Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Sunday, September 9, 2012

Schools, Restraint, and Seclusion: Terror May Be Worse Than Spanking


Several organizations are working hard to prohibit the use of spanking as a punishment in U.S. schools, and for a variety of reasons they are probably right to do so. In my opinion, though, there are more common and more dangerous “disciplinary” methods than spanking used in schools, and these deserve our attention because they are so often directed toward special needs children.

Physical restraint in certain positions and for more than a brief period can be fatal, especially when the restrained person is being treated with certain medications. While that problem is well known, it is harder for most people to imagine that seclusion can be terrifying and damaging in its own way, especially for younger children or those with handicapping conditions.

In the New York Times  today, the journalist and filmmaker Bill Lichtenstein describes his young daughter’s experiences with seclusion as they occurred a few years ago in a public school in Lexington, MA (www.nytimes.com/2012/09/09/opinion/sunday/a-terrifying-way-to-discipline-children.html). Lichtenstein mentions that the five-year-old kindergartener, who had some language delays, began to have serious tantrums at home after starting school. Communications from the school suggested that she was doing well and did not mention any unusual disciplinary problems. Her parents had no idea that she was being punished by any method involving seclusion--  indeed, that she was being punished at all--  until they received a call saying they should come to get her because she had taken all her clothes off! When they got to the school, they found the little girl standing by herself in a basement mop closet with one light bulb. She had been locked in the closet five times that morning and could not get out when she needed to pee, so had taken off her clothes in order not to wet them.

What were the behaviors that led to her being locked up? Were they matters of safety for herself or others--  the approved purpose for use of seclusion? No, she had failed to follow directions. (Remember, this was a child with language delays.) She had been placed in seclusion almost every day for three months without any communication of this fact to her parents. The short-term result was tantrums; now, years later, she still has nightmares. A lawsuit, settled out of court, has forced the school system to pay for her ongoing treatment.

What is the story here? How can schools get away with this kind of treatment of children? It’s simply because they ARE schools. A set of HHS rules for psychiatric hospitals, residential treatment centers for children, and group homes, initiated in 1999 and finalized in 2007 (www.gao.gov/assets/230/228149.pdf) , restricted the use of restraint and seclusion in those places and required documentation of all restraint and seclusion events. But these rules did not apply to schools. In fact, one Seventh Day Adventist boarding school in West Virginia, which was the subject of complaints about restraint and seclusion several years ago, argued successfully that as it was a school and not a residential treatment center it was not subject to restrictions. (This school was and is a holding area for children adopted from abroad whose parents can’t cope with them.)

Meanwhile, efforts are being made by the U.S Department of Education to develop control over use of restraint and seclusion in schools. The publication Restraint and Seclusion: Research Document ( www2.ed.gov/policy/seclusion/restraints-and-seclusion-resources.pdf; May, 2012) describes a set of principles and procedures that States and school systems should consider when they establish their own policies about restraint and seclusion as disciplinary techniques. This document stresses that “Restraint and seclusion should not be used as routine school safety measures; that is, they should not be implemented except in situations where a child’s behavior poses imminent danger of serious physical harm to self or others and not as a routine  strategy implemented to address instructional problems or inappropriate behavior (e.g., disrespect, noncompliance, insubordination, out of seat), as a means of coercion or retaliation, or as a convenience”. The reference to using restraint or seclusion as coercion or retaliation resonates strongly with reports on their use in hospitals and RTCs in the past, when staff were observed to antagonize vulnerable individuals until their escalating actions “gave permission” for restraint.

According to the DE document, there are presently no Federal guidelines for the use of restraint and seclusion in schools, and like many other aspects of education in the United States, local policies vary enormously in both public and private schools. As the document implies, there is further variation that results from better or worse training of school staff and their understanding  of methods of behavior management.

One common confusion (and this is my point, not DE’s, although again it is implied in the document) is about the differences between time-out and seclusion; it may be that some poorly-trained or supervised school staff members fail to understand the distinction. Time-out (for all its faults) is an acceptable behavior management technique, it is intended to calm the child, and it is done in an observable, non-locked setting. Seclusion is leaving a child alone in a locked area where he or she may be able to be seen but may not be able to communicate with anyone. The experience of the Lichtenstein’s daughter was clearly not time-out--  time-outs do not involve being locked up alone in a small room for an hour, with daily repetitions.  

DE, under the leadership of Arne Duncan, is to be congratulated on starting a dialogue about schools’ use of seclusion as well as of restraint. However, I would think still better of the document if it addressed issues of developmentally appropriate practice and the fact that young or communication-impaired children are likely to be terrified by seclusion as older children may not be. It seems to me very possible that a five-year-old would find being physically restrained by a teacher less frightening than seclusion, because at least someone would be there (I’m not recommending restraint, of course).

The fact that seclusion does not in itself cause physical harm does not make it acceptable for school use, although unimaginative adults may think it of little concern. Terror does not support learning and can well cause long-term ill effects. I believe that getting this insidiously harmful practice under national control is a more pressing priority than prohibiting spanking. Requirements for documentation of seclusion events would be a good start toward regulation.





