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PBS Show to Highlight British School for Children With Severe Disorders

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When I wrote about restraints and seclusion several weeks ago, it raised a kerfuffle with one reader who thought disability advocates are drawing undue attention to the issue. Read the original post, and a follow-up. The implication was that sometimes, teachers just have to restrain or seclude children; the techniques have to remain a tool in their arsenal.

So when my editor sent me information about a documentary following a school in England for young children with severe behavior problems, my interest was definitely piqued. How do they do it, I wonder?

Hold Me Tight, Let Me Go is premiering July 28. For those who don't have access to PBS or who miss the broadcast, the documentary will also be online.

Filmmakers visited the Mulberry Bush School to document its work with emotionally disturbed students aged 5 to 12. I read through the Web site trying to glean insights into this school's therapeutic methods. One of the first figures that popped out is that it has an adult-to-child ratio of 108 to 40, which is extraordinary. It's also extraordinarily expensive, at 123,000 pounds a year per child, according to one news report, or more than $203,000 a year. The money comes from the agencies that place students there. It's a residential school, which allows for a great deal of trust and relationship-building between the children and the adults who care for them.

The Web site says the school does use "gentle restraint." But, judging from this article in the London-based Times (this documentary aired a year ago there), nothing beats time and unceasing effort to care for these children, most of whom have been victims of horrific abuse.

The staff are hit, spat at, kicked and head-butted on a daily basis. The worst excesses are dealt with by a period of restraint. To be spinning out of control is not only a danger to others: it’s also a very frightening state for a child to be in. For all their stomping and swaggering, these children are desperate for someone to look after them. Holding them on a huge beanbag outside the classroom gives them a chance to take control of their feelings. But most importantly for children who have been serially let down by those who are supposed to care for them, the adults here don’t go away. Staff talk about “an unconditional regard for the child.” Privately they admit they are often pushed to their limits, but they get up the next day and do it all again.

I don't blame teachers for saying that headbutting and kicking is not what they signed up for. But not all children exhibit behavior this severe, and yet we still cannot seem to find a place for them. Is there something that we can learn from the Mulberry Bush School, as unique as that program may be? I know I'll be watching to find out.

4 Comments

Christina, this sounds a lot like therapeutic holding. Therapeutic holding, similar to holding therapy and attachment therapy, is not research-based and relies on the discounted theory of recapitulation, which incorrectly presumes that children can re-experience missed developmental milestones at later stages of development (this is where re-birthing came from). I'm not certain that this is the methodology they use, but the bean bag sounds disturbingly familiar, but I've had direct experience with a teacher from a school that claims a similar pedigree.

Anyway, if I'm right and they use these "holds" and distinguish them from "restraints," it's as bad as overusing restraint, if not worse. See here: http://childrenintherapy.org/resolutions/ and here: http://en.wikipedia.org/wiki/Attachment_therapy

This is quite the opposite solution. What about evidence-based approaches? What about PBS? What about ABA?

The real issue here is not whether children are restrained or not, but the circumstances under which restraint occurs, and the teachers' beliefs or expectations about the effects of restraint. When children are genuinely out of control, the most minimal effective restraint can give them a chance to calm down, and can be helpful if followed by adult support for the transition back to ordinary [non-restrained] behavior. Adults need to be very well trained in order to do a good job of this-- it's all too easy to get angry and use the restraint as punishment, followed by further scolding.

There are two beliefs held by some adults, that may seriously interfere with the appropriate use of restraint. The more serious problem is entailed in the belief that children who are calm should be placed in restraint and hassled until they are enraged, with the intention of causing a catharsis of anger. This approach, called holding therapy (or sometimes "attachment therapy"), is potentially dangerous, having been associated with a number of child deaths, and has not been shown to be effective by reliable research.

The second belief, somewhat less serious in its repercussions, but still problematic, is that the out-of-control child, when placed in restraint, is especially open to therapeutic interventions, and that the restraint experience itself is therapeutic. This belief has led to child injuries, inclusing a case where a girl's arm was broken as it was twisted behind her back in order to restrain her.

Both these practices and beliefs can be classified as "alternative" rather than conventional treatments. When schools use these approaches, the chances for injuries or even deaths are quite real (see the recent GAO report on this issue). It is particularly important that teachers and staff learn not to restrain children in the prone (face-down) position or by pressure on the torso that limits breathing. They should also understand that some physical conditions and medications make restraint more dangerous.

When schools' policies stress appropriate use of restraint for out-of-control children, and when teachers and other staff members are appropriately trained to use the minimum effective restraint in order to protect the child and others, to calm the child, and to transition the child back to desirable work and play, their use of restraint seems to be beneficial. However, it is usually best to try to anticipate situations where a child may get out of control, and try to prevent those, rather than doing damage control when the child becomes distraught. Depending on restraint as a major guidance or discipline method is a great mistake.

I think that Jean does a good job of summarizing the high points of the cautions/dangers associated with use of restraints. As a parent, I have certainly been faced with situations in which physical intervention was the most obviously and immediately available possibility in the moment. Any parent of a toddler has certainly faced situations in which scooping the child up before they ran into the street or knocked over the china cabinet or lashed out at another person has been the intervention of choice.

Clearly in kids with maturity delays but advanced age and size this becomes difficult. I believe that, just as toddlers, they have a deep need to locate the adults that they can count on to step in and take charge to protect them when in danger. The description of a bean-bag chair in the hallway in which both adult and child sit until the child has either spent their anger, or retained personal control, cn provide an experience that, to me, has been not only an interruption of danger, but also provided a bonding and reassuring possibility--particularly when the adult remains in contact all through the cycle of regaining control and processing the situation.

This is very different from the reported instances in which children are locked into isolation rooms, left alone for periods of time that do not relate to what state the child is in, or are performed by untrained (or minimally trained) adults, and for purposes of punishment rather than protection. I have seen "discipline plans" that appeared to do nothing more than to escalate responses to a child's behavior until the child is pushed into a "need" for greater and greater restraint and removal.

A weekend workshop on how to hold a kid without getting hurt is nowhere near sufficient to train an adult in appropriate uses.

As a teacher in a preschool special education classroom I have had training in Crisis Prevention Intervention (CPI). Nonviolent Crisis Intervention is based on providing the least amount of physical intervention support for the student's needs. These intervention strategies are at the highest scale (last resort) of behavioral management. These strategies are used and taught to the children in schools in order to help manage their behavior. Steps are taken in which to not have them escalate to the level of retraint. The hierarchy varies from least to most intrusive ending in physical retraint being the last resort for the child's safety.

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