Published Online: July 11, 2012

Special Educators' Use of Restraints, Seclusion Topic of Senate Hearing

In one of Kaye Otten’s early years as a teacher, she was granted emergency certification to teach special education in a Nebraska classroom where one of her 2nd grade students was large, aggressive, and always hungry as a result of a rare genetic disorder called Prader-Willi syndrome.

“He knew he could use his size to get what he wanted,” Ms. Otten recalled. “He would pull chunks of hair out of my head.”

The plan to help him calm down didn’t always work, leaving the untrained Ms. Otten and her colleagues to stop the student’s behavior by holding the boy or isolating him from other students, or both, in scenarios that repeated themselves multiple times that school year. But by the time the student was in 5th grade, Ms. Otten and her colleagues had to restrain the student only once all year.

Now, more than 20 years later, as a behavior and autism specialist for schools in Lee’s Summit, Mo., Ms. Otten credits that reduction in the use of restraints and seclusion to analyzing why and when students’ behavior goes off track and intervening when signs of trouble arise. Better training on the use of restraints and seclusion also helped.

Educators’ use of restraints, seclusion, and alternative strategies for managing disruptive student behaviors are scheduled to be the focus of a first-of-its-kind hearing Thursday before the Senate education committee.

The hearing, “Beyond Seclusion and Restraint: Creating Positive Learning Environments for All Students,” will mark the first time the issue has an airing in that chamber. Late last year, Sen. Tom Harkin, D-Iowa, chair of the committee, sponsored a billRequires Adobe Acrobat Reader that would sharply restrict or ban the use of restraints and seclusion, which have come under fire because of multiple reports of students getting injured or dying as a result of such actions. Similar legislation Requires Adobe Acrobat Reader in the House of Representatives was passed more than two years ago and has been reintroduced, but since then, both bills have stalled.

Whether the hearing will push the bill forward is unclear: There are hopes that it would be incorporated into a new version of the Elementary and Secondary Education Act, currently called the No Child Left Behind law, but its reauthorization is also at a standstill.

Need for Training

In general, students may be restrained or secluded only when they are in immediate danger of hurting themselves or someone else. But critics say too often these practices are used to discipline students or remove them from class if they are being disruptive. Part of the problem: Many teachers and school staff don’t have the right kind of training needed to use the measures safely, nor do they have training that would help them devise alternate ways to calm students and keep the students and themselves safe. The Senate and House versions of the Keeping All Students Safe Act would authorize grant money to states and school districts to be used on training related to students’ behavior.

“The training I got was because I pursued it,” Ms. Otten said of her early teaching years in Nebraska. “I would have been able to gather a paycheck without doing more training.”

In her district now, there is no edict that says schools cannot restrain or seclude students, although a recent lawsuit over seclusion rooms made the district eager for change. Ms. Otten started gathering data and taking a close look at the students for whom there seemed to be many incidents of restraint and seclusion, just as she had back when she was responsible for the student with Prader-Willi.

“We graphed how many times he was aggressive and how long it took him to calm down,” she said. She and colleagues taught the boy to pay attention to changes in himself that preceded episodes of aggression. The student was rewarded when he was able to contain himself.

Recent national data encompassing 85 percent of all public school students show that about 79 percent of the students who are physically restrained at school are disabled.

“Teachers teaching these kids need something different,” Ms. Otten said. “That’s where I hope this debate goes. That’s where I think we’re missing the boat.”

But federal dollars for some behavior-related training has been cut, notes the Alexandria, Va.-based American Association of School Administrators in a report released today about restraint and seclusion called “Keeping Schools Safe: Ensuring Federal Policy Supports School Safety,” and school districts have cut back on their own professional development efforts because of budget cuts. In a surveyRequires Adobe Acrobat Reader of about 400 AASA members, 91 percent of respondents said their districts would benefit from more money for training in schoolwide positive behavioral interventions and supports and nonviolent crisis interventions.

The AASA opposes any federal effort to regulate the practices, and in the report says it “is confident that the overwhelming majority of school personnel are acting to protect students when employing seclusion and restraint interventions.”

The group points to the many state laws that have been passed limiting restraint and seclusion or specifying when these techniques can be used and says that the Senate bill would undermine some of those laws. Some provisions of the proposed federal law, such as requiring schools to hold debriefings shortly after a student is restrained that include all the teachers and staff involved and to collect and report data on these incidents, would be cumbersome, AASA says.

