The restraint and seclusion of students with disabilities

According to federal data, more than 100,000 students are restrained or secluded in U.S. public schools every year. Nearly four out of five are students with disabilities. “Restraint” at school refers to immobilizing a student, whether physically or through a mechanical device, or otherwise restricting a student’s ability to move his or her torso, arms, legs, or head. “Seclusion” refers to the involuntary confinement of a student in a room or area, from which the student is physically prevented from leaving.

The practice of restraint and seclusion dates back to premedieval times. The question of how it took hold in U.S. public schools is an interesting one.

In the 19th century, Americans could be forced into hospitals, asylums, and other institutions (where the restraint of patients was commonplace) for an extraordinarily wide range of conditions. For instance, records from one “hospital for the insane” show that, from the 1860s through 1880s, patients were admitted for everything from asthma and brain fever to sunstroke and “women trouble.” As late as the mid-20th century, children with special needs were routinely confined to institutions as well, and most were denied access to public education.

It wasn’t until the 1950s that we began to see a nationwide shift toward more inclusive practices in education, healthcare, and other sectors. Around the same time that the 1954 Brown v. Board decision challenged racial segregation in the schools, advocates for the disabled called attention to the abuses suffered by children and adults in restrictive institutions. As a result, large numbers of psychiatric patients were transitioned to more integrated, community-based settings. And with the 1975 passage of  the Education for All Handicapped Children Act (later to become IDEA), millions of students with special needs were integrated for the first time with other students in K-12 schools.

But if many children were moved out of neglectful and abusive settings, they were moved into a public school system that had its own history of harsh discipline. In retrospect, given the schools’ prevailing emphasis on order, compliance, and even corporal punishment (which remains legal and still occurs throughout much of the country today), it’s no surprise that they would adopt the very same restraint and seclusion practices that had long been common in group homes and other restrictive institutions (see Peterson, Ryan, & Rozalski, 2013).

Abuses and investigations

In recent decades, we’ve learned that many if not most restraint and seclusion practices are ineffectual at best, and sometimes fatal. In a 2009 report, the federal Government Accountability Office (GAO) described multiple allegations of severe abuses in schools around the nation. These included a 5-year-old allegedly being tied to chairs with bungee cords and duct tape by a teacher and suffering broken arms and nosebleeds, the death of a 7-year-old after being held facedown for hours by school staff, and a 13-year-old reportedly hanging himself in a seclusion room after prolonged confinement. Even when children’s lives are not at risk, research has shown that restraint and seclusion may inflict trauma on students (Ryan & Peterson, 2004) or damage therapeutic relationships between students and staff (Haimowitz, Urff, & Huckshorn, 2006).

In light of this evidence, the U.S. Department of Education (DOE) advised schools, in 2012, that “every effort should be made to structure environments and provide supports so that restraint and seclusion are unnecessary.” In 2016, the DOE underscored that schools should never use physical restraint or seclusion for disciplinary purposes, never restrain students with a device or equipment, and use physical restraint or seclusion only if children’s behavior poses imminent danger of serious physical harm to themselves or others.

In recent decades, we’ve learned that many if not most restraint and seclusion practices are ineffectual at best, and sometimes fatal.

Legislative activity has picked up, too. Last year, following a report chronicling widespread abuses in the state, Illinois became the latest state to bar school workers from locking children alone in seclusion and to limit the use of physical restraint to situations involving imminent danger of physical harm. In the current session of Congress, both the House and the Senate have introduced bills that would limit or prohibit the use of restraint and seclusion in schools nationwide.

We’ve also seen an increase in private litigation and government enforcement of civil rights laws in this area, and advocates are hopeful that courts will find restraint and seclusion to be unlawful, especially when applied to students with disabilities. Examples of recent litigation include Q.T. et al. v. Fairfax County School Board (Va. 2021) and K.C. v. LaPorte Community School Corp (Ind. 2021).

