The Case of Restraint

Disclaimer:  There are exceptions to every rule.  Children and adults with disabilities are people with their own individual needs and desires.  The ideas and advice given in this blog are for your consideration only and should not be taken as legal, medical or educational advice, as every single situation is different.

I’m about to write an unpopular post.

I know it will be unpopular.  However, when I started this journey, I vowed to speak truths, not vie for a popularity contest.

Remember, I’ve sat on all sides of the table…parent of a child with disabilities, special ed teacher, advocate, assistant principal in a school with self contained classrooms for children with severe emotional disabilities, and as a special education district administrator.

I ask that you hear me out on this one.  

Max Benson was a beautiful 13 year old boy that died at the hands of inept, horrible educators.  He was restrained ON THE FLOOR for an hour and 45 minutes.  AN HOUR AND 45 MINUTES!!!!  What in the actual…I just can’t…I can’t even.  This baby urinated on himself and vomited during the restraint.  This situation makes my heart ache.

https://www.dailymail.co.uk/news/article-7682031/School-workers-charged-manslaughter-autistic-student-died-restrained.html?ns_mchannel=rss&ns_campaign=1490&ito=1490

I’ve worked with many, many children with extreme emotional disabilities.  I have been trained in safe physical restraint and have trained hundreds of staff members in safe physical restraint.  It’s something that should be taken very seriously and should be done with extreme caution.

Apparently, not everyone understands this.  Not everyone was trained to understand the dangers of putting their hands on a child.  Or, maybe they were trained and just didn’t care, I don’t know which.  But I know that what these people did to this boy is horrendous and it hurts me to think about his tragic end.

Many schools will now turn to a hands off approach.  Many teachers will say, no way am I touching a child…look what happened.  Instead of using this tragedy as a learning experience, many will go completely in the opposite direction.  I understand.  I get the fear.

When I was a trainer, I told my staff this…”Every time you put your hands on another person to restrain them, you are risking their life and yours.  Remember that.  We only do this when ABSOLUTELY necessary.  When someone is in such danger of hurting themselves or someone else that there is no other option.”

We don’t restrain because a kid is trashing a room.  We don’t restrain if a kid spits on you.  We don’t restrain if a kid hits you and walks away.    And this, this is the problem.  Judgement.  People have to use their best judgement.  And sometimes people’s judgement sucks!  I once had a teacher WANT to restrain a child because he was throwing books because technically he could hurt himself IF HE BROKE A WINDOW.  He wasn’t even throwing books at the window!  She was promptly asked to leave the room and we had a long conversation after.

I become afraid when schools say they are completely hands off.  There are times when it is necessary to provide some sort of restriction.  You may not like to hear that, but it is truth.  When we aren’t training staff to safely and professionally provide this intervention, they will use their own means and that’s when we have problems.

Let me share a couple of instances with you, my personal experiences as an administrator and teacher.  I will, of course, not use the student’s real names.

