Without Training, Special Education Teachers Resort To Restraint And Seclusion

These classrooms were decorated before the Dedication Ceremony on July 24, 2008.
These classrooms were decorated before the Dedication Ceremony on July 24, 2008.

This piece comes to us courtesy of EdSource, where it was originally published.

Every day in special education classrooms across California, teachers and aides oversee students whose emotional and behavioral disabilities can trigger violent confrontations. In some cases, teachers and aides wrestle these students to the floor, pin them against classroom walls, and escort or drag them into seclusion rooms.

Operating outside the restrictions of general education, special education staff are authorized by the California Education Code to declare a “behavioral emergency.” That determination allows staff members to initiate emergency interventions that are defined only by what they may not be: electric shock, denying access to bathroom facilities, noxious sprays to the face, and interventions that can be expected to cause excessive emotional trauma.

In 696 behavioral emergency reports from 2011-12, the latest data available, obtained through public records requests and analyzed by EdSource Today, narratives describe intense physical and emotional battles between special education staff and students, with both sides reporting cuts, bruises and injuries. Students punch staff members, run out of classrooms or bang their heads against walls or cabinets, according to the reports, which are the most recent available. In turn, staff members may attempt to calm students through conversation but often end up physically restraining students or isolating students in rooms that they cannot leave, known as seclusion.

Debate is fierce over whether restraint and seclusion practices should be allowed in special education, with some administrators, teachers and aides arguing that they cannot do their jobs without the techniques. But investigations, including a 2009 Congressional report, have documented egregious misuse of the practices nationwide, and special education advocates say that skillful use of behavior management strategies, and appropriate placements, would make restraint and seclusion unnecessary.

Yet both sides agree on one point: The key to reducing the use of restraint and seclusion is to provide staff with intensive training.

Teachers and aides “should be experts,” said Eric Richards, a special education teacher in the Sacramento City Unified School District who has been in the field for more than 15 years.

Instead, the least-experienced staff often serve the most challenging students in California, according to interviews with special education teachers, administrators, advocates and parents across the state. In nearly all of the 696 incidents analyzed, instructional aides, who are typically the least-trained staff members in a classroom, were involved in restraining or secluding students.

The techniques carry significant risks. “The use of restraint and seclusion can have very serious consequences, including, most tragically, death,” U.S. Secretary of Education Arne Duncan said in 2012.

Students who are restrained or secluded fall into two general categories: nonverbal children with autism or intellectual disabilities, and students diagnosed with an emotional disturbance, whose definition includes an inability to get along with peers and “a pervasive mood of unhappiness.”

But finding experienced special education teachers and aides who are well trained in behavioral management can be difficult. The state has faced an acute shortage of special education teachers for decades, according to the U.S. Department of Education. And special education teachers leave the profession at nearly twice the rate of general education teachers, according to the National Coalition on Personnel Shortages in Special Education and Related Services.

More than any other area of K-12 education, special education classrooms rely on relatively low-paid and often part-time staff – classroom aides, instructional assistants and entry-level counselors – to work closely with students. Instructional aide positions generally require a high school diploma and, in some cases, passing a test of basic math and writing skills, although some private special education schools require a bachelor’s degree. Training is on the job and in professional development sessions, from which aides are sometimes excluded. Starting pay can be as low as $12.50 an hour.

State law does not require teachers and aides who work with extremely challenging special education students to be trained in how to de-escalate a crisis, how to prevent the need for restraint and seclusion or how to safely restrain a student –except in one category: prone restraint. In a prone restraint, which is considered the most dangerous technique used on students, two or more staff members hold a student facedown on the floor with all four of the student’s limbs immobilized. Adults who put their weight on a child during a prone restraint can block the child’s airway – a particular hazard for those with asthma.

Prone restraint “should never be used” in special education because of the risk of serious injury or death, according to a 2012 resource document published by the U.S. Department of Education. That recommendation never became a policy or regulation for the department.

Although the state requires prone restraint training, it does not track who receives it. That is up to districts to monitor according to their own internal procedures.

Prone restraint most frequently used

In the behavioral emergency reports from across the state reviewed by EdSource Today, a prone restraint was used in 44 percent of the cases, making it the most frequently used technique.

While state training requirements in restraint and seclusion practices are minimal, school districts can set their own training mandates, as can private special education schools known as “nonpublic schools,” which receive public special education funds to serve district students.

State-funded Special Education Local Plan Areas, which are regional organizations that review special education placements, also offer trainings in crisis intervention and restraint procedures. But the regional agencies do not require that special education teachers and aides attend the trainings.

