Posted on Thu, Apr. 28, 2005
Safer restraints in group homes?
Proposed rules would ban workers from sitting on children
HEATHER VOGELL
Charlotte Observer
Staff Writer
South Carolina is poised to ban group home workers from restraining
children by putting pressure on their chest or abdomen -- a maneuver
that killed two Carolina children in two years.
Shirley Arciszewski, 12, died after a worker restrained her at a
Charlotte group home for mentally ill children in September. An
autopsy blamed asphyxia caused by an adult lying on her.
In 2003, a 220-pound worker at a group home outside Charleston lay
across 9-year-old Jamal Odum's back for seven minutes. He also died
of asphyxia.
Neither North Carolina nor South Carolina explicitly bars workers
from lying or sitting on children to control them.
"These are extremely dangerous techniques," said Rochelle Caton, an
attorney with S.C. Protection and Advocacy for People with
Disabilities in Columbia. "Even if you are properly trained."
Roughly 6,000 children enter group homes and similar institutions
each year in the Carolinas because of emotional and behavioral
problems their families can't handle. Physical restraints aren't
rare; both states allow workers to hold children to keep them from
hurting themselves or others.
Misleading training?
After Jamal's death, three workers at New Hope For Children in
Jedburg, S.C., were arrested. One was charged with homicide by child
abuse and two others faced lesser offenses.The charges were dropped
in February after prosecutors saw the home's training manual. It
included a photograph showing a worker lying on top of a person to
restrain him, said Berkeley County Deputy Solicitor Blair Jennings.
"Clearly, what they did wasn't right," Jennings said. "But we
weren't going to be able to prove he acted recklessly with the
training he received."
Jay Orvin, president and CEO of the home's parent corporation, said
New Hope Treatment Centers voluntarily removed the photo after
Jamal's death because of concerns that it "might be confusing."
He said it did not depict a worker laying across a child, but showed
a child face-down on the floor with a worker "forming a bridge" over
the child's body and holding his arms.
The manual did not endorse restraining children by putting pressure
on their torso, Orvin said.
"There was never, ever, ever anything in our manuals that said it
was OK to do it that way," he said.
What would be banned?
Laying across a child's back or chest would be banned outright under
the new rules the S.C. Department of Health and Human Services is
considering, according to a draft obtained by the Observer.
The prohibited practices would also include causing pain to force
compliance, sitting on or straddling any part of the body, or using
drugs or mechanical devices to restrain a child.
The 11-page proposed "Emergency Safety Interventions" policy, which
also covers the use of locked seclusion rooms, requires homes to
notify a child's parents or guardian as soon as possible after
performing a restraint.
They also mandate that workers learn de-escalation techniques and
understand the risk of so-called positional asphyxia, which can
occur when body position restricts a person's ability to breathe.
Under the proposal, facilities would need to create a plan for
reducing the use of restraints.
The new regulations would affect roughly 1,800 children in group
homes and similar institutions across South Carolina whose treatment
is paid for by state and federal Medicaid dollars.
States set the rules for providers who treat kids on Medicaid, the
government's health insurance plan for the poor and disabled. S.C.
officials said Jamal's death was among the reasons they decided to
tighten their standards.
State clinicians who regularly visited the homes also urged the
agency to adopt better guidelines, said Jeanne Carlton, an HHS
supervisor.
The use of restraints has undergone scrutiny in recent years after
deaths at facilities across the country, said Caton, the advocate.
Medications or health conditions such as asthma make some holds that
appear safe dangerous for children, she said. Children who have
suffered physical or sexual abuse at home -- as many in group homes
have -- find restraints particularly hard to endure, she said.
"When you take a child who has been sexually abused and hold them
down, you are retraumatizing them," she said.
N.C. and beyond
North Carolina doesn't explicitly ban restraints that compress the
chest, or require training in the dangers of such holds. About 4,000
children live in the state's group homes.But N.C. rules say
restraints can't be used in a way that causes harm or abuse. And
Joan Kaye, an N.C. Division of Mental Health team leader, said
regulators review all training programs that group homes use.
"We know that that's an unsafe practice," she said. "We would
definitely not be approving any training program that had that in
it."
Shirley was not the only N.C. child to die after a restraint. In
1999, 9-year-old Timithy Thomas suffocated at a Banner Elk charter
school on the grounds of a group home during a "basket hold." In
that restraint, a worker stands behind a child, crosses his arms
over the child's chest and eases him to the ground.
S.C. health and human services staff are reviewing comments from
providers and advocates about the draft, said Sheila Mills, an HHS
bureau chief. It could still change.
Penalties for breaking the restraint rules would resemble those for
breaking other Medicaid standards, she said. Fines are set on a
case-by-case basis, she said.
When that review is done, agency administrator Robert Kerr will
decide whether to adopt the new standards. The decision should be
made by June 30, officials said.
Proposed Prohibitions for S.C. Group Homes
Pain inducement to obtain compliance
Bone locks
Hyperextension of joints
Peer restraint
Use of seclusion rooms that do not meet agency, licensing or
accreditation standards
The use of extra medications to control an individual's behavior or
restrict his or her freedom
Use of restraint when child would be medically compromised
Mechanical restraint
Restraint and seclusion used simultaneously with mechanical
restraint devices
Pressure or weight on the chest, lungs, sternum, diaphragm, back or
abdomen, causing chest compression
Straddling or sitting on any part of the body, or any maneuver that
places pressure, weight or leverage on the neck or throat, on any
artery, or on the back of the child's head or neck, or that
otherwise obstructs or restricts the circulation of blood or
obstructs an airway
Any type of choking, and any type of neck or head hold
Any technique that involves pushing on or into the child's mouth,
nose, eyes or any part of the face, or covering the face or body
with anything, including soft objects such as pillows
Any maneuver that involves punching, hitting, poking, pinching or
shoving |
