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crisis cycle

The Birth of a Restraint

Brice Moss, LCSW-R, is the Director of Residential Services at ANDRUS.

We all want to avoid restraints at all costs.  They are traumatizing to children, and are retraumatizing to survivors.  They are inherently counter-therapeutic.

When restraints happen, we often talk about the behaviors at the end of the crisis cycle that required a restraint – a child was abusing himself and wouldn’t stop, or a child was repeatedly kicking a peer or a staff and wouldn’t stop.  I am pleased to say that there are almost no unnecessary restraints that are done at Andrus – the behaviors that were happening at the end of the crisis cycle required us to restrain a child for safety reasons.

But the end of the crisis cycle is not where restraints are born.  Restraints are born before the crisis cycle.  Here are a couple of scenarios and the lessons I have learned from each one:

1)     The children and the staff are waiting for kids to get their allowance so they can go on a shopping trip.  While waiting, they are sitting in the living room, and are not engaged in an activity.  This is the sort of scenario that begins a process that can end up in a hold.  Unoccupied down time doesn’t always seem that important, but it can be the start of a situation that leads to a child recalling unhappy memories and getting triggered.  Thus we start down a path that might end up in crisis and an unavoidable restraint.

  • It is very important to keep our children occupied.  Any time children are not engaged with staff in an activity is perilous – a powder keg waiting for a spark.  It is important for staff to pull something out of their “bag of tricks” – a guessing game, singing a song, playing a quick hand of cards – while waiting for the allowance to be handed out.  That can do a lot to decrease the likelihood of a restraint being “born.”

2)     A cottage has been hectic recently and very trying for the staff.  The Program Manager has had to address a child or family complaint and has not been able to provide the regular supervision.  Staff’s energy reserves are low – and so is their patience.  Instead of managing his emotions perfectly, and closely monitoring his tone of voice and body language, a staff person responds to a child’s behavior with the kind of frustration you can hear in his voice or see in his posture.  A child feels subjectively triggered and we start down a path that might end up in crisis and an unavoidable restraint.

  • It is easier to prevent something from happening in the first place, than it is to manage a situation in which a child is triggered.   We do work that is challenging on many levels.  Humans get frustrated in normal circumstances.  Working every day with children who have intense needs and hair-trigger sensitivity,  it can bedifficult to manage our emotions.  So it is especially important that we have regular supportive supervision, that we keep an eye on our emotional thermometer, that we check in with our teammates, and that we tap in and tap out when we’re not at our best.  The children we work with don’t always hear our words very well.  But they are exquisitely sensitive to our non-verbal cues – our tone of voice and body language.  Managing those well decreases the likelihood of a restraint being “born.”

3)     We’re transitioning from the basketball court to dinner.  Staff loses track of the time and we’re running late.  Instead of giving the kids a 15 minute warning, and one at ten minutes, one at five minutes and a final one-minute warning, a staff person suddenly realizes the time and she abruptly tries to hurry the kids into the cottage for dinner.  A child feels subjectively controlled, he is reminded of his trauma (where he was controlled by an adult caretaker in an abusive way), and thus we start down a path that can easily end up in crisis and an unavoidable restraint.

  • With our children, it is critical to plan our transitions well so we move smoothly from one activity to the next.  We need to tell children how long we’ll be in an activity before we begin it.  We need to review behavioral expectations so children know what is being asked of them.  We need to stop a minute or two early and have the children practice their Safety Plans while they’re calm, as we transition from one activity to another.  Managing transitions well decreases the likelihood of a restraint being “born.”

It’s easy to justify a restraint based on the unsafe behavior at the end of the crisis cycle.  It’s harder to see that down time, non-verbal cues, and poorly executed transitions have anything to do with restraints.  But these areas – and many more – are the spawning ground of restraints.  By managing them well, we can avoid situations in which a crisis can result and a restraint becomes necessary.