The Seclusion and Restraint Issue

12 Mar
The steady and increasing drumbeat of disability advocates is zeroing in on the use of seclusion and restraints in the school system. My friends over at change.org are leading the charge along with a number of others, if you check out their links.
While this has been an issue for a few decades, I think I can safely say that it has begun to approach critical mass. Changes are being made around the country, in the state of Georgia and in my own school system. Keep in mind that corporal punishment was still pretty common in many Georgia districts until relatively recently.

Before diving into the fray, let me give you a bit of my own personal history on the subject. I’ve already written abit of my own old school background on the subject of spanking. My first real exposure to the practice in special education was when I was a para at the local psychoeducational center about 15 years ago. Basically the guideline for time-out was when the student was hurting others or destroying property. The same goes for restraint. Basically, it makes sense to me that if a child of 9 is severely emotionally disturbed and is beating the crap out of another student (or teacher) that physical intervention is warranted. If he/she is throwing a chair or gouging out their own eye, I’m trying to wrap my mind around how I might help the child or others without the laying on of hands. I already know the answer to that, which I’ll share in a moment.

But we did use restraint and seclusion using guidelines and training from the Crisis Prevention Institute. We also used life space interviews after a student got out of time out. The procedures that we followed at the psychoed were, in my opinion, second to none. But seclusion and restraint were NOt our methods of choice. We relied an a very robust arsenal of positive behavioral supports, because you simply can not teach a classroom where everyone is in timeout. It took a lot of personnel to moniter the rooms, as well as the risk of personal injury. So in our class at the time, we had a point sheet/token economy, a level system, a group reward/contingency program, therapeutic rec/leisure and generally tried to make the climate as positive and rewarding as possible. so when a student had to go to time out, they were really and truly missing out on something. On top of that, I introduced a sort of “punch-out” token economy that was more immediate. The effect of that, was that I could take up the token card instead of ejecting the student while reinforcing everyone else. So it was a time-out-in-place. But the student always got reinforced when they were ready to rejoin the group/task. By the end of that year, I rarely ever, ever had to put a kid in time-out or lay hands on them in our class. However, the practice of restraint and seclusion did end up costing me personally and dearly that year.

While I was being a para for a teacher of mostly middle school students. the teacher of the younger kids was having major problems with one of her 9 year-old students. so the director made the decision to move me in that class to help deal with that student. That lasted about 2 days. He was a pretty wild kid, and I did end up having to hold him on the ground quite a lot. He was small, but extraordinarily fast and strong which is why they decided a big male was needed to help handle things. In hindsight, this was not necessarily the best thing. And it turned out to be a very bad thing. One day, after he had been particular trying, it was finally the end of the day and time for him to get on the bus to go home. So we went out to the bus, but instead of getting on the bus, he took off like a shot through a crowded end-of-school parking lot and towards the very busy end-of-the-day-traffic street. The teacher was in hot pursuit and so was I (we already had the rest of the kids on their buses). She told me to call the police, which is what I should of done. But I didn’t. To be perfectly honest, I had had it with this kid and was at the end of my rope. I was going to get him. While there was an element of danger for the kid with buses and cars, that might not have been the only reason I went after him. I caught up to him and made a lunge to go for the final grab. And that was it.

I have no idea exactly what happened, but it was all over for me. My knee somehow got terribly twisted and I went down hard and heavy. It could have been the uneven grass we were on or the sudden swerve the kid took and me being too stupid and reckless. At that moment, the true idiocy of my actions caught up and washed rght over me in a wave of pain. And I would spend the next few hours in an emergency room. Nothing was broken, but I had some ligments that were badly torn. That was it for my running career. To this very day, that knee will sometimes bother me for wierd and strange reasons. Losing weight definitely has helped keep me from limping and gimping around. But it is a persistent reminder of the folly inherent within restraint practices. At least by school teachers, no matter how young and fit.