Maureen O’Leary Burness, co-executive director of the Statewide Task Force on Special Education, a group formed in 2013 to study special education and recommend policy changes, characterized crisis prevention and intervention training statewide as “varied” and “inconsistently attended.” Demand for training is strong, she said, with teachers and aides eager to learn skills to help them manage students that have emotional and behavioral disabilities. Most of the trainings are run on the “train the trainer” model, where a few special education employees receive training and go back to their district to train others in what they’ve learned.

But professional development budgets are often constrained, and districts are limited in how much they are able to spend to hire substitutes while teachers are being trained. Some county offices of education, including the Los Angeles County Office of Education, offer training in crisis intervention and prevention at no cost to district staff members. But outside agencies charge districts from $60 to $1,000 a day per person or more for training sessions.

“Cost is absolutely a factor,” Burness said.

The result is a special education system where staff are often ill-prepared to provide the behavioral help their students need, said Jeffrey Hayden, a board certified behavior analyst in Camarillo who consults with districts and private special education schools.

“It’s a complete system failure,” Hayden said. “They are not provided the tools they need to do their job.”

Although the behavioral emergency reports analyzed by EdSource Today can’t tell the full story of why a staff member decided to use restraint or seclusion on a child, and what the long-term effect of that emergency intervention was, the reports provide a rare look at practices that advocates and some education officials consider troubling, and that some teachers consider a misunderstood part of their job. (View a sample of the reports here.)

In one case, a 12-year-old boy at the Jack Weaver School, a private special education school in Murrieta in Riverside County, was held in a series of prone restraints – for 12 minutes, three minutes, three minutes again and then for five minutes – plus a nine-minute standing restraint in an incident in October 2011, according to the behavioral emergency report. The incident began when the boy hit a counselor in the chest with his lunch pail, threw the lunch pail at a parked car, and ran to a moving mail truck in the parking lot and yelled, “Just hit me please!” The student punched one of the aides in the chest and face with full force, the report said.

In another case, a student of unspecified age at TERI Learning Academy, an Oceanside private school for students with developmental disabilities, was restrained three times in a chair with her arms held across her chest in a “basket hold” in June 2012, according to the behavioral emergency report. The incident began when the girl slapped her aide. During an attempt to restrain the girl for the fourth time, the girl fell against a wall, banged her face and cut her mouth, and then kicked several aides and rammed her head against a wall. Four staff members, shielding themselves with pads, then corralled her into the “calm room,” where the 15-minute emergency ended. The girl had two black eyes, a bloody mouth and a lump on her head.

Restraints, including prone restraints, are sometimes unavoidable, said Kathie Merrill, director of the Sierra School of Sonoma County, a nonpublic special education school in Santa Rosa owned by Specialized Education Services Inc., a Pennsylvania company.

“You don’t do a prone unless a student is resisting in such a way that you can’t keep him safe in a lesser way,” Merrill said.

All staff members at the Sierra School must be trained once every two years in a crisis intervention technique known as “Pro-ACT” -– Professional Assault Crisis Training -– created by the company of the same name based in Upland.

“Two days of Pro-ACT is about how to avoid putting your hands on [a student], how to talk a student down, how to respond to a crisis,” Merrill said. A third day is devoted to how to perform physical restraints, including prone restraints, she said.

Training in positive behavior management

But Diana Browning Wright, co-founder of the Los Angeles-based Positive Environments, Network of Trainers, a statewide training organization that receives funds from the California Department of Education, said some trained staff members are quick to use the new physical restraint techniques they’ve learned.

“The problem with restraints is that we train people on them, and then people want to do them, always,” Wright said. “When you’ve taught big, burly guys how to do restraint, it’s hard to get them to do verbal interventions.”

Wright’s work emphasizes understanding the reasons behind a student’s behavior, building a positive relationship with the student and using specifically targeted strategies, such as giving individual attention or offering a snack break. Done correctly by trained staff, these methods can make restraint and seclusion extremely rare events, Wright said.

While student behavior can be very challenging, the key to improving it lies in how educators respond, she said. “It’s about the staff,” Wright said.

In the Twin Rivers Unified School District north of Sacramento, special education aide Martha Penry said her training hasn’t given her the techniques to be effective. “The training I receive for behavior management is to try to redirect their behavior and it doesn’t work – I’ll be frank with you,” she said.

She and co-workers can be at a loss for what to do when a student is hitting or biting them, she said, and restraining students is not allowed in their classroom. “We have no training on what to do in those instances, other than to stand there and take it,” she said. “I have bruises and teeth marks on me.”

