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Posted by Rachel Dissell/Plain Dealer Reporter
January 10, 2009 07:00AM
A 17-year-old girl who suffocated while being restrained at a center for troubled children was held in a potentially deadly face-down position that was recently banned by at least one state agency.
The restraint has been blamed for the deaths of at least 40 children in facilities nationwide since 1993.
Cuyahoga County Coroner Frank Miller said Faith Finley had been held in what is known as the prone restraint.
He ruled her Dec. 13 death a homicide Monday, saying she was suffocating while she was restrained at Parmadale Family Services in Parma and choked on vomit. Parma police are investigating.
A movement to ban the dangerous “prone restraint” has grown among agencies that serve children. The Ohio Department of Mental Retardation and Developmental Disabilities banned it in November.
The danger of the restraint led to the ban, according to a memo sent to agencies that the department licenses. Copies went to at least a dozen additional state officials.
“Research supports the belief that prone restraints are potentially fatal due to the impact this maneuver has on reducing a person’s ability to breathe,” the memo reads.
Unclear is whether Parmadale was aware of the memo.
Staff is trained on all the dangers and methods involved in restraints, said Tom Mullen, president of Catholic Charities, which runs Parmadale.
Staff is taught to use a face-to-the-ceiling restraint where staff members secure a child to the floor by pinning their arms and legs to the ground and not compressing the torso in any way, he said.
If staff did not follow the policy, action would be taken, he said. Two workers involved in the restraint on Faith are on paid leave pending the police investigation.
The face-down restraint, which puts pressure on the stomach area, can be especially dangerous if used on a person taking psychotropic drugs. The drugs can cause some to easily vomit while relaxing the gag reflex, making it harder for them to clear their throats. Faith was taking medication in that category.
Nationwide, since 1993, at least 64 children died and thousands were injured while being restrained in face-down and other methods. About half of the restraints that caused deaths were unnecessary, a review of restraint deaths by Cornell University Residential Child Care Project found.
Cornell’s trainers, who have worked with Parmadale, teach both the face-up and facedown techniques as a part of their Therapeutic Crisis Intervention system but warn neither is safe. Facilities choose which methods suit their philosophy. Some choose never to use restraints.
“Every single restraint assumes a certain level of risk, including death,” said Michael Nunno, the project’s principal investigator. “You never want your intervention to be more risky than what the child is doing.”
According to the coroner’s ruling, Faith was restrained after an “outburst of disruptive behavior.”
Faith had been tossing things around her room and may have approached the staff aggressively, said Parma police and Parmadale officials.
That type of behavior alone is not enough to restrain a child, Nunno said.
Workers often get into power struggles with kids they supervise, especially if the atmosphere in the facility is chaotic. Staff involved in such struggles should remove themselves from dealing with the children, he said.
According to police records and other sources, the situation in Parmadale’s Cottage 14, where Faith lived, was particularly tense.
In the days leading up to her restraint, several children escaped, one stole a car, a child-care worker was injured by a teen and — just before Faith died — another girl in the cottage was beaten so badly, she was taken to the hospital.
People can be trained and tested over and over, Mullen said, but in the heat of a situation, it’s hard to maintain control of an agitated child who is struggling with staff.
“What people need to understand is that these are interactions between humans,” he said.
Bellefaire JCB in Shaker Heights, which also treats troubled children, uses restraint as a last resort, said Jeffrey Cox, clinical director.
“For us, disruptive is not enough,” he said. If a child were to punch a staff member and walk away, that would not be a restraint situation because the immediate danger would be over, he said.
When restraints are used, the child’s vital signs are carefully monitored, and children are not left alone immediately after being restrained, Cox said.
Faith was allowed to rest on the floor after she was released from the restraint, and workers later discovered her breathing was shallow. Parmadale staff lacked access to life-saving measures such as an automatic defibrillator to try to restart her heart.
The number of restraint-related injuries in Ohio is unclear because no agency collects the data. Information about major incidents, such as deaths or serious injuries, is supposed to be reported to the agency or agencies that license a facility. But that information is not shared.
In 2006, the Ohio Association of County Behavioral Health Authorities, an umbrella group that includes county mental health boards, pleaded for the creation of a statewide system to report child injuries in facilities.
The report pointed out that thousands of restraint-related injuries each year, including rug burns, black eyes, bloody noses and broken teeth, are not required to be reported. It concluded that fear of liability and the potential of losing facilities, which are already in short supply, were reasons that reforms were not being pushed.
“We tinker around the edges, but nobody is biting the bullet and fixing this problem,” Cheri Walter, CEO of the group, said at the time.
Asked this week if any changes had been made since the 2006 paper was printed, Walter said, “Frankly, nothing has changed.”
But now, officials are facing the death of a 17-year-old.
“It’s unfortunately taken kids’ deaths to prompt these kinds of changes,” Nunno said.