Physical Restraints in Schools

1
Physical Restraints in Schools

• Doris H. Hunt Ed.S., Ed.D.

2
Hartford CourantSpecial Report and
WebsiteHartford, Connecticut

• 142 restraint-related deaths in U.S. over a
• 10-year period
• 33 caused by asphyxia (Weiss, 1998)

3
What is physical restraint?

• Restraint is defined as any physical
• method of restricting an individuals
• freedom of movement, physical activity or
• normal access to his/her body
• (International Society of Psychiatric and
• Mental Health Nurses, 1999

4
3 types of restraint procedures
Mechanical Entails the use of any device (tape, tie downs) to limit an individuals body movement. Limited use in schools with a few exceptions, not permitted.
Ambulatory Entails the use of one or more people using their bodies to restrict anothers movement. Can be used given certain criteria are met.
Chemical Entails the use of medication to control behavior or restrict a patients freedom of movement Not used in schools
5
History of Restraint

• Originated in Frances psychiatric hospitals
• during the late 18th century.
• Developed by Philippe Pinel Jean
• Baptiste Pussin to prevent patients from
• injuring themselves or others (AACAP,
• 2000 Fisher, 1994 Weiner, 1992).

6
History of Restraints

• Restraints have been used for children with ED
• since the 1950s, and was included in a list of
• techniques for the antiseptic manipulation of
• surface behavior compiled by Redl Wineman
• (1952).
• Authors stated explicitly that physical
  restraint
• should not be used as, nor be associated with
• physical punishment.

7
Standards and Guidelines forUsing Restraint

• Most medical, psychiatric and law enforcement
• applications, strict guidelines govern the use
  of
• physical restraint
• Joint Commission on Accreditation of Healthcare
• Organizations
• National Association of Psychiatric Treatment
  Centers for
• Children
• American Academy of Pediatrics
• Unfortunately, no such accreditation
• requirement for schools, or child caring agencies

8
Use of Restraints inEducation

• Growing concern due to IDEA concept of
• serving children with special needs in LRE.
• Regular Education Initiative and
• inclusion movements of the 1990s have
• accelerated this process

9
Results of ProfessionalTraining

• National training prevention programs
• advertise that intensive staff training in
• schools reduced assaultive incidences by
• 80, and resulted in a 77 reduction in
• disruptive incidents (Crisis Prevention
• Institute, 2002).

10

• Causal Factors for Restraints
• Debrief of staff and clients following 81
  incidents of restraint in a psychiatric hospital
  setting resulted.
• Staff reported 65 of restraints initiated due
  to
• perceived safety threat, while 19 were for
  patient noncompliance.
• Patients reported that a staff member threatening
  time-outs were a causal factor for escalated
  levels of aggressive behavior (Petti, et. al.,
  2001).

11

• State Legislation Typically
• Contains
• Definitions of terms common to physical
• restraint
• Required procedures and training for staff
• Conditions when physical restraint can and
• cannot be used
• Guidelines for the proper administration of
• physical restraint
• Reporting requirements when restraint is
• employed.

12

• Does Physical Restraint Violate a
• Students Individuals Rights?
• Plaintiffs typically argue restraints violate an
• individuals rights under
• Eighth Amendment, which prohibits administering
  cruel or unusual punishment, and
• Fourteenth Amendment, which provides for an
• individuals liberty interests in freedom of
  movement and personal security

13

• Parental Options for Filing a
• Complaint
• - The Office for Civil Rights (OCR) in the U.S.
  Department
• of Education serves as the primary administrative
• enforcement mechanism for Section 504 and the
• Americans with Disabilities Act (ADA) in relation
  to
• schools.
• - Additionally, educational cases are frequently
  handled by
• the State Education Agency (SEA), which resolves
• disputes regarding the IDEA using impartial due
  process
• hearings, and at the states option, a
  second-tier
• impartial administrative review.
• - All OCR and SEA Hearing Officer Reports may
  also be
• appealed to federal court.

14

• Rulings can be grouped into
• four general categories
• - Decisions affecting the use of mechanical
• restraints
• - Decisions affecting the use of ambulatory
• restraints
• - Professional training pertaining to staff who
• perform restraints and
• - Individual rights related to the Eighth and
• Fourteenth Amendments, Section 504, and the
• American with Disabilities Act (ADA).

15

• Mechanical Restraints
• - The preponderance of rulings by the
• Courts, SEA and OCR found the use of any
• type of mechanical restraint other than a
• time out or tray chair to be unacceptable,
• and in clear violation of a students
• individual rights.

