Concerned About Unconventional Mental Health Interventions?

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

Tuesday, September 11, 2012

Schools Using Seclusion: Not Just Lexington's Problem


My post about Bill Lichtenstein’s Times op-ed describing his young daughter’s experience of seclusion for behavior management in a Massachusetts public school drew a lot of comments. Some people said this could not possibly have happened, referring to Massachusetts laws in some cases and making ad hominem remarks in others. Other people referred to similar events known to them. It seems very possible that although schools try to regulate the use of restraint for behavior management, they may have neglected to set careful policy about seclusion--  and that this may be a nationwide problem.

Guidelines about the use of restraint and seclusion in residential psychiatric facilities have similar rules about each of these methods, including requirements for careful documentation (www.crisisprevention.com/CPI/media/Media/Resources/alignments/Joint-Commission-Restraint-Seclusion-Alignment-2011.pdf).  However, the guidelines do emphasize training in the risks of restraint and they do not refer to the stress placed by seclusion on younger or developmentally handicapped individuals.

Schools, of course, have as their primary responsibility work with children at different levels of development, including those with developmental delays or other handicapping conditions. That is, schools have a special concern with the possible impact of seclusion when used as a behavior management technique. Training of teachers and school staff in use of seclusion--  as well as in use of restraint--  is essential. Understandably, though, the training emphasis is generally on restraint techniques, which have the potential for causing physical harm or even death. Seclusion may be regarded as harmless or equated with “time-out”, even though the two are quite different, as recommendations of the U.S. Department of Education make clear.

An article by Molly Bloom in the Columbus, Ohio, Dispatch in August, 2012 (www.dispatch.com/content/stories/local/2012/08/06/teachers-get-little-training-on-seclusion.html) noted that Ohio teachers whose schools have seclusion rooms receive little training in how to use them, and their preparation includes little discussion of the use of seclusion with special needs children. Bloom reported an investigation showing that none of the schools examined had trained teachers for use of seclusion rooms, even though most of the schools using such rooms focused on children with disabilities. The company used for restraint and seclusion training in Ohio reported that it does not teach about the use of seclusion. Bloom’s article also stated that although restraint and seclusion are supposed to be limited to situations where physical harm is a likely outcome, other types of misbehavior were the most common precursors of seclusion. In addition, as one comment on my previous post pointed out, restraint may be involved in bringing children to a seclusion room. Bloom’s article referred to children who had scrapes and bruises following seclusion.

In Kansas, a bill before the legislature in 2011 would have mandated teacher training on the use of seclusion and would have required that lockable seclusion rooms “shall ensure that the lock automatically disengages when the teacher or attendant viewing the child walks away from the seclusion room or in cases of emergency, such as fire or severe weather “ (www.kslegislature.org/li/b2011_12/measures/documents/hb2444_00_0000.pdf). This bill died in committee. It was strongly opposed by Kansas school boards, who complained that these would be unfunded mandates and that training costs and increased litigation would need to be covered. (That last bit seems to me to indicate that the authors were aware of existing inappropriate use of seclusion, or why worry about increased litigation?) The school board association contribution (www.kasb.org/assets/Advocacy/test12/HB2444S.pdf) also argued that redress for people who suffered harm from either restraint or seclusion was already available under existing law--  for example, that parents can appeal the use of seclusion to a school hearing officer, and if dissatisfied to a district court, etc. This is no doubt true, but may be of little use to poor or ill-educated parents who don’t understand the laws and can’t afford an attorney, or even to those overwhelmed with work and responsibility for special needs children. In any case, harm may already have been done, as occurred with the Lichtenstein child, and correcting that harm may not be an easy matter.

Teachers need specific training about the use of seclusion rooms (by whatever name they are called--  it would appear that in Kansas they have been called Thinking Rooms and Opportunity Rooms). They need to understand the differences between time-out and seclusion. They need to know how a child’s perceptual and communicative abilities or disabilities can be factors in the impact of seclusion. Above all, they need to understand developmentally appropriate practice and the different responses to seclusion of children of different developmental levels. Although no doubt most teachers have some understanding of these things, the U.S. Department of Education’s recommendations are directed toward being sure that all teachers, aides, and school staff know what they are doing if and when they use seclusion. But this may not happen unless communities are alerted and demand policy and procedure changes.




  



2 comments:

  1. As a parent who agreed to a 766 school placement in Boston and for years has been stonewalled when trying to get the child moved to a less restrictive environment I now see that this is a violation of my child's civil rights. The boy is a kind gentile aspey who has been humiliated and shamed. It is time to make social change those with hidden disabilities. Archaic cruel practices of restraint and seclusion practiced in the name of behavioral therapy break hearts and pave the way for further institutionalization.

    ReplyDelete
    Replies
    1. Thanks very much for sharing this. Regrettably, institutions called schools can still get away with an approach to restraint and seclusion that is prohibited in treatment programs.

      Delete