The state secretary of welfare will start the new year with the first tangible action in her campaign to end the physical restraining of youths in group homes: a warning to workers that such action should last no more than 10 minutes.

		In Harm's Way Pennsylvania pays more than a million dollars a day to house and care for some 8,900 abused, neglected, unruly, delinquent and mentally ill children, but it lacks essential tools to protect these children from harm. The Post-Gazette examined these issues in a four part series: Children in custody often hurt, abused Who's telling the truth? Use of physical force on troublesome kids unchecked Sex abuse is the product of a volatile mix

The decision by Welfare Secretary Estelle Richman follows the death in January of an 18-year-old Philadelphia man who suffocated after staff at a reform school held him down for nearly three hours. Within days after that, staff at a Fayette County wilderness camp for troubled children broke both arms of a 14-year-old who was restrained for 20 minutes.

Despite three deaths and untold broken bones over the past seven years in restraints in Pennsylvania, some group homes are balking at the secretary's campaign against the measures, which are called "takedowns."

So intense is this struggle that it took six months for a committee Ms. Richman wanted to call the No-Restraint Task Force to agree on only one thing: taking the "no" off the name and identifying itself instead as the Restraint Initiative.

The dispute comes down to this: The secretary and her supporters contend group homes can't fulfill their obligation to keep children safe when restraining them. Some group homes and their supporters contend they can't keep kids from injuring themselves or others without restraining them.

As it stands now, state law says children may be restrained only when someone is in serious imminent danger and other intervention methods have failed.

Despite that, residents of group homes report that they're thrown to the ground and held down for offenses such as mouthing off to staff. Minor and major injuries often result. In addition to the Fayette case, at least two children, one 10, the other 14, suffered broken bones in restraints this year. Totals are unknown because the state doesn't keep track.

Ms. Richman wants restraint forbidden, but that could take years to get written into state regulation. In the meantime, she plans to send group homes a formal notice recommending specific methods for reducing restraints and limiting their length.

A draft of this "special transmittal" from Ms. Richman says, "In order to avoid the risk of serious injury or death of a child ... best practice recommends that a restrictive procedure last no more than three minutes." If a restraint continues past that, the transmittal says, homes should monitor the youngster's vital signs. "However," it continues, "the department firmly believes that, in most situations, a restrictive procedure should not last longer than 10 minutes."

The welfare department received 126 comments on the draft proposal and might alter it based on those recommendations before the secretary sends it. But officials say the time limitations are likely to stay.

Supporters of this effort say homes with adequate and properly trained staff can prevent children's behavior from escalating to the point that they need to be restrained. Ms. Richman says she saw restraints virtually eliminated when she worked directly with clients at a facility early in her career. "I know what it takes. I know exactly what it takes to avoid restraints," she said in an interview this year.

Shelly D. Yanoff, executive director of the advocacy group Philadelphia Citizens for Children and Youth, is among the secretary's supporters while acknowledging the difficulty of accomplishing the goal. "If this were easy, it would have been done a while ago," she said.

She said strong language is essential to change the cultural norm now allowing restraint. "Society has to say we are not going to have kids in our care dead or with broken bones from restraints," she said. "I just don't think we can have a child in state custody who is at physical risk because our policy allows such things."

Stacey Ward, a spokeswoman for the state Department of Public Welfare, said the secretary knew zero tolerance for restraint required a cultural change, which would take time, training and money.

Many group home directors believe, however, that while it might be possible to reduce restraints, it's impossible to eliminate them.

"We absolutely support restraint reduction," said Bernadette Bianchi, executive director of the Pennsylvania Council of Children, Youth and Family Services, which represents 135 organizations in Pennsylvania. "It is the term restraint-free that is the problem."

James Rieland, Allegheny County's director of probation services and president of the state's chief juvenile probation officers organization, strongly opposes a ban on restraint: "If anyone seriously believes you can move to a restraint-free environment, you are fooling yourself. ... I would welcome a review of restraints. But don't talk about restraint elimination. Talk about a realistic approach and don't jam something down our throats that is very threatening."

Mr. Rieland said that it was unreasonable to suggest a reform school could not restrain a 17-year-old convicted of armed robbery who announced he was going to leave the open campus. "If he is there for a delinquent charge, I can restrain him rather than letting him go. The court has empowered me to keep him there, and I am going to make him stay, though the last thing I want to do is roll around on the ground with a 200-pound 17-year-old," he said.

Ms. Bianchi said if restraint were outlawed, agencies might respond by using psychotropic drugs to excess to modify children's behavior, might evict troublesome youngsters and might refuse to house potentially difficult kids.

Daniel P. Hunt, chief executive officer at Bradley, which operates three residential treatment facilities for children with mental illness, agrees that rejection of children is a real possibility. Why would an agency forbidden to restrain take a chance on a youngster who injured workers at his last facility by hitting them with his walker? Mr. Hunt asked.

Based on his own experience, Mr. Hunt believes that, with the proper plan, staffing, training and resources, restraint almost can be eliminated.

Still, he said, there are some situations, after "52,000 other things are tried first," in which restraint must be used as an emergency safety intervention when a life is at stake.

What, he asks, should a facility do if a child known to be a self-mutilator is threatening to cut his own throat? What, he asked, should a facility do if a child with a history of head banging will not stop and his eyesight is threatened as a result?

In those situations, he and Ms. Richman probably agree. She said she'd accept a restraint to truly save a life. But, she said, she couldn't countenance it if it occurred because the facility didn't have enough workers on duty that day to try alternatives first.