Injuries are common for both staff members and students, according to some special education staff. “If you talk to a human resources director, the most common reason special education teachers go out on workman’s compensation is from some kind of injury they got from a student,” said Burness of the Statewide Task Force on Special Education.

Behavior management becomes even more complex when students who have severe behavior issues are placed in classrooms with students who have mild to moderate disabilities. Such placements are an effort to provide the least restrictive educational setting for students, as required by federal disability law. But in some cases, students are placed for months in classrooms where teachers haven’t been trained to address their disabilities, said Pam Makovkin, a special education teacher who for eight years has taught mildly to moderately disabled students in public elementary schools in the Bay Area.

“Restraint is not good,” Makovkin said. “But the problem is a lot deeper: Children are placed in the wrong environment.”

Students who are interested in what they’re learning are likely to stay on task, she said, so using creative teaching approaches is her starting point. “I’m trying to engage their intelligence all the time,” she said.

But she said that in the case of one very bright student, nothing she tried seemed to relieve his bouts of kicking, hitting and yelling – not redirecting him to another task, bribing him with a reward or bringing in a pet lizard for him to learn about. “His was true emotional disturbance – some kind of trauma had happened,” she said. “I don’t have the training for that. Just because I did a 10-week course doesn’t mean I’m an expert on trauma and post-traumatic stress.”

Eventually, the boy was moved to a more therapeutic setting, she said.

But in another classroom for students with mild to moderate disabilities, a 5th-grade boy with serious emotional disabilities repeatedly banged his head against a metal file cabinet and wouldn’t stop. His teacher called on Makovkin many times to help her restrain the boy, face down, lying on the ground in a prone restraint. “I know it’s traumatic for the child,” she said. “I wish people would understand it really is horrible for the teacher as well.”

Reducing the use of restraint and seclusion requires both training and a culture change, said Darlene Garcia, principal of Casa Pacifica Centers for Children and Families, which operates a private special education school in Camarillo. Some staff members objected a few years ago when the school turned the seclusion room into a “multi-sensory de-escalation room” where students can climb on gym structures to calm themselves down. Some teachers felt they couldn’t manage the students without the seclusion room, she said.

“We stuck by the decision,” and some teachers quit, she said.

Rather than crisis intervention training, many behavioral experts and educators say schools would be better off investing in a prevention strategy known as Schoolwide Positive Behavioral Interventions and Supports, a framework that outlines tiers of interventions and uses a database to track behavioral improvement. Widespread agreement exists among behavioral experts and school administrators that the framework is the most effective way to keep restraint and seclusion incidents to a minimum, according to the American Association of School Administrators, a Virginia-based national professional organization.

“However, this system can be expensive to implement,” because it requires school-wide trainings, consultations with behavioral experts and behavior data tracking systems, wrote Sasha Pudelski, assistant director of policy and advocacy at the administrators association, in a 2013 article for her organization.

In the Mt. Diablo Unified School District, aides want to receive training in behavior management and crisis intervention, said Lorien Quirk, behaviorist program manager with the district. Staff that work in the district’s mental health collaborative are required to receive Pro-ACT training, she said, but aides who work with students with other severe disabilities, including autism, are not.

“They need a lot more training than we’re able to give them,” she said. Aides take a four-hour Introduction to Special Education class and learn strategies from staff trained in behavior modification techniques who spend one to two hours a week in the classroom, she said.

In making her typical rounds visiting special education classrooms, Quirk said she was surprised one day in 2012 to find a 6th-grade boy with Down syndrome running through the classroom, tipping over desks and ripping papers off the wall. When the boy began moving toward the teacher’s computer, Quirk believed he “would have been capable of picking it up and throwing it.”

The teacher “had absolutely no control over the class,” said Quirk, and the aides “had no idea how to redirect him.”

Quirk and a staff member took over, starting by sending the other students out of the room. They placed the boy in a chair and held his arms across his chest until he stopped struggling, said Quirk, who has gone through the Pro-ACT training.

Afterwards, Quirk drew up a plan for rewarding the student for completing certain tasks, a strategy she hoped would help the classroom staff work productively with him. “That was a tough year for that kid,” she said.

She recalled the restraint incident with some chagrin. “A poorly managed classroom is the root of it,” she said. “None of this was really his fault.”

Denise Keller, a member of the leadership team of Positive Environments, Network of Trainers, sees a path to reducing restraint and seclusion, and improving academic achievement in special education. “What we can do is keep training,” she said.

This story was reported as part of the California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School of Journalism.