The METO Settlement

Roberta Opheim: The facility actually believed that these physical restraints were having positive results. And what we were finding was it just… that the information we found, the statistics we found did not support that. And it was from the daily program worker in their cottage all the way up to the senior management of the facility.

They said they researched that mechanical restraints were safer than, say, a physical hold or other types of restraint techniques. And then we asked them for their evidence of that. And the evidence, all of the research evidence that they submitted to us was based on law-enforcement research where you're approaching a suspect of unknown behaviors and the law enforcement officer has to get immediate control of the scene.

That's different than in a program that sees that person 24 hours a day, seven days a week, knows the person, gets to know them, knows their habits. And that's where the individual nature—one person might calm down by being less stimulated, someone else might calm down by having music, you know, headphones with music. Others might calm down by playing a game or interacting one-on-one with staff.

But they were using really what I would refer to as more of a conditioned response. If you do this behavior, the result is going to be a restraint and, therefore, you will learn because that's a negative consequence that you don't want to do that behavior anymore. But that again involves high cognitive processing or executive reasoning skills, and that's not what was happening.

In fact for individuals with developmental disabilities, they sometimes get into patterns that say attention for negative behavior is better than no attention at all. Or others want to test the boundaries, so you say you will do this if I do that. Well, I'm going to do that to see if you really mean what you say. And that's the kind of patterning that we saw going on where the staff was as patterned.

You know, when we talked to the staff members, they said, "Well, in two minutes if they don't respond, we must restrain them. That's what the program says. That's what we have to do. We can't deviate." You know, even if they were observing, that's something else. In fact, no restraint should be used if the person comes back under behavioral control. Yet, they believed they had to execute it.

So an individual engaged in a behavior and that behavior got the staff to respond. If you do that, I'm going to have to restrain you. The person immediately stood up and assumed the position to be restrained. That meant that they were already calm, could already follow directions, and yet that's the point at which they said, "Okay, you're calm, we don't need to restrain you." But they didn't. They followed through with the pattern and programming.