Calm Down or Else

By BENEDICT CAREY
Published: July 15, 2008
International Herald Tribune
http://www.iht.com/articles/2008/07/15/healthscience/15restraint.php

The children return from school confused, scared and sometimes with bruises on their wrists, arms or face. Many won’t talk about what happened, or simply can’t, because they are unable to communicate easily, if at all.

“What Tim eventually said,” said John Miller, a podiatrist in Allegany, N.Y., about his son, then 12, “was that he didn’t want to go to school because he thought the school was trying to kill him.”
Dr. Miller learned that Tim, who has Asperger’s syndrome, was being unusually confrontational in class, and that more than once teachers had held him down on the floor to “calm him down,” according to logs teachers kept to track his behavior; on at least one occasion, adults held Tim prone for 20 minutes until he stopped struggling.

The Millers are suing the district, in part for costs of therapy for their son as a result of the restraints. The district did not dispute the logs but denied that teachers behaved improperly.

For more than a decade, parents of children with developmental and psychiatric problems have pushed to gain more access to mainstream schools and classrooms for their sons and daughters.

One unfortunate result, some experts say, is schools’ increasing use of precisely the sort of practices families hoped to avoid by steering clear of institutionalized settings: takedowns, isolation rooms, restraining chairs with straps, and worse.

No one keeps careful track of how often school staff members use such maneuvers. But last year the public system served 600,000 more special education students than it did a decade ago, many at least part time in regular classrooms. Many staff members are not adequately trained to handle severe behavior problems, researchers say.

In April, a 9-year-old Montreal boy with autism died of suffocation when a special education teacher wrapped him in a weighted blanket to calm him, according to the coroner’s report. Two Michigan public school students with autism have died while being held on the ground in so-called prone restraint.

Michigan, Pennsylvania and Tennessee have recently tightened regulations governing the use of restraints and seclusion in schools. California, Iowa and New York are among states considering stronger prohibitions, and reports have appeared on blogs and in newspapers across the country, from The Orange County Register to The Wall Street Journal.

“Behavior problems in school are way up, and there’s good reason to believe that the use of these procedures is up, too,” said Reece L. Peterson, a professor of special education at the University of Nebraska. “It’s an awful combination, because many parents expect restraints to be used — as long as it’s not their kid.”

Federal law leaves it to states and school districts to decide when physical restraints and seclusion are appropriate, and standards vary widely. Oversight is virtually nonexistent in most states, despite the potential for harm and scant evidence of benefit, Dr. Peterson said.

Psychiatric facilities and nursing homes are generally far more accountable to report on such incidents than schools, experts say.

In dozens of interviews, parents, special education experts and lawyers who work to protect disabled people said they now regularly heard of cases of abuse in public schools — up to one or two a week surface on some parent e-mail lists — much more often than a decade ago.

“In all the years I went to school, I never, ever saw or heard of anything like the horrific stories about restraint that we see just about every day now,” said Alison Tepper Singer, executive vice president of Autism Speaks, a charity dedicated to curing the disorder.

The issue is politically sensitive at a time when schools have done a lot to accommodate students with special needs, and some have questioned whether mainstreaming has gone too far.

“Some parent organizations, they’re so grateful to the schools that their kids have been mainstreamed that they don’t want to risk really pushing for change,” said Dee Alpert, an advocate in New York who reports on the issue in the online journal specialeducationmuckraker.com.

For teachers, who have many other responsibilities — not least, to teach — managing even one child with a disability can add a wild card to the day.

“In a class of 30 to 35 children, there’s a huge question of how much safety or teaching a teacher can provide if he or she is being called on to calm or contain a student on a regular basis,” said Patti Ralabate, a special education expert at the National Education Association.

“The teacher is responsible for the safety of all the children in the classroom.”

The line between skillful conflict resolution and abuse is slipperier than many assume. Federal law requires that schools develop a behavioral plan for every student with a disability, which may include techniques to defuse the child’s frustration: a break from the class, for instance, or time out to listen to an iPod.

But in a hectic classroom, children with diagnoses like attention deficit disorder, anxiety or autism can seemingly become defiant, edgy or aggressive on a dime — and the plan, if one exists, can go straight out the window, investigations have found. Even defying a teacher’s instructions — “noncompliance” — can invite a takedown or time alone in a locked room, they found.

In an extensive report published last year, investigators in California documented cases of abuse from districts in the San Francisco Bay Area, the suburbs of Los Angeles and in the rural northeastern part of the state.

During the 2005-6 school year, an 8-year-old with a diagnosis of attention deficit disorder and mild mental retardation was repeatedly locked in a “seclusion room” alone, adjacent to the classroom — at least 31 times in a single year. His parents heard about it from another parent, who saw the boy trying in vain to escape.

In another school, a teacher held a 12-year-old with a diagnosis of attention deficit disorder “face down on the floor, straddling him at his hips, and holding his hands behind his back,” according to the investigation, which was done by California’s office of protection and advocacy. Congress established such offices in each state in the 1970s to protect the rights of the disabled.

