Classroom Management and Discipline/Therapeutic Holds

Pre-Hold Checklist

 * Holds should be only used when the child represents a threat to the safety of himself or herself, or to others.
 * Physical holds are to be used only when other less restrictive means of behavior control have been tried and have failed (e.g. redirection, time out).
 * Holds should never be attempted without at least two people, so that a witness is present. Three staff is recommended.
 * Holds should not be attempted if doing so puts staff at undue risk. Call the police instead.
 * Holds that last for longer than 30 minutes become “restraint”. Therefore, staff is required to attempt releasing the child, even if the child’s behavior requires the immediate re-application of another hold (and another 30 minutes begins).

The Hold Team
Staff members should, whenever possible, surround the student in an equilateral triangle formation, with one staff member in front, and two behind the student within walking distance of the student’s shoulders. This position makes it impossible for the student to watch all of the Hold Team at once. Until a hold is initiated, all staff should remain 3 feet from the student. Distances of 18 to 35 inches place staff at risk for being punched or kicked.

The staff member in front of the student is the leader. If the student changes directions to face another staff member in the triangle, then they become the new leader.

The leader is responsible for communicating intentions with the team and the student, and initiating the hold. Team communication can be non-verbal (eye, hand, or head movements) or through a short verbal prompt (“Go”, “Now”, etc.). Team members should be ready to begin the hold as soon as the leader steps forward.

Take-down Procedure

 * 1) While maintaining eye contact with the student, the leader steps forward and hugs the student around the knees with both arms.  Looking at the legs in advance discloses the leader’s intention to the student, and may result in evasion.
 * 2) Simultaneously, the two staff behind the student should step in to the student. Each of them should curl their inside arm up (parallel to the student’s body), cupping and holding the student’s shoulder.  At the same time, the staff’s outside hand should hold the student’s arm (at the wrist) out and across the staff member’s chest.
 * 3) Once arms are held, the two standing staff members step backward and support the student in a controlled descent to the floor (not a drop).
 * 4) On the floor, the leader can use their body to hold the student’s legs firm by lying laterally over the knees.  Be careful not to touch the abdomen.
 * 5) On the floor, the staff members at the shoulder hold the shoulder with one hand, and the wrist with the other.  The student’s arms should be straight out, with palms down.  Staff should orient their arm holding the shoulder so as to avoid being bitten.
 * 6) Staff members at the shoulder can also reverse their position.  Instead of facing down at the feet, they may move on the other side of the arm to face the head.  Again, watch out for bites.  Staff members at the shoulder may also lie down on their stomachs while holding, so long as no body weight is constricting blood flow to the student’s arms.

NOTE: An identical take-down and hold procedure that placed the student on their front used to be widely taught and practiced, but is not recommended due to the elevated risk of asphyxia.

Hold Maintenance
Student struggles, proximity to walls or other objects, or the need to switch staff members on and off the hold will necessitate regular changes in the application of the hold.
 * At all times during a therapeutic hold, the purpose is to provide the minimum resistance necessary to keep the student in place and calm. Do not use all of your strength at all times.  Very little energy is required to hold a student who is not struggling against you.  Using too much force tires you, and may injure the student.
 * It is recommended that only one person communicate with the student (usually the leader, unless there is another team member better skilled, or with a better rapport). The topic should be restricted to what the student needs to do in order for the hold to be removed (example: Step one – Stop screaming and struggling, Step 2 – Communicate feelings, Step 3 – Agree to go into time out and remain there).  Steps should only be taken one at a time.  Do not argue with the student.  Do not judge or criticize the student’s behavior.
 * Obviously, take-downs do not always go perfectly. Many factors can contribute to this, including an unexpected escape attempt by the student, evasive tactics by a student familiar with take-downs, or errors of hesitation within a team that is unfamiliar with the procedure or unprepared for the variables involved.  Even if the procedure executes less than perfectly, the ideal hold position can still be achieved while the student is already on the ground, by the coordinated movement of the team, so long as team communication is effective.

Hold Release

 * When the student has complied with the steps prescribed by the team leader, or if 30 minutes of time have passed, the hold must be removed.
 * Releasing a held student may pose a threat to other students, and at the team’s discretion, it may be wise to clear the room first.
 * Before release, the leader should notify the student that this is about to occur, remind him/her what behavior is expected per the verbal agreement, and warn which behaviors will result in the hold being reapplied.
 * If violence or struggle occurs immediately after release, while the team is in close range (less than 18 inches), the hold can be reapplied. Otherwise, the team should step back into the safety range (over 36 inches away), clearing a path for the student to go to time out.
 * Should a hold need to be re-applied, parents or police may need to be contacted. Hospitalization may be necessary for students who continue to threaten harm to themselves or others.

Post-Crisis Procedure

 * Parents should be notified as completely as possible as to the precipitating incidents, and other events during the hold.
 * Each member of the team should write a report detailing their own recollection of the incident, share it with supervisors, and keep a copy on file.
 * A hold team meeting may be useful in discussing what was effective and ineffective during the hold, so that it can be improved in future applications.