attempts to associate the work we do with Scientology only shows how desperate certain people with certain interests have become to try and discredit us, rather than issue any kind of substantive rebuttal to our criticisms and discuss the issues at hand.