Changing the Culture

Michael George, the director of Centennial School in Bethlehem, Pa., said his school was one of the most violent he’d ever seen when he first walked into it 14 years ago, even though most of his career was spent working with students with emotional and behavioral disorders.

The school, which typically enrolls about 100 students with emotional and behavioral disabilities from area school districts, had a record of 1,064 physical restraints used in the year before he took over.

But in a single year, Mr. George said subtle shifts in the school culture led to a dramatic decrease in the number of times students were held down or isolated—procedures often used in tandem. The school also figured out that some disruptive, aggressive behavior may have been related to hunger—some students travel long distances to attend—so Centennial added breakfast and snack programs.

Now, the school registers restraint numbers in the single digits in a given school year.

When Mr. George, who is slated to testify at the committee hearing along with a parent and other experts, is told by others that there must be something special about his staff and his school to achieve these results, he notes that he’s cut staff by about 20 positions during his tenure at the school and many of his teachers are Lehigh University students who may have little teaching experience and stay at Centennial for just a few years before moving on.

What did change: Mr. George restructured the school week to add training time. Teachers are trained intensely in how to reinforce positive behavior and ignore misbehavior—and their success is part of what they are evaluated on, Mr. George said.

Some students who have returned to traditional public schools are indistinguishable from other students there, he said.

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“It’s all within our grasp. People should be trained this way when they’re taking their undergraduate courses,” he said.

But in its report, the AASA says the vision of a school where students with disabilities can be kept on task and calm without restraint and seclusion is an unlikely one.

“It is unrealistic to assume students with disabilities will respond to nonviolent crisis interventions as successfully as general education students,” the organization’s report says.

A Volatile Mix

Ms. Otten concedes that there can be difficulties reforming the behavior of some special education students who have very low cognitive abilities. In some of the schools in her district, a special room with a camera has been set up where a student can be sent to calm down and keep from distracting classmates. But even in these cases, the need for interventions became less frequent as time has passed, she said.

Part of the reason restraint and seclusion have been in the spotlight in recent years is because of a collection of factors converging at schools, said Reece L. Peterson, a professor of special education and communication disorders at the University of Nebraska-Lincoln and a specialist on alternatives to restraint and seclusion.

“It reflects the situation many educators find themselves in: We have more workload in terms of larger classes due to budget cuts, compounded by the focus on test scores,” he said. “It creates an environment of anxiety. When you add high-needs kids to that mix ... and the support services for those kids aren’t there, ... it becomes a perfect storm of problems.”

Frustration and stress can trigger a school employee to restrain or seclude a student.

“I can see where they would believe that at that moment that is the thing to do,” he said.

But, he added, “I have not encountered any teacher that would not say they would be very pleased if they never had to use these procedures.”

Training and dissemination of best practices about how to work with these students is key, he said, regardless of whether a federal law is ever passed.

“Without supports, it’s still going to be an issue, and we’ll still have these horror stories,” Mr. Peterson said.

Federal Proposal Flawed

Even those who want restraint and seclusion reform say the Senate bill has flaws. It outright bans seclusion, and prohibits mechanical restraints. While tying students up, restricting them with duct tape, or rolling them in carpet and other extreme techniques that have led to student injuries and parent complaints might be among the more obvious restraints that should be banned, there are questions about whether the ban would include handcuffing students by police and the weighted vests some children wear to calm them down.

Students might be restrained mechanically, anyway, Ms. Otten said.

“Just saying you’re going to ban it is not going to solve the problem,” Ms. Otten said. “It’s going to go underground.”

The AASA says Sen. Harkin’s bill sets too high a bar for when schools could restrain students. The bill says students must be at risk of inflicting “serious bodily injury” on themselves or someone else, and that courts have concluded that injuries such as a broken nose don’t constitute “serious bodily injury.” The group’s survey found that more than 80 percent of those who responded said they need to be able to use restraints or seclusion or both in their districts.

The Senate bill’s ban on seclusion might also be too broadly applied, Mr. Peterson said. It might also end up excluding viable alternatives to isolating students, such as “calm-down” rooms that are unlocked or without doors so that students may enter voluntarily if they feel they are losing control. These include “Snoezelen” rooms—a word that combines the Dutch verbs “snuffelen,” which means to seek out or explore, and “doezelen,” meaning to relax—that are being tried in some schools. In these spaces, often filled with soft music, low lighting, lava lamps, and other soothing features, students can compose themselves and think and overcome overstimulation, if that was prompting them to become aggressive.

And Mr. Peterson said, the ban could prevent the simple act of teachers asking a student to join them in the hallway to get them away from whatever is making them anxious or angry.

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