Physical Restraint and Seclusion: Roots of the Problem

Lack of Research

Little research has been conducted to determine the efficacy, appropriate applications, or prevalence of either seclusion or restraint in educational settings. This fact is surprising, if not negligent, because the use of these procedures has been debated among special educators for over three decades and in fact has been controversial since the initial development of these procedures in the late eighteenth century for use in psychiatric hospitals in Europe.¹² In addition, the terms restraint and seclusion are almost always combined in research and policy discussions when they are very different things. Our experience is that the use of one can actually reduce the use of the other, and so their use needs to be researched and discussed separately.

Concern About Increase of More Aversive Options

Many well-meaning and ethical educators are concerned that banning the use of seclusion and restraint in public schools would result in an increase in unintended and possibly more aversive consequences. There could be an increase in more restrictive placements that lack appropriate peer models and access to many aspects of the general education curriculum; the involvement of law enforcement, which often has had little or no training in positive behavior supports and tends to rely heavily on force and punitive methods; and student and staff injuries.

Lack of Options

Public schools are the only entity legally obligated to provide services for students with disabilities who exhibit high levels of aggression. Hospital facilities can discharge them (often citing lack of insurance coverage), parents can (albeit tragically and very reluctantly) make their child a ward of the state, child care facilities can expel them, and private schools that specialize in meeting the complex behavioral and mental health needs of these students can send them back to their school district of residence with little warning. Public school districts are left with the legal responsibility of providing a free and appropriate public education to even the most challenging students. However, currently many times public schools do not have the resources or personnel with the skills needed to meet the needs of students who exhibit dangerous behavior.

What Can Educators Do?

In this time of intense public pressure to reduce and possibly eliminate seclusion and restraint while still maintaining a safe learning environment for staff and students, what can educators do while awaiting additional guidance from leaders in the field and governmental authorities?

Be Informed

Any educator who works with students with chronic behavioral challenges should know and follow their state and district policy and procedures (if they exist) regarding the use of seclusion and restraint. In addition, educators need to be aware of the dangers that exist every time seclusion or restraint is used. Many children have died or been physically or psychologically injured due to the misuse of physical restraint or seclusion.

Provide or Ask for Training

We strongly believe that all teachers, and at the least any teacher certified to teach students at high risk of exhibiting dangerous behavior, should be provided formal crisis prevention and intervention training as part of their requirements for certification. If they do not have this training prior to employment, it is the public school district's responsibility to provide it.

The three crisis intervention programs we are most familiar with are those listed in Table 18.1. Additional information on these and other crisis intervention programs can be found in an article by Mike Couvillon and his colleagues including summaries of their content and Web site and contact information.¹³

If you are a teacher working with students who have a history of or potential for aggression and your district has not provided you with crisis prevention and intervention training, request it in writing, and keep a copy of this request. Too many times teachers of the most behaviorally challenging students are expected to figure things out and fend for themselves. Providing a free and appropriate public education for these students is not solely your responsibility. Be professional yet assertive about what you need to accomplish this challenge. If you are an administrator, invest in crisis prevention and intervention training—ideally for all staff and minimally for those involved with potentially aggressive students—and develop crisis policies and procedures at the building and district levels consistent with those developed by your state.

Commit to Positive Behavior Support in Philosophy and Practice

The positive behavior support movement started in part to develop alternatives to aversive behavior management procedures such as restraint and seclusion. Reading this book and putting the interventions it contains into practice is a start. Read as much and go to as many trainings as you can on positive behavior support, and implement these practices at all three tiers of intervention.

Monitor Use of Restraint and Seclusion

By the time this book is published, your state should have guidelines for monitoring the use of restraint and seclusion. Even if they do not, we believe it is unethical to use physical restraint and/or seclusion without monitoring their use through a data collection system. Lack of a mandate by governing officials does not excuse educators from this responsibility. Examples of physical management (restraint) and safe room (seclusion) logs that we have used are provided in Figures 18.1 and 18.2.

Nonviolent Crisis Prevention and Intervention Programs

Key Points to Remember

• When prevention and positive interventions are not sufficiently effective and a student is a danger to self or others, two ways to maintain safety are physical restraint and seclusion.
• The use of physical restraint and seclusion in schools is highly controversial and should be used only as a last resort when a student is endangering self or others.
• The use of physical restraint and seclusion has been debated in special education since its inception. In the past decade, the controversy has reached an all-time level of prominence in the national public arena.
• Secretary of Education Arne Duncan wrote a letter to all chief state school officers in July 2009 encouraging them to review current policies and, if needed, have revised policies in place to start the 2009–2010 school year, publish these guidelines, and notify parents as to what the guidelines contain.
• Public schools face pressure to ensure that learning environments are safe places for everyone. The result has been zero tolerance policies and potentially abusive physical restraint and seclusion practices.
• As of May 2009, only twenty-four states had established policies or provided any type of guidelines to school districts regarding the use of restraint or seclusion, the content was varied, and the policies were not necessarily legally binding in all cases.
• Approximately 65 percent of teachers of students with emotional and behavioral disorders enter the field without being fully certified, and their burnout is highest among groups of teachers.
• Little research has been conducted to determine the efficacy, appropriate applications, or prevalence of seclusion or restraint in educational settings.
• Public schools are the only entity legally obligated to provide services for students with disabilities who exhibit high levels of aggression, yet they do not always have the resources and staff with the needed skills to deal with complex and dangerous behaviors.
• Teachers of students at risk for exhibiting dangerous behaviors need to be aware of district and state policy on the use of physical restraint and seclusion, be trained in crisis prevention and intervention, commit to positive behavior support practices, and take data on any use of physical restraint and seclusion.

Discussion Questions and Activities

1. What are the physical restraint and seclusion guidelines in your district and state?
2. You work with a student who has exhibited dangerous behavior frequently. Your district has not provided training in crisis prevention and intervention. You are meeting with your special education director to discuss the need for training for all staff who work with this student. Outline your argument.
3. You observe a teacher who consistently uses physical restraint or seclusion to gain compliance, and not necessarily only when safety is a concern. What would be your course of action?