Physical Restraint and Seclusion: Roots of the Problem (page 3)
Roots of the Problem
It has been a source of great frustration during our careers that this topic seems to have been largely avoided. We have often heard, ''Well, if teachers program correctly, that just shouldn't happen.'' In reality, no teacher is perfect, and regardless of the best intentions and efforts of educators, sometimes dangerous situations do arise. So we are not going to avoid this topic, but rather confront it honestly and head-on in hopes of providing guidance to other teachers who may also be frustrated. This crisis has been many years in the making and has multiple roots.
Current School Culture
Public schools today face pressure to ensure that learning environments are safe places for everyone. Extreme and rare cases, such as the fatal stabbing of a music teacher by a sixteen-year-old special education student in Texas in 2009, can lead to overreaction in terms of zero tolerance policies and being too quick to use or abuse physical restraint or seclusion practices.
Lack of Regulation
At the time of GAO's investigative report on the use of restraint and seclusion in public schools, only twenty-four states had established policies or provided any type of guidelines to school districts, the content was varied, and the policies were not necessarily legally binding in all cases. The use of seclusion and restraint is regulated and controlled in every other setting that serves youth with emotional and behavioral challenges (state hospitals, psychiatric residential treatment facilities, and others). The Individuals with Disabilities Education Act (IDEA) does not mention seclusion and restraint, providing no legal recourse for their misuse or abuse in school settings.
Lack of Training
Teachers of students with emotional and behavioral disorders are consistently among the highest-ranked personnel shortage area, and a disproportionate number of them are uncertified or alternatively certified, resulting in a lack of much-needed specialized training.9 In fact, approximately 65 percent of teachers of students with emotional and behavioral disorders enter the field without being fully certified,10 and their burnout is higher than that of any other group of teachers.11 The result is that the teachers holding these positions have significantly fewer years of teaching experience than other special and general education teachers.
Paraprofessionals who are often assigned to be one-on-one aides to potentially aggressive students are not required to have any specialized training in positive behavior support. Those in leadership positions, such as building and district administrators, often have even less experience and training in working with this population than do special education staff. The bottom line is that the most difficult-to-manage students are being taught in too many cases by the least prepared educators.
This is a recipe for disaster and not solely the fault or responsibility of the local education agency. State departments of education, institutions of higher education, and government accountability agencies all need to become involved in the solution to this problem. The goal is to ensure that teachers certified to teach this challenging population have had the specialized training needed to be considered minimally qualified, if not highly qualified, as required by No Child Left Behind.
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?
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
- What are the physical restraint and seclusion guidelines in your district and state?
- 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.
- 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?
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