  1.  Mike was a 6 year old student.  He had experienced so much trauma in his young life.  He was brilliant.  He was a wonderful student.  He entered rages often.  We had an intensive behavior plan in place and met with his dad every 6 weeks or so.  He was under psychiatric care and involved in therapy outside of school.  One day, he began to rage.  It was fierce.  He wanted to die.  He knew how.  He had a plan.  At some point, he decided he wanted to eat himself.  Literally.  We had called his dad and he was on his way.  We were doing all we could to not restrain him…because she was sitting down and we NEVER restrain when a child is sitting or laying.  We essentially just tried to block his hands every time they went to his mouth.  He was fast and bit himself good several times.  When dad arrived, he was so out of control.  He began to run to the corners of the room and bite deep into his flesh. In tears, dad looked at me and asked me to restrain him until he could calm down.  I did.  It took 7 minutes for him to regain rationality and begin to breathe deeply.  We released him and he was calm enough to draw, a coping strategy and was able to return to class.  Without restraint, he could have really harmed himself and may have required serious medical attention.
  2. Karen was a 5th grade girl.  She was a larger girl and new to our school.  We hadn’t determined her triggers yet.  Her parents were wonderful and met with us often to discuss her needs.  One day, Karen decided she hated the teacher and the Smartboard.  She began throwing chairs and desks at the Smartboard.  We cleared the room of other students and 3 staff members remained.  We did not restrain…property can be replaced.  We used proxemics (body positioning) to force her to move away from the technology.  Most kids don’t want to be next to their teachers when they are this angry, so simply putting our bodies in front of the Smartboard was enough for her to decide to move away.  She quickly found another target, the bookshelves.  She dumped all of the bookshelves and the desks in the room.  She started screaming that she wanted to die.  She began to run into the wall and decided to lay down and began to cry.  Often times, crying is a sign of de-escalation.  As staff began to relax, Karen jumped up and bolted for the door.  She yelled that she was ready to die.  With staff close behind, she leapt for the stairs.  She missed.  In my attempt to ensure she didn’t go head first down the stairs, I jumped over her and put my body in front of hers.  She twisted around and with all of her might, pulled back and kicked me, boots and all, right in the face.  I saw stars.  I had to go to the hospital.  Should I have restrained sooner?  She could have really hurt herself.  If she had made it to the stairs, it could have been fatal.  It was a judgement call that I made.
  3. Peter was a 4th grade boy with autism.  He often spoke of killing himself when he was enraged.  But, he was typically very passive and parents and outside therapists were confident these statements were just scripting.  We knew his triggers and were working with him to help him overcome the challenges he struggled with.  Peter’s parents went on vacation and he was distraught.  He was angry and scared and his world had been turned completely upside down.  We had prepared him the best we could.  We had a social story, discussions, 1:1 social work time and parents had talked about it at home too.  On this day, Peter began to scream that he wanted to die.  He began pacing which is a sign of heightened anxiety and we attempted to alleviate the anxiety and intervene prior to his burst of emotion.  We were not successful.  The change at home was just too much for Peter.  We asked him if he wanted a few moments of quiet and he answered affirmatively, so we sent the other students with an aide, on an errand.  When they left, Peter escalated quickly.  At one point, he began thrusting his head into a concrete wall.  Over and over again.  We quickly moved in front of that wall and he found another.  Then another.  We lined the wall with a mat from the gym and he moved to another wall.  We just couldn’t keep him safe at that point and if he was successful at making contact with the wall, at his rate of speed, he could have hurt himself badly.  We restrained him, as trained.  It lasted about 4 minutes.  His rate of breathing returned to normal and his muscles were less tense.  We released him and he laid down.  He told us he was sad about his parents and we worked through it.

See, restraint should never be used as a punishment or a consequence for behavior.  Restraint should ONLY be used in situations where without restraint, the person or the people around them would be harmed.

I trained staff for 6 years.  Our district used CPI’s program, Non-violent Physical Crisis Intervention.  One of the hardest things for staff to understand was that physical intervention was to keep people safe and that was the only time it should be used.

The district I worked in was strict.  As an educator, I was fierce in my belief that we are only intervening physically when we have no option to keep people safe.  I have had rooms trashed so bad that they were unrecognizable.  Bulletin boards ripped to shreds, book libraries urinated on, technology broken, but still I would not put my hands on a child unless he was self harming or hurting someone else.

Here’s the thing.  Sometimes not restraining is way more dangerous than someone who has been well trained performing a safe physical restraint.  Look at the three students I told you about.  This happens all the time, all over America.  Mental health services are poor in our country.  Children need more help than they are getting.  That’s another post, but the rate children are being dx compared to the available support is appalling!

Instead of saying, absolutely, not a chance do I want a part of any program that could possibly restrain my child, maybe look at the bigger picture.  For one thing, it may not be your child who has lost control.