My next job was at a psychiatric hospital in a child and adolescent unit. Even though it was the late 1990’s it seemed like the 1980’s sometimes the way it was run, especially in the area of behavior management. When I arrived, there were lots of people who were experts on therapy and behavior but none of them were behaviorists. The social workers were into family systems, the behavior specialist was actually specialized more with those who had been sexually abused and the doctor/psychiatrist was into psychoanalytical therapy while being supported by the MD’s and nurses with lots of psychotropic medications. seclusion and restraint was used quite regularly, but it is hard to imagine not using it with some of the severe behaviors that warranted being hospitalized. I saw it all while I was there, but since it was a locked facility, I never had to chase anyone down. Plus the health service technicians did all of the physical work. And sometimes that meant a 5 point restraint system under a doctor’s order. While there was a token economy and level system in place, it was not used very well. So I did use other contingencies that I had control over, like access to a computer lab. The kids loved the computer lab and I had the best hardware and software money could buy at the time. I had a $7,000 budget! So I had resources to apply towards behavior and teaching. If a kid acted up in my class, he/she was simply removed to time-out or more medication.

But the big issue/movement in the 1990’s was deinstitutionalization, which meant that the C&A unit was closed and I lost my job. I’ll have to write more sometime about the repercussions of that movement. Suffice to say that the present movement towards not using seclusion and restraints is a direct result of that battle that was mostly won by the advocates. Most of the cases that were served by a huge (and expensive) team of doctors, nurses, behavior specialists, recreation specialists, psycholigists and social workers are now being served by the school system and mostly one teacher and a para. So the teachers are being held responsible for behaviors and clients that they are not trained to care for. Is it any wonder that there is abuse and mistakes and serious consequences?

When I first started here, most of the kids were fairly moderate. We were community-based, which involved going into the community almost everyday to a job or community site. My kids loved getting on the bus and getting off the school campus. So did I and the paras. The contingency was simply that if a kid acted up, he didn’t get to go out that day. And that was usually sufficient. Today, the climate has changed. Community-based instruction is quickly disappearing. We go out maybe once or twice a week. The shift has been toward academics and the Standards. True, we try to work on life skills and weave the content with the skills but some standards and skills simply do not line up. And the level of severity of the disabilities has become more acute. Many of these students would have been under the care of a team of doctors, nurses, psychologists and specialists back in 1970’s and ’80’s. But those facilities went away the same time as the C&A unit. Now it is all me.

The schools are poorly equipped to deal with severe behavior probloems. The state charges schools with the primary mission of educating students in a curriculum that is largely aimed at getting students into college. Any other agenda is secondary to that primary mission of an academic education. How effective a given school system is in that one single mission is up for discussion. I agree that schools do need to focus on this one thing (and learn to do it well) while providing a safe and humane environment for all learners. There should also be options for vocational and life skills, but that is another discussion. The point is, is that when it comes to dealing with behaviors that result in the school becoming unsafe for students, there needs to be some options. And right now, I see the only possible option is calling the police, which is what I should have done 15 years ago. We were located right next to the police station at the time! I do believe in teaching students with behavior problems, but I learned very early on that when a child is in the midst of a full meltdown or tantrum, there is no learning or teaching that is going on.
Actually, there is one other option that might work. That is to convert all of the time-out and seclusion rooms into places that lock from the inside. Then when a student is out of control and getting assaultive, the teachers can seclude themselves. Or perhaps fixing the valium dispenser in the teacher’s lounge would work.

Seriously, I do support the work of those advocating for more and better humane treatment of students, generally speaking. But just as there were adverse consequences to pushing everyone out of institutions and into the community, there will be adverse consequences for making seclusion and restraint forbidden practices. I hope that the movement results in a more positive climate within schools and classrooms, but I don’t think it will result in the sort of programs envisioned by most people. What made states move to deinstitutionalize was that they saw they could save a ton of money. The result was a lot of mentally ill homeless people and many of them being served within jails and prisons. Sure, many were better off in group homes. Many weren’t. A 10 minute period in seclusion often allows the student to remain in school the rest of the day. If the police are called, will the result be the same?

I’m going to go ahead and attach my seclusion/time-out procedure so that you can feel free to review it. I’m open to criticism about it if there is anything wrong with it. Of course, if you are against seclusion/time-out under any and every circumstance then you won’t like it no matter what the policy is! But the alternative of having the student removed indefinitely, or having people hospitalized is not very attractive. It would wonderful if everyone was extensively trained and supported, but that hasn’t ever happened even in the most ideal of circumstances and conditions. With serious budget constraints across the country, professional development is the first thing that gets tossed out the window, followed closely by para and behavioral support.

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