Physical restraint is a controversial practice used as a response to student behavior in many public and private schools across the country. Guidelines for the use of restraint – also known as “physical management” or “safe holds” – vary significantly across states. There are limited federal guidelines in regards to the use of restraint, as IDEA 2004 does not make mention of if or how it should be used with students with disabilities (McAfee et al., 2006).
When discussing the use of physical restraint, the most common form used in schools involves teachers and staff members using their hands to control the movement of a child who is a danger to him or herself or others. The term does not refer to chemical or mechanical restraints, which are largely prohibited for use in the school setting.
Using physical restraint should always be a last resort; used only by trained staff and only if the student is an imminent physical threat to him or herself or others. Staff members must understand that students on the Autism Spectrum sometimes engage in behaviors that are self-injurious or result in injuries to others as an attempt to communicate. There are many interventions that are proactive and positive that can help one to avoid restraint entirely if the school team is educated on alternative supports that can be put into place. The purpose of physical restraint in schools is to maintain safety – never to be used as punishment.
The Crisis Prevention Institute (CPI) method of physical restraint and de-escalation techniques is used internationally in schools, hospitals and jails. The primary focus of CPI’s training is on the environmental variables that can and should be manipulated prior to any episode of physical restraint occurring. CPI, as well as numerous other training methods, requires staff to examine their own physical stance, facial expression, tone of voice and proximity to the student based on what level of behavior the student is engaging in on the escalation cycle. The reason this education of the escalation cycle is so critical to the avoidance of physical restraint is often staff become anxious when a student begins to become verbally aggressive and staff engage in restraint techniques out of panic. CPI instruction trains that students sometimes need to vent, and allowing them to yell, scream or cry can often help them release this pent up energy and frustration without further escalating the situation by going ‘hands-on’ into a physical management situation.
A list of strategies to avoid the use of restraint is not valid if consideration has not been given to the reason why a student is engaging in the dangerous behavior also known as the function of the behavior. An effective way to assess this is to conduct a functional assessment based on the principles of Applied Behavior Analysis (ABA). Functional assessment data is collected on the behavioral effects of environmental variables and assesses what happens before, during and after an incident of specific student behavior to look for patterns. The goal is to modify the environment of the student based on the known patterns of behavior (i.e. When it is loud, Tommy screams and pinches his teacher). If the teacher knows this she can provide ear plugs or the option for Tommy to read in the library before starting loud activities. She can also ignore the student’s inappropriate behavior while reinforcing the more appropriate behavior of using the ear plugs and engaging in the activity. The reason a functional assessment is important is because a student might engage in behaviors that topographically (on the surface) look the same (i.e. kicking), but the student may be doing it for several different reasons. For example:
When a student asks for his favorite cookie and the teacher responds “No” he might kick his teacher. In this setting he is kicking to communicate his unhappiness with his teacher’s statement and to attempt to obtain the desired object. Since the function of this particular behavior is positive reinforcement, or obtainment of a tangible item, simply restraining the student each time he kicks does not teach a new or replacement behavior to communicate his frustration. Instead he will likely replace the kicking with another inappropriate method of expressing himself (i.e. pinching). This allows the cycle of aggression to continue.
Alternately, he might kick when he is at a classroom party when many other children are running around. The party may be overwhelming and over stimulating. When he is in a busy setting he may approach a peer and kick them, which results in the student being removed from the group in a time out. When he is allowed to re-join the group he kicks another child. When his teacher tells him to stop, he continues to go after children until his teacher is forced to hold and restrain him to keep him from hurting himself or others. In this environment he kicks in an attempt to escape an environment that is too over stimulating for him to handle. By restraining him or putting him in time out we are reinforcing the kicking as a way for him to communicate his need for a break and change in environment. This also allows the cycle of aggression to continue.
In both of these examples an appropriate intervention to avoid any type of restraint is to teach socially appropriate methods to communicate his needs (see below examples).
The following are some strategies to be explored when looking for alternatives to restraint in a public school setting:
Teach the child a safety signal – this signal should be used when they are angry, frustrated or need a break. If the student is engaging in physical aggression in order to escape an activity, providing them with a more appropriate way to escape the activity not only teaches them an appropriate communication skill, but also reduces the frequency of physical aggression episodes. Safety signals can consist of verbal phrases, such as “break please,”, and picture cards or hand signs/gestures. It is important to remember these safety signals must be explicitly taught by breaking down the steps.
