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Stopping Abusive Restraint and Seclusion Use in School - Making it Happen in 2010 - HB 81 – Rep. Dorothy Hukill SB 2118 - Sen. Andy Gardiner
September 19, 2009, 10:33 pmStopping Abusive Restraint and Seclusion Use in School
Making it Happen in 2010
HB 81 – Rep. Dorothy Hukill SB 2118 - Sen. Andy Gardiner
Current Florida law protects children and adults with disabilities in licensed facilities and contracted programs from abusive restraint and seclusion, but fails to provide the same protections to children with disabilities in schools.
Research shows that physical force, immobilization, and isolation are dehumanizing and escalate behaviors.
Restraint and seclusion should not be viewed as treatment options but rather as treatment failures.
Restraint and seclusion risks lives and inflicts emotional and physical trauma.
Children with trauma histories are often re-traumatized when subjected to restraint and seclusion. Trauma is exacerbated for students with low cognitive ability, communication difficulties, and/or moderate to severe emotional disabilities.
Research shows that trauma and retraumatization significantly increase the risk of mental health problems, difficulties with social relationships and behavior, physical illness and poor school performance.
Abusive Use of Restraint and Seclusion
Seclusion and restraint refer to crisis interventions in which a student is isolated from others (seclusion) or physically held (restraint).
Seclusion and restraint are susceptible to misapplication and abuse placing students at equal or more risk than their problem behavior.
Seclusion and restraint are inappropriately used for behaviors that do not place the student or others at risk of harm or injury (e.g., noncompliance, threats, disruption, manifestations of the disabilities).
Students, peers, and/or staff are more likely to be injured during attempts to restrain or place into seclusion.
Risk of injury increases when staff members are not adequately trained.
Use of seclusion and restraint may inadvertently reinforce the problem behavior.
Most Dangerous Practices
In Florida, several people with disabilities died because of suffocation during prone restraint. Investigations into these deaths prompting Sen. Baker and Campbell and Rep. Galvano to sponsor and pass reform in 2006 covering practices in most licensed and regulated settings serving people with disabilities. See the Advocacy Center’s Restraint and Seclusion on Persons with Disabilities Executive Office of the Governor Submission dated March 31, 2006. In addition, see the staff analysis associated with SB 2662 (2006).
Schools are routinely using prone restraint.
Inappropriate use of mechanical restraint in schools is also widespread. For example, frequently teachers and staff “secure” children with disabilities into their chairs for hours at a time to control their behavior. This deprivation of freedom of movement is not “treatment” and is not an acceptable behavioral support practice. Restraint use for the purpose of staff convenience is highly inappropriate. Sometimes, mechanical restraint is implemented through the abusive use of orthopedic and medical supports, such as Rifton Chairs.
Seclusion - confining and isolating children - can cause a myriad of negative emotional reactions, including feelings of fear, anger, anxiety, boredom, confusion, embarrassment, depression, humiliation, abandonment, loneliness, sadness, loss of dignity, powerlessness, helplessness, despair, and delusion.
Lack of Parental Notification and Involvement; Insufficient Focus on Debriefing and Prevention; Need for Trauma Prevention and Treatment
Inadequate documentation and failure to notify parents is commonplace.
Failure to use data to analyze and address the cause of the behavior is also common.
Most behaviors currently used to justify seclusion and restraint could be prevented with early identification and intensive early intervention.
Schools do not routinely conduct necessary debriefings after each restraint and seclusion event.
Parents see behavioral changes at home linked to the trauma of restraint and seclusion experienced by their children. They observe typical signs and symptoms of abuse as well as other serious changes, but are often not notified about the precipitating event – the use or restraint or seclusion.
Failure to notify parents is both inappropriate and harmful. When parents are not involved in supporting their children after a restraint or seclusion, the children are at risk of additional trauma. Moreover, lack of parental notification denies the children their natural advocates in the process of evaluation of the children’s functional behavioral assessments and positive behavior intervention plans.
Signs, symptoms and reported changes include:
o Escalation of behaviors at school; behaviors at home where there were none before
o Easily startled; easily cries
o Not wanting to leave the house
o Not wanting to be touched or having anyone get too close to them
o Sleep problems, nightmares, bed wetting
o Loss of interest in things that use to be enjoyable to him/her
o Loss of appetite; other sudden changes in behavior or school performance
o New learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes
o Watchfulness, as though preparing for something bad to happen
o Becoming overly compliant, passive, or withdrawn
o Not wanting to go back to school and fear of school
o Fear of being alone or left alone in a room
o Unexplained bruises, broken bones, or abrasions
o Attempted suicide
THE SOLUTION - HB 81
Promote respect and dignity for all – students, families and school employees.
Focus on prevention, reduction and regulation of use of restraint and seclusion.
Prohibit dangerous practices (for example, prone restraint, supine restraint, mechanical restraint and seclusion prohibited).
Permit manual physical restraint only when an imminent risk of serious injury or death exists.
Ensure positive behavior intervention plans.
Promote trauma informed environments that provide for the physical safety and security of students and staff.
Ensure freedom from the abusive and unnecessary use of seclusion or restraint in the public schools.
Promote ongoing reduction of the use of manual physical restraint in the public schools.
Ensure parental involvement and reporting.
Improve staff training.
For more information contact:
Phyllis Musumeci, Palm Beach County Sylvia W. Smith or Dana L. Farmer
Florida Families against Restraint and Seclusion Public Policy Coordinators
familiesagainstrestraint@yahoo.com
Advocacy Center for Persons
cvm514@bellsouth.net with Disabilities, Inc.Sylvias@advocacycenter.org
850-322-2258 (Sylvia) 850-264-9230 (Dana) Danaf@advocacycenter.org
Susan K. Goldstein
Susan Goldstein Consulting, Inc.
