Innovative
Methods for Handling Hitting, Biting, and Kicking
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The
use of restraint to control an adult client who is either hitting himself or
attacking staff is a controversial area. Kim Sanders and her associates at
Grafton Services in the northeast have found innovative ways to eliminate the
use of restraint when a client has a meltdown. They have been able to do this
and keep both clients and staff safe from injury. An added bonus was they were
able to decrease the use of medications in some clients.
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First
of all, the staff has to believe this is possible. To change the mindset that
restraint is the only way to deal with dangerous behavior requires a supervisor
who absolutely believes in it. The principle of this method is both brilliant
and simple. Instead of restraining the person, you block his/her actions with
something SOFT. Soft, large objects sofa cushions or beanbag chairs are held up
as a shield. The staff let the client pound on it, and the staff is trained not
to push with the soft shield. They want to block the person from causing harm
to himself or others. For clients with really severe behavior issues, the use of
padded martial arts shields or a baseball umpire chest protector works well
because these soft objects have handles. If a particular client kicks a staff
person's legs, they put soft soccer shin guards on the staff person's legs. If
they bite another person's hands, soft, padded protective gloves are put on the
staff's hands. Providing a soft object for the client to attack seems to calm
the client down, whereas forceful restraint makes the client more angry or
scared. For head banging, the staff member puts on a furry fleece car wash mitt
and holds it near the person's head and lets him hit the glove. The client
usually likes the feeling of the glove and stops hitting, and then the staff
lets the client have the glove.
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Some
behavior analysts will say that this procedure will reward bad behavior. To
this statement, Kim replies, "You cannot teach during a crisis. These
methods are used only during a crisis. When the crisis is over, then you can go
back to behavioral methods."
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Kim
and her staff have carefully documented the results of their program and showed
these figures at the 2008 Autism Society of America conference. They presented
graphs showing the decrease in the number of times they had to restrain a
violent client using this technique. In 2005, restraint had to be used 1,400
times in their many facilities. In 2008, that number had been reduced to just
eight times! This is remarkable progress.
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Staff
injuries and turnover have also decreased. As staff started believing in the
new method, and seeing its success with their clients, they became more and
more creative in developing new ways to use it. However, the keystone of this
technique remains having a manager who believes in it, make sure that staff are
properly trained in using it, and monitor that it is being consistently used
with clients.
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Temple
Grandin "The Way I See It: A Personal Look at Autism &
Asperger's" (2011)
