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Dr. Federici Responds to Monica Pignotti

April 13, 2010

Ronald Federici responded to my question about what hospitals currently use the face-down prone restraint procedure illustrated in his book. He states that the following hospitals use this technique:

  1. Cook County Hospital, Illinois
  2. Regional Institute for Children, Maryland
  3. 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.

  1. As far as I can tell, Stroger doesn’t have an in-patient psychiatric ward.

    • I had wondered about that as well. I wasn’t able to find reference to one either, on their website, which makes me wonder if the facility even exists anymore. I submitted an inquiry to them and will let people know if they respond.

      • I know they have an outpatient clinic, but as far as I know the state mental facility is Chicago Read Mental Health center. (I live in Chicago, can you tell?)

  2. My opinions:

    The State of Virginia has done nothing substantial, if anything, about Dr. Federici’s promotion of an extremely dangerous prone restraint method “as therapy,” despite the fact that restraint, as Dr. Federici teaches it in his book, is universally deplored. The State of Virginia risks the consequences of condoning this practice, and unfortunately, nothing may change until a child is suffocated and/or crushed by the Federici method.

    Larry Poniatowski, RN, of the JCAHO Division on Restraint, claimed that the consensus of a 1999 JCAHO Task Force on Restraints was that “therapeutic holds” or “physical holds,” to modify behavior, do not produce any sort of therapeutic benefit and should not be used in any circumstances. Further, he said JCAHO “would never condone [them]”; that “they are really corporal punishment and not allowed.” He emphasized that restraints should only be used as an emergency measure to prevent a person from hurting himself or others.

    JCAHO advises where prone restraint cannot be avoided in emergencies, that no weight be put on the chest (Dr. Federici has two adults on the child, one lying over the child’s chest); that the airway not be blocked (Dr. Federici suggests putting the child head-down into a pillow or jacket); and that prone restraint especially not be done with children. Dr. Federici further recommends that parents not look at the child’s face (as it turns blue, one presumes). This dehumanizing practice is a recipe for disaster. And it must be extremely painful, emotionally and physically, for the child.

    Federici was informed years ago about the dangers of prone restraint; for him not to correct this situation is highly irresponsible. At a minimum, Dr. Federici needs to take his self-published book (both editions) off the market, and warn the public and past clients of the dangers inherent in this restraint practice.

    Dr. Federici’s associate, Dr. Dave Ziegler, is not so pure when it comes to physical restraint. In 2001, Dr. Ziegler wrote approvingly of Howard Bath’s promotion of restraint for “therapeutic benefit”:

    “Dr Howard Bath, in his excellent 1994 article on this subject, summed up the issue in a manner that is difficult to improve upon: ‘Quite apart from the collateral benefit of containing a dangerous behavior (most often the protection of other children and adults and the prevention of “contagion” effect), sensitive employment of physical restraint can effectively demonstrate limits for a child, provide a timely response to a child’s need for protection from his or her own impulses, and prevent a child from receiving reinforcing rewards for aggression. In contrast to the use of seclusion, it achieves these ends in an interactive and inclusive manner. Additional therapeutic benefits may be found in attachment-related possibilities. A care worker with an understanding of a child’s temporal responses to confrontation and the typical phases of temper tantrums will allow and channel the expressions of anger and rage and be alert to the opportunities that the resolution affords for mutual bonding. Physical restraint is not a management tool that should be employed when less intrusive approaches will suffice, but when used appropriately it can have significant therapeutic, benefits.’ ”

    From: “To Hold, or Not to Hold…Is That the Right Question?”
    Residential Treatment for Children & Youth, 2001, 18(4):42-43

    For more on Dr. Ziegler:

  3. To Faith: I received your response regarding your experience with your adopted child and I thank you for the points you raise and appreciate that you mostly addressed the topic rather than personally attack me, even though you strongly disagree with me. I feel you brought up a number of points that are so important to address that they shouldn’t be buried in the comments section because I feel that others could benefit from such a discussion. Therefore, instead of posting your comment here, I will be posting a new blog article with a point by point response to your comment within the next few days. I do hope that this will be the beginning of a constructive dialogue.

Trackbacks & Pingbacks

  1. Questions for Dr. Ronald Federici « Potentially Harmful and Other Questionable Therapies
  2. Just One More Thing, Dr. Federici « Potentially Harmful and Other Questionable Therapies
  3. Refuting the Straw Man Argument and Misrepresentation of My Position on Prone Restraints « Potentially Harmful and Other Questionable Therapies
  4. Jean Mercer Responds to Adoptive Parent’s Comments « Potentially Harmful and Other Questionable Therapies
  5. Monica Pignotti Responds to Adoptive Parent’s Comments « Potentially Harmful and Other Questionable Therapies

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