Use of restraint common in group homes,
Ontario has no standards on using physical measures with kids who are acting out
Flailing on the floor until your “fists and forehead are swollen” can get you physically restrained in a Toronto group home. But so can spilling your popcorn and becoming “rude and disrespectful.”
Restraints were used in more than one-third of 1,200 serious occurrence reports filed in 2013 by group homes and residential treatment centres in the city, according to a Star analysis.
At one treatment facility, 43 of the 119 serious occurrence reports filed to the Ministry of Children and Youth Services include a youth being physically restrained and injected by a registered nurse with a drug, presumably a sedative.
In one report, the child is quoted as saying, “I want you to hurt me and put me into restraint.” In another, the child reportedly begs to be let go because “I’m going to pee myself.” The restraint continues and the child urinates on himself.
Under provincial regulations, physical restraints can be used only to prevent residents from injuring themselves or others or from causing significant property damage.
They can only be used when less intrusive methods have been tried or deemed not to be effective.
After two high-profile inquests into the deaths of two children restrained in Brampton and Peterborough-area group homes in the late 1990s, provincial regulations were changed to require ministry-approved training in physical restraints for all frontline staff.
All of the six ministry-approved programs also include instructions on how to prevent aggressive behaviour without resorting to physical intervention. And all teach variations on three types of physical interventions: standing and floor re- straints, which usually require two staff members, and single-person holds. But only one training program — Therapeutic Crisis Intervention, developed by Cornell University in Ithaca, N.Y. — is designed specifically for children and youth, notes Kim Snow, an associate professor at Ryerson University’s School of Child and Youth Care. The others were developed for adults and adapted to children, she says.
Snow, who has more than 30 years of experience in the field and ran several group homes in the 1980s, says any restraint used for less than 10 minutes is a sign of untrained staff.
“When I read (in serious occurrence reports) about a 5-minute or 10-minute restraint or containment, that tells me the child is not out of control,” she says. “Those always tell me it’s a power and control issue.”
It takes highly skilled staff to work with children with histories of trauma and accompanying rage to be able to contain them without physically intervening, Snow says.
“When people lack those skills they become frightened and they intervene much too quickly.” When that happens, the child or youth’s physical and psychological safety is at risk, she adds.
A2008 Cornell University study on the various types of physical interventions found “all restraints present considerable risk to the youth, are intrusive to the youth, have a negative effect on the treatment environment, and have a profound effect on those youth who have experienced trauma in their lives.”
A 2013 report by the governmentappointed Youth Leaving Care working group identified inconsistent care and “particularly the policy on the use of restraints” as a major problem.
The working group, which included young people who grew up in children’s aid, recommended the ministry work with group home providers to “clarify and reinforce policies and best practices to make sure they are followed.”
Irwin Elman, Ontario’s advocate for children and youth, says the province should ban physical restraints, not just for the child or youth who might be subject to a hold, but for the other children in the home who witness it.
“These are children who often come with experiences of violence or serious mental health challenges,” he adds. “How in hell do we expect them to achieve to their full potential, to heal, to find supportive relationships in those kinds of environments?”
At Valoris, the children’s aid society serving Prescott-Russell, east of Ottawa, officials were concerned about the high use of restraints and decided to act.
Instead of training every worker in physical restraint techniques, “which is sort of an open invitation to do restraints in the face of any kind of difficulty with the client,” the society trained only those who would clearly need the training in an emergency, says Raymond Lemay, the society’s recently retired executive director.
The society also brought in a renowned American expert on alternatives to restraints to teach all staff how to prevent aggressive behaviour and diffuse volatile situations before they get out of hand.
“We told staff that every restraint is a failure of service,” Lemay says. “Restraints still occur, but it’s gone down dramatically, perhaps 80 per cent.”
The use of restraints “has improved tremendously over the years, at least at my agency,” says Bob Hanrahan, director of Hanrahan Youth Services, which operates four group homes, including two in Scarborough.
Out of 126 serious occurrences recorded at Hanrahan’s two Toronto homes, 27 involved restraints, according to ministry documents from 2013. Last year, the agency recorded “just three or four” restraints in those facilities, says Hanrahan. He credits his agency’s two staff trainers who teach interventions and strategies to all front-line workers and foster parents.
But it is difficult to know what is happening across the province because the government doesn’t keep aggregate data, Snow says.
“I have not seen any research on this. I have not seen a systematic review of what’s going on. And we still have no basic standards,” she says.
Snow, who is working with the provincial advocate’s office on its own examination of serious occurrence reports, hopes the ministry review of residential care, announced last week, looks at staff training and safeguards.
“Are children in group homes and residential treatment centres safe?” she asks.
“That is the minimum expectation that I would have of this panel. And I think the province has to answer that question.”
“Are children in group homes and residential treatment centres safe? That is the minimum expectation that I would have of this panel. And I think the province has to answer that question.”
KIM SNOW ASSOCIATE PROFESSOR, RYERSON UNIVERSITY, PICTURED ABOVE