16
Federal Court Rulings
Jefferson v. Yselta Independent School District (1987) Teacher and principal did not have qualified immunity from liability for tying a second grade student to a chair.
Ronnie Lee S. v. Mingo County Board of Education (1997) Elementary school did not have qualified immunity from liability when restraining a child with autism to chair by means of a vest.
SEA Rulings
Portland (ME) School District (1987) Teachers strapping down of a student with profound retardation violated his Sec. 504 rights.
OCR Rulings
Oakland (CA) Unified School District (1993) Students Sec 504 and ADA Rights had been violated when his mouth was taped shut
Aiken County (SC) School District Students Sec 504 and ADA Rights had been violated when his mouth was taped shut
17
Ambulatory Restraints

• Courts, SEA, and OCR have consistently found
  ambulatory restraints may be used without
  violating an individuals rights or threatening
  their safety.

18
Federal Court Rulings
Garland Independent School District v. Wilks (1987) Restraining a child with autism engaged in aggressive and self-injurious behaviors was not considered to be excessive or violate the childs constitutional protection from cruel and unusual punishment.
SEA Rulings
Florence (SC) County No. 1 School District (1987) School personnel had not violated students Sec. 504 rights restraining him to prevent harm, despite language in the IEP forbidding corporal punishment.
OCR Rulings
Ohio County Public Schools (1989) Did not find evidence to support parent's claim teacher used excessive force in restraining a student.
Walls-Orgunquit (ME) Count Schools (1990) School district did not violate a students Dec. 504 rights when using a physical restraint to control violent behavior
Gateway (CA) v, Unified School District (1995) Determined a students behavior modification plan permitted the use of physical restraint.
19
Professional Training

• Wyatt v. King (793 F. Supp 1058, 1992), US
  Circuit Court determined staff working with
  mentally ill required specific training regarding
  interventions germane to their unique care.
• Training should include psychopharmacology,
• Psychopathology, psychotherapeutic
  interventions, as well as interviewing and
  assessment procedures for determining a
  patients mental status

20
Individual Rights

• Decisions pertaining to individuals rights
  regarding the Eighth and Fourteenth Amendments,
  Section 504 and ADA.
• Courts ruled institutions must take into account
  a patient rights at all times, and that any
  restrictions to individual liberties must be in
  their best interest.

21
Federal Court Rulings
Jackson v. Biishop (1968) Interventions not professionally indicated and unnecessarily restrictive may violate a patients 14th amendment liberty issues
Bell v. Wolfish (1979) Supreme Court stressed that innocent persons have a right to be free from punishment
Youngber v. Romeo (1982) Supreme Court ruled persons involuntarily committed to state institutions have a constitutionally protected liberty interest under de process clause of the 14th amendment to reasonably sage conditions of confinement, and freedom from unreasonable bodily restraints. Theses were fundamental liberties that can be limited only by an overriding non-punitive state interest.
OCR Rulings
Chicago (IL) Public Schools District decision (1993) Determined a districts failure to monitor and respond to conditions at a private school for students with severe disabilities violated the students Section 504 and their ADA rights.


22
Restraint Procedures

• Restraints should never be performed as a means
  of punishment or to force compliance from a
  student.
• Restraints should never be performed with
  untrained personnel.
• Mechanical restraints are not permissible with
  students in a school setting, and that physical
  or ambulatory restraints should be administered
  only when the safety of the student, peers, or
  staff members are at-risk.
• When restraints are administered, staff must
  perform the safest method available using the
  minimal amount of force necessary to protect the
  student and others from physical injury or harm.
• Once a restraint a performed, its use should be
  discontinued as soon as possible.
• No restraint should be administered in such a
  manner that prevents a student from breathing or
  speaking.
• The students physical status including
  respiration and skin color should be continuously
  throughout the restraint procedure.

23
Reporting and Parent Notification

• School procedures for reporting notification
  should be in place.
• Following a restraint, the staff member who
  administered the restraint should verbally notify
  an administrator ASAP.
• A written report should be provided to the
  administrator resposnible for mainitaining an
  on-going record of all physical restraints
  conduced by the school within a 24 hour period.
• The administrator should verbally inform the
  students parents or guardians of the restraint
  verbally ASAP.
• Written reports to the parents including a
  description of the event and staff involved
  should be postmarked no later than 3 working days
  following an incident.

