#065 Are restraints ethical? With Marc Tumeinski, Ph.D.

#065 Are restraints ethical? With Marc Tumeinski, Ph.D.

You can listen to this podcast episode on iTunes or Spotify.

This podcast episode was recorded many months ago. It was an obvious oversight that we didn’t talk about the use of restraints and violence against black people.

The recent death of George Floyd is currently in the media and well known.

However, restraints have been killing Black people and people with disabilities and other devalued groups in great numbers every year for decades.

I’ve attached one article here (one of many available) that shows that Black people experience restraint use more frequently than white people in services. There are additional articles linked below about restraints in human services.

I encourage each of you to spend some time thinking about your position on the use of restraints. It becomes more complex the deeper you look into the issue. Resist the urge to think that you’ve got this all figured out! ☺

Transcript

Genia:
Welcome to Good Things in Life. The podcast that helps us support our kids with intellectual disabilities to build good inclusive lives at home at school and in the community. I’m your host, Genia Stephen. And today I’m excited to be here with Marc Tumeinski talking about the issue of restraints. Marc has a Ph.D, I was going to say Dr. Tumeinski, but then I have to clarify, he’s a medical doctor, PhD, is the training coordinator for The Social Role Valorization Implementation Project in Massachusetts, helping to teach workshops throughout North America. And as a service provider, he supported kids and adults with physical and intellectual disabilities, as well as mental health disorders at home and at school and at work. Marc has and does give workshops and spoken at conferences on issues of violence in human services, and specifically on the use of restrictive practices, like using restraints. Marc has presented in the US, Canada, Australia, and New Zealand and the Netherlands and has published at least one article that I’m aware of on the topic of restraint use. Marc also consults in Ontario where I live, Ontario, Canada. Marc has consulted to a group of family members in human services that are working hard here to bring about an end to the use of and training in restraints by human services. Here, Marc, welcome and thank you so much for joining me today. I’m really grateful.

Marc:
Thank you, Genia. I’m very happy for the opportunity and to talk about this important topic.

Genia:
Yeah, it’s, it’s a super important topic. Marc, I’d love it if you’d start by talking about how you like, why this? You know, what, what is, I’d love it if you could start by talking about your relationship with people with disabilities and their families, but I guess the second question is why this topic?

Marc:
Sure. Thank you. So, yeah. Why, why people with impairments? Why this topic in particular? So when I was growing up in the States, I probably like a lot of people, didn’t really have anybody around me who had impairments. We had one neighbor who had a son who lived right next door with some kind of intellectual impairment, really nobody in my school per se. I can remember probably my biggest experience in school, they took us out to visit a psychiatric hospital one day. And that was sort of the big introduction. Right. But that was it really. I went off to college then I didn’t study anything to do with human services. And when I graduated, decided, “Wow, what do I do next?” And I was looking for work and saw an advertisement for an organization that it turns out, although I didn’t realize this at the time, was supporting people, mostly adults with some kind of mental disorder, psychiatric disorder to find work.

Marc:
And they actually were looking for somebody to do some technical work in their computers. So I applied for the job and got it. And it was a temporary, about a six-month position. But because I was there in the office, I was seeing some of the people they were supporting come in and out. And there’s just something that struck me about that and the way that people are trying to get to know them and help them. And so I, before my position ended talk to the, my boss basically and said, “This probably makes no sense to you, but I would love to get involved with the kind of work you’re doing.” And to his credit, he said, yes. And after a period of orientation and training, I started to work within helping people find work, who again were at some kind of a psychiatric disorder. And it was a beautiful experience and an eye-opening experience for me.

Marc:
And that’s really set me off on this path to where I am today. Early on, I had the opportunity to study instead of it is that maybe you’ve talked about in previous podcasts, social valorization, which really helped me to think deeply about who I was and how I could be in relationship with people. After that, I did start to work with some different groups of people. I moved a little bit to supporting both young people, you know, teenagers and adults with different kinds of physical and intellectual impairments. And that’s really where I spent the rest of my time and support to people. And so part of that, I was helping people at home, but I was also getting involved with young people at school, not so much during the day at school, but sort of what happens after school for young people. So that’s, that was really my introduction to an informal services.

Genia:
And how did you, I mean, you teach on all kinds of really important topics related to supporting people with disabilities to have good lives, but you’ve taken a particular interest in the issue of violence in human services and advocating to end the use of restraints in human services. And why that?

Marc:
Sure, great question. So I’ve always thought I’ve had an interest in that, in the topic of kind of interpersonal violence even before getting in the services. But I can remember one day, and this is again, after graduation, I’m working in the field, seeing a report in a newspaper from the United States that outlined across the entire US the number of people who were either being injured or even outright killed by the use of restraints. And this was just a shock to me, that’s something like this could be going on in my own community and I’d never heard of it before. And that just set me back.

