DE-ESCALATION TECHNIQUES: All direct care staff are required to participate and successfully pass Therapeutic Crisis Intervention training. During this training they learn de-escalation techniques to defuse a situation in an attempt to avoid the use of restraint and/or seclusion.
De-escalation techniques include:
-Using active listening to validate feelings
-managing the environment
-redirection and distractions
-giving the child time and space
RESTRAINTS:Physical interventions to contain and/or control the behavior of children andyoung people in care should only be used to ensure safety and protection. Except where otherwise specified as part of an approved individual crisis management plan (ICMP), physical interventions should only be employed as a safety response to acute physical behavior and their use is restricted to the following circumstances: The child/young person, other client, staff members or others are at imminent risk of physical harm.
-As any physical intervention involves some risk of injury to child/young person, or staff, staff must assess this risk against the risk involved in failing to physically intervene when it may be warranted. Physical intervention should never increase (or create more) risk than the behavior it is trying to contain.
-Physical restraints should only be employed after other less intrusive approaches (such as behavior support techniques, or verbal interventions) have been attempted unsuccessfully, or where there is no time to try such alternatives.
-Physical interventions must only be employed for the minimum time necessary. They must cease when the child/young person is judged to be safe and no longer at risk of self-injury, or harming others.
-Staff that has successfully completed the physical component of Therapeutic Crisis Intervention training may only undertake physical interventions. They must also have demonstrated competency in performing the intervention techniques, which is measured and documented according to relevant professional and/or state regulatory guidelines.
-All staff involved in an incident of physical intervention must have successfully completed the same training program which has been fully endorsed and implemented in the agency, been assessed as competent in the use of physical interventions and successfully completed a skills review within the previous six months. Brookhaven utilizes Therapeutic Crisis Intervention as the training program.
Approved restraints include:
-Small Child Restraint: This restraint requires one staff to conduct the hold (but a second staff must be present to witness the restraint and assist as a second if needed). The lead staff approaches the child from behind and pushes on the back of the child’s upper arms, causing the arm’s to cross in front. The staff grasps above the wrist and secures the arms by locking the elbows. This is done by placing the child’s top arm under the other arm, resulting in the child’s wrist being under her elbow. The staff has the option of walking the child backwards to a wall and sliding down the wall, bringing the child down inside his legs. The result being the child and the staff are seated on the floor, with the child sitting inside the worker’s legs. If a wall is not available the staff member brings the child to the floor by stepping backward and bringing the child down along the inside of his leg. If another staff member is needed to help control the legs, this person wraps his arms around the child’s legs, avoiding knees and ankles, facing away from the child.
-Standing Restraint: This restraint requires two staff members. The staff approaches the child from the front and each staff secures an arm by grasping above the wrist, and holding the child’s arm against their chests, the child’s hand at the adult’s waist. If the child continues to be violent both staff pivot and step behind the young person, standing hip to hip.
-Seated Wall Restraint: This restraint requires two staff members at all times but may include three. Staff begins with initiating a standing restraint and pivoting behind the child (as described in the standing restraint). Once in position, if the child cannot be contained in a standing position, the adult’s walk the child backward a short distance to the wall, bring the child down on the inside of the adult’s legs. The result is the child and adults are seated on the floor, with the child sitting between the adults. The adults secure the legs by placing their inside legs over the young person’s leg being careful not to place pressure on the young person’s leg, groin, or knee. If a third adults is available this person can secure the legs by wrapping her arms around the young person’s legs, avoiding knees, ankles, facing away from the young person.
-Prone Restraint: This restraint requires two staff members at all times but may include three. The child’s arms are secured by the staff bringing his/her leg close to the young person to secure the child’s arm close to his side. The lead staff leans across the young person resting her weight on her arm on the opposite side of the young person. Care is taken to make sure that weight is not placed on the back of the young person in order not to restrict the young person’s ability to breathe. The assisting staff member holds both of the young person’s arms above the wrists while securing the legs. Care is used to make sure weight is not placed on the young person’s knees or ankles.
-Supine Restraint: This restraint requires three staff members at all times. The child’s arms are secured by the lead staff and the assisting staff by placing the child’s arms on the floor and holding it above the wrist with their outside arms. A third worker secures the legs by wrapping his arms around the young person’s legs “circling the legs” above the knees. When the third worker is in position on the legs, the two worker’s securing the arm’s, bend the child’s arms, palms up, toward the young person’s head, as if the young person was flexing his arms. The arms are secured by the worker grasping the young person’s arm just above the wrist and placing the worker’s inside knee against the person’s armpit and the outside knee against the young person’s wrist.
SECLUSION:(however named) is the confinement of a child/youth in a segregated room, for the purpose of preventing harm to self or others, with the child/youth’s freedom to leave physically restricted. Seclusion is not a punishment; the child/youth is considered in seclusion
If a child is secluded over 10 minutes, a shift supervisor will be contacted for approval/oversight.
If a child is secluded over 30 minutes, a clinical staff will be contacted for approval/oversight.
Any child/youth in seclusion, and escalated must be monitored closely. If they are secluded in a quiet room, staff will remain by the quiet room door so they have eyes on for the time secluded (even if they are not escalated). If the child/youth is in their bedroom, and they are in an escalated state, staff must remain at their bedroom door and do 5 minute checks through the window. If they are not in an escalated stat, but are in their bedroom due to a plan,
VOLUNTARY TIME OUT: Child is using the quiet room by choice and freedom to leave will NOT be prevented. Voluntary time out is not considered seclusion, even though the voluntary time out may occur in response to verbal direction. A child taking a voluntary time out is still closely monitored by staff.