24

• New Complaint! - Complaint filed in Disability
  Rights of NC v. Wake Co Bd of Ed and Robert
  Sturey in abuse restraints case (pdf) 09/16/08
• The complaint alleged that children with autism
  were improperly restrained in class, including a
  child in handcuffs and a child returning home
  from school with bruises.

25
Requirement

• The Individuals with Disabilities Education Act
  (IDEA) requires that a child's Individualized
  Education Planning (IEP) Team consider to the
  child's behavior if it interferes with his or her
  education or the education of others. IDEA is
  explicit in what it requires the IEP team to do
  when a child with a disability has behavior
  problems
• If a child's behavior impairs the child's
  learning or that of others, the IEP team shall
  consider the use of positive behavioral
  interventions and supports (20 U.S.C. Section
  1414(d)(3)(B)(i))
• If school personnel decide to change the child's
  placement because of a violation of a code of
  student conduct, the school district, parent, and
  relevant members of the IEP team shall review all
  relevant information including the IEP, to
  determine if the conduct was caused by or had a
  relationship to the child's disability (20 U.S.C.
  Section 1415(k)(1)(E) (
• If the team determines that the child's conduct
  was a manifestation of the disability, the IEP
  shall conduct a functional behavioral assessment,
  and implement a behavior intervention plan (20
  U.S.C. 1415(k)(i)(F
• If a behavior intervention plan already exists,
  the team must review and modify it to address the
  child's behavior (20 U.S.C. 1415(k)(i)(F)

26
Cases

• Sexual Abuse in Schools
• Kalie McArthur v. Academy School District 20
  Parents sue district after daughter sexually
  assaulted by "peer tutor
• Time Out and Seclusion
• Teacher Fired, Isolation Room Closed, Lawsuit
  Pending. Evidence shows a video (taken from a
  school surveillance tape) is a shocking report of
  videotaped abuse of a 14 year old boy who has
  autism (2009).

27
Cases continued

• Covington v. Knox Co (TN) - U. S. Court of
  Appeals for the Sixth Circuit. Decision in
  "time-out room" child abuse case creates
  exceptions to exhaustion requirement in damages
  cases. 250,000 Settlement in McCarter Case -
  In a case about sexual abuse of a child with
  cerebral palsy and school's failure to provide an
  appropriate education, the state, school district
  and parents entered into a settlement agreement
  of 250,000 for damages, attorneys fees and
  expenses, vocational and rehabilitation services,
  and state-wide policy changes.Shawn Witte v.
  Clark County (NV) School Board, et. al. - U. S.
  Court of Appeals for the Ninth Circuit. School
  brutality case damages sought under Section 504
  and the ADA on behalf of child with disability.
  Court issued pro-child decision discussed
  exhaustion of remedies under the IDEA and
  appropriate damages for physical abuse and
  injury. W.B. v. Matula, U. S. Court of Appeals
  for the Third Circuit. In case where child was
  bullied by teacher and other students, court held
  that damages are available under Section 504,
  IDEA, and Section 1983 since the district refused
  to evaluate, classify and provide appropriate
  services to the disabled child includes
  discussion of exhaustion, qualified immunity, and
  due process.

28
Cases Continued

• Disability Rights Wisconsin, Inc., v. v.
  Wisconsin Dept. of Public Instruction Elizabeth
  Burmaster, Superintendent of Public
  Instruction (7th Cir. 2006)This case involved
  several children who were dragged into seclusion
  / time out rooms at Lincoln Elementary School.
  The media learned about these incidents and did a
  news story about the abused children. When
  Disability Rights of Wisconsin tried to
  investigate, the Department of Public Instruction
  refused to provide any information about the
  identity of the children involved or their
  parents, claiming that this "confidential
  information," pursuant to the Family Educational
  Privacy Act. The court provided a detailed
  description of one seclusion room that was
  "approximately 5 feet by 9 feet in size. Dark
  grey carpeting covered the floor and the walls.
  Fluorescent ceiling lighting illuminated the
  room. The door to the room had a lock and no
  interior door knob, which violated the fire
  code (and has since been remedied)."The Court
  analyzed the laws that govern Protection and
  Advocacy agencies and ruled in favor of
  Disability Rights of Wisconsin. The decision
  includes a detailed description of the
  responsibilities of P As to protect individuals
  with disabilities, limitations on confidentiality
  under the Family Educational Rights to Privacy
  Act, and other issues.