Restraint and Seclusion Debate

The environment at the Centennial School when Michael George took charge of it in 1998 was violent.

Teachers at the school for students with autism and behavioral challenges had to forcibly restrain students more than 1,000 times during the previous year. As many as 25 staff members were being sent to hospital emergency rooms with injuries every year.

“We had teachers who were punched in the face,” George says. “The students had figured out they could assault teachers because the only thing that’s going to happen to them was that teachers were going to put you to the ground, hold you tightly, talk softly to you, and ask you to settle down.”

Within months of his arrival, George implemented new techniques for dealing with obstreperous behavior among the school’s 85 students. By the end of that first year, the number of restraint incidents had been reduced to zero, and the school’s seclusion rooms—where children who behaved badly were locked away in solitary confinement for hours at a time—were permanently closed.

At the time, George didn’t think he was doing anything particularly revolutionary.

Prior to arriving in Bethlehem, Pennsylvania, George worked at a similar school in Eugene, Oregon where he and his staff never restrained one child in seven years. “This was just the way we did business,” George says. “I didn’t think anything of it. I wasn’t following national statistics at the time. Restraint and seclusion weren’t on the national radar. No one was talking about it."

Lately, national media have been focusing attention on how children are being injured or—in a few cases—have died at the hands of school staff members trying to control unruly behavior. At the same time, some members of Congress are trying to severely curtail the use of restraints and permanently retire so-called “scream rooms” nationwide, just as George did at Centennial School 15 years ago.

An ABC News Nightline investigation in 2012 revealed that at least 75 students had died and thousands more were injured after being restrained by school staff or locked away in a seclusion room. The stories put a spotlight on George and the Centennial School, governed by Lehigh University’s College of Education, for adhering to Positive Behavioral Intervention and Supports techniques for dealing with children with behavioral problems.

At Centennial School, children might be separated from their classmates, but never placed in seclusion and rarely restrained. Teachers might ask the student to calm down and discuss what is making them angry or frustrated. In some cases, the teacher might ignore the child until the behavior becomes acceptable.

The emphasis is on teaching children a better way to behave rather than simply punishing bad behavior, George says. “I view misbehavior on the part of young children as a skill deficit that can be taught. If students haven’t yet acquired a skill, we should teach it; we should teach social behavior in the same way we teach academics,” he says. “After all if you’re in math class and you miss 2 plus 2, teachers don’t put you in a closet and restrain you to the floor. They gently correct you  and give you more information so you won’t make the error in the future.”

Like many others, George said he was “outraged” by some of the punishment tactics revealed in the Nightline report, which included methods such as electrical shocks and specialized duffel bags to stuff children into when they misbehaved. “I couldn’t believe things like that were happening in our society,” George said.

Earlier that year, the U.S. Department of Education put out a “resource document” that was extremely critical of the practices of seclusion and restraint. “Restraint or seclusion should not be used as routine school safety measures; that is they should not be implemented except in situations where a child’s behavior poses imminent danger of serious physical harm to self or others and not as a routine strategy implemented to address instructional problems or inappropriate behavior, as a means of coercion or retaliation, or as a convenience,” the document says.

According to one analysis of U.S. Department of Education data, practices that include pinning children face down on the floor, tying them up with straps, handcuffs, bungee cords or duct tape and locking them in dark closets were used more than 267,000 times during the 2012 school year alone.

The analysis, by non-profit newsroom ProPublica and National Public Radio, showed that three-quarters of the children that had been restrained or secluded had physical, emotional or intellectual disabilities. Mechanical restraints were used 7,600 times. And child experts and advocates like George say those figures are likely understated. Less than one-third of all schools reported using restraints or seclusion even once during the school year, according to ProPublica.

In many states, schools are not required to report instances of restraint or seclusion—not to state education authorities, not to law enforcement, not even to the parents of students on whom the techniques are being applied.

