Not All Schools Use Restraint Or Seclusion. Here’s A Look At Some Alternatives
BRIDGEPORT, Conn. — The first time Ed Nientimp heard about a model to reduce how often teachers and other staff physically restrain students or place them in seclusion rooms, he couldn’t help a little skepticism.
Nientimp had worked in special education for years and saw restraint and seclusion as unfortunate but necessary tools to calm students and keep classrooms safe. Even as he registered for training from Ukeru, a new crisis training program offering alternatives to the controversial techniques, he didn’t expect to be convinced.
“As a skeptic, I thought we would go and review the program and come back and report to the board and the superintendent that what we are doing is state-of-the-art and best practice,” said Nientimp, director of student services in the Millcreek Township School District in western Pennsylvania. “That was really the goal: to rule it out.”
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But Nientimp found himself impressed by the training, and particularly by Ukeru data that showed dramatic drops in restraint and seclusion emerging from relatively simple tweaks to the way staff members think about student behavior and react to tense situations. He agreed to pilot the new practices in three Millcreek Township classrooms.
Sure enough, Nientimp recalls, restraints dropped dramatically in those classrooms during the trial period. The next year, Millcreek Township rolled out the system districtwide and restraints disappeared entirely.
Five years later, the district hasn’t recorded a single restraint in its public schools since, and Nientimp is a true believer.
“It’s almost so simple that it’s like, ‘Duh, why didn’t we do this (earlier)?'” he said. “We’re just more benevolent and more caring, and as a school that’s what we should be.”
Each year, tens of thousands of American students in K-12 schools are restrained — physically held or bound with mechanical devices such as straps — or secluded — isolated anywhere from a closet to a specially designed room. These interventions — which are performed by a variety of school employees, including teachers, aides, administrators and other staff — lead to hundreds of serious injuries annually and in rare cases have resulted in death.
While some teachers and administrators consider these interventions necessary to keep students safe, critics argue that they risk physically harming and even traumatizing students, while failing to address the problems underlying their behavior. Students with disabilities account for the vast majority of restraint and seclusion incidents nationwide, and Black students are also far overrepresented in the totals. Some states severely restrict, if not altogether ban, the practices, while the federal Department of Education has for years advised that the techniques should be “avoided to the greatest extent possible.”
Now, a growing body of formal research, as well as on-the-ground experience in schools nationwide, suggests restraint and seclusion may not be necessary at all. One 2018 study found that implementing a new model for addressing challenging behavior — one that centered on meeting students’ needs and defusing situations before they escalate — all but eliminated the practices at a health care facility serving children and adults, while also reducing staff injury and improving mastery of individual goals.
In Millcreek Township, most of the changes Nientimp led weren’t revolutionary. Staff members were instructed to prioritize “comfort over control,” meaning they would calm a student before attempting to proceed with instruction. For rare instances when student behavior escalated, they were given large foam pads to hold between themselves and a student until the student had settled down.
“It’s about not trying to control that student in that situation (by saying), ‘You’re getting escalated, but this worksheet is more important,'” said Kate Barbaro, a special education supervisor in Millcreek Township. “(It’s about) putting that aside and meeting the student’s needs where they’re at in that moment, providing compassion, and coming at them with ‘What happened to you’ vs. ‘What’s wrong with you.'”
A growing number of school districts have seen similar results, trading restraint and seclusion for more careful approaches that emphasize student comfort.
“It doesn’t take a lot of money, it doesn’t take state-of-the-art curriculums,” said Janice LeBel, a psychologist with the Massachusetts Department of Mental Health who has spent more than two decades working to reduce restraint and seclusion. “It does take a willingness to be flexible in the moment, to understand behavior in context.”
‘When someone’s at their worst, we need to help’
The model used in Millcreek Township — among several hundred other schools, behavioral health facilities, residential treatment centers, psychiatric hospitals and foster care systems nationwide — was developed by Kim Sanders, a behavioral health specialist who has firsthand experience with restraint and seclusion and all that comes with it.
Decades ago, while staffing a residential facility for people with disabilities, Sanders frequently used physical interventions in response to challenging behaviors from students. The network she worked for, Grafton Integrated Health, had clear guidelines around the practices, allowing their use only in cases of “imminent harm to self or others,” but Sanders tended to skirt those rules.
In many cases, she said in a recent interview, she was simply scared.
“Did I restrain and seclude kids outside of what those guidelines intended? Absolutely,” said Sanders. “When I was 19 years old making those decisions, my definition of ‘imminent danger’ I guarantee you was a lot different than the directors of our facility who wrote those policies.”
Over time, however, Sanders began to wonder if there was a better way. In 2004, she helped lead Grafton in introducing Ukeru, a new initiative within the health network to reduce restraint and seclusion, with “comfort over control” as its guiding philosophy.
Whereas previously caregivers might have been trained to approach a distressed student and raise their voices, now they were taught to back away, speak softly and seek to calm the child however necessary. In some cases, that might mean giving students a cool wash rag. At other times it might mean directing them toward an activity they enjoy.
“When someone’s at their worst, we need to help them get out of it,” Sanders said.
In the worst-case scenario where a student becomes aggressive, blocking pads keep teachers safe without endangering students.
Almost immediately upon implementing its new model, Grafton saw a drastic drop in physical restraint and a corresponding increase in goal mastery. Before long, its model had spread to school districts and clinical settings nationwide.
One of Ukeru’s chief emphases, Sanders said, is shifting responsibility away from students and toward teachers, who are trained through the program to recognize warning signs in student behavior and to mitigate tense situations before they escalate.
“It’s putting the responsibility back on the adults to be the problem solvers,” Sanders said. “While being mindful that everything we’re going to try, we want to make sure we’re not re-traumatizing a child.”
