Restraint and Seclusion in Schools: A Graduate Student's Experience
By Brian M. Yankouski
Four years ago, I worked with John, a 13-year-old student who was a fun loving, very intelligent young man at a special education school for students with severe developmental disabilities. Working with John had a lasting impact on my professional development. John, who was diagnosed as having pervasive developmental disordernot otherwise specified, had a history of severely aggressive behaviors toward staff (e.g., biting, hitting, kicking, hair pulling), property destruction, and self-injurious behavior (e.g., biting himself). His previous school placement was unable to effectively manage his challenging behaviors. The staff used taste aversion (e.g., a noxious substance, such as hot pepper, was forced into his mouth when he bit himself) as part of the behavior modification process to reduce his self-injurious behavior. When John became aggressive toward staff they placed him in a supine restraint and strapped him to a mat for up to 5 hours in a school day. He would fall asleep in school so often that the staff thought he had a sleeping disorder and did not realize that he was sleeping because he was tired from struggling to get out of the restraints. After John was placed at our school, I worked with a team of dedicated professionals to bring his problem behaviors to a near zero level within 3 months. Instances when restraint, including prone or emergency floor restraint, was used in order to maintain his and staff members' safety decreased in frequency until they were no longer necessary. This student inspired me to become a school psychologist and fostered my interest in the area of restraint and seclusion.
With the recent Congressional hearings on restraint and seclusion in schools, we heard countless stories about the misuse of restraint and seclusion practices that have resulted in the abuse and death of students. Fortunately, my story had a more positive ending due to our staff's knowledge of behavior analysis, de-escalation techniques, and how to appropriately use restraint procedures. Many of the students I worked with in this private school were successful because we only used physical restraint in limited emergency situations to maintain staff and student safety. Moreover, we focused on using a range of prevention measures and positive behavioral approaches to reduce dangerous outbursts and teach appropriate prosocial behaviors. When restraint techniques were necessary, they were used safely due to the school's sound policies, implementation of positive behavior supports (PBS), comprehensive staff training in crisis intervention, and use of a collaborative team approach.
School Discipline Policies and Procedures
While at the school, I worked closely with administration to revise its school policy on restraint and seclusion. I was fortunate that the administration recognized the extent of the misuse of these procedures and how it could expose the school to litigation. In addition, it was helpful that there was internal buy-in and administrative support to make the school a safe and positive learning environment for the students and staff. As a graduate student in school psychology, I was honored to be able to directly influence school policy that protected students from physical and psychological harm.
We included preventive strategies such as PBS as part of the procedures that must be used prior to using restraint. We also developed clear definitions of terms and descriptions as to when restraint was allowed (e.g., when a student posed a significant danger to self or others) and when it was prohibited (e.g., as a means of punishment). We also decided to prohibit the use of seclusion as part of our policy because we did not believe in isolating a student in a confined room. While we did have padded rooms to safely maintain aggressive or self-injurious students, we had the policy that at least one staff member had to remain in the room with the student at all times. This ensured that the student was safe and the staff member could implement de-escalation techniques to help calm the student. We also included other protocols in the policy, such as staff training requirements, how to do face-to-face monitoring of restraints, debriefing procedures after an incident, data collection, and reporting procedures to parents. These are some examples of components that schools should consider when developing their policies on restraint and seclusion. Indeed, when writing a policy, remember that any student could be subject to restraint and seclusion, and that these procedures are not limited to students receiving special education. It is imperative that any school implementing these procedures has policies in place to guide staff and hold school personnel accountable for their actions.
Research has shown that PBS is effective in reducing the use of restraint and seclusion in schools (Horner & Sugai, 2009). Therefore, any program that uses restraint and seclusion should have PBS implemented at the school, classroom, and individual student levels. We effectively used PBS at each of these levels. Data-based progress monitoring was a significant part of the process employed to examine the use of these practices and to develop strategies for reducing the need for these procedures. Outcomes indicated that restraint procedures were used at lower rates than previous years prior to the implementation of PBS.