In November 2021, the DOE’s Office for Civil Rights (OCR) resolved an investigation of the Saco school district in Maine, which enrolls 1,700 students. The investigation showed that, over a three-year period, there were more than 500 incidents of restraint and seclusion, 95% of which involved students with disabilities. Many students were restrained or secluded dozens of times: In a single school year, one student with a history of trauma was subjected to 61 incidents of restraint or seclusion (totaling more than 400 minutes), and another student experienced 29 incidents. Seclusion rooms were as narrow as three feet wide; some were not padded; others had exposed ceiling pipes that students could reach.

The Saco investigation revealed numerous inappropriate responses by school personnel. In one instance, a student repeatedly banged his head against a wall and staff stood by and did nothing, reasoning that the student would “stop when it hurts.” In other situations, a school resource officer (SRO) improperly restrained students despite not being trained and certified to do so; the SRO repeatedly failed to follow a student’s behavior plan and “escalated” incidents to the point where school administrators had to call parents to pick up their children or, in one instance, send a child to the hospital.

Separately, in December 2021, the U.S. Department of Justice (DOJ) resolved an investigation of the Frederick County, Maryland, school district involving the restraint and seclusion of students as young as 5 years old. The investigation revealed that the district restrained students 7,253 times over 2½ years. Although students with disabilities make up only 11% of students enrolled in the district, the investigation revealed that 100% of those secluded and 99% of those restrained were students with disabilities. The DOJ found that Frederick County schools routinely resorted to seclusion and restraint in nonemergency situations instead of using tailored behavioral interventions. For example, school personnel “routinely secluded and restrained students for ‘elopement,’ a behavior common in children with autism in which they run or wander away from caregivers or locations, instead of revising students’ behavioral intervention plans to address this behavior.” Notably, the district continued to use seclusion and restraint even when those techniques appeared to intensify students’ distress, with some students engaging in self-harm and showing other signs of trauma while in seclusion.

Both investigations illuminate the effects that restraint and seclusion practices can have on educational opportunity. The OCR noted that the Saco district sometimes kept students with disabilities out of school for multiple days after incidents involving restraint and seclusion. The extent of this practice was unknowable because the district did not formally track early dismissals and stay-home orders, but the DOJ noted that the Frederick County district’s seclusion practices segregated students with disabilities from their classmates and resulted in them missing weeks, or in some cases months, of instructional time.

Slow progress

Despite the proliferation of research, guidance, and enforcement activity, there is little evidence that the use of restraint and seclusion is on the decline. Federal data show that more than 100,000 students were restrained or secluded in U.S. public schools in each of the 2013-14, 2015-16, and 2017-18 school years. (These are likely gross undercounts: According to a 2019 GAO report, 70% of districts — including several of the nation’s largest school systems — have reported zero incidents to federal data collection authorities.)

As the GAO has noted, many practitioners maintain that restraint and seclusion are necessary to “reduce injury and agitation” in particular situations, and that “it would be very difficult for organizations to run programs for children and adults with special needs without being able to use these methods.” Addressing educators’ concerns (and providing workable alternatives) is therefore critical. Fortunately, some resources (and new funding sources) are available. For example, the 2012 federal guidance authored by the DOE and the Substance Abuse and Mental Health Services Administration offers 15 principles concerning restraint and seclusion to help schools establish sound policies and protocols, training, and parental notification and documentation procedures. The DOE’s 2016 guidance offers further resources and information to help schools avoid civil rights violations. And organizations such as the Alliance Against Seclusion and Restraint can help schools reduce the use of restraint or seclusion and embrace approaches that reflect the latest understanding of child development, neuroscience, trauma, and needs.

These shifts in practice may not be easy for educators, especially during a pandemic that has wreaked havoc on students’ (and educators’) mental health. But the alternative — holding on to ineffective and harmful restraint or seclusion practices — may be far worse, and even deadly.

 

References

Haimowitz, S., Urff, J., & Huckshorn, K.A. (2006). Restraint and seclusion: A risk management guide. National Association of State Mental Health Program Directors.

Peterson, R.L., Ryan, J.B., & Rozalski, M. (Eds.). (2013). Physical restraint and seclusion in schools. Council For Exceptional Children.

Ryan, J.B. & Peterson, R.L. (2004). Physical restraint in school. Behavioral Disorders, 29 (2), 154-168.

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This article appears in the March 2022 issue of Kappan, Vol. 103, No. 6, pp. 62-63.