Marc:
And the more I dug into it, I realized it’s not just a problem in the United States, it’s happening all across the globe. And I, you know, part of, I think what I was thinking and some of this was my own, you know, my training and services was, you know, we really have to stand up for people and speak up for people who maybe others aren’t stepping up for or standing up for, or speaking out for. And nobody was really talking about this. And so I started to dig into it with a friend of mine, actually. The two of us were working together and we started to look at this and the more we got into it, the more we became concerned and thought, well, how can we start to get others to be thinking about this practice?

Genia:
And so I want to ask, I want to ask some sort of some kind of introductory questions about this that I think are in a lot of people’s minds. You know, certainly, there have been reports that probably many people have seen in the news of people killed by the use of restraints by police officers, for example. And I think that it’s a reasonable assumption that people make maybe not accurate, but a reasonable assumption that people are killed essentially in a violent altercation. You know what I mean? Like the police officers are doing their best to subdue a violent person and that unfortunately, the results is that the person is harmed in that interaction. And that, that would, in some ways, some, some version of that kind of situation is the only situation in which somebody might be harmed by restraints or the only reason to or the only harm that is caused by restraints. I just outlined it. Just realize it’s not a question, but I wonder if you could speak to that perception.

Marc:
Well, I think you’re right and it’s a perception that I had, and I think a lot of people, as you point out probably do have, and at least in my experience and, and the talking with people and they’re about this studying the issue I find that’s a fairly well, let’s put it this way. I won’t say it’s outright false, but I think it’s fairly misleading. And I think it’s probably not a helpful way to think about it. I think that it’s much more widespread use and frankly, study after study has found that mostly his nonsense or not being initiated because some act of interpersonal violence by someone who is receiving supports against either themselves or a staff person or another, another person who just happens to be close by, that’s not the case. I really want to emphasize that more often than not.

Marc:
What we find is it was a result of some kind of power dynamic where maybe a staff person is saying, you need to do this, or you need to put that down, or you’re not listening to me or go to the other room. And that set off kind of a sequence of events where unfortunately the service worker brings out the tool that they’ve been trained to use. And in many case that may include things like listening to giving the person space, but when all else fails, so to speak somebody laying hands on somebody else to restrain them. And I think it’s more often that kind of a situation than outright violence. And also, frankly, it’s not limited to either police officers or B people who have training, perhaps, which is a big issue.

Genia:
You mean that it’s not just people who are trained to use restraints that are using restraints?

Marc:
To a certain extent or people who’ve received very superficial training in it. You know, less than a day, a couple of hours.

Genia:
Right. And how widespread is the issue of violence or, I want to use the word sort of power dominance that includes hands-on interactions. So it may not, you know, it may not always be what one might call violence, but there is some sort of laying on of hands that’s really about power and dominance. How widespread of an issue is this?

Marc:
Well, that’s a good question. Depends how we think about it. I, partly this is hard to find out to because partly nobody keeps track. And again, I’m making a lot of general statements there, right. But I would say in a lot of different service fields and nobody’s really keeping track of that. So I might start the conversation in different place, which is when we think about the people are receiving services, whether they’re, you know, infants, toddlers, young people, teenagers, adults, elders.

Marc:
Often, the people are receiving services are vulnerable in lots of ways. I know the people in a power when you think about it from their perspective of power or the people who have less power, right, who are vulnerable in that sense, you know, are that the other people in their lives have more power. And I don’t just mean physical power, but kind of social power find them. And when you have people who are vulnerable and who are at the, that end of the power imbalance it just opens the door to the possibility of all kinds of bad things happening. So, and I’m not discounting that there may be violence. Sometimes a vulnerable person may respond in frustration, hurt themselves, or try to hurt another person. Right. But I would say that if we think about kind of the use of power and control more broadly, most of that is stacked on the side of the support worker, right?

Marc:
They’re the ones with the legitimize support role the power of an organization behind them, the rules and regulations on their side. And probably even the people who will take their side, if it comes down to it. And sometimes even though the people who can speak, sometimes you may be supporting somebody who doesn’t have the ability to communicate very effectively. So there’s a lot of power on that side. And I’m, I have been an AMA support worker. I don’t want to discount the difficulty of the role of the good people who carry out the role. In fact, I think a lot of this is structural support workers can get put in a position where there’s almost no good, good solution, right. So I’m not in any way kind of blaming people. But just trying to point out some of the structural barriers that exist that make it really hard, to kind of slow things down, listen to the other person, figure out what’s going on and see if we can come up with a better way than, you know, putting hands on somebody.

Genia:
Yeah. When you’re talking about where the, where the weight of power and authority lies, it’s in schools, especially in the last little while we hear a lot about violence in schools. And we hear a lot about like zero-tolerance policies. So we, you know, kids, I remember, so I yesterday I turned 44 and we’re recording this in February of 2020. So just for context. So I remember being in, I think grade four, and I remember one of our teachers smacking a student with a ruler and this was well after the time that that was acceptable, but it was certainly within living memory of it, you know, it was, and, and at that time there far more discussion about the inappropriateness of corporal punishment of students by teachers and not a lot of conversation about students being the threat. They were considered vulnerable, not the threat, but now there’s quite a lot of conversation around zero tolerance for violence in schools.

