Q.

Our center's involved with school based programs and I have concerns about using physical restraints on elementary and high school adolescents.
 

A.

As I understand it, your mental health center has entered into a joint agreement with your local school system.  You provide case management services and outpatient counseling services to emotionally disturbed children on site at the school. 

Because the children involved have severe behavioral problems your counselors and case managers have begun to use physical holding techniques with a much higher frequency than your previous use of such techniques.  Your staff have been trained in aggression control techniques provided by CPI.  However, they have been trained by a school CPI trainer who also encourages the use of prone holds.  In fact, children have been restrained with a staff member sitting on the child on the floor.  Further, the school has asked you to restrain children when there is some type of risk that they will run away from the school.  While the parents have a signed consent, you believe that the consent is not specific regarding the use of holds and the possibility that a child will be physically detained if the child attempts to leave school.  You are interested in retaining a consultant who has experience in this area. 

As I told you over the phone, I believe that the prone holds with a staff member sitting on a child can be dangerous.  I encourage you to discontinue using this type of hold.  We have had a claim in which a counselor used a "basket hold" in a prone position and the adolescent being held died.  I also encourage you to use another trainer specifically certified by CPI and to contact CPI to determine if they have a specific training module for adolescents.  Further, I agree that if your staff are going to be involved in a physically detaining a child who wants to leave the school, they should have a specific consent from the child's parents.  This type of incident will invariably involve some type of intense physical contact which could result in injury.