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Seclusion and Restraints: Overblown Concerns?


A blog reader, LadyJane66, added a lengthy response to the bottom of a blog entry I wrote in December. Because that post is now off the front page of this blog, I thought it was worth bringing up the comment for further discussion. The gist of the comment is that the report of the National Disability Rights Network on seclusion and restraints is inaccurate and doesn't talk about the REAL problem, which is the issue of student-against-student violence, or student-against-teacher violence:

...The 100 or so incidences of potentially abusive uses of seclusion and restraint documented in NDRN’s Report span over at least a decade long period and include non-school incidents. These cases were reported by 57 protection and advocacy network offices presumably located across the country. If you average the number of incidents included in the Report over the 10 year period over which they were reported, you are looking at 10-20 cases of potentially abusive uses of seclusion and restraint annually.

We now ask the public and Congress to compare this number to the actual number of violent incidents that may actually be occurring at this nation’s schools annually and multiply that number by the 10+ year period covered in NDRN’s Report.

It is only by putting the examples cited in NDRN's Report into context that the scope of the overall issue of school violence and the need for school safety can be measured.

There's a lot more where that came from, so I encourage you to read the whole comment. Quite a bit of the writing seems to echo the information at this relatively new website, The Truth About Prone Restraint.

When I wrote last week on seclusion and restraint, I had an opportunity to speak with Reece L. Peterson at the University of Nebraska-Lincoln, who is an expert on this issue. He brought up the issue of student attacks on teachers, and I wish I had been able to get into that more. Writing news articles always requires a careful balancing act on what gets in and what has to be left out, because there's only so much space, so I'm glad I have the blog to explore issues further.

From reading its report, I don't sense that the NDRN is suggesting that other violence in schools is unimportant. The organization has a specific mandate and is therefore going to focus on issues that affect its primary clientele. Here's where I think there's a disconnect -- there are clearly times when seclusion and restraint are *not* being used as a way to keep children or school staff from immediate harm; but as punishment for perceived misbehavior. I think that NDRN and LadyJane66 might agree that those situations do not appropriately call for either restraint or seclusion.

But is the focus on restraint and seclusion of students obscuring more important issues related to violence? Are restraints and seclusion as clearly bad as the NDRN suggests they are?


I took a peek at the website, as well as reading LadyJane's post. First, I think it serves no one well to pose a dichotomy between the safety of teachers and the safety of students (or between students with special needs vs those who have regular needs). I would agree that at the point at which a crisis occurs, it is too late to begin Postive Behavior Supports. But isn't that exactly the point?

I don't know where LJ is getting the data that suggests that ED students make more threats or that the threats are more violent. I question the data only because I know how difficult it is to obtain any reliable and comparative data that has anything to do with incidences of discipline/wrong-doing at any level within schools--let alone at this level of specificity. In my district we have an ongoing disagreement between administrative report of violence against teachers and what the union claims is a much higher rate of unreported incidents. I don't know which has the greater truth. Nor is there any publicly available information about student on student assaults or threats.

I would go so far as supporting LJ in seeing all threats or assaults as important. It is, I think, a serious error to believe that restraint is the best means of preventing assault on students or teachers. One fear is that it may operate in the opposite direction. Not only does it frequently become over-used--taking the place of strategies more likely to result in learning replacement behavior--but it tends to foster the idea that putting hands on someone is an acceptable solution to conflict--and their own fault. Would LJ, or anyone else, advocate for such techniques to become commonplace among other populations?

As someone who participated in the creation of the National Disability Rights Network’s (NDRN) report “School is Not Supposed to Hurt” I am compelled to respond to some of the misconceptions in ladyjane’s response. “The lady doth protest too much, methinks” was the quote from Hamlet that came to me upon reading ladyjane’s response to your December blog on seclusion in special education

I find ladyjane’s analysis of the NDRN report inaccurate for a number of reasons. First, the examples in our report are not over the time frame of a decade as ladyjane asserts. We worked to keep the examples in our report contemporaneous to 2009, and for the most part the examples are within two or three years of the report issuance date. The examples in our report of the four school children who died as a result of restraint or seclusion died occurred between 2002 and 2006. We felt we could not ignore their untimely deaths in our report.

Next, I find her statistical analysis of our examples improper. To capture and keep the attention of Members of Congress, their staff, and the press, not to mention the American public, we decided to keep our report brief rather than include all the examples we had gathered. So, while we only included a limited number of examples in our report, it is just a sampling of these events occurring nationwide. Therefore, it is inaccurate to statistically extrapolate how many actual examples of restraint and seclusion are happening in the country from the sample in our report.