Professional training in crisis intervention, including the appropriate use of restraint and seclusion, promotes staff and student safety in schools utilizing these procedures. Our school had all staff members trained by an accredited crisis intervention training program. We had a crisis response team in the school consisting of approximately five members who were all certified instructors in the program. These instructors provided all new staff with a comprehensive 2-day training in crisis intervention that focused on preventive strategies and how to safely perform restraints when necessary. All staff members were required to participate in a 1-day refresher course every year. Having inhouse instructors in the program was helpful because staff could consult with instructors and work out how to intervene more effectively with students to prevent the need for restraint. This consultation has been extremely helpful in working with challenging student populations and being able to safely manage aggressive and self-injurious behaviors. I recently completed the instructor certification program to enhance my own professional development in the area of crisis intervention and appropriate use of restraint and seclusion in schools. I found the program to be beneficial in training school professionals on how to prevent the need for restraint, ways to safely manage student behaviors, and intervene with students in crisis. Graduate students should consider being trained in crisis prevention and intervention because this training can assist in reducing the number of situations in which restraint and seclusion may be necessary (Ryan, Peterson, Tetreault, & Van der Hagen, 2004).
A Team Approach
Lastly, we utilized a team approach when using restraint with students. This was a beneficial practice that was stressed in our crisis intervention training. With a team of people assisting with a restraint, you can have multiple staff members performing the restraint, and more importantly, other staff can monitor the student during the restraint to ensure the safety of the staff and students. Furthermore, you can have other staff attending to the students in the class or someone could contact a nurse or school administrator if needed for backup and protection against allegations of institutional abuse (Coats, 2006).
Restraint and seclusion practices in schools should be limited to emergency situations when a student is posing a significant danger to self or others. When implemented properly, these procedures can assist in maintaining a safe and positive school climate and afford students an opportunity to remain in the least restrictive educational placement. Schools utilizing these procedures should have well-established school policies, provide staff training in their appropriate use, and offer careful administrative oversight. As school psychologists, we can contribute to the policies and procedures that result in safe schools with positive learning environments. School psychologists are charged with advocating for the mental health needs of all students and play a critical role at all levels of support for students with behavioral, social, and emotional concerns (NASP, 2009). Therefore, given the growing concern surrounding restraint and seclusion use in schools, it is critical that school psychologists advocate at the local, state, and federal levels to protect the rights of students and to maintain safe and positive learning environments for all students in our nation's schools.
References and Resources
Coats, K. I. (2006). Intensive kids-intensive interventions: Designing school programs for behaviorally disordered children and youth. Boca Raton, FL: Universal Publishers.
Couvillon, M., Peterson, R. L., Ryan, J. B., Scheuermann, B., & Stegall, J. (2010). A review of crisis intervention training programs for schools. Teaching Exceptional Children, 42(5), 6–17.
Horner, R., & Sugai, G. (2009). Considerations for seclusion and restraint use in school-wide positive behavior supports. Retrieved from http:// www.pbis.org/common/pbisresources/publications/Seclusion_Restraint_inBehaviorSupport.pdf
Johnson, S. F. (2010). Preventing physical restraints in schools: A guide for parents, educators, and professionals. Warner, NH: Education Law Resource Center, LLC.
National Association of School Psychologists. (2009). Appropriate behavioral, social, and emotional supports to meet the needs of all students [Position Statement]. Bethesda, MD: Author.
Ryan, J., & Peterson, R. (2004). Physical restraint in school. Behavioral Disorders, 29(2), 154–168.
Ryan, J., Peterson, R., Tetreault, G., & Van der Hagen, E. (2004). Reducing the use of seclusion and restraint in a day school program. In M. Nunno, D. Day, & L. B. Bullard (Eds.), For our own safety: Examining the safety of high-risk interventions for children and young people (pp. 201–217). Atlanta, GA: Child Welfare League of America, Inc.
Brian M. Yankouski is a graduate student in the EdS program in school psychology at Seton Hall University in South Orange, New Jersey. He is student member of NASP and a member of the Government and Professional Relations Committee for the New Jersey Association of School Psychologists where he is advocating for state legislation on restraint and seclusion. Brian presented on restraint and seclusion in schools at the 2011 and 2012 NASP conventions.