End Prone Restraint, Embrace Alternatives for Illinois Public School Students

Today’s guest author is Jennifer Rowe.  Jennifer is an accomplished artist, art teacher, and research enthusiast. Jennifer is a late-diagnosed autistic individual and has become an accidental activist.  She enjoys researching articles about autism and is passionate about autism advocacy.  Currently, she is concerned about seclusion and restraint as it claimed the life of an autistic teen in her local community.  In her spare time, Jennifer likes spending time in nature and day trips to the ocean with her husband and two children. 

From August 2017 to December 2018, Illinois public school districts documented over 15,000 physical restraints with a quarter of those beginning with no documented safety reason.  In the 50,000 pages of documentation of seclusion and restraint incidents in Illinois public schools, there are records of many students saying they can’t breathe and are being hurt as they are being restrained. Specific injuries – “Cuts on the students’ hands, scratches on necks and noses. Collarbones that hurt to touch. Knots on their heads and split lips. Sore ankles and wrists.” – were documented, and at least twenty-four times an ambulance had to be called due to the severity of the injury.

The day after these findings from the ProPublica Illinois and Chicago Tribune investigation were published, emergency rules banning both seclusion and prone restraint were enacted.  Prone restraint, where an individual is “pinned” face down to the floor or ground, can cause severe injury or death as it can prevent the student from being able to breathe.

Over 30 states have banned prone restraint, and for a time it appeared that Illinois would be the next state to pass legislation prohibiting the use of prone restraint in its schools.

In December 2019, two weeks after the emergency rules banning seclusion and restraint went into effect, the Illinois Board of Education amended those rules to temporarily allow supine (on the back) and prone restraint so schools could have time for transition and re-training. In April, the Illinois State Board of Education (ISBE) negotiated with the Joint Committee on Administrative Rules (JCAR)  to allow schools to use prone restraint for one more year through spring 2021.  ISBE spokesperson, Jackie Matthews, said this decision was made because some schools “were concerned they didn’t have enough time to transition to other methods.”  This decision also came after a few small schools sent letters urging the ISBE to lift the ban on prone-restraint.  Teachers, staff, and parents of children attending Giant Steps, a school serving autitsic students, sent the most letters of any school.  One of the most powerful Illinois House of Representative leaders, Jim Durkin, is on the Giant Steps advisory board. Giant Steps is in the district of Representative Keith Wheeler, who is also the co-chair of the Joint Committee on Administrative Rules.

During the meetings that led up to the May vote on the bill that would ban seclusion and restraint, there was broad agreement among the stakeholders that those practices should be banned, but at the “11th hour” school administrators and principals objected to the proposed legislation because they said the required meetings with staff, parents, and students after each incident would be too much of a burden on the staff.  More details about how these events unfolded in Illinois can be found in the complementary NeuroClastic article, “It’s Time to End Prone Restraint in Illinois Public Schools.”

We know that restraint can lead to trauma, injury and death, but there are alternatives.  While teachers and staff are being trained and transitioning to these alternatives, other types of restraint can be used instead of prone restraint. Guy Stephens, the Founder and Executive Director of the Alliance Against Seclusion and Restraint, noted that, “We can do better and if we can do better we should.”  Guy said that he has participated in training programs for alternative approaches such as Ukeru and Collaborative Proactive Solutions.

 The Ukeru system, a crisis management technique that is built on an approach of comfort rather than control, is one highly successful alternative. In my interview with Kim Sanders, president of Ukeru systems, she stated that the Ukeru system is already being used in 250 organizations with about 30 to 40 percent of those being  public schools that  have adopted it either district wide or in self-contained classrooms. A study of the Ukeru system, which is a trauma informed approach, showed “a 99% decrease in restraint frequency, a 97% decrease in staff injury from a restraint, a 64% decrease in client-induced staff injury, and an increase in client goal mastery 133% from 2003 to 2016” with the majority of the dramatic change occurring in the first three to four years. 

Adopting Ukeru or other trauma informed methods of crisis management can even save money through lessened lost-time expenses, staff turnover, and workers’ compensation insurance policy costs.

In my interview, Kim Sanders, Ukeru president and recognized innovator in moving toward a restraint free environment, said “It does take time,” for the changes to be made.  In the beginning the focus is on “minimization vs. elimination.”  Initially, teachers may use restraints other than prone restraint as the new method is being adopted. Teachers and staff are also taught blocking techniques using large pads to block physically aggressive moves.  The more they use this blocking strategy, the less they use restraint.  First, standing restraint is eliminated; next, seated restraint can be eliminated.  Adopting this alternative is “more about a culture change than a training,” notes Kim Sanders.