What if a child loses it in the middle of class and picks up a desk and say he’s going to harm your child?  You’re gonna want a staff that is trained to safely handle the situation.

As a parent, it’s important for you to ask some questions and some ideas as to what you should expect.

  1.  How are staff trained in safe physical restraint and verbal de-escalation? What program are staff trained in and how is continuing education and training provided?  This should be something that teachers and administrators should know without hesitation.  If they say, I’m not sure, let me check, there’s a problem.  In the district where I worked, everyone knew the name of the program, who did the training, when trainings were and who to talk to if they had questions.
  2. What is the protocol in the event of a situation that results in a physical restraint? This should be easy.  The answer should not come with hesitation.  There should be a protocol.  Some schools have a crisis team that has experience and special training.  I always called a nurse to be a fourth set of eyes, if it was going on longer than just a couple of minutes, to make sure the child wasn’t experiencing any distress.  Whatever the system, there should absolutely be one and everyone involved should know it.
  3. How will I know if there is a restraint situation involving my child?  You should be contacted.  You should get a written report and also a phone call.  If this isn’t their practice, insist it be done.
  4. When would you consider restraining my child?  Ask for scenarios.  Share your child’s behaviors and ask how they would be handled.
  5. When a restraint is necessary, how do you know when to release the child?  Correct answers would include things like:
    -The child can answer questions rationally (when is your birthday, what is your favorite holiday, etc.)
    -Breathing returns to normal
    -Muscles feel less tense
    -The restraint is not strained, yet more relaxed
  6. Who is typically involved in a restraint situation?  Again, the team should easily be able to tell you.  I always like to hear things like:  social worker, administrator, teacher, aide, etc.  At least two people, preferable three and I usually had a nurse in at some point.  Also, the team could shift based on the student’s needs.  If the social worker triggers the student, for whatever reason, they should not be part of the team  This is solely for deescalation.  We are not teaching at this point.  We just want to calm the child and keep everyone safe.
  7. What happens after a safe physical restraint?  The correct answer is that the child is able to return to class and the team convenes to debrief.  What happened?  What was the trigger?  Was the restraint necessary?  What could we have done different?  How can this be avoided next time?

While physical restraint is not fun for anyone, there are times where it is used to keep our kids safe and when used appropriately can help avoid more dire situations.

Note that a safe physical restraint should not be painful.  It may be uncomfortable because movement is restricted, but actual pain shouldn’t occur.

I had a 3rd grade boy who, we learned, craved physical restraint.  He would escalate so high until we would restrain him and he would then just melt into us.  It took us a couple of months, but we finally figured out that he was seeking the deep pressure that he felt when he was in a hold.  So, we replaced that BEFORE he escalated so we could avoid it in the future.  He didn’t know that’s what he was seeking, but when we gave it a name, he used it.  When he was feeling disregulated, he would yell “squeeze”!  We first started with a bear hug, moved to a squeeze machine and worked to teach him to give himself deep pressure squeezes.

My point is that if a child is in pain, the staff is not doing it right.

This is such a touchy subject.  I hope that every school in America sent the article about Max to every single one of their staff members.  Educators MUST understand the ramifications of their actions.  They must maintain control of their emotions.  Districts must monitor staff response to crisis and provide frequent training.

We cannot allow what happened to Max to ever happen to another child…ever.

And, for the record, my son’s school knows that if he is self harming and needs to be restrained to stop the harm, they have my support.

What happened to Max should NEVER have happened!  As someone who has been involved in this for many years, I just can’t understand how this happened.

Be involved.  Ask questions.  Make decision.

~C

Please follow my Facebook page at https://www.facebook.com/Livingalifeofintent

Disclaimer:  There are exceptions to every rule.  Children and adults with disabilities are people with their own individual needs and desires.  The ideas and advice given in this blog are for your consideration only and should not be taken as legal, medical or educational advice, as every single situation is different.

 

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