In February, U.S. Sen. Tom Harkin, D-Iowa, chairman of the Senate Health, Education, Labor and Pensions Committee, introduced the Keeping All Students Safe Act, which would bar the use of seclusion in locked, unattended rooms and would prohibit almost all uses of restraint procedures in schools.

“These practices provide no educational benefit, yet unsupervised seclusion and physical restraints are being used thousands of times each year against our nation’s school children,” Harkin said during a news conference. “My goal is to bring about change—to stop the use of seclusion and to severely limit the use of restraints in schools, and to provide teachers and school leaders with the resources to replace these antiquated techniques with learning environments that engage students so incidences of challenging behaviors are decreased and learning in schools is optimized.”

George, who attended Harkin’s news conference and has testified before Congress about seclusion and restraint, agrees with the goals of the senator’s bill, including the outright banning of locked seclusion rooms, a practice he called “terrifying” for children.

One 13-year-old boy hanged himself after school officials gave him a rope to keep his pants up and locked him in a room by himself, according to ProPublica.

“Seclusion likely results in all kinds of adverse psychological effects on the child,” George says. “Picture yourself as a child in school, and a group of adults come into your room, drag you to a closet, lock the door and walk away, and leave you in the dark. It’s solitary confinement is what it is, and I don’t know that we need to be using that with our children.”

Only Georgia has completely banned the use of scream rooms. Ten other states only allow seclusion in emergencies. Six other states, including George’s home state of Pennsylvania, only place prohibitions against using the practice on disabled students.

Regulations on the circumstances or method of placing restraints on unruly children also vary widely from state to state.  “We can do this by state if we wish, but I think it’s grossly unfair to parents in one state to have their children corporally punished, run into timeout rooms, restrained to the floor … and then right across the border, in another state, those practices are banned,” George says.

“We wouldn’t allow pedophilia in one state and not in another. I think national standards of some sort would be very helpful in this regard because we’re talking about situations that cause psychological trauma and have the potential of causing death.” But one important group of educators is opposed to the bill.

“We believe the use of seclusion and restraint has enabled many students with serious emotional or behavioral conditions to be educated not only within our public schools, but also in the least restrictive and safest environments possible,” says a 2012 report prepared by the American Association of School Administrators.

“Some of the approximately 4.7 million school personnel working in our public schools are not perfect,” the report says. “The unfortunate reality is that they make a variety of mistakes, sometimes intentionally, that can hurt children. However, AASA does not support federal policies built around the few wrongful individuals who choose to disobey school policies, state regulations, or state and federal criminal laws.”

While the AASA report asserts that “school personnel around the country understand seclusion and restraint should only be used in rare circumstances where other interventions have failed to address student behavior,” George says that the practices in many schools have become a primary method of dealing with bad behavior rather than a last resort to be used only when the secluded child has become a danger to himself or herself and/or others.

“There are people, I think, who would like to institutionalize the practice as one more strategy or technique in dealing with children who have obstreperous behavior,” George says. “And I believe when you get yourself in that position, you’re going to find that it will be overused and abused. I think that’s what you have in this country at this point.”

Restraint and seclusion were “common” at Centennial School when George arrived. “That was just how you dealt with these children I was told, and when I suggested otherwise, people said, ‘you don’t understand these children…. When you work with children with behavior problems, you restrain them,’” George says.

And it wasn’t just teachers who were skeptical of the changes George was proposing.

“The students were upset when I changed the rules,” George says. “Kids habituate to the environment they’re in. To them the misbehavior-restraint cycle was school. I was now asking them to control themselves and take responsibility for their behaviors. “Adults don’t understand sometimes when they put in things like seclusion rooms and restraint procedures and they engage in that practice frequently, they’re basically communicating to the students that this is the proper way to deal with conflict. Adults are the ones that set the rules. It starts with a different approach, a different philosophy, different beliefs in what you believe about children  and following through with those beliefs even when it gets tough.”