Concerned About Unconventional Mental Health Interventions?

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

Tuesday, September 25, 2012

Seclusion and Special Education: The Lichtenstein Papers



Following the publication of an op-ed piece by Bill Lichtenstein in the New York Times a couple of weeks ago, describing the subjection of a 5-year-old special needs child to seclusion in a small, poorly-lit room as a behavior management tool, there has been a good deal of he-said, she-said, and they-said. The Times contributed to this an editorial note acknowledging that the child’s custodial parent, her mother, should have been consulted before the article by her father was published.

Lichtenstein, the father, is standing by his statements in spite of considerable criticism--  and I would point out that if any details of his narrative are inaccurate, that’s unfortunate, but the basic story is undeniably true and echoes similar tales from all over the United States. Those tales are predominantly about experiences of special needs students who are in theory protected from mistreatment under the Americans with Disabilities Act, but who in practice may be exposed to unacceptable efforts to manage their behavior.

At http://lexington.patch.com/articles/lps-superintendent-statement-challenges-nyt-oped-alleging-mistreatment-ofspecialneedsstudent#pdf-11299348, Lichtenstein has posted a number of documents that give further information about the events experienced by then-five-year-old Rose. (Some of these appear to me to have agreed to confidentiality, but then I’m not a lawyer.)
I’ll summarize some of the information in those documents. One document, prepared by the Commonwealth of Massachusetts Department of Education Bureau of Special Education Appeals, gives further information about Rose and clarifies that she did have special educational needs and that these had been apparent years before she entered the Lexington public schools. She had had difficulty at age two and a half in a Montessori classroom, where she did not tolerate frustration well and would hit or throw things in response—not unheard-of characteristics in a two-year-old, but intense enough to be noticed by her teachers. Some of the same difficulties were seen in a later preschool and in a Lexington preschool program.

When Rose entered the Lexington school, she had an IEP (Individual Educational Plan) that recognized her delays in both receptive and expressive language and difficulties with self-regulation. (Language delays are well known to be accompanied by age-inappropriate behavior, as children with these problems may fail to understand information and directions adults give them, and may experience extreme frustration when they have difficulty asking for help or communicating other problems.) However, she was mainstreamed into a regular education class and pulled out for occupational therapy and speech/language work.

After a few months, Rose was assigned a 1:1 aide whose previous experience had been with a child who was restrained much of the time.  The aide did not know that Rose had an IEP, had no training about seclusion, and did not see school policies about restraint or seclusion. It appears to have been the aide’s job to take Rose to one of two seclusion rooms, which she did in response to actions like yelling or not following directions, rather than in response to situations which threatened safety (the acceptable reason for use of restraint or seclusion). Rose’s parents were notified that she had been taken out of the classroom to a “quiet room”, but the rooms were not described. Neither did school team meetings discuss the use of seclusion as any part of Rose’s IEP.

When Rose was placed in a seclusion room, the apparent plan was that she would be allowed out when at the end of a five-minute period she could calmly say that she was ready to come out. Because of her receptive language problems, she might not have understood this; because of her expressive language problems, she may not have been able to make the required statement. In any case, it appears that she frequently experienced multiple five-minute periods adding up to as much as an hour, although the school principal stated that the limit was to be 15 minutes in total.

It is difficult to argue that five minutes of seclusion could never, ever be a suitable response to a child’s behavioral difficulties--  although seclusion becomes a wholly different matter if the room is frighteningly dark or if the child does not know an adult is near. The problem here was not necessarily the simple use of seclusion, but seems to have been what Oscar Wilde called “officialism”.  Administrators felt that rules had been established, but did not manage to give appropriate training to those who would actually be in contact with the child or with the parents, or to supervise and be aware of how a “plan” was being applied. This scenario has become so horribly familiar in the many stories of social workers who did not see the foster child they were to monitor and were surprised when the child died at the hands of the foster parents or others.

In the Ohio seclusion cases and elsewhere, failure to supervise or train aides has been the cause of harm to children through inappropriate use of restraint and seclusion. As I pointed out several days ago, organizations that offer restraint training do not teach about seclusion (which someone presumably thinks is harmless). My crystal ball says that at this very moment people across the country are cobbling together seclusion training programs that they will advertise as evidence-based when they see that a few groups report that they liked the training. Please, school administrators, pay attention to what’s going on! Don’t just assume that if you’ve paid out public funds to train teachers and aides about seclusion, and you’ve got policies in place, that you can just forget the whole issue. You yourselves need to know what should be happening as well as what IS happening. Don’t succumb to officialism any longer.

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