Genia:
And what they mean is zero tolerance of the kids. The kids get away with no, no aggressive behavior. I’ve read all kinds of all kinds of responses from teachers and educational assistance. I’m talking about, you know, how difficult their jobs are and you know, how much they have to put up with. And the, you know, they get split. Kids are spitting on them and hitting them and kicking them. And, you know, it’s that this sort of where the potential threat is, is centralized, is now far more in the hands of the kids, which legitimizes then the use of restraints. I don’t think anybody’s, I’m advocating on bringing back corporate punishment with rulers, but you know, like that, that argument that, well, it’s totally legitimate that people staff in schools need to be protecting themselves and other children from children or from students is a really common story.

Genia:
And of course, it’s true just as you’re saying, sometimes people are acting aggressively. It’s not that that neither of us are saying that that never happens. So there is a vulnerability of the students, there’s this, there’s a structural justification within schools right now for zero tolerance and protecting staff and students from other students. So I guess I’m just saying like in the school system, it’s the same as in the adult system, but also given that it’s legitimate for students given that the concerns are legitimate, that staff and other students shouldn’t be exposed to aggressive behavior. What is the justification, I guess, for taking a restraints approach to difficult behaviors in school? That was a very long winded way of getting to that.

Marc:
No, that’s fine. And you’ve touched on a lot of important points and I appreciate the chance to talk about this. So I mean, I’ll back up a little bit and say that I agree. I, I agree with you on, and it was a great summary. So definitely that, that report that I was talking about before in the newspaper that kind of got my interest first was back in 1999. And even at that time, frankly, the use of restraint techniques, the schools was probably, well, let’s put it this way. It’s limited compared with today. I think one of the things that surprised me was that we’re actually seeing an increase of the use of these kinds of techniques in schools. Traditionally, people think of restraint, you think of perhaps a psychiatric hospital, for example, or, or a correctional type setting in jail or prison. And while that’s still continues, I think one of the surprising things, maybe not surprising now in hindsight, and I’ll talk about that in a minute.

Marc:
But those raised things that they have started to be used in schools, as you said, even while we got rid of that idea of corporal punishment. And, you know, in most countries in the world in school, we are seeing the rise of the use of these kinds of techniques in schools and not just for children in specialized so-called specialized educational programs, but even just generally I think for the, for the school population, we’re actually seeing even, either by teachers who may not be trained or by AIDS, some schools even calling in the police when there, when there’s an incident it’s just really hard to understand. So I think part of it, as you say, is the power imbalance part of it, I think, as it reflects maybe somewhat what’s going on in the larger culture seemed to be a culture that is rightly concerned about aggression. And yet I think some of what’s happening in schools may reflect some of that fear as well.

Marc:
I mean, I want to be really upfront. My presumption frankly, is that there’s not, there is no simple answer to this. There is no simple one strategy that’s going to stop this from happening. I think you’ll what you’ll hear though, is with the right training, we can fix this and I don’t think that’s accurate, right. I don’t think it’s a simple answer or a technical solution. I think it’s a question of, of relationship and morality, as well as some structural stuff we can do smaller schools, you know, better student, teacher ratio, things like that. But at its heart, I think it’s a question we need to think about as a culture and by culture. I mean, not just as a country about the culture of a school, for example, right. And how are we going to approach this? I think that has to really be an important question.

Marc:
And if you don’t mind, I think it’s also good. It may be to be kind of clear about some of the vocabulary here. When I talk about restraints, the way I, I sort of simply put it as it’s the use of some kind of power to limit another person’s movement. And traditionally we see that happen in one of three ways. It can happen as we’ve already said in this podcast, putting hands on none of the person. So that’ll be called off and holds right, putting a hold on somebody. It can also be done mechanically. We see less of this in schools, but it can happen where, where you’re using some kind of a, let’s say a Velcro strap to, to risk, to immobilize someone from using their limbs, for example, and moving, that’d be kind of a mechanical type restraint. And just one more chemical restraint, which is the use of some kind of a drug to, again, limit someone’s movement through kind of lowering their activity level.

Marc:
Right. So using drugs here, now we can see these three used in combination. You may have someone who is who, you know, they put a hold on and then are given a drug to, to immobilize them, for example, so they can be used in combination. And I think it’s good to be sort of clear about that and think about, you know, what kind is being used, whether that’s in a school or a residential program or whatever kind of service it is, right. What are there are there, which types of restraints are being used and prevalent is a good first step just to figure out what’s actually happening. This is somewhat related to the, to the question of seclusion, putting someone in this occlude so-called seclusion, right? So putting them in a locked room, I think there’s a connection, but it’s, there’s some differences between restraints and seclusion as well though. You do often find them being used together. So that’s important to think about that as well, I think.

Genia:
So I’d love to hear your thoughts about the, how somebody might start to think about restraints as a moral issue, of complex moral and cultural issue.

