I'd like input from other states on this issue: In Montana we have a number of youth therapeutic facilities (group homes, shelters) that permit unlicensed staff to provide "emergency" manual restraint (one or two person physical holds, including basket holds) to prevent injury to peers or staff. I provide medication management to some of these youth, as an independent provider without facility oversight. The staff are all trained in MANDT (one program for verbal deescalation and manual restraint). My concern is the overuse of this manual technique and the lack of review by a medical provider. Schools are not allowed to do this hands on manual restraint. I'm not sure how these youth facilities have received authorization. From what I can determine, a facility clinical supervisor reviews documentation, and this person may be an LCSW, LCPC, or candidate for licensure. These facilities do NOT have RNs or LPNs or APRNs reviewing these procedures. There is not a requirement (or if there is I can't find it in statutes) to have a child receive a medical assessment y a physician or FNP/ Peds NP if there are complaints by the youth (e.g., My arm hurts, I can't breathe etc). I am aware of a number of deaths that have occurred from baskethold restraints, it is NOT harmless. Recently I had staff at a group home tell me they could not bring the 10 year old child in for a medication checkup at my office 'that day' because he was 'too volatile' and had required numerous physical holds during the past week. I considered if I had adequate grounds to make a CPS report or contact administrative oversight bodies about the issue. We seem to have a very disconnected health care system these days.