When the core mission of an organization suffers due to restraint avoidance
we have a situation where management and or staff has adopted the belief that 'the cure (restraint) is worse than the disease (crisis)'. At the PCMA we recognize this situation when we hear staff describe this kind of situations:
“We just let him sleep on the couch at his day training program or there’s going to be a restraint”
“My staff were so burned out from restraining that we just let the client do whatever he wants.”
“We are supposed to be teaching him to write his name, but he bites us so often we just let him trace letters.”
How does this belief, that restraint is worse than dealing with crisis, come into existence?
Many facilities claim to be “hands-off,” meaning that they use no form of restraint during an emergency. Because they choose not to touch an individual in crisis, staff will learn to do anything they can to avoid a problem. Sometimes that involves giving the person whatever they ask for or allowing them to sleep when they are supposed to be working. In other cases the physical procedures used are so ineffective that staff don’t even try using them because we only end up getting injured.
Both situations result in a larger problem, which is a lack of progress such as
- failed educational goals,
- loss of future placements, or a
- failure to acquire a functional level of independence.
A 'Hands-Off Policy' can have several causes, and this policy typically produces one of these three strategies: Stop demanding progress with the individual (like 'let him sleep') - or by becoming hostage to the individuals demands - or just let the individual rage and destroy the environment ('room clear'). But whatever the strategy chosen to avoid the restraint, the progress with the individual stops or is severely slowed down.