Marc:
Sure. Well I think there’s a lot of a lot we can do. I think one really important way to do this and it really helped me early on and, and all the way through my study, this is, is to read either first person accounts of people who’ve been restrained, who talk about what that experience was like from their perspective. Right. What did it feel like for staff person or a teacher to lay hands on you and keep you from moving? So do you use any of the kinds of restraints on you or to put you in a so-called seclusion room, right? The timeout room or something like that to read first person accounts or better yet, of course, to talk with people this has happened to not with any agenda, just to try to understand, just to put yourself in their shoes and understand how would I feel if that happened to me.

Marc:
Right. And, and I mean, really kind of think about that in detail, right? What would it, what would it be like? What would my heart rate be like my vision, what thoughts would be going through my head? What would my emotional reaction be? I think that’s really important. Again, oftentimes we may have to do that, reading it, and there’s lots of first person accounts that we can find. And they’re hard to read, but I think it’s an important thing to do. Whereas I said that to talk with people that this has happened to, and just have them describe to you now that can be hard for someone to describe. So I have to be cautious about that. They have to be comfortable in sharing that, of course. And it can be hard to talk it out again. So, so I’d be cautious about that, but nonetheless, that is an important, cause it humanizes it, right. It helps us to understand.

Genia:
Yeah. And you’d want to do that was sort of like intentionally suspending your yes, but mind, right? Like the purpose would just be all other considerations aside, but is the experience like, yeah, got it.

Marc:
Absolutely. And I have to say, I would even extend that. I would say I’ve also found it helpful to actually have the person, whether a staff person or a teacher who’s done it to ask them to talk their way through it because you’ll often find some of the very same things. Their heart rate was their heart rate was going up. Their emotions were on edge. Right. and they might, you know, you think for a trained teacher who just loves kids who wants to work with kids who wants to educate kids and, and some of them afterwards the saying, how did I end up in this space where part of my job is to be laying hands on a child like that. And so to ask them about it too, it’s very different purpose. And I don’t want to discount the vulnerability in that. Right. The power of balance we talked about earlier, but nonetheless, I think it’s important to ask them as well. Like what was that like for you?

Marc:
And then also to think about it in the long run, because oftentimes this is, I think one of the false notions around the use of restraints is that it’s a one off, right? We did it once and it’s over. Most people who are restrained are restrained and multiple times. And we see this a lot in schools. Kids can be restrained hundreds of times in the school year, for example, many times a day. And so I think there’s a cumulative effect too. And there’s a cumulative effect of both on the person who is restrained the child or the adult as well as on the person doing the restraint, right. There’s a risk of course, that if you’re doing it, it becomes, you become numb to it over time. And the cumulative effect on the person can be emotional accumulated effect and intellectual accumulative effect can also be really damaging, you know, we’ve left out of course, the physical risk of injury or even outright death as you pointed out.

Genia:
Right. Yeah.

Genia:
This podcast episode was recorded many months ago. It was an obvious oversight that we didn’t talk about the use of restraints and violence against black people. One action that I can take and should be taking on this podcast is pointing out how the issues related to inclusion for people with disabilities are connected to the issue of racism. I’ll be working on remaining conscious and committed to this as we move forward. The recent death of George Floyd is currently in the media and very well known around the world. However, restraints have been killing black people and people with disabilities and other devalued groups in great numbers every year for decades and decades.

Genia:
I’ve attached one article in the full show notes, one of many available that shows that black people experience restraint use more frequently than white people in services and other articles about restraints in human services. You can find all of them at goodthingsinlife.org/065. I encourage you to spend time thinking about your position on the use of restraints. It becomes more and more complex the deeper you look into the issue. So resist the urge to think that you’ve got this all figured out, if that comes up for you. This interview with Marc and the articles that I’ve linked to at goodthingsinlife.org/065 are a good place to start. Okay. Let’s get into the interview.

Genia:
Which I mean, I was asked, I thought you might actually know how prevalent restraints and harm from restraints was. So I, I don’t know the answer to that question when I asked you, but if you get into a community like a disability community in a work capacity of some kind in like an advocacy role, I can’t imagine it would take very long before. The degrees of separation between you and somebody that has been physically harmed or killed by restraints is maybe like two or three. I don’t know that to be a fact, but it feels to me like that. Like it’s not, it’s not uncommon. I guess is.

Marc:
Correct. No, it’s a very common, depending on the kind of service that you may be working in whether in a school or a residential program, a day program, a nursing home, a rest home. This is a very common practice. I mean, again, I hesitate to put numbers. Sometimes I can get some for you, but, but partly it’s because it’s hard to find numbers. There’s no kind of central location to find these things, right. It can be very difficult to find out how often it’s being used. We can get some numbers on it. Another indicator of course, is the degree to which you have policies around this, which is always a sign that it’s happening a lot, right? When a school has to develop a policy, when a system has to develop a policy, then you know, it’s risen to to enough of an occurrence that, that an organization has to come up with a policy on it.

Marc:
Right. So that’s another way that we know. And I would say a third way. We know it’s on it’s prevalent. And in some cases on the rise I mentioned on the rise in schools is the number of organizations that provide training and how to do this. That too, in my, just since 1999, when I first started studying this, there has really been, I hate to put it this way, but almost an economic boom in organizations that offer to train staff in how to do this. And they’re not doing that. They’re doing that because there’s people who are willing to pay for it, right. There’s a customer base until there’s an economic motive here as well.