14 comments:

  1. The state of Massachusetts has very clear regulations about the use of restraint in public schools. All staff who work with children receive annual training. Only a very few people receive the extended training which allows them to do restraint and they should be the only people doing restraint when it is absolutely necessary.
    I've worked in public schools in MA for years and I'm very surprised that a wealthy community like Lexington wouldn't have very well trained & intelligent teachers because of parent demands. I feel like there's more to this story.

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  2. This was about seclusion, not about restraint, remember. Do you know whether the restraint training includes how and when to use seclusion?

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    1. In order for the child to get to the room she would have do so independently. If an adult had to physically put their hands on her to get her to the room then that comes under the term restraint. Once she was put in that room the room would have to have a window. The child would be observed the entire time she was in the room. The whole process should have witnesses. It would also be documented & the parents would be contacted.
      I have never seen seclusion used in a school

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  3. I don't think leading someone to a place counts as restraint, but you're certainly right that seclusion involves observation-- though not necessarily observation that the person is aware of, which would be the real issue from the child's viewpoint.

    However, your first concern was that the story was not complete. Perhaps you're right, but I find it hard to believe that an experienced journalist would risk a defamation suit by publishing this story and naming the school district (with whom he's already been to court) unless he was sure of his complete accuracy, or that the Times would print such a story without some assurance that it's correct and complete.

    On the other hand, I do wonder how it came about that the case was settled out of court without an agreement that the event not be publicized.

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    1. This story was so disturbing in so many ways but I particularly shocked & disgusted at the way the staff could be so openly callous & cruel about the use of a "discipline" technique that is clearly against state education regulations & laws. I just had to look this up & I found that the use of a seclusion room is strictly forbidden in Massachusetts.
      This wasn't just his child but others. I don't see why the whole community didn't start a lawsuit against the school.
      And yes, it would be very inappropriate for the facts not to be checked by NYT, for a journalist to write such an outrageously inaccurate piece, and for the school to allow him to write such horrific things about it.

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    2. MA law allows putting the child in a time out as long as the child has access to a staff member.

      The language does not define time out vs seclusion. Not does it define 'access'.

      My understanding is that 'access' is frequently interpreted to mean 'within earshot', so because the language is so ambiguous, the schools can choose to interpret it any way that suits them.

      Other families have also voiced similar experiences, so this does appear to have been gone on. The town has yet to issue an official statement.

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    3. It seems to be common for states and localities to use language loosely about these things (see hb2444_memo_02-20-12.doc for references to "Thinking Rooms" and "Opportunity Rooms" in Kansas). However, the DE report does discriminate clearly between time-out and seclusion.

      The U.S. tradition has been to have localities develop their own policies on a variety of curricular and procedural issues. Now DE is suggesting that policies be developed that are congruent with DE principles. As far as I can see, only community pressure will actually get this done, as DE has neither a carrot or a stick. When HHS pressed residential treatment facilities about restraint ans seclusion, they had Medicaid funds as leverage-- there's no similar form of persuasion here.

      Thanks for your comment about other families' experiences. If you could cite some evidence like newspaper articles, that would be useful for everyone who is thinking about this matter.

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    4. One family responded on an email list that I am a part of. I also had another parent tell me off list that she heard of a third. This wasn't done publicly and it's certainly not my place to publicize their experiences.

      I am not aware of any other articles regarding this that provide any additional information, they discuss and analyze but that's about it.

      But I just wanted to make it clear, that the way the law is worded, absolutely allows for this kind of thing to happen. There is absolutely nothing to prevent it. So no one should dismiss this because they think the law prevents it - that is simply not the case.

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    5. Thanks very much for these comments.

      I certainly didn't mean to ask you to disclose other people's experiences, but I thought there might have been some local press coverage.

      The Internet material about events in Kansas, which I hope to write about soon, suggests that MA is not the only state with these problems.

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    6. 603 CMR 46.00 - 46.06 is the MA DOE law & reg for restraint in public schools. It clearly states no seclusion. Mr. L. clearly states his daughter was locked in a closet! That certainly seems like an offense.
      Also he said she screamed for help. No one heard her? All staff who work with children are mandated reporters. Did they all agree with this "technique?" If so they were complicit in her abuse. Didn't this scare all the other children?
      And finally, why did he wait over six years to write the piece? What finally prompted it

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    7. There are a hundred unanswered questions here and I am hoping that in the near future we will find out some more facts.

      Your point about scaring the other children is such an important one, as it's clear that observing violence can be as traumatic as experiencing it. The experience here may be parallel to what has been described by children who have overheard the screams of others undergoing "holding therapy".

      As for why he waited, of course I don't know, but I would guess that it had to do first with settling the lawsuit and second with having the daughter recover and get old enough to make a meaningful decision that publication was all right with her. (I don't mean to suggest that those were first and second in the order of the family's priorities.)

      Please have a look at the piece I posted today for some other information about the use of seclusion.

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  4. To "Anonymous": You will understand why I can't take responsibility for posting your remarks about Bill Lichtenstein. If you will provide your name and contact information, I'll consider posting what you say. As you see, I use my real name here, and I believe it's appropriate for anyone offering criticism to do so.

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  5. Incidentally, those who believe the op-ed piece was factually wrong can send their comments to nytnews@nytimes.com. I have asked the new public editor, Margaret Sullivan, to describe the role of fact-checking in op-eds.

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  6. I'm still waiting for a response from the Times public editor and will post it when I get it.

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