You may know that many therapeutic schools and psychiatric settings seclude and/or restrain children for the purposes of de-escalation and regaining behavioral control.
“Seclusion” typically refers to the removal of an individual into a specifically designated space used for de-escalation (e.g., a small bare room with padded walls), while “restraint” encompasses a range of interventions by staff member including holding a child’s arms and legs, or use of special tools such as straps, in order to restrict the movement of the child. According to data released from the U.S. Department of Education Office of Civil Rights, 107,000 kids were subjected to physical restraint or were confined to seclusion rooms in schools during the years 2011 and 2012.
Some purport that these interventions are necessary and humane, however, evidence increasingly suggests that restraint and seclusion can be physically and psychologically dangerous as well as costly to agencies. A thorough investigation by the Government Accountability Commission in 2009 found hundreds of complaints of abuse and death caused by negligent use of restraint procedures in schools and pediatric residential treatment facilities, suggesting that there are small but grave risks when physical restraints are performed irresponsibly. Additionally, even when restrictive interventions are performed consistent with safety protocols, patients often report that they are psychologically harmful and aversive. This is particularly true for children and adolescents who have experienced prior trauma.
For a long time, restraint and seclusion were considered the only option if a child’s behavior was “out of control.” As eloquently said by Connecticut Child Advocate Sarah Egan, J.D. in this interesting New England Psychologist article, “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.”
There is a lot of buzz about restraint and seclusion in schools these days because Sen. Tom Harkin (D – IA) and Rep. George Miller (D – CA) have introduced the federal Keeping All Students Safe Act (S. 2036/H.R. 1893) that would ban the use of restraints and seclusion in schools except in cases of clear physical danger.
The New England Psychologist article does a nice job of describing one reason why this issue is complicated: Current definitions and reporting practices of schools vary widely between states and between schools and agencies. Enacting federal legislation across such a heterogeneous system is bound to be very messy.
Another complication that we have been talking about at Think:Kids is this one: It can be very destabilizing to take away one tool without giving schools and agencies another tool to use in its place. If we ask a school to stop restraining and secluding children without teaching staff what else they can do to achieve their intended goals, we can expect mayhem. That’s why we suggest that schools begin acting NOW to think about other ways to de-escalate children and regain behavioral control (or even better, prevent escalation from occurring in the first place).
In 2011, DeHert and colleagues published a paper reviewing four interventions that successfully reduced rates of restraint and seclusion in youth settings. These interventions included a model of strength-based care, a behavioral therapy oriented management program, introduction of a padded room (in this case, they replaced restraint with seclusion), and adoption of the Collaborative Problem Solving approach. Averaging across these four interventions, occasions of restraint were reduced 93%, and occasions of seclusion were reduced 75%. As you can see, Collaborative Problem Solving is not the only way, but it is one way. Talk to us if you want more information.
A final note about the fate of the Keeping All Students Safe Act
Both sponsors of the bill, Sen. Harkin and Rep. Miller, are retiring from congress in 2014. In their absence, advocates are concerned that it will likely be difficult to get this legislation introduced and passed in future sessions. Staff members of both the Senate and House committees agree that it’s critical that concerned parents, advocates, educators and the public let their congresspeople know how they feel about the use of restraints and seclusion in schools and the importance of the Keeping All Students Safe Act. Without that groundswell of support, they say, the bill is likely to die. You can find the phone numbers for your senators and representative here.