Genia:
Right. And it’s an interesting connection you just made between you know, what’s happening a lot or there’s an expectation for it to happen a lot or w which is of course not quite the same thing, but closely tied together when there are policies in place. And in fact, at least where I live in Ontario, Canada, it’s government mandated sure. Organizations have restraint training we’re sharing policies and restraint training. So, you know, even up to the, the government level, there’s an expectation that people will be restrained in human services in the province that I live in. So that just is an excellent you know, proof of what you’re saying there.

Marc:
And that, I mean, again, some of my information may about a day, but, but my understanding of that, and that’s partly what brought me into the work that you mentioned earlier, working with that group of citizens against their strain, trying to where at Kansas was that that was such a blanket policy. It didn’t matter what kind of programmer he was supporting. And so I know there were organizations who were supporting adults who were, had very little voluntary movement, right? Could perhaps move fingers, a limb, their heads, and yet their staff were being trained in the use of physical holds. Right. Which again, common sense would tell you, there was, there would be no way that the majority of people that were supporting would be able to do anything right. And yet you’re spending money and time on training staff to use these techniques. So you have to ask the question why what’s going on here.

Genia:
Yeah. So I want to circle back to thinking about restraints as a moral issue. And I mean, my podcast is not like a podcast about moral issues per se, right? Like it, I think that lots of people would argue that lots of the things that we talk about here are moral issues, but that’s not kind of the point of the podcast. But I think that when you’re talking, essentially when you’re talking about restraints and a moral issue, one of the things that I kind of keep coming back to in my mind is that you have to kind of make a moral decision about this. If part of the decision that you’re making is that if I’m committed to not causing harm to vulnerable people, it may mean that I will sit in a space where I’m, where I may be harmed. And that seems like a moral statement or a moral not a statement like convictions.

Genia:
So if I commit to, if I say I’m not going to restrain other people because I don’t, you know, because I believe that that can be harmful and I don’t want to cause harm, then that person might hit me or something else. And it was so, so often in our society right now the, really the, the what we hear being talked about and what, what, what is fair and legitimate is like, I have a right to not be harmed. So we’re talking about an, an issue where really we’re saying, I’m not arguing that people have a right, not to be harmed, but that it’s not necessarily all about one’s rights and one might differ their right to not be harmed in order to like the trade off being, not harming somebody else.

Marc:
Sure. Yeah. And I think you’ve put your finger on again, a very difficult but important. Again, I don’t, I mean, we can keep this sort of simple. Sometimes you say moral and ethical and, and people may be shutter or that, or, or think suddenly we have to get really philosophical. But I think we can approach in a way, like, what’s the right thing to do in this situation. Right. What’s, what’s, what’s not only how am I not going to harm people, but how can I be helpful? Right. So I think we can say, you could say moral, you could say ethical, you could say what’s the right thing to do here. Right. Keep it, keep it on that kind of common sense level. And I think you’re right. We have to think about, you know, what are our guiding principles going to be? Often, this is a, this is a question, not just for one person, but for a group of people, right. To the degree that this happens in services or schools, it’s not just the teacher or the staff person, right.

Marc:
You’re part of a larger team. So there has to be some kind of group, I would think conversation, reflection and decision making, as you’ve alluded to about what is the right thing to do in those situations, right. How can we not cause harm and how can we actually be helpful to people? And so I think, you know, one question is right, is as you say, trying to discern, well, what is right and what’s wrong. Right. That can be one question, a related question is what are the principles we’re going to use in this situation? Right. So for example, yeah. You know, are we committed to the practice of empathy to try and understand people or the principle of being patient, right. The principle of humility, right? So the commitment to one another and to the well-being of the persons for it, right. What are going to be our guiding principles? I think another really important question is who are we going to be in the lives of the people that we support?

Genia:
Can you repeat that, Marc? Sorry.

Marc:
I think a really important question to spend time with, and it sounds simple, but it’s just, who are we going to be? And the lives of the people of the children we’re teaching or the people we’re supporting.

Genia:
Right. Who are we going to be.

Marc:
Who are we going to be in their lives, right? Who am I going to be in the life of this person? And who are we going to be again, as a group of, let’s say, teachers and administrators, for example, or teachers and needs and administrators, or people working in a particular kind of a program, right. Who are we to be in people’s lives, right. That’s again, it comes back, I think so often to relationship, right? Who are we in? Who are we going to be in people’s lives? And I think that’s where spending a lot of time on thinking about that.

Genia:
So I have a question that’s maybe outside your wheelhouse, but maybe not. So you can just tell me if you don’t have anything to offer in this regard, but I’m thinking right now of some teachers that I know very, very well who have spent time thinking about that question. Okay. And who, who actually really are intentional in the way they show up every day, but they’re kind of getting a little ground down lately because they are experiencing a lot of, not necessarily violence, but a lot of aggression, a lot of like not being treated particularly well. And so, my question is, do you have any suggestions on how people who have thought deeply about who they want to be in the lives of vulnerable people, how those people then keep themselves sort of well and resilient while they are experiencingsome of the really hard things that may come with being with people and, you know, not holding dominion over them or protecting oneself in exchange for or in their interactions with other people?