Ladyjane’s discussion of statistics reinforces the need for a key recommendation in the report we issued. Unlike the school violence statistics ladyjane quotes repeatedly throughout her post, incidents of restraint and seclusion in our schools are rarely reported to anyone: parent or guardian, principal, local educational agency, state educational agency, the United States Department of Education, etc. To address this deficiency, one of the recommendations in our report is that mandatory reporting should be occurring. It also underscores that no matter how many instances we come across, many others are certainly going undetected.

Third, and most baffling to me, is ladyjane’s insinuation that by issuing this report, NDRN is recommending that no actions be taken by teachers or other school personnel in situations where physical safety of an individual is involved. In fact, I question if she even read the report. For, if you looked at the recommendations section, you would clearly see that NDRN recommends, four times, that restraints (other than prone restraint) can be used when the immediate physical safety of the student, staff, or others is clearly in jeopardy. Reading over the examples listed in ladyjane’s response, I do not see an example that would not fall within that recommendation.

Ladyjane also questions the use of positive behavioral supports in heightened situations as a way to mitigate the use of restraint or seclusion. NDRN believes that the implementation of school wide positive behavioral supports are not meant to address a situation as it is occurring, but is meant to keep potential problematic situations from escalating to the stage where the use of restraint or seclusion is considered. There are examples in our report (from Anne Arundel County Maryland and Bethlehem Pennsylvania) that show how the use of positive behavioral supports reduces disciplinary sanctions, lost instructional time, and reduces the use of interventions, such as restraint and seclusions and expulsion.

Given the scope of the examples that were being reported by the Protection and Advocacy system, inconsistencies from jurisdiction to jurisdiction in requirements concerning restraint and seclusion, the lack of reporting, even to parents and guardians, the fact that children in a group home or health facility had greater protections than children in our school systems, and the needless deaths and injuries that have occurred because of restraint and seclusion, NDRN felt compelled to issue this report and raise the profile of this matter. NDRN was not attempting to say that restraint and seclusion is the only issue that needs to be addressed to make schools a safe place for children and others.

We hope to work with all interested parties to address this and other critical safety issues for our children that attend school. I am sure that ladyjane and NDRN both truly fall on the same side of the issue of child safety in schools, especially for the most vulnerable populations. I recommend you read the whole report, which can be found at www.ndrn.org.

It's difficult for me to respond to this, but I don't want silence to look like assent. These concerns are NOT overblown. My lovely ASD son has thrived and behaved safely and appropriately in a variety of settings with good supports.

Because my school system wanted to save money on staffing, behavioral consultation, and data collection, (to the tune of not even completing an FBA after multiple restraints and multiple requests), my son was placed in a program where he was regularly physically restrained, often for more than 20 minutes at a time, and placed, sometimes for hours, in a tiny concrete room by himself. No one tried to teach him the skills he needed to calm himself. Books I gave them about emotional regulation for ASD kids were tossed aside. The staff had not been trained in restraint safety. I called meeting after meeting to try to change things and people nodded at me and did absolutely nothing.

He has been restrained 22 times this school year. Last year's count is unknown because the school refused to document the many restraints and incidents of seclusion that occurred until I documented their refusal in writing and sent them a copy of the law (our state is one of the few that has a law). We filed for due process and things are slightly better; we have some optimism about a different, appropriate program next year. Note that this process has cost us over $15,000, and that the program our son will be leaving is expected to continue, "serving" primarily kids in the foster care system. Who will file on behalf of those kids to get them the supports they need?

Just in case you think my son is a violent 200-pound teenager wreaking havoc on innocent teachers (which still would not justify using restraint in the absence of PBS and an FBA), consider this: this happened during his kindergarten and first grade years in school. Two years later, he currently weighs 50 pounds.

This is real. And it's not a joke. Attitudes like LadyJane's (and forgive me but I couldn't bring myself to read her full comment) as expressed in your post are the problem: schools and educators who think that responding violently to problem behavior is the only answer. What are you teaching?

COPAA (the Council of Parent Attorneys & Advocates) has accounted for 143 incidents of the use of restraints, seclusion, and aversives in a study we did over the last 2 months, http://www.copaa.org/news/unsafe.html
Most of the reported incidents were within the last 2 years. 71% of the parents had not consented; and 71% of the children did not have research-based positive behavioral intervention plans.