- Find the “in charge” adult
- Get the adult’s attention
- Use the safety signal
Provide a “safe place” – an area the student can go to and relax or cool down. These areas have been called many things (safety zone, quiet corner, “chill out” room, Zen pen), but the overall purpose is to get the child there before they engage in any physical aggression. The room ideally should be a separate room from their regular classroom so they have more privacy and maintain dignity. The room should be free of any items the student can use to hurt him/herself or others, and be relatively calming (could have sensory tools, pillows, dimmed lighting, etc.). It is also imperative the room or area is never used as punishment or as a “time out” room. The purpose of the room is to assist the child to calm, not to punish them for being overwhelmed or angry.
Clear the classroom – often school teams feel they had to restrain a student because he/she was a danger to the other students. When staff put their hands on a student to escort him/her out of the room the student sometimes becomes extremely aggressive requiring full physical restraint. The less restrictive choice would be to move the other students out of the classroom. This is often an unpopular alternative since an entire class of students must be disrupted. However it often eliminates the need to physically restrain the student who is struggling. Having a plan for each classroom on how to summon help, how to line the other students up, where they can go and what those students can do during these interruptions is essential so staff don’t panic in the moment and end up restraining when it could have been avoided.
Careful documentation of how often the classroom needs to be cleared, what preceded the act of aggression and how long the other students were kept out of their classroom should be documented for team decision-making on what other changes to the environment can be made to assist the struggling student. Clearing the classroom is an important reactive step – however should not be a long term “fix” to the problem.
Respect personal boundaries - Often students become aggressive as a communication method. They might feel you are too close, don’t want you touching them, don’t like the way your perfume smells or they want to stop the current activity. When these are carefully documented by staff, patterns of behavior can be identified and staff can respect those student preferences. If the child hits when you get too close, you can tape a parameter around the student’s desk that people are only allowed in if he/she has invited you. This increases the student’s sense of control over his/her environment and will reduce their need to try and control the environment in other ways (i.e. hitting, running, kicking etc.).
Provide visual supports – using visual supports across the day of a student with Autism is a critical preventative measure. These supports include visual schedules to pre-warn of any changes in the child’s day, visual statements of the child’s safety rules (i.e. hands and feet to self, quiet mouth) and visual calming routines. Teachers can also present visuals that remind the child to engage in calming activities when they begin to escalate. Verbally engaging with the student who is beginning to escalate can often make things worse because so many students on the Autism Spectrum struggle to process auditory information. Instead of the teacher saying, “Tommy, calm down and take 10 breaths,” the teacher can show a picture that represents deep breaths and then count on her fingers modeling for the student the appropriate behavior.
Respect the aggression as a “crisis” for the child – children are typically not engaging in aggressive behaviors to be mean, hurt anyone or misbehave. They have lost control of their environment and themselves and the aggression is a reaction to that. They are often engaging in the “fight or flight” response, which includes very little rational thought. Yelling at the student or becoming angry and aggressive will escalate the situation by frightening the student. Instead adults must strive to remain calm and use supportive statements instead of scolding and yelling. This is another reason providing staff with visuals that represent the desired behaviors assists everyone in staying calm. They can present the visual card to the student instead of relying solely on verbal cues and instruction. This statement is not meant to excuse the acts of physical aggression – physical aggression is never OK. However in the moment staff must accept that the ability of the student to process their environment and expectations is diminished and react accordingly.
Physical restraint has been used for decades in the public schools as a response to student behaviors that are dangerous. Clear guidelines for the amount of staff training, documentation and parental notification must be defined in any plan that includes restraint. It should only be used as a last resort when all other techniques have failed. Best practice – and in some states legal mandate – requires a team meeting following any three episodes of physical restraint to re-evaluate programming decisions, behavior intervention plans and environmental factors. It is critical the team try to step into the role of the student to understand his or her perception of the situation and modify staff responses as well as the environment to teach the child replacement behaviors and maintain a safe learning environment for all.
Additional resources and references:
McAfee, J. K., Schwilk, C., & Mitruski, M. (2006). Public Policy on Physical Restraint of Children with Disabilities in Public Schools. Education and Treatment of Children. 29(4), 711-728
Crisis Prevention Institute - http://www.crisisprevention.com/