When dangerous behaviors require a safe and human response in order to limit harm, only highly-trained staff should be expected to respond. Those behaviors must pose an imminent danger of serious physical harm.
NAPPI training includes both self-protection and restraint training in 14 modules designed to prepare and train staff in how to address a dangerous situation from its start through the review afterwards.
- S.M.A.R.T® Physical Principles
- X-Shield and Blocking Blows
- Escaping Grabs
- Escaping Chokes
- Hair Pulls and Bites
If a Restraint is necessary two caregivers must be in agreement that at least 3 restraint avoidance techniques were employed prior to the restraint.
- Physical Escort(s)
- Standing Restraint
- Seated Restraint
- Side Floor Restraint (CPR Recovery)
- Modifications for Small Bodies
- Modifications for Large Bodies
- Wrestling Separation
- Mechanical Restraint
NAPPI does NOT and NEVER has supported the use of restraints in the prone or supine position.
Online self-protection training is available to NAPPI Certified trainers only.
Restraints can almost always be avoided. Nurses, Care Givers, Educators etc. need many skills to do their jobs; they also need skills to help create environments where restraints are unlikely to happen. NAPPI’s culture helps to develop powerful and positive relationships and creates a culture of cooperation and partnership. In addition, NAPPI’s refocusing, defusing and de-escalation techniques, with our SMART Principles® and use of the Lalemand Red Behavioral Scale® teach staff how to assess the early warning signs of violence and make it possible to avoid almost every restraint. Ask yourself, "Will what I am about to do be safer than what I am doing now?"
However, at times, a minor event will escalate out of control, resulting in the need for physical restraint. In this situation, staff need to use bodily force to limit someone’s freedom of movement. It is important to note that restraints should only be used as a last resort to keep everyone safe. The following should be taken into consideration when applying the restraint:
The type of restraint/hold used should match the level of danger.
The restraint should be used only when NOT restraining will result in more harm than the restraint.
The restraint must be terminated as soon as objectively possible.
Organizations must have clear, objective policies and procedures that state when a restraint can – and cannot – happen, along with a process for release, documentation, debriefing, and improvement. NAPPI’s Post Incident Review is a key component in debriefing the incident to determine what behaviors led up to the incident, who was involved, and how it could be avoided in the future.
Assessing the safety of a restraint technique is very difficult to do, and must take into account the physicality of the restrainer and the restrained. Restraints can place staff and clients at risk for injury. Assessing the safety of a restraint technique should meet the following NAPPI criteria:
- Minimum impact on the person being restrained
- Minimum impact on the environment
- A large margin of safety
- Applicable to a variety of situations
- Teach one skill
- It should flow from a natural reaction
- Easy to learn and recall
Suggested Reading & Resources
The reading below will give you a good sense for how restraints and seclusion affect children and educators, and some tools to begin discussions from a common understanding.
- Chris Van Ee Ph.D. Letter.
- Convention on the Rights of Persons with Disabilities (2009). United Nations, New York, NY.
- Seclusion and Restraints: Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers (2009). Gregory D Kutz, GAO-09-719T http://www.gao.gov/new.items/d09719t.pdf
- School is not Supposed to Hurt: Investigative Report on Abusive Restraint and Seclusion in Schools (2009). National Disability Rights Network, Washington DC, www.ndrn.org
- Physical Restraint: A Historical Review and Current Practice, Kim J. Masters, MD Psychiatric Annals. 2017;47(1):52-55