Leslie Morrison, director of investigations at the California office, said parents often complained about such episodes but were usually reluctant to cooperate with an investigation. “They’re afraid the school will retaliate,” she said.

And the children, who have an array of psychiatric diagnoses, from attention deficit to autism, often do not understand what is happening or why. “They just think they did something wrong and are being punished,” Ms. Morrison said. “Many of them are not verbal at all and can’t even tell their parents.”

In Tim Miller’s case, school logs obtained by his father illustrate how quickly a situation can escalate, regardless of behavior plans. In one entry, dated March 18, 2005, a teacher wrote:

“Tim was screaming down the hall. He ran past me and began to double his fist to punch the locker. At this point I scooped my arm underneath his and directed him into my room.”

After the boy continued to struggle, this teacher and another “laid him onto the mat, where he was held approximately 20 minutes,” the log said.

Tim, now 15, graduated from the school last year and in June completed his first year of high school, excelling in a variety of mainstream classes without incident. In a telephone interview, he said he no longer thought much about the takedowns.

“I just think now that they were idiots to do that,” he said. “I remember telling my mom to pray to God that they wouldn’t keep doing it, and wishing the other kids would see what was happening.”

When a school has a so-called zero tolerance approach to bad behavior, it often does makes a public spectacle of controlling a child’s behavior, said several parents interviewed for this article.

Kathy Sexton, who lives near Dallas, had to pick up her 11-year-old son, Anthony, who has a diagnosis of attention deficit disorder, at the police station, after school staff members had the boy hauled away in handcuffs for cursing at a teacher.

“I didn’t hear about it for hours and had to go get him at jail,” Ms. Sexton said in a phone interview. “He was hysterical, obviously, and he’s had his ups and downs since then. It’s hard to know what a thing like that does to a child that age.”

Several companies offer programs to teach so-called de-escalation techniques to school staff, and a scattering of schools have developed model programs to pre-empt confrontations, and defuse them when they happen.

But experts say that until policymakers and schools adopt standards, on exactly which techniques are allowed and when, children with behavior problems will in many districts run the risk of being forcibly brought into line.

Dr. Peterson, the Nebraska professor, illustrates the challenges by citing two recent cases in Iowa. In one, the parents of an 11-year-old who died while being held down called for a ban on restraints; in the other, parents charged that a school failed their son by not restraining him. The boy ran away and drowned.

“It’s damned if you do, damned if you don’t,” Dr. Peterson said, “and it reflects the level of confusion there is about this whole issue.”

Some California Schools Locking Children In Closets

Jun 27, 2008 12:19 am US/Pacific
Anna Werner

(CBS 5) Locking children in closets doesn't sound like something that could possibly happen in California's school system. But CBS 5 Investigates has uncovered evidence that it is a hidden problem, not reported by schools, and unknown to many parents.

A closet in a classroom that brings the memories back for a student we will call Chris.

"The door is closed, it's totally dark. There is a little tiny beam of light that comes under the door, but that's it." Chris told CBS 5 Investigates. When he was asked if he was trapped, he responded, "Pretty much."

Chris was a 6th grader at Mendenhall Middle School in Livermore. Despite his high IQ, behaviors resulting from a diagnosis of ADHD landed him in a special education class. He quickly discovered that anything considered 'misbehavior', like getting up out of your chair or not completing class assignments meant a trip to the closet.

"You really don't understand what it's like until you actually go through it," Chris said.

He says he was put in the "Quiet Room" a lot, and there was no getting out. "They would sit on the door so you couldn't get out and then sometimes they would put a chair up against the door," Chris recalled. "I sat in there for a whole school day one time."

And once, he tried to resist going in and a teacher got physical.

"He twisted my arm up behind my back and then he just pushed me and I hit the wall pretty hard," Chris said. "I felt intimidated kind of, because I mean he is bigger than me and he knows that."

How can that happen? Most parents can't imagine it: Their child shut into a room, sometimes as small as a closet. Under California law, it's only supposed to happen if the child is a danger to themselves or others. But advocates tell CBS 5 Investigates it's happening far more frequently than that.

Leslie Morrison is an investigator with Protection and Advocacy Inc., a non-profit that works with the disabled. "I think it's an enormous problem," she said. "In all of the cases that we investigated, the underlying incident that triggered restraint and seclusion is non-compliance with staff direction. They didn't do what the teacher asked them to do."

For example, there is a fenced area that looks kind of like a dog run at the John F. Kennedy School near Modesto. A U.S. Department of Education investigation found children were left here without access to a toilet, water or food, even some who had medical conditions including diabetes, seizures and asthma.

"Seclusion is very psychologically traumatizing, especially for children. Children fear being locked in a closet," Morrison said.

And it's not just seclusion. Morrison said teachers also sometimes physically restrain children improperly. Such as a 6-year-old who came home with duct tape on his clothing. It was used to literally tie him into a chair at a school in Southern California.

And staff at many schools also engage in so-called "take downs." Morrison said, "The most common one is face down on the floor and then you lean into their back or sides so that they can't breathe."