I mention this because I think the report written by the National Disability Rights Network was an excellent report about restraint/seclusion in the U.S. If there is any doubt about the seriousness of the issue, COPAA's report backs up NDRN's concerns. I further think it is a serious misstatement to assert that NDRN has only established that there are 10-20 restraint/seclusion incidents a year. That's not what the NDRN report said, and the COPAA report backs up NDRN's point that restraints and seclusion are pervasive.

I salute NDRN and the P&As for their work on this issue. I'm proud of their report. I think it was a thoughtful, very well researched and very well written contribution to the discourse in our country. I wish any critique of the report would also be at the same high level. When children's lives are at stake, its important.

This post is to clarify a position. I stand behind my original post, National Disability Rights Network (NDRN) misrepresented the issues and facts in its Report. The COPAA report is also misleading. These are not 143 incidents over 2 months, but 143 incidents over many years. The NY child handcuffing incident took place several years ago. Neither organization offers data that puts the abuse allegations into context of overall violent incidents and restraint or seclusion use.

There are two points to this post. First, to inform people of the entire issue and facts. Second, to address the legal and constitutional issues regarding banning the use of prone restraint for only one segment of the population (see final paragraphs).

We do not doubt that instances of abuse and neglect take place in school and that attention should be given so that they stop. However, it is completely irresponsible of NDRN and COPAA to use 100 or so incidences to promote an agenda that affects the safety and lives of over 50 million students and 6 million teachers. As noted in our previous post, the Department of Justice has reports of close to one million violent incidents annually a number which by most accounts is severely underreported.

We have no objection to persons wanting to raise awareness and "up" the training in positive supports in an effort to decrease the use of restraint and seclusion, we're all for it. If teachers and staff are using restraint and seclusion when its use is unwarranted, then its use should be restricted appropriately. We are not in favor of using restraint when you do not have to. Name a person or a teacher who would rather restrain a child when they can talk or redirect him/her just as easily. We are also in favor when physical intervention is necessary that the least restrictive form of restraint be used. If standing or seated holds can be used and are sufficient to maintain the child’s and others safety, then by all means use a standing or seated restraint. It is when standing and seated restraint are insufficient to maintain safety and floor restraint needs to be considered is where we disagree with the ban that the advocates are calling for in their report.

The supine restraint option that NDRN offers is not as safe or as therapeutic as prone restraint. Clients have complained about supine restraint feeling more, not less, vulnerable, students are forced to be eye-to-eye with the person that is restraining them, panic reactions occur more frequently and children are not given space or privacy to regain control of themselves. Teachers and other staff are less likely to intervene if they can only use supine restraint because they are constantly subjected to being spit upon or bitten. In agencies forced to use supine restraint children that were once able to be managed are excluded from programs, holding times are longer, and assaults and injuries go up for both student and staff. See www.thetruthaboutpronerestraint.com and www.thetruthaboutpronerestraint.com/blog.

In a comment submitted in response to Pennsylvania DPW attempt to ban prone restraint, Scott Martin, Commissioner of Lancaster County writes: “Being in the supine position enables them [children] to be more successful in punching, scratching, eye-gouging, pulling hair, biting and spitting. . . . Unlike the prone position, the supine gives full leg striking ability which has led to many serious injuries to staff members. . . .When a child is placed in the prone position, they are limited in their ability to further assault. When you place them supine, you give them every opportunity to do so.”

Prone restraint simply means that the subject of the restraint is in a face down position. It is not the name of a particular restraint technique as there are many ways to restrain someone face down. All prone holding methods are not unsafe, just as all standing, seated or face up holding methods are not safe.

Face up or face down, the real issue is chest compression that restricts breathing and not paying complete attention to the physical and emotional well being of the person being restrained during the entire time they are being restrained. No restraint training program teaches prone restraint where staff is placing weight on the child’s back or chest. If there are instances where knees or elbows are placed on a child’s back or staff is placing weight on the child’s back – these are training issues.

There is a principal that underlies the very foundation of this country which can be found in the 5th and 14th Amendments of the United States Constitution as well as the Declaration of Independence. This principal is that everyone is equal under the law and that everyone is entitled to equal protection under the law. How can an advocacy group lobbying for equal protection for disabled persons be consistent in their mission for promoting equality and justice when it is demanding unequal treatment. The law does not require anyone to submit meekly to the unlawful infliction of violence regardless of what mental condition may be causing the threatening behavior or the age of the actor. Human services providers, educators and the other students deserve the same rights as every other citizen as long as the manner of intervention is least restrictive, effective and reasonable.

Personally, I’m for personal empowerment. Give teachers the entire spectrum of tools they need to teach children and maintain a safe environment, and give supervisors and administrators the authority and support to do their jobs as well.

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