Restraint and seclusion use in U.S. School settings: Recommendations from allied treatment disciplines.

Abstract

Restraint and seclusion (R&S) are high risk, emergency procedures that are used in response to perceived violent, dangerous situations. They have been employed for years in a variety of settings that serve children, such as psychiatric hospitals and residential treatment facilities, but are now being recognized as used in the public schools. The field of education has begun to examine these practices in response to national scrutiny and a Congressional investigation. The fields of mental health and child welfare were similarly scrutinized 10 years ago following national media attention and have advanced R&S practice through the adoption of a prevention framework and core strategies to prevent and reduce use. A review of the evolution of the national R&S movement, the adverse effects of these procedures, and a comprehensive approach to prevent their use with specific core strategies such as leadership, workforce development, and youth and family involvement in order to facilitate organizational culture and practice change are discussed. Proposed guidelines for R&S use in schools and systemic recommendations to promote R&S practice alignment between the child-serving service sectors are also offered.

Promoting Inclusion Through Evidence-Based Alternatives to Restraint and Seclusion

“…The responsibility to implement effective practices should not be placed on the shoulders of local educators alone. Rather, federal, state, district, and building decision makers must work to establish the professional capacity to make these schools more effective learning environments for all students (Freeman & Sugai, 2013;LeBel et al, 2012). The policies and procedures reported in this article offer an important reference point for the field.…”

“…There are several factors that may contribute to the likelihood that restraint and seclusion will be used in school settings, including (a) the inclusion of students with significant emotional and behavioral needs in general education settings, (b) the lack of specialized support for students in these settings, and (c) the limited training provided to teachers and school staff to address intensive behavior support needs (LeBel, Nunno, Mohr, & O'Halloran, 2012). While restraint and seclusion continue to be used in school settings, there is a paucity of data supporting the effectiveness of these procedures to improve behavior (Curie, 2005).…”

The Restraint and Seclusion of Students With a Disability: Examining Trends in U.S. School Districts and Their Policy Implications

“…Many consider the use of restraint and seclusion on students to be generally ineffective (LeBel, Nunno, Mohr, & O’Halloran, 2012; May, 2011; NDRN, 2010; Westling, Trader, Smith, & Marshall, 2010). The physical nature of restraint and seclusion may actually reinforce nonsocial aggression in students (May, 2011).…”

Evaluation of a Program Model for Minimizing Restraint and Seclusion

“…Hence, researchers and practitioners have attempted to reduce restraint. For example, LeBel et al (2012) reported that restraint and seclusion are used on children, adolescents, and youth in residential and educational settings and that these practices are traumatizing and dangerous to both the children and staff involved in each incident. In a study by Borckardt et al (2011), a reduction of restraint and seclusion was achieved in an inpatient psychiatric hospital and Campbell et al (2008) found a slight increase in the use of restraint when restraint training was provided to professionals.…”

“…Restraint and seclusion traditionally have been used to interrupt or contain harmful behavior or to decrease the frequency of behavior in the future (Jones and Timbers 2002;LeBel et al 2012;Luiselli 2009). Restraint, by definition, limits mobility of parts of the body through the use of a manual method, a physical or mechanical device, material, or equipment (Mohr et al 2010); and seclusion is defined as confinement when a patient is physically prevented from leaving a room where the person is alone without the presence of others (National Council for Behavioral Health 2006).…”