But Morrison said without proper training, "As the child is struggling to breathe the person is holding them down on the floor to stop the struggling. And what happens is you actually stop them breathing."

Morrison's group is backing SB 1515, legislation by California State Senator Sheila Kuehl that would limit restraints and ban seclusion. But some who work in the field oppose it.

Carroll Schroeder heads the California Alliance of Child and Family Services, a lobbying group for non-profit providers which opposes SB 1515. "If and when the time comes, you need to have at least those two options available to you," Schroeder said. "If those kids don't have that option of that room, either the schools call the police, and the police will pick them up, or they will be suspended from school."

But not according to Frank Marone, a recognized behaviorist with B*E*T*A Behavior Education Training Associates. The group works with students with disabilities. "We have been able to illustrate that restraint is not necessary," he said.

They work with students such as Mario McMillan, who is autistic. "He would start hitting, throwing chairs, throwing his shoes," his mother Rufina McMillan told CBS 5 Investigates. At his former private school in Oakland, Spectrum, documents show teachers physically restrained McMillan on numerous occasions.

"I was very worried," Rufina McMillan said. "Maybe he would stop breathing."

But at the Via school, where Mario goes to school now, and where Marone trains teachers only positive behavior techniques and not to use restraint or seclusion, a big change. "He's calm now, totally calm," his mother said.

Meanwhile, Chris is now home-schooled and doing better. But he said that he can't forget that closet. "Human beings aren't supposed to be treating each other like that, you know," Chris said. "I mean it's just not supposed to happen."

After Chris's family filed a complaint, the Livermore School District shut his special education program down. John F. Kennedy School in Modesto said they have changed their practices as a result of the government investigation. As for Spectrum, they say they use safe and approved techniques to restrain students when there is danger.

Editor's Note: The following are statements from schools reacting to the CBS 5 Investigates report on children being restrained or shut into closets at California schools.

Statement by Chris Holmes
Regional Director, West
Spectrum Center Schools

The emotional and physical well-being of our students and staff are paramount and we do everything humanly possible to safeguard them. Our students have significant, complex needs and our staff is specially trained to respond to students in an appropriate therapeutic manner. For example, we redirect students' behavior by encouraging them to take a short break with a staff member or participate in some other activity that allows them to re-engage the required educational task. At times, the Individual Education Program (IEP) team, including parents and school district representatives, may determine that seclusion is necessary for occasions when a student is in severe crisis and may seriously injure himself or others.

In other cases, staff members employ safe and approved hands-on, non-mechanical techniques to help manage a student who is in danger of causing serious injury to himself or others. In all cases, these actions are taken with the student's safety, dignity and privacy as our most important priorities.

Statement by Jane Johnston
Assistant Superintendent
Stanislaus County Office of Education

We worked with an outside expert consultant to review practices at John F. Kennedy School (JFK). As a result we have increased documentation of responses to student behaviors and training for staff over the last year. While rarely used as a behavioral management strategy, escorting a student to an area where they can calm down rather than physically restraining them is often the best option. It is also often the most dignified and respectful option, as well as the safest for students and staff.

We continue to be very proud of our program which focuses on positive behavioral interventions. Our students (approximately 57 out of the 14,000 special education students in Stanislaus County) are severely handicapped and behaviorally challenged. While their behavior problems have impeded their ability to be successful in their home schools, they make significant progress at JFK.

SJ School Police Handcuff Autistic Boy

Gunnar Moody, 11, told NBC11 that it all started when he was singing a song while doing sit-ups in physical education class.

"She was like, 'Gunnar, you have to leave now.' I didn't do anything wrong. Why do I have to leave? Everyone else is being loud; why do I have to get in trouble?' Then she said it three more times and then she handcuffed me. And it was kind of humiliating because it was in front of all those kids and she was, like, picking me up and dragging me out," Gunnar said.

Gunnar's parents said what happened at Bret Harte Middle School is unacceptable.

"The bottom line he's in phys ed. And all the kids are making noise yelling, screaming and talking and he gets singled out for going 'la-la-la?'" Michael Moody, Gunnar's father, said.

His mother, Laura Moody, asked a campus police officer if Gunnar had threatened anyone.

"I specifically asked the officer, 'did he threaten you?' She said no. I said, 'did he threaten any other child?' And she said no. I think there should be a better line drawn on what kind of force to use. And especially with children with disabilites," Laura Moody said.

NBC11 obtained a copy of Gunnar's behavior support plan that outlines what to do if he misbehaves in school. Using physical force is not one of them.

The San Jose Unified School District issued the following statement: The officer's actions helped to maintain a safe atmosphere for the other 30 students in the class.

The use of restraints is extremely rare and would only be used when deemed absolutely necessary by the officer for the protection of the student and his other classmates.

Gunnar's parents plan to meet with school district leaders Friday to talk about what happened.

Gunnar is suspended for three days.

Asked if he want to go back to Bret Harte Middle School, Gunnar said, "No. Because the kids will like pick on me and stuff. Because that happened."

http://www.nbc11.com/news/15183731/detail.html