‘Focused on the problems’
Other models offer similar approaches to reduce restraint and seclusion. The federally funded Center on Positive Behavioral Interventions and Support, for example, prescribes a three-tiered approach that includes teaching students social and emotional skills, promoting self-regulation and implementing individualized de-escalation strategies.
A 2014 study from the University of Connecticut found that positive behavioral interventions and supports reduced restraints by 25% and the amount of time students spent in restraint by 46% at an alternative K-12 school. Seclusions decreased 59%, while the amount of time spent in seclusion decreased by 58%.
“Sometimes schools can get caught in these cycles going from one crisis to another,” said Nicholas Gelbar, a psychologist who led the UConn study. “Putting these systems in place requires (schools to say), ‘Let’s take a preventative, data-based approach, let’s look at how we can go about creating whole-school methods as well as really individualized plans.'”
Catherine Lhamon, who heads the U.S. Department of Education’s office that investigates civil rights violations, cites the example of Saco, Maine, where one school saw an 80% reduction in restraint and seclusion incidents in a single year after changing its policies around physical interventions and retraining staff.
That case study, Lhamon said, “supports that there are things that can work where schools have training, effective resources and knowledge about the appropriate ways to serve students with disabilities.”
Ross Greene, a psychologist and author of several books on child behavior, argues for a particularly deep-rooted approach designed to meet students’ needs proactively. Whereas Ukeru and PBIS aim to settle distressed students without restraint and seclusion, Greene’s model, which he calls Collaborative & Proactive Solutions, seeks to prevent students from becoming distressed in the first place.
As part of CPS, teachers are trained to identify and address lagging skills and “unsolved problems” that lead a student to act out.
“Instead of focusing on a kid’s concerning behavior and trying to modify it, we are instead focused on the problems that are causing those behaviors and solving them,” Greene said.
Maine School Administrative District 75, just north of Portland, was one of the first school districts to pilot Greene’s model. Within just a few years, the local schools went from more than 300 restraints and seclusions to about 20.
Amy Hall, the district’s elementary special education coordinator, said the decline in use of the practices owed to a shift in mindset among staff members, paired with a commitment of resources from administrators.
“We’re not accepting anymore that this kid is escalating on a daily basis and that’s just part of what a behavior program is,” Hall said. “Now we’re like, ‘They’re escalating on a daily basis … we need to get the team together. We’re missing something. We need to do something differently.'”
Audra Knippa, a special education teacher in the district’s elementary therapeutic intervention program, said the biggest change has been an emphasis on listening to students.
She recalls one girl with behavioral challenges who often acted up when it came time for reading assignments. Teachers initially assumed the student was simply bored or disinterested, until spending some time with her and learning the true issue: She struggled deeply with reading comprehension, making the work highly difficult and frustrating.
By diagnosing and addressing the underlying issue, as opposed to just the behavior, the teachers were able to more effectively help her learn (assigning her simpler texts or even graphic novels), while also reducing her outbursts.
“She was no longer having behaviors around reading because it wasn’t so challenging for her, it didn’t seem impossible,” Knippa said. “She wasn’t having these major escalations, tearing apart classrooms, so there was no need for restraint or seclusion.”
‘Most people want to do the right thing’
If alternative models like Ukeru and CPS are so effective at reducing restraint and seclusion, why aren’t they more widespread, or even universal?
Knippa said some teachers struggle with the attitude adjustment required to soothe aggressive behavior instead of punishing it, which she said seems to run contrary to the values many people are taught.
“A lot of people were raised themselves or raised their own children — or it’s just the way society works — (that) if you do something wrong, we’re going to impose this punishment or this consequence on you,” she said. “So, to say to them, ‘I know that Johnny just tore apart the classroom today, but instead of suspending him let’s sit down and talk to him about what’s wrong,’ it’s a huge mindset shift for people.”
LeBel, from the Massachusetts Department of Mental Health, said she understands why not all schools adopt best practices to reduce use of the interventions. Two and a half years into the COVID-19 pandemic, more children than ever are struggling with their mental health, and many teachers are as well. Meanwhile, staff shortages at many schools make it difficult to provide the individualized care some students might need.
With all those stressors — and without proper training — restraint and seclusion can feel like the easiest, or only, response to a student in distress.
“People are laboring with extraordinary demand, too little information and not enough knowledge about how to create positive, comforting classrooms,” LeBel said.
Greene acknowledges that alternatives are “not an easy sell” in all cases. Often, he said, educators struggle to see an alternative to the way they have always done things.
When he encounters this attitude, he responds with a simple challenge: Use your imagination.
“What I often say to them is, ‘I want you not to imagine life as it currently is, I want you to imagine life as it could be,'” he said. “What if there was a way for you to not be jumping from one crisis to another like chickens with your heads cut off?”
Increasingly, though, educators don’t have to imagine. If they want to know what life after restraint and seclusion looks like they can simply look to Maine School Administrative District 75 or Millcreek Township or any of the hundreds of other school districts from South Carolina to Vancouver that have leaned away from physical interventions in recent years.
Barbaro, from Millcreek Township, understands why teachers rely on the tactics. But she also knows firsthand that another way is possible.
“(Teachers) were restraining because that’s what we were trained to do, and people’s adrenaline goes up in a crisis and (they think), ‘This is how I get out of this, this is how I stay safe,” Barbaro said. “If you flip that and say, ‘No, you don’t, that’s actually hurting people,’ most people want to do the right thing.”
Emilie Munson and Mary Katherine Wildeman contributed to this report.
© 2022 Connecticut Post
Distributed by Tribune Content Agency, LLC
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