Hogg Foundation for Mental Health

RLS Seminar Addresses Safe and Appropriate Behavioral Interventions

January 1, 2005

A wide-ranging discussion about encouraging agencies to use appropriate behavioral interventions drew nearly 250 participants to the thirteenth Robert Lee Sutherland Seminar: "Safe and Appropriate Behavioral Interventions: Changing the Culture of Care" held in Austin on December 2-3, 2004.

The seminar provided an extensive dialogue on methods to avoid the need for emergency interventions—including the use of restraints, seclusion, and other alternatives for persons at risk of harming themselves or others— and drew upon the experiences and training of a diverse group of behavioral healthcare providers, mental health advocates, consumers and family members, systems administrators, scholars, and policy makers.

An increasingly complex and controversial issue for schools, juvenile justice facilities, residential treatment centers, foster care providers, and hospitals, the use of restraints and/or seclusion for those with mental or behavioral problems can at times be a necessary protective measure. However, when employed inappropriately or without proper training, certain interventions can be dangerous for staff and clients.

"This seminar addressed a number of emerging challenges for service providers and institutions that are confronting reduced budgets and high turnover," said Dr. Lynda Frost, associate director for mental health policy and law at the Hogg Foundation for Mental Health. "Fortunately, new clinical procedures and strategies are emerging that could dramatically reduce restraint and seclusion as methods of mitigating dangerous incidents."

One seminar participant commented that "this conference was one of the most informative, organized, and rewarding conferences that I have attended in my many years of care and supervision of clients with mental health problems." Another participant added, "this was an outstanding seminar! I am new to the field, but you have validated my instincts about what is the correct way to respect and treat residents of the facilities we regulate."

The first day of the seminar started with a presentation by Laura Prescott, president and founder of Sister Witness International, who gave a moving and personal account of how restraint and seclusion can sometimes cause victims of sexual or physical abuse to "re-experience" their trauma. She advocated for proactive, trauma-sensitive, and client-centered approaches in policy and practice in order to interrupt cycles of re-traumatization and create safer environments for clients and staff and provide concrete tools for agencies to use in the process.

Aaryce Hayes, program specialist for Advocacy Inc., provided an overview of current practices involving seclusion and restraint in Texas— including procedural differences between organizations and a comparison of federal and state standards—and suggested changes in vocabulary, data collection methods, and regulations that would increase communication across systems and states.

Hayes' presentation was followed by Texas State Representative Elliott Naishtat, who discussed how the state can facilitate culture change across agencies and populations to help reduce the use of restraint and seclusion. Rep. Naishtat emphasized that the state must clearly articulate its guidelines and expectations for agencies and institutions in order to avoid individualized approaches that limit communication and progress across programmatic settings.

Lloyd Bullard, project director for the Child Welfare League of America's Coordinating Center on Best Practices in Behavior Management, provided the luncheon address for the seminar. He highlighted the best practice approaches and resources developed through the Child Welfare League of America's multi-site evaluation project completed in 2004.

Dr. Joel Dvoskin, a professor at the University of Arizona College of Medicine, conducted an interactive session that examined difficult and potentially violent hypothetical situations submitted by seminar participants prior to and during the conference. Along with Laura Prescott and selected audience members, Dr. Dvoskin re-enacted problematic situations, and the audience collectively assessed the crisis, discussed alternatives, and reached a consensus on how the situation could have been prevented or at a minimum be resolved with the least risk of harm to consumers and staff.

Dr. Eduardo Sanchez, commissioner of the Texas Department of State Health Services, addressed participants and stressed the significance of their efforts to reduce the use of seclusion and restraint in their work environments.

The first day ended with two breakout sessions. In one session, Dr. Dvoskin posed additional hypothetical situations to representatives of several intervention training programs, Dr. Randy Boardman of CPI and Tim Geels of The Mandt System. The speakers and audience participants discussed means of preventing and de-escalating incidents involving a child with autism in a school classroom and an adult patient from a state hospital on a community trip, among others.

The other breakout session, "Funding that Works for Communities: Creative Strategies for Generating Resources," was conducted by the Hogg Foundation for Mental Health's regional foundation librarian, Allison Supancic, and program officers Reymundo Rodriguez and Carolyn Young. The session helped agencies and community-based organizations plan creatively and strategically when applying for philanthropic support for programs and services, in part by creating new community partnerships, mobilizing economic and human resources, and identifying non-traditional funding opportunities.

The day concluded with a networking reception for speakers and participants to continue the discussions.

The next day, a smaller group of sixty selected participants returned for a day of focused plenary sessions led by Dr. Lynda Frost and small, professionally-facilitated working sessions. The participants analyzed over two dozen additional hypothetical situations for a publication resulting from the seminar and identified the next steps for agencies to develop a culture of care that minimizes the use of seclusion and restraint. The results of the participants' hard work will be published by the Hogg Foundation this spring.

The Robert Lee Sutherland Seminars are a living tribute to the first director of the Hogg Foundation for Mental Health. Beginning in 1978, and continuing biennially since, the seminars have encouraged people to work cooperatively to address timely issues for the improvement of mental health and the quality of life in Texas.

For more information on restraint and seclusion, or for information resulting from the Sutherland Seminar, access the Hogg Foundation for Mental Health web site.