Restraint

Physical Restraint & Seclusion

As many reports have documented, the use of restraint and seclusion can have very serious consequences, including, most tragically, death.
Restraint and Seclusion: Resource Document – US Department of Education

Seclusion and restraint are safety measures, not treatment, and they should never be part of standard treatment for someone’s condition. Their use—particularly when it is recurrent or protracted– represents a treatment failure and should be addressed as such. Federal regulations and standards by accrediting bodies prohibit the use of seclusion and restraint in healthcare settings as punishment or to compensate for staffing shortages.

Restraint and Seclusion – Bazelon Center for Mental Health Law

There is no evidence that physically restraining or putting children in unsupervised seclusion in the K-12 school system provides any educational or therapeutic benefit to a child. In fact, use of either seclusion or restraints in non-emergency situations poses significant physical and psychological danger to students.

Dangerous Use of Seclusion and Restraint – US Senate Health, Education, Labor and Pensions (HELP) Committee

Chairman Harkin’s Keeping All Students Safe Act would prohibit the use of seclusion in locked, unattended rooms or enclosures… [sic] Any restraint that restricts breathing is prohibited, as are aversive behavioral interventions that compromise health and safety.

Keeping All Students Safe Act 2013

Seclusion and Restraint – US House of Representatives – Committee on Education and Workforce

Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers – Investigation by: US Government Accountability Office
Examining the Abusive and Deadly Use of Seclusion and Restraint in Schools – US Government Accountability Office Hearing before the Committee on Education and Labor
The statute requires that seclusion and restraint be used only:
To ensure the physical safety of the individual or others; and subject to a written order by a physician or other licensed practitioner permitted by the facility and state law. In most cases, the written order will be obtained soon after the restraint or seclusion is initiated by staff.
Federal Standards for use of Restraint and Seclusion  – Bazelon Center for Mental Health Law
At present, there is no federal statute protecting children nationwide; state laws govern the use of restraint and seclusion. These approaches vary widely. A patchwork quilt of laws, regulations, voluntary guidance, and complete silence covers the nation. The quilt has many holes, as this report demonstrates.
How Safe is the Schoolhouse? – By Jessica Butler -Published by the Autism National Committee

 

Mental Health Advocates Agree…

School is Not Supposed to Hurt – National Disability Rights Network

Position on Restraint and Seclusion – National Disability Rights Network

Position Statement – Seclusion and Restraints – Mental Health America

Considerations for Seclusion and Restraint Use in School‐wide Positive Behavior Supports – Positive Behavior Interventions and Support

Position on the Use of Seclusion and Restraint – American Psychiatric Nurses Association

 

How Can Polices on Restraints Improve?

According to the The Alliance to Prevent Restraint, Aversive Interventions and Seclusion (APRAIS)

The key to reducing the use of aversives, restraints, and seclusion is to ensure that individuals who exhibit challenging behaviors have access to comprehensive and individualized positive behavior support.

According to The Technical Assistance Center on Positive Behavioral Interventions and Supports Restraints & Seclusion are prone to “misapplication and abuse placing students at equal or more risk than their problem behavior” Concerns include the following:

  1. Seclusion and restraint procedures are inappropriately selected and implemented as“treatment” or “behavioral intervention,” rather than as a safety procedure.
  2. Seclusion and restraint are inappropriately used for behaviors that do not place the student or others at risk of harm or injury (e.g., noncompliance, threats, disruption).
  3. Students, peers, and/or staff may be physically hurt or injured during attempts to conduct seclusion and restraint procedures.
  4. Risk of injury and harm is increased because seclusion and restraint are implemented by staff who are not adequately trained.
  5. Use of seclusion and restraint may inadvertently result in reinforcement or strengthening of the problem behavior.
  6. Seclusion and restraint are implemented independent of comprehensive, function‐based behavioral intervention plans.

Toward Effective Policy

  1. The majority of problem behaviors that are used to justify seclusion and restraint could be prevented with early identification and intensive early intervention. The need for seclusion and restraint procedures is in part a result of insufficient investment in prevention efforts.
  2. Seclusion and restraint can be included as a safety response, but should not be included in a behavior support plan without a formal functional behavioral assessment (a process used to identify why the problem behavior continues to occur).
  3. Seclusion and restraint should only be implemented (a) as safety measures (b) within a comprehensive behavior support plan, (c) by highly trained personnel, and (d) with public, accurate, and continuous data related to (1) fidelity of implementation and (2) impact on behavioral outcomes (both increasing desired and decreasing problem behaviors).

Resources:

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES – Substance Abuse and Mental Health Services Administration – www.samhsa.gov

Promoting Alternatives to the Use of Seclusion and Restraint