Marc:
Yeah. Great question. I will offer againsome thoughts and maybe you’ll have some to add yourself and your listeners. I hope we’ll continue to reflect on the question cause it’s a really good one, I think, and this will tie back a little bit to something you said just a few minutes ago or earlier in the podcast. Yeah. You mentioned this idea that some people might accept, perhaps let’s say I hit without responding and kind. And I think we can think about that particularly when it comes to young, you know, younger children and certainly I’ve seen adults and I think it can work there, but let’s think about schools for a minute. Right. You know, we can think about, yeah, there are people who might, who might do that and try not to respond in kind, but to respond, you know, in a different way to diffuse the situation, right.

Marc:
To try to do the right thing. No, I don’t think we can compel that. This is part of the part of, part of the issue, right? You can’t compel anybody to do that. So here’s where it gets kind of tricky in the world of employment because your employer can require certain things of you. I would say that’s not in a certain sense. It’s not, we can’t compel somebody to do that. That does have to be a personal decision. Now at the same time, if you feel like you’re working in a, in a setting, let’s say a particular school or a classroom or a program where the likelihood of violence being directed against you is high. That, and you don’t feel like maybe that’s not the place, right. For you at least at this point in your life. All right. And I think we have to make that decision, but I would say broaden, because again, I don’t want to fall into the trap of thinking what I said at the beginning of the, of the podcast.

Marc:
Right? Most of the time that’s being used, it’s not, it was not prompted by an act of violence. It may have been just a, trying to kind of manage things in their program and someone’s not listening. Right. We’re trying to keep the classroom quiet and someone’s not being quiet and it escalates from there. So I think we need to really think about, right. Do we have the kind of qualities if we’re going to work with, with children, let’s say, for example, who may, you know, at one end to try to do things to hurt themselves or to hurt others or may just be kind of loud or disruptive or not good at always paying attention. Right. Which can happen of course, to any of us. Right. Is this the right place for me? Am I the right person sort of in this classroom? So we, I think we really do have to think about that before something occurs. Right. So let me tie that back to your question that about resilience.

Marc:
Part of it can be that kind of let’s see. How do we think about those kind of internal preparation beforehand to have conversations about what might happen to think about what others have done and what would be the right thing to do, what principals are going to use. Right. So that we’re not surprised. Right. I think thinking about it ahead of time can be one step and resilience. Right. And preparing yourself is to have thought it through carefully, right. To talk about it with others. That can be really good to do second lead again, to, to, to don’t put yourself in situations where maybe you’re more likely to have your buttons pushed.

Marc:
If, you know, that’s the case. We can always of course prepare ahead of time for that. But there may be a classroom where maybe you’re just not the right person for there. Right. and so we have to think about that too. Right. Are we in the right place and are we prepared to do what it takes to be there? And of course, there’s lots of other things we can do. Right. You know, taking good breaks and talking with others and, you know, going for a walk and doing the things that, you know, help us to kind of stay grounded. But I, with you, it’s harder to do nowadays for lots of reasons, whether that’s increased aggression, increased regulations you know, more centralization, right. In other words, directions coming from above you in the system there’s a lot more pressure and you know, their pressure’s gonna come out somehow. So, we do have to be aware of that, I think, as you said.

Genia:
Yeah. And so you said, and I agree that you cannot compel somebody to be willing tocommit tonot restraining somebody. You can’t [inaudible]. But if you’re a parent and your child does sometimes you know, hit or bite or something, if they are when they get upset, which also makes me say that, I think we should have, we should do another one of this Marc where we talk about all of the reasons why kids,maybe almost driven to the point of the question. I think that would be really valuable. But that’s kind of another topic, but if you’re a parent and your kid is sometimes lashing out and you are deeply committed to saying, no, you cannot restrain my child, but you cannot compel somebody else that, you know, you’re kind of in a bit of a pickle in that situation. What, do you have any thoughts about how parents might, I guess a couple of things, have conversations with schools where they might help the school to be engaging in this kind of, and thinking about this at the level of, you know, this is kind of a the right thing to do? But also just in the sort of more strategic, tactical level around if I’m asking them not to restrain my child and that’s not a thing that’s not going to happen, what’s a parent to do?

Marc:
Sure, sure. Well so a few thoughts again, I think I would sort of phrase it that you can’t, you can’t, you can probably compel people not to do something like not to use restraint, but I don’t think you can compel absorption of violence. That’s what I was trying to say earlier. Right. I think you can ask people not to do something. I don’t want you to do this. If my child does a leave, leaves their seat, you know, don’t do this, but I think you can’t, you probably what you can’t compel somebody to just except even kind of physical violence or even sometimes, you know, to be yelled at. Right. that’s, that’s something somebody has to kind of choose to be able to do and sort of just prepared for them. And frankly, you know, you think about the hours put into training someone to do restraint there’s there’s ways we could train people to learn to kind of absorb, right.

