A Last Resort?

The United States Department of Education issued guidance in 2012 that provided principles to make clear that restraint or seclusion should never be used except in situations where a child’s behavior poses an imminent danger of serious physical harm to self or others. The guidance states that restraint and seclusion should be avoided to the greatest extent possible without endangering the safety of students and staff. The guidance also clarifies that restraint and seclusion should only be used as a last resort when a child or others are in immediate danger of serious physical harm.

The phrase “imminent serious physical harm” is critical as it is the criteria under which the guidance suggests restraint and seclusion might be considered. Imminent, serious, physical harm has the same meaning as serious bodily injury as used in the Individuals with Disabilities Education Act (IDEA). It means bodily injury which involves:

  • A substantial risk of death;
  • Extreme physical pain;
  • Protracted and obvious disfigurement; or
  • Protracted loss or impairment of the function of a bodily member, organ, or mental faculty.

Let’s think about this for a moment. According to federal guidance, restraint and seclusion are only appropriate to consider in life-threatening situations. This is a high standard, and it is the correct standard. To be clear, at Alliance Against Seclusion and Restraint we don’t believe that seclusion is ever appropriate. Putting a child in a room or area against their will and not allowing them to leave is never a proper intervention. We also believe that the use of physcial restraint should be exceeding rare. Why should restraint only ever be used in a situation that poses an imminent life-threatening danger? Well, hundreds of children have died worldwide due to the use of physical restraint in schools, residential facilities, and medical settings.

The use of physical restraint is the use of potentially deadly force. Deadly force should be avoided to the greatest extent possible. When is it acceptable to use deadly force on a disabled 5-year-old? 

Despite the high standard and the fact that many states have laws that say that restraint and seclusion should only be a last resort and only used in situations that involve imminent serious physical harm, we find that more often than not, restraint and seclusion are used for noncompliance, disrespect, minor behaviors, property damage and as a punishment. We often hear justifications for restraint and seclusion, including examples such as a student jumping in front of a car, a fistfight between high school students, or a student with a deadly weapon. These examples are red herring intended to justify the abuse of excessive and unnecessary restraint and seclusion.

Of course, in situations involving a potentially life-threatening situation, we should do what is needed to save a life; however, the overwhelming majority of instances of restraint do not involve these exceedingly rare examples. 

Today, I want to share a more typical example of what we see leading to the use of restraint and seclusion – noncompliance. First, a trigger warning: what you are about to read will be difficult and upsetting. We will review an actual report, which we redacted to protect the victim’s identity. The report we are sharing is the official restraint documentation provided to the family following the event. This report involves a 5-year-old female kindergarten student with a disability being restrained and secluded for 55 minutes in the third week of the school year for noncompliance and having a meltdown. The incident begins on the playground, moves to a classroom, and ends in the “quiet room” (aka seclusion room). According to the official documentation, the restraint begins at 10:50 am and ends at 11:45 am. 

What led to this young child being restrained? Did she have a weapon? Did she attempt to dart in front of a moving car? Was she invoved in a fistfight? No, she did not go down the playground slide the “correct way”; this was about noncompliance. According to the report, the student came down from the slide and hit and spit on the behavioral specialist, who was demanding compliance. It sounded like the child had escalated to a dysregulated condition and was responding from a fight or flight state. Rather than working to co-regulate or de-escalate the child, physical force was used to “transition” the student to the classroom “with assistance.” Let’s be clear whether you say “transition with assistance” or “transport,” we are talking about physical restraint. It is restraint if you are holding anyone or moving them against their will. The question is, did this 5-year-old female kindergarten student present an imminent danger of serious physical harm? Was this a life-threatening situation? It’s hard to imagine that not going down the slide the “correct way” was a life-threaten scenario. 

The report states that the student continued to hit, kick and spit while being restrained (or transition with assistance). Of course, a child (or anyone) will hit, kick, and spit when you are restraining them. We all are hardwired for survival. Behavior is biology; putting hands on a child to restrain them will prompt a fight or flight response. It is worth noting that the report indicates that the child was offered choices before being physically restrained. What were the choices, you ask? The options were to walk on their own or to be physically restrained. A couple of issues here, but the simple one is that when a child is dysregulated, their prefrontal cortex (the thinking/rational part of the brain) is not available for choices. We need to help someone regulate before we can offer them choices, not to mention this was not much of a choice.

The form asked what type of restraint was used, and the response was a “calming room.” A calming room (aka a seclusion room) is not a type of restraint. What you did to force the child into the calming room was the restrain portion of this event. When you held them, dragged them, or “transitioned them with assistance,” as was reported. Next, the form asks what type of injuries (if any) occurred. The response to the question was, “No injuries seen.”

You can’t see trauma, but I assure you this event resulted in trauma for this little girl, a trauma that might lead to changes in her brain and might be with her forever.

One of the final questions on the form asked about the child’s behavior during the restraint. It was noted that the child was yelling, “crying with tears,” spitting, and attempting to hit and scratch adults. Given the lack of clarity in the report, it is unclear whether these behaviors occurred during the physical restraint or seclusion, assumably both, as it indicates the child continued to yell, kick and spit after the restraint ended; this is horrible. This child was terrified; this is child abuse. A 5-year-old female kindergarten student with a disability was restrained and secluded because she did not go down the playground slide the “correct way.” There is no excuse for this adult behavior. Utilizing a life-threatening and traumatizing intervention on a small, vulnerable child because they weren’t compliant is unacceptable. In the end, the child was blamed and, according to the report, was spoken to about following directions. It was the adult behavior that needed to be reviewed, and changed not the child.

Next time you hear someone say that restraint and seclusion are necessary, think about this story. When you hear someone say we only use restraint and seclusion as a last resort, think about this story. These scenarios are far more common than the rare situations involving imminent danger of serious physical harm to self or others. Seclusion is never an appropriate response, and physical restraint usage should be exceedingly rare. We can and must do better for students, teachers, and staff.

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