argument from authority, Community Alliance for the Ethical Treatment of Youth, Containment Holds, Cook County Hospital, David Ziegler, Jasper Mountain, JCAHO, John Stroger Hospital of Cook County, Monica Pignotti, Prone Restraint, Regional Institute for Children, Restraint Techniques, Ronald Federici
Dr. Federici Responds to Monica Pignotti
- Cook County Hospital, Illinois
- Regional Institute for Children, Maryland
- Jasper Mountain, Oregon
Odd that Cook County Hospital is no longer called Cook County Hospital. It has a name change and is now called John Stroger Hospital of Cook County, which makes me wonder how current his information is. Based on the checking I have done, Stroger Hospital of Cook County has no inpatient psychiatric unit. Federici’s bio materials have stated he did an internship there back in the mid 1980s, but currently it doesn’t appear to even exist, so it appears his information is not current, as a psychiatric unit that does not exist can hardly practice prone restraint on children.
I plan to check this information out and see if anyone at Stroger uses this prone, face-down restraint technique. As I noted previously, even if they are using this technique (which is highly doubtful, given the current literature on the dangers of face-down prone restraints and JCAHO’s stance against it) it is very different when restraint techniques are used under the strict supervision of a residential facility, as opposed to parents using the techniques who are alone with the child. Even if trained by a therapist, it is not the same as being fully credentialed on the use of restraints, the kind of training nurses and paramedics get, but few mental health professionals ever get, much less parents.
A search on Jasper Mountain revealed that in 2007, they were hit with a lawsuit according to the Community Alliance for the Ethical Treatment of Youth:
One year after a rash of broken bones brought intense scrutiny to the Jasper Mountain treatment home for abused children, the controversy has not gone away.Guardians of three children — one suffered a broken arm, one a broken wrist and one abroken ankle — are now suing the home and seeking $200,000 for each child for suffering, plus medical expenses. Jasper Mountain Executive Director Dave Ziegler, meanwhile, continues to spar with child welfare officials.
Details are available at the above website. They appear to be quite a controversial organization, especially when it comes to their use of restraint:
The use of restraining holds is a controversial issue nationwide. Government agencies are moving toward a position that restraining holds should be reserved for rare circumstances. But Ziegler is a nationally known proponent of using restraining holds for therapeutic purposes.
“What (the state) would love to see is for us to negotiate and wheel and deal with kids and never have another restraint ever,” Ziegler said.
“That’s a naive stance. There are therapeutic benefits to drawing a line for kids and not letting violent kids get violent to themselves and get violent to others and, at times, that requires physical direction.”
Interesting that Federici would choose this organization to name as one that is in agreement with the restraint procedures he recommends in his book. While Federici denies his holds are for the purpose of therapy, apparently Ziegler takes a different position on this matter.
Jasper Mountain’s policy is available as a PDF online.
Containment holds are only appropriate in serious situations where the goal is to prevent immediate harm to the child, to others in the environment or serious threats of violence. When a containment hold is necessary, it is essential that the staff members are as calm as possible to handle the situation wisely and with the least amount of physical force necessary. The staff need to send a signal to the child that the potentially violent situation is under control. It is critical to abused children that, during holds, the child is treated appropriately and respectfully.
They state that they used these holds only when there is immediate danger to the child, which is different from what Federici recommends in his book, since he recommends his Sequence One Hold be used, even if the child backs down and promises to be good.
I will update this article as I learn more about the institutions listed by Dr. Federici.
Thanks, Dr. Federici. I really appreciate your informative response to my question, which really does shed more light on this issue. I am learning a great deal from you, even though I could do without your gratuitous ad hominem attacks and appeals to authority in your subsequent comment as well as your false statements about Charly Miller. Oh, and by the way, Charly Miller is not the only one to have concerns about prone restraints. You got me all wrong, Dr. F. I don’t “rely” on the word of any one individual for anything, no matter who they are. What I rely on is substantive evidence. She cited actual literature to support her concerns and there are a number of groups that have serious concerns and have been working to get them banned completely. In fact, the State of Ohio felt so strongly about this issue that they banned prone restraint altogether. Here is what researchers at Cornell University had to say about the issue based on their research. Sorry, Dr. Federici but the argument to trust you simply because you have had years of hands-on experience just doesn’t cut it. Many fatal errors were made in the 80s and 90s and the last people I would want to trust are people with years of hands-on experience from the 80s and 90s who have somehow failed to notice the current findings on the dangers of such restraints.
JCAHO has made their position very clear and 30% of the deaths investigated were from so-called “therapeutic holds”. They state (and again, this applies to hospitals under strict supervision, not parents left to their own devices at home):
If a patient must be restrained in the supine position, ensure the head is free to rotate to the side and, when possible, the head of the bed is elevated to minimize the risk of aspiration. If a patient must be restrained in the prone position, ensure the airway is unobstructed at all times. For example, do not cover or bury the patients face. Also, ensure that expansion of the patients lungs is not restricted by excessive pressure on the patients back. Special caution is required for children, elderly patients, and very obese patients.
Certainly two adults on top of a child would not be acceptable. I plan to go into this more in future postings in order to illustrate just why this is such a serious issue.