Marc:
If they were up for that, right. Absorb that kind of interpersonal violence, which is again, maybe another podcast. Right. What are some of the ways that, and we have examples of people who have learned to do that. Right. but anyway, back to your initial questions. Yeah. There’s no easy answer to this. In fact, there may not be an answer. I mean, sometimes we just have to do the best we can or come up with kind of the least worst solution. I think, you know, if you’re a parent right. Trying to understand and, and let the teachers in the school administration know like, you’re right. Obviously you love your child, but you also respect the job that the teachers administration doing and you understand what are their concerns? What are their fears, what other pressures that they’re under. So to try to understand it, I know that can be asking a lot.

Marc:
Right. Cause sometimes schools don’t do that for families. Sorry. I’m aware of that. But that kind of, at least mutual building kind of mutual recognition can be really important. And I wish schools would do the same to families. So trying to find out where they coming from, like what, what are their concerns and fears? You know, it can be things like perhaps, you know, either telling stories about your child, like how, you know, or showing photos and videos of things like things they’re doing in other places, like, how are they at home? How are they with their brothers and sisters? How were they when they’re on vacation? Right. And maybe to, to show them what you’re seeing with my child right. Is not the whole picture. Right, right. That can be, I think, a very powerful lesson for teachers ministers. And they may never have a chance to do that because all they see is kind of their structures.

Marc:
It may be a crowded classroom with not enough teachers and staff. And you’ve got a lot of things going on. Maybe that’s not the best environment. Right. So showing your child, showing your child in environments where they thrive and flourish, that can be something, you know, letting and you know, of course, just letting them know that you’re concerned. And you want information. I think asking formation, how often is this happening to my child? Right. How often are they being taken out of their seat or sent to a different place or somebody putting hands on them, even if it’s to direct them to another room. Right. Right. Often, is that happening? When does it happen? Is it the morning? This is a, is it a transition times is in the afternoon, is it always the same teacher or aide? Right. Is it always when the same, maybe it’s another student that’s, that’s quote unquote setting them off. Right. Like to just asking for, for information, you may not get it. But I think it’s important to ask, to let them know that you are, you want to be there, you want to do something about this and you need information that, to help them to, to try to come up with a better way to approach it.

Marc:
Right. Right. You make it information about getting at the core of something that may be adjustable as opposed to just responding to the behavior, as opposed to, you know, really seeing it as a communication around another issue that could be altered.

Marc:
Sure. That’s right. Yeah. Or maybe a structure that could be altered. Right. Cause it is, you know, is it, is there a better way to kind of move from class time to lunch? No, that just works better for your child. For example, maybe being around this teacher or aide isn’t the best. And so on.

Genia:
So one of the things that you just said that really caught my ear is that, you know, maybe this, this structure at school or this situation at school is, is not the ideal situation for this child. And I think that I want to say more and more often, but maybe this has just been the same level of problem for a long time now. It’s true. There’s like a lot of kids in the class and there’s, you know, it’s very hard to individualize what’s going on in order to accommodate all the kids in the class and, you know and so lots of parents are thinking, well, the reasonable thing to do then is to pay place my son or daughter into a self contained classroom with smaller teacher to student ratios where they can, you know, people will be more understanding. And there, that is a very, very complex decision making process for parents and are not trying to unpack the whole thing, but it, I feel compelled to sort of point out that the use of restraints is not less in segregated self contained classrooms than it is in sort of general education. Like there’s no evidence to support that the use of restraints decreases in those settings. Am I right in saying that?

Marc:
Sure. I would say it even strongly more strongly, I would say that actually we would see more of it. Right. Because, and more of it in a segregated kind of a setting. Right. I think this is part of the, part of the issue here is that we, we tend to kind of narrowly focus. Okay. What was the inciting incident? What was happening two minutes before, right. And we may have to kind of step back even longer and think more broadly than that. Right. I think study after study, it’s very predictable, the kind of physical and social environments that actually can ramp people up. And I mean, both the people who are receiving the service and the staff, right. Both the students, both students and teachers, if you’re separated from kind of typical activities and society, all right. We don’t do well with isolation as human beings.

Marc:
We act out when we’re alone and isolated like that. Right. If we’re noisy and crowded environment, if my teacher and the aides aren’t communicating well, right. The teacher knows something, they don’t communicate with the aid. If people aren’t trying to see things from my perspective, if there’s a lot of turnover, right. We’ve had, you know, for substitute teachers over the last two years. Right. if there’s a real emphasis on sort of behaving and so on, right. If you have poor teeth, if you have poor role modeling and teaching, right. Do the teacher and aid get along, you know are they good with one other and seem like they enjoy being there. Right. do people have high expectations about who I am as a student and what can I do or low expectations because perhaps of some kind of perceived impairment, right.