A culture change involves a mindset shift away from behaviorism toward what we’ve learned in recent decades from neuroscience.  Patterns of thought and behavior are ingrained.  Instead of looking for root issues of behavior to inform interventions, rewards and punishment are too often the tools of modifying behavior, which is a primary focus in our schools and other institutions. The Individuals with Disabilities Education Act (IDEA) requires the IEP team to consider “positive behavioral supports and interventions” (PBIS) for any student whose behavior impedes their learning or another’s learning.  PBIS is not a specific intervention; it is a framework used in all 50 states.  Though behavioral approaches are considered “evidence based” that does not mean they are actually healthy for the child. Behavior modification fails to acknowledge the significance of trauma, so it fails to recognize that the behaviors are often due to stress responses.

In a trauma-informed approach, instead of focusing on controlling behavior, the focus is on establishing a relationship of trust where the student feels safe and from that will be able to accept help and learn. The Substance Abuse and Mental Health Services Administration 2014 guidance for trauma informed approach states “Young people bring their experiences of trauma into the school systems, often interfering with their school success,” and additionally, “… the public institutions and service systems that are intended to provide services and supports to individuals are often themselves trauma-inducing. The use of coercive practices, such as seclusion and restraints…can be re-traumatizing for individuals who already enter these systems with significant histories of trauma.”   Ukeru system is just one of a number of trauma-informed approaches that can be used to eliminate seclusion and restraint.

Another trauma informed approach is the Collaborative & Proactive Solutions (CPS) model, developed by Dr. Ross Greene, which has the goal of fostering a collaborative partnership between adult and child and to engage kids in problems affecting them. Studies have shown a significant decrease in restraint and seclusion when the CPS model was implemented. Studies also show a decrease in both the use of restraint and staff injury after implementing the trauma-informed approach, Collaborative and Proactive Solutions (CPS).   

The CPS Lives in the Balance website explains the doubt that it’s really possible to eliminate seclusion and restraint for students with the most challenging behavior may be because staff “are still focused on modifying behavior instead of solving problems collaboratively and are still placing expectations on students that they are unable to reliably meet.”

The Lives in the Balance website provides free resources to aid in reducing and fully eliminating the use of seclusion and restraint.  A proactive plan is presented and begins by focusing on a “new lens” through which behavior is to be viewed.  The focus shifts from modifying behavior to identifying expectations the child is having difficulty meeting and problem solving those.  The theme of the CPS model is Kids do well if they can. In other words, if a student could do well, s/he would do well.” Tools are provided as a proactive measure to avoid perpetuating a cycle of seclusion and restraint. Then comes the collaborative problem solving stage, “Plan B,” and a video link shows what it looks like to do this for the first time, in this case with a child who had endured 140 seclusions and restraints over the three months he attended a “therapeutic” school for autistic students.          

Focusing on strategies to reduce stress, fear, and frustration can prevent aggression and crisis situations. The Low Arousal Approach is another trauma informed system that answers questions that those coming from a behaviorism mindset may be asking: For example,  “Is low arousal giving in?” and “Are we reinforcing negative behaviors?” A core principle of this approach is that people inadvertently trigger behaviors, so it’s often our own behavior that needs to change. Through the Low Arousal approach, triggers are identified and low-intensity solutions are used for the distressed individuals instead of punitive consequences.

Understanding of triggers and effective solutions for an autistic student who is struggling can also be enhanced through talking with autistic adults or reading about the experiences and perspectives of autistic individuals, such as can be found in the articles on NeuroClastic.

It is clear that aggression and crisis situations can be prevented by focusing on strategies to reduce stress, fear, and frustration. Without a knowledge of trauma-informed practices and the mindset change that accompanies that knowledge, teachers and staff can inadvertently trigger and escalate situations. 

Data clearly shows the benefits of trauma informed and collaborative problem solving approaches to dramatically reduce the use of seclusion or restraint and the accompanying  injuries to students and staff.

Illinois public school children need you to speak out so they can be safe in their classrooms.  Additionally, students across our nation need you to speak out so they can be safe at school because many states still do not ban prone-restraint or seclusion. Talk to teachers, school staff, friends, and family about the harm that occurs because of seclusion and restraint.  Ask about what specific practices are used at your child’s school.  Share the data, the stories of those who have lost their lives, and these articles to help protect the students.  Together we can influence change, help bring and end to seclusion and prone restraint, and protect and save lives.

Please join the Alliance Against Seclusion and Restraint and NeuroClastic in this nationwide letter-writing campaign to influence the Illinois State Board of Education to support the ban of seclusion and restraint for the students in Illinois public schools.  These abusive practices of seclusion and restraint need to stop now before more children experience trauma, injury, or even death.  A letter template and an electronic petition can be found on the NeuroClastic web site.

Sign the petition or send your own letter – together we can make a difference.

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