The METO Settlement

Roberta Opheim: The important thing was that we discovered… that the new emerging practices, best standard practices—and I don't even want to say it's new—but, was that one, all behaviors negative or otherwise, are a form of expression or communication when the person isn't able to communicate their needs or wishes in any other way.

That behavior can be maladaptive, meaning it's really inappropriate. We can't be having people spitting at individuals, or hitting them, or in any way risking harm to themselves or to someone else. Some of these individuals would engage in self-destructive behavior—scratching, cutting, banging their heads—and certainly there needed to be intervention to prevent harm. But what we found was that, contrary to what the behavior planning required, that you're supposed to start a process, identifying the behavior, what's it trying to accomplish, and then looking for positive re-directive methods to retrain that pattern of behavior into a more positive, socially acceptable norm. And then, only as a last resort and only when there was an immediate life threat, would you go to restraints.

What we discovered in the program was that they would identify the target behavior that needed to be redirected, and they might give them one prompt or two prompts but if, within two minutes, the person didn't redirect their behavior as instructed to do, they were would be placed in the restraint. So there was… then after you've restrained somebody a number of times, you're supposed to certainly look and say, "Is this program working?" Because the positive redirection should be directing that behavior and it it's not, then what's going wrong with the program?