Contradiction

You promote positive approaches but you teach physical restraint. Isn't that a contradiction?

There is nothing contradictory about using positive approaches and keeping everyone safe as you do so. The contradiction—some would say the crime—comes when we use physical restraint without working conscientiously to see that we never have to. We are firmly committed to using positive approaches with everyone, no matter how extreme their behavior, and we believe that having thoughtful and effective procedures for intervening in serious behavioral emergencies increases our capacity to do so.
No matter how committed we are to safe driving, most of us wouldn't dream of purchasing a new car without airbags. That's because if something bizarre happens and that thin ribbon of paint down the middle of the road suddenly stops protecting us from an oncoming car, the airbag can save our life. But staying alert and unimpaired by fatigue or substances, minding our following distance, wearing glasses when we need them, keeping our vehicle in good repair, scanning ahead for signs of danger, minimizing distractions within the car, and maintaining undivided attention on the road without reading, texting, dialing, writing, applying makeup, shaving, playing video games, watching movies, or otherwise multitasking, usually means we will never need our airbag. Airbag deployment is exceedingly rare and means something has gone catastrophically wrong. That's exactly the case with physical restraint.

Positive approaches are the only responsible way to provide supports to people with developmental or psychiatric disabilities. When used systematically and systemically they can render physical restraint moot, but as powerful as positive approaches are, they ain't magic. Sometimes people have very unfortunate medical histories and life experiences that can slow their responsiveness to our interventions, and sometimes, despite concentrated and coordinated efforts, it takes time for us to fully understand how to best support a person.

I know a young man who went to live at a large residential habilitation facility in Washington State. He had autism, didn't speak much, and was powerfully built. Tragically, he also had an extensive history of horrific abuse at the hands of previous service providers and had significant violent post-traumatic stress behaviors. Within days of admission, he seriously injured numerous staff, causing some to be hospitalized and others to go out on extended disability leave.

Fortunately for this young man, the unit on which he was living was staffed by an amazing team of dedicated, compassionate, and clinically sophisticated people. They made it their mission to build a trusting relationship with this young man, to understand subtle nuances of his communication, to improve his quality of life, and to develop pervasive, meaningful supports. All while keeping him, themselves, and the other people living there safe. Developing a relationship meant spending time with him, which sometimes meant risking assault. Physical interventions were sometimes used for safety, but sparingly and with enormous sensitivity. The transformation was amazing. In fairly short order, given the severity of the behaviors, the frequency and magnitude of assaultive behavior dropped to near zero rates. More impressive still was that his support staff were able to reduce their use of physical interventions in advance of the decrease in assault. That is testimony to their skill, courage, and commitment to positive approaches as well as to safety.

Good luck. Thanks for shaking the Magic 8 Ball.