April 1st, 2014

Efforts hindered to eliminate restraint and seclusion in schools

To understand the challenges facing reformers who want to eliminate the practice of physical restraint and seclusion of schoolchildren, look no further than numbers reported in Connecticut and Massachusetts.

A Connecticut Department of Education report released in February documents 33,743 incidents of restraint or seclusion involving children with disabilities because of behavior during the 2012-2013 school year. But in that same time period, the Massachusetts Department of Elementary and Secondary Education reported only 165 such incidents.

Massachusetts requires school officials to report the use of any physical restraint that results in any injury to a student or staff member or any physical restraint lasting longer than 20 minutes. In Connecticut, however, as soon as a staff person puts their hands on a child, it is considered restraint with the exception of touching intended to calm, comfort or escort a child, says Connecticut Child Advocate Sarah Egan, J.D..

Last year, Egan’s office partnered with Connecticut’s Office for Protection Advocacy to promote better policies and practices to reduce restraint and seclusion after both agencies investigated allegations of emotionally distraught children being dragged down hallways to what were dubbed “scream rooms” at the Farm Hill Elementary School in Middletown. The agencies concluded a “systems failure” led to the use of two unfurnished rooms in which children could be seen and heard kicking and screaming while school staff held the doors shut.

“They had the hammer and nail approach, not because they were evil but those were the tools they had and so that’s what they used,” Egan says of the Farm Hill case. “Now they did have other tools at their disposal that they may not have been really trained on or been thinking about like community mental health supports or collaboration with the Department of Children & Families.”

Eight Connecticut agencies last year launched a public education campaign to reduce restraint and seclusion, echoing similar reform efforts across the country in response to growing awareness of the physical and psychological damage these practices cause. The U.S. Department of Education issued a 2012 resource document discouraging restraint and seclusion “except in situations where a child’s behavior poses imminent danger of serious physical harm to self or others.” But there is no federal law or regulation specifically restricting the use of restraint and seclusion in the nation’s schools unlike in federally funded mental health and juvenile justice facilities.

Identifying the frequency and severity of restraint and seclusion remains a significant challenge, says Janice LeBel, Ed.D., director of program management, child and adolescent services at the Massachusetts Department of Mental Health. She is a nationally recognized expert on restraint and seclusion who spoke to Connecticut officials at a forum on the issue last year.

“There is no national database, no common framework for reporting on restraint and seclusion,” LeBel says. “There’s often no common definition so we have a very basic problem with understanding the nature … and what people consider restraint and seclusion.”

LeBel and colleagues from several other Massachusetts agencies developed a set of six preventive strategies to avoid restraint and seclusion that have been implemented in different Commonwealth settings, including public and private schools. These Six Core Strategies comprise a no-cost, public domain curriculum included on the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-Based Programs and Practices.

Another tool for school officials is Positive Behavioral Interventions and Supports (PBIS) an evidence-based, framework implemented in more than 19,000 U.S. public schools, according to a report issued in February by the U.S. Senate Health Education Labor and Pension Committee.

Restraint and seclusion to control unruly behavior among school children has been around for as long as there have been schools, but LeBel says there is a “persistent myth” that these practices are somehow effective when the harm is well-documented. Another myth, says LeBel, is that restraint and seclusion are somehow quicker ways of dealing with problem behavior.

Several years ago, LeBel and colleagues did a task analysis and time study of physical restraint episodes within mental health facilities and found that a one-hour episode later claimed 11 to 13 hours of staff time for documentation, debriefing and follow-up with family members or staff who may have been injured. LeBel says she would expect that schools would experience a similar drain on staff time with such episodes.

“It was very much an eye-opening exercise to understand that this was a very complicated process,” LeBel says. “It was quite shocking to see that most of the activity associated with these very painful occurrences happened after the fact.”

“For children, those restraints aren’t over. They live on,” LeBel adds. “They can become defining moments, and it can really step on their capacity to be successful in a class or to trust those that are trying to help them or work with them.”

By Janine Weisman

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