954-830-6300
skgoldstein@hotmail.com
Making it Happen in 2010
HB 81 – Rep. Dorothy Hukill SB 2118 - Sen. Andy Gardiner
Current Florida law protects children and adults with disabilities in licensed facilities and contracted programs from abusive restraint and seclusion, but fails to provide the same protections to children with disabilities in schools.
Research shows that physical force, immobilization, and isolation are dehumanizing and escalate behaviors.
Restraint and seclusion should not be viewed as treatment options but rather as treatment failures.
Restraint and seclusion risks lives and inflicts emotional and physical trauma.
Children with trauma histories are often re-traumatized when subjected to restraint and seclusion. Trauma is exacerbated for students with low cognitive ability, communication difficulties, and/or moderate to severe emotional disabilities.
Research shows that trauma and retraumatization significantly increase the risk of mental health problems, difficulties with social relationships and behavior, physical illness and poor school performance.
Abusive Use of Restraint and Seclusion
Seclusion and restraint refer to crisis interventions in which a student is isolated from others (seclusion) or physically held (restraint).
Seclusion and restraint are susceptible to misapplication and abuse placing students at equal or more risk than their problem behavior.
Seclusion and restraint are inappropriately used for behaviors that do not place the student or others at risk of harm or injury (e.g., noncompliance, threats, disruption, manifestations of the disabilities).
Students, peers, and/or staff are more likely to be injured during attempts to restrain or place into seclusion.
Risk of injury increases when staff members are not adequately trained.
Use of seclusion and restraint may inadvertently reinforce the problem behavior.
Most Dangerous Practices
In Florida, several people with disabilities died because of suffocation during prone restraint. Investigations into these deaths prompting Sen. Baker and Campbell and Rep. Galvano to sponsor and pass reform in 2006 covering practices in most licensed and regulated settings serving people with disabilities. See the Advocacy Center’s Restraint and Seclusion on Persons with Disabilities Executive Office of the Governor Submission dated March 31, 2006. In addition, see the staff analysis associated with SB 2662 (2006).
Schools are routinely using prone restraint.
Inappropriate use of mechanical restraint in schools is also widespread. For example, frequently teachers and staff “secure” children with disabilities into their chairs for hours at a time to control their behavior. This deprivation of freedom of movement is not “treatment” and is not an acceptable behavioral support practice. Restraint use for the purpose of staff convenience is highly inappropriate. Sometimes, mechanical restraint is implemented through the abusive use of orthopedic and medical supports, such as Rifton Chairs.
Seclusion - confining and isolating children - can cause a myriad of negative emotional reactions, including feelings of fear, anger, anxiety, boredom, confusion, embarrassment, depression, humiliation, abandonment, loneliness, sadness, loss of dignity, powerlessness, helplessness, despair, and delusion.
Lack of Parental Notification and Involvement; Insufficient Focus on Debriefing and Prevention; Need for Trauma Prevention and Treatment
Inadequate documentation and failure to notify parents is commonplace.
Failure to use data to analyze and address the cause of the behavior is also common.
Most behaviors currently used to justify seclusion and restraint could be prevented with early identification and intensive early intervention.
Schools do not routinely conduct necessary debriefings after each restraint and seclusion event.
Parents see behavioral changes at home linked to the trauma of restraint and seclusion experienced by their children. They observe typical signs and symptoms of abuse as well as other serious changes, but are often not notified about the precipitating event – the use or restraint or seclusion.
Failure to notify parents is both inappropriate and harmful. When parents are not involved in supporting their children after a restraint or seclusion, the children are at risk of additional trauma. Moreover, lack of parental notification denies the children their natural advocates in the process of evaluation of the children’s functional behavioral assessments and positive behavior intervention plans.
Signs, symptoms and reported changes include:
o Escalation of behaviors at school; behaviors at home where there were none before
o Easily startled; easily cries
o Not wanting to leave the house
o Not wanting to be touched or having anyone get too close to them
o Sleep problems, nightmares, bed wetting
o Loss of interest in things that use to be enjoyable to him/her
o Loss of appetite; other sudden changes in behavior or school performance
o New learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes
o Watchfulness, as though preparing for something bad to happen
o Becoming overly compliant, passive, or withdrawn
o Not wanting to go back to school and fear of school
o Fear of being alone or left alone in a room
o Unexplained bruises, broken bones, or abrasions
o Attempted suicide
THE SOLUTION - HB 81
Promote respect and dignity for all – students, families and school employees.
Focus on prevention, reduction and regulation of use of restraint and seclusion.
Prohibit dangerous practices (for example, prone restraint, supine restraint, mechanical restraint and seclusion prohibited).
Permit manual physical restraint only when an imminent risk of serious injury or death exists.
Ensure positive behavior intervention plans.
Promote trauma informed environments that provide for the physical safety and security of students and staff.
Ensure freedom from the abusive and unnecessary use of seclusion or restraint in the public schools.
Promote ongoing reduction of the use of manual physical restraint in the public schools.
Ensure parental involvement and reporting.
Improve staff training.
For more information contact:
Phyllis Musumeci, Palm Beach County Sylvia W. Smith or Dana L. Farmer
Florida Families against Restraint and Seclusion Public Policy Coordinators
familiesagainstrestraint@yahoo.com
Advocacy Center for Persons
cvm514@bellsouth.net with Disabilities, Inc.Sylvias@advocacycenter.org
850-322-2258 (Sylvia) 850-264-9230 (Dana) Danaf@advocacycenter.org
Susan K. Goldstein
Susan Goldstein Consulting, Inc.
954-830-6300
skgoldstein@hotmail.com
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