The Low Arousal Approach to reducing restraint and seclusion

Today’s guest author is Emily LaMarca. Emily has a background in Business and Wellness, but has focused her energy over the past ten years on advocating for Disability Rights. Her son Cole, who happens to have Down syndrome, is her biggest inspiration. She has always followed Cole’s lead and this has led her to her most recent fight against the misuse of restraint and seclusion in Massachusetts schools and dedication to finding a better way to address challenging behavior.

Emily and her family

I came across the Low Arousal Approach and Professor Andrew McDonnell’s work three years after our son had been repeatedly restrained and secluded in his Central Massachusetts Elementary School. Ten years old at the time, we quickly saw the signs of trauma take hold. Four years later our son has been diagnosed with post-traumatic stress disorder (PTSD), an anxiety disorder. Today he continues to have nightmares and a consistent worry that teachers from his old school will find him and restrain him again. When we learned his story was not unique, it became important to understand how restraint and seclusion fit into our schools, and training was a big piece of this.

Massachusetts regulations require that a teacher or support staff participating in restraining a child be trained in de-escalation and restraint. This is where I started. I began talking to friends who had taken de-escalation and restraint training and then moved on to reading the training manuals. The manuals use terminology like violent, dangerous, potentially dangerous individuals, and in one case advises the reader to “always assume aggression could happen, even when it doesn’t seem likely.”

These training programs seemed to focus on the worst-case scenario and painted the picture that children should be feared. One de-escalation technique included entering their space and placing a hand on the child’s inner elbow. It was described as a simple, non-intrusive preventative method for improving staff safety. The manuals included safety stances that felt intimidating and cold. The approaches I was reading were focused on controlling the situation. The techniques felt calculated, too calculated to be implemented in real-life situations.

There was also the issue that de-escalation techniques were being taught alongside restraint techniques, something that just did not make sense to me.

It wasn’t long after I found the work of Dr. Ross Greene and Dr. Mona Delahooke, whose methodologies I believe play a crucial part in the movement to reduce the use of restraint and seclusion. Not long after, I was introduced to Professor Andrew McDonnell and his Low Arousal Approach. Like Dr. Greene and Dr. Delahooke, Professor McDonnell articulated the importance of perspective on behavior and introduced a humanistic approach to get there.

The Low Arousal Approach can be described as a person-centered, non-confrontational method of managing behavior. It is empathic in practice and works to create a necessary relationship built upon dignity and respect. The Low Arousal Approach places a heavy emphasis on avoiding the use of punishment. This behavioral management system does not feel like a system at all, rather a humane, individualized approach that works to reduce stress, fear, and frustration.

The training in the Low Arousal Approach was eye-opening. They articulated everything that I knew to be true for my son and communicated an approach that felt human. It allowed for the person being supported to have good and bad days, as every person does. It took down the unreachable bar that is set for so many children, a bar that even adults cannot reach consistently. The Low Arousal Approach gave me hope because it was real. It took into consideration how challenging it must be for a child with additional needs to navigate the school environment, an environment with so many unwritten rules and expectations. The Low Arousal Approach was connective, and it saw the person that was struggling and focused on helping them.

The Low Arousal Approach does not adopt a typical behavior philosophy-that behavior can be explained through four basic functions: escape, attention, access to tangibles, and automatic reinforcement. It proposes a more complex view of behavior because after all, humans are complicated and so is the world in which we live.

The Low Arousal Approach does not believe “simplistic behavioral functions cannot encapsulate the complexity of human nature and behavior.” The Low Arousal Approach looks deeper and focuses on the situation and the person, not on the behavior itself.

Since trauma plays a large role in behaviors of concern a trauma-informed approach is taken within the Low Arousal Approach. Being trauma-informed means that you acknowledge the impact that trauma has on the person you are supporting. You understand that a stressed individual is not in control of their behaviors and although you may see the person as angry, you also understand that they may be scared and afraid. As Professor McDonnell explains, if you see someone as dangerous you are less likely to want to help them. If you perceive the person as afraid or scared and know their “thinking brain” is off-line, then your response will differ from if you were to see their behavior as intentional.

The Low Arousal Approach avoids touch and fast movements and avoids invading someone’s space. The approach teaches us to be aware of how our actions can be perceived by someone who is highly stressed. It also helps us to understand that stress can lead to sensory overload and slower processing times. When a person is highly stressed, they will see the world as more chaotic and unpredictable.

When a stressed person feels they have no control they will fight to regain some form of it, so reducing the number of individualized rules and giving choices is imperative. While all these things are being done, a trusting and empathic relationship is being built.

There are many aspects of this approach that I believe set it apart from other training, but I think the most powerful is that it places a heavy emphasis on the role that our own behavior and emotions play in high-stress situations. It does not place all the responsibility on the person being supported. The approach acknowledges that our expectations, emotions, language choices, behaviors, and responses are critical in these situations. Being able to self-reflect on the role we play in a situation is a necessary piece to the Low Arousal Approach, although not an easy one.

And because emotions are contagious, the Low Arousal Approach teaches us how to regulate our emotional arousal. It acknowledges that our position is stressful too and that can impact our mental health. An important piece of this training is teaching us how to identify our stress and draw upon individualized coping mechanisms to manage these stresses and emotions.

Educational Adviser Gareth Morewood speaks to Emily Howland about the LASER programme for schools and other educational settings, now available for online delivery.

Another key element is that the Low Arousal Approach trains away from using restraint or seclusion. In The Reflective Journey, A Practitioner’s Guide to the Low Arousal Approach, McDonnell explains why this is important. In his words; restraint and its application can be highly addictive in nature. When it is used once, we begin a psychological process of justifying the action to keep people safe, protect property, prevent self-harm, or stop a behavior from escalating further. People can begin to see restraint as an acceptable side effect of their work, a necessary evil. He says that once we start to believe that we have exhausted all options, then we will never change our own practice.

When quoting a colleague, McDonnell says “Restraining someone is relatively easy; not restraining someone takes courage”

. I believe this whole-heartedly. I also believe it speaks to the choice we have in how we train our educators. It is easy to continue doing the same thing, even though there are undeniable consequences to this – children and teachers being hurt, traumatized, and in some cases, children have died. It takes courage to admit that despite the best of intentions we were wrong. It takes courage to go against the grain and try something different. I hope there are enough courageous people who believe that we can do better because the resources are there to support them. I am incredibly grateful to people like Professor McDonnell and his colleagues, who have dedicated their lives to educating others so that one day the practices of restraint and seclusion will be considered as they should be: unnecessary, inhumane, and archaic.

Author

%d bloggers like this:
search previous next tag category expand menu location phone mail time cart zoom edit close