The focus on the use of restraint and seclusion (R & S) procedures in schools -- procedures which are most often applied to children with disabilities -- has gained new momentum, perhaps due, in part, to our documentary film The Kids We Lose. Coinciding with this renewed focus is strong evidence to suggest that the use of these procedures is actually seriously underreported by many schools and states.
Training on the use of R & S procedures is standard fare for many classroom teachers, especially those working with kids with social, emotional, and behavioral challenges. For a long time, training in such procedures was also the norm in inpatient psychiatry units, residential facilities, and prisons, until many such treatment facilities made a concerted (and successful) effort to reduce their use of these procedures.
There's a common belief that R & S procedures are necessary for keeping kids and staff safe. This point of view is completely at odds with the reality. Kids and adults frequently get hurt during restraint and seclusion incidents (some quite seriously, including death). Moreover, to my knowledge, there is absolutely no science supporting the belief that R & S procedures improve safety. Indeed, experience tells me that reducing the use of R & S reduces injuries to staff and kids.
The companies disseminating these strategies often promote their products as “crisis prevention” programs. This is true only in the most narrow sense. Recognizing the early warning signs that a chid is becoming escalated and using de-escalation strategies might prevent the use of restraint and seclusion but, as noted in a report from the U.S. Department of Education in 2012, “there is no evidence that using restraint or seclusion is effective in reducing the occurrence of the problem behaviors that frequently precipitate the use of such techniques.” And de-escalating a kid who’s already emotionally aroused is not a fail-safe proposition -- no matter how skilled the person doing the de-escalating -- which helps explain why rates of R & S are so high in schools in so many states.
Of course, there's also no reason to believe that restraint and seclusion will solve the problems that are causing those behaviors. By the time those behaviors occur -- in other words, by the time it’s clear that a student is becoming escalated -- caregivers are already very late. The sequence of events leading to use of R & S -- the Cycle of Restraint and Seclusion -- is actually quite straightforward, but begins way before those behaviors occur. Here’s the typical scenario:
1) There’s a known, predictable expectation a child is having difficulty meeting
2) Caregivers try to get the kid to meet the expectation anyway, often by insisting or pushing harder, in the erroneous belief that insisting and pushing harder will elicit better performance
3) The kid exhibits a behavior to signal that s/he is having difficulty meeting the expectation
4) If the behavior is “big” enough, the adults are now aware that the kid is escalating and deploy their de-escalation strategies
5) If the de-escalation strategies don’t work, the adults will deploy R & S procedures
Note that the Cycle of R & S begins with an expectation a child is having difficulty meeting. In the Collaborative & Proactive Solutions (CPS) model, these expectations are known as unsolved problems. Those unsolved problems are highly predictable and identifiable. That being the case, they can be solved proactively.
Solving problems collaboratively and proactively is as early as it gets. When you’re getting out in front of those problems, the Cycle of R & S is never set in motion. That’s true crisis prevention. Everything that occurs beyond the unsolved problem is late. The kid’s behavior is late. De-escalation is late. Restraint and seclusion are late.
Another key component of the CPS model involves giving very serious consideration to whether a kid can actually meet the expectations being placed upon him or her. That’s early too. If the kid can’t meet the expectation, it’s worth pondering why those expectations are being placed on the child in the first place. The standard answers -- “That’s what the other kids are expected to do” or “That’s what we expect from sixth graders” or “That’s something he’s going to have to do on standardized tests” -- are completely at odds with special education law, differentiated instruction, and personalized learning. And the answer “He can do it when he wants to” is completely at odds with the what the research has been telling us about behaviorally challenging kids for the past 40-50 years; namely, that they are lacking skills, not motivation. Having a student endure countless restraints and seclusions because of expectations we already know he or she can’t reliably meet just makes no sense whatsoever.
No one wants to restrain or seclude a kid. A very long time ago -- before I went to graduate school -- you would have found me restraining and secluding kids on an inpatient psychiatry unit in Miami, Florida. I hated it, partially because the kids were usually bigger than me, but especially because it quickly began making no sense to me. It became clear that intervening once kids are already escalated is horrendous timing. And it became clear that many kids do not calm down when they have adults pinning them to the ground. And -- perhaps most importantly -- it became clear that R & S procedures do not solve the problems that are causing the kids to spin out of control in the first place. This knowledge eventually contributed to the creation of the CPS model. That model has been demonstrated to be highly effective at reducing or eliminating restraint and seclusion in restrictive therapeutic facilities. And Lives in the Balance is currently working with numerous school systems to accomplish the same thing.
But schools and school staff frequently work at a disadvantage, especially compared to child and adolescent inpatient psychiatry units, even though the populations of both settings are frequently quite similar. Medication management on inpatient units is tightly controlled and monitored; in many special ed classrooms, staff are unaware of what psychotopic medications a child is taking, have little contact with prescribing physicians, and are often unaware of changes to a child's medication regimen. In schools -- even in special education classrooms -- there is great pressure to teach, even though many of the children in such classrooms are only sporadically available for learning. In such classrooms, there is often great reluctance to temporarily suspend expectations in the service of stabilization. These differences make it very difficult for kids to thrive, and they make it very difficult for staff to feel good about what they do.
By the way, Alberta recently released, with some fanfare, its new guidelines on the use of restraint and seclusion in schools in the province. The word "behavior" appears frequently in the guidelines. The word "expectations" does not appear at all.
Lives in the Balance has also begun working on ensuring that policies in individual states and school systems reflect the reality: restraint and seclusion are acts of desperation; they do not keep anyone safer; they are the result of a treatment failure; and they simply tell us caregivers that we're still late. And that we can do better, by both the kids and school staff. We simply can't continue traumatizing kids and their caregivers because of obsolete mentalities and models of care.
If you’d like to help us out, become a Lives in the Balance Advocator, and we’ll let you know how you can be engaged on the issue in your state, province, or country. We’ll also help you become aware of other Advocators who are making a different in their neck of the woods.
Ross Greene, Ph.D.