Marc:
There could be all kinds of things that we know if enough of these are in place, we can predict, at least that restraint is around the corner. Right. Once you see a certain number of these factors in place. So yeah, I think that’s another thing families can do is kind of step back and observe and see what’s going on here. Right. And say, Hmm, can we move the focus from what was my child doing two minutes before to what’s going on five days a week, right. During school hours, you know, for this whole year and try to look at some of that. So changing the focus, I think can be, and again, none of this is rocket scientist is this is straightforward. You’d ask anybody just generally, Hey, what, what’s a happy environment for you. Right. What’s an environment that makes you feel calm.

Marc:
Like what would be, describe a really good classroom experience for me, that’d be, that’d be a good exercise to go through. Right. What would it be like? And I’m sure most people wouldn’t say it would be kind of a noisy, distracted, lots of turnover. Right? Nobody communicating with one another cutoff from the rest of the school activity. Right. If you know that while you’re in one classroom, maybe the other students are in gym or going on a field trip or all having lunch together. And yet you’re not a part of that. What does that setting that student up for? Yeah. Yeah. Or as a parent, if you’re a parent and you feel like you’re not being right. You’re not a part of things. Right. They’re kind of handling you that, you know, again, that also can be very, this is beyond restraint for a minute here, but I mean, that’s a, if that’s how they’re treating you, they may be treating those students the same.

Genia:
Right? Yeah, yup. So if parents were interested in learning more about the issue of restraints, where would they go to connect with you or other other resources?

Marc:
You know, frankly, with the internet today, right. There’s a lot, there’s a lot out there. You’ll have to dig for some of this, but there’s some good material that you can find good research studies, you know, statistics you know, some positive strategies. But I would also say frankly, like most of this again is not, it’s common sense with a bit of a twist if you know your child well, right. I mean, it’s, I’m not calling for anything new per se. Right. It’s think about relationship, think about being good with each other, you know, think about the environments that help us to succeed. Right. So there’s, there’s no kind of magic or out of reach response here. Right. I think a lot of it’s just kind of common sense stuff, but we just have to be intentional about it. And not get dragged into seeing impairment or limitation.

Marc:
Right. But a child. And it’s a school. I would say the other positive thing I think, this is a little bit off your question. I’m sorry. But just that there’s a lot of positive history here with schools. Right. There’s a lot of good still there, despite all of those struggles today. And I, and I know I see it happening in schools, right. There’s still a lot of good, positive feeling and good positive history and good positive potential in schools. Right. So I think it is one place where as I look around, I think sometimes I’m not sure in a correctional setting in psychiatric, Oh, what would it take to change? But I think in a school, I can see a lot more positive things happening, you know, more easily. But anyway, I will send you some material. And I, and I, I’m always happy to be in contact with people. So share my email. I’m happy to talk with anybody.

Genia:
Thank you. We’ll make sure that all of that is in the show notes for this episode, Marc, if you were, if you had sort of one encouraging thing to say to a parent, who’s struggling with the issue of restraints right now in the life of their child what would you offer them?

Marc:
Right. Well, I guess you know, trust your, trust, your instincts as a parent. Right. And look for, to talk to, right. I don’t, don’t sort of be, don’t feel like the, if they’re offering you restraint as an option, like you have to go for that or, or that they, the professionals, “smell something you don’t know.” Right. I would step back to your relationship with your child. Right. And what helps children to learn and grow because it will work right. Again, there’s no magic fix here, but I would trust that over the kind of professionalized sort of depersonalized approach and the sort of technical approach that restraints, I think over promise. And I think of distracting from really what we need to be thinking about when supporting children. Right. And whatever kind of situation whether that’s a school or a home.

Genia:
Yeah. Yeah. Well, Marc, thank you very, very much. I would love to, as I said earlier, have a conversation at another time about you know, just helping people think through the issue of kind of people being driven to the point of aggression, which I think is very often under appreciated. Not necessarily by not necessarily all the time at home by parents, but certainly I think having some thoughts or questions that people might ask to help get to that root cause that you were talking about earlier would be really helpful for people. So I’d love to have another conversation like this. And I am just really grateful for your time and willingness to raise the issue of restraints here on the podcast and to help people think about this, starting from the question of what is the right thing to do here. So thank you very much.

Marc:
Oh, thank you. This is again, great experience for me. I encourage you in the work you’re doing here in the podcast and would welcome that further conversation in the future.

Genia:
Awesome. Thanks so much, Marc.

Marc:
Thanks.

Genia:
Thanks so much for joining Marc and I today for our conversation about restraints. It’s a complex issue. It’s definitely not straightforward. Marc said near the end of this podcast episode, that one helpful thing can be, to look to others, to talk to if you are struggling with these issues and to get some support. And I’d just like to tell you and remind you, if you already know that there is a free Facebook group connected to this podcast, the Good Things in Life Podcast Facebook group, and you can find that by going to goodthingsinlife.org/group. And that would be one place where you could go to talk to others about issues like restraints or anything else that you are struggling with in relationships, you raising your son or daughter with a disability to have a good rich, inclusive life at home at school and in the community. I hope that you are well and have a great week. Thank you so much.

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Special thanks to Marc Tumeinski, Ph.D. for joining me this week. Until next time!

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