The accompanying images in this post are of something that has been referred to as a 'Therapeutic Floor Hold' in some training materials.   It consistutes, in our view, inappropriate restraint.  The (usually) vulnerable person who is being restrained is first taken to the floor - often through the use of some kind of unbalancing using a 'trip'.   Once on the floor, the staff fold the person's arms around their body (forming a cradle, or wrap position) and then hold them from behind to restrict their movement.   The person on top simply applies their bodyweight to the subject underneath, immobilising them through the use of greater mass and the effect of gravity. The unfortunate thing about a technique like this is that it works, to a large extent.  It may even work so well as to be inescapable. Don't do this inappropriate restraint!

1.  In this series we have described holds where the person on the floor is being subjected to the force of a heavy mass on top of them, pushing down through their body.   The compression can have, especially over a period of minutes, significant effects on the person's physiology such that their cardio-respiratory system is compromised and they go into cardio-respiratory distress and, due to being unable to move to relieve the problems, they expire.   Much has been written on this subject and research continues towards the causes and effects of different actions by staff and the conditions of the subject which exacerbate the issues.  Certainly though, wherever possible, prolonged pressure on the back of a restrained subject is to be avoided wherever possible.  Don't lie on top of people when you restrain them!
2. Here the real problem with this restraint technique.   It is most often used with children's care environments, and it is therefore most often used with our most difficult, distressed and defiant children.  Those children become defiant and difficult to work with because they often come from a context and environment where despicable things have been experienced by them.   Sometimes the despicable thing has happened to them directly.   And often, it was by an adult who was overpowering them and then inappropriately touching them or violating them.   Now, look at the pictures again and feel the revolting surge of "DON'T DO THAT!" which should be any right-thinking person's response to such a technique.

We need to design and implement restraint techniques for working with children which avoid becoming inappropriate restraint.  Instead, the techniques should be:

• effective in protecting staff who use them (both physically and emotionally)
• effective in safeguarding the distressed or dangerous children they are being used to safeguard
• protective of the fragile emotional states which provoke distressed and dangerous behaviour in children

IN our next post in this series we will look at more fragile restraint techniques and hope again that no-one is including them in training, anywhere! All the best for now, Gerard O'Dea, Director of Training,  www.positivehandling.co.uk