Monday, March 2, 2009

Thinking Outside the Box



photo credit-Shutr
creative commons license


There are two old sayings that come to mind when I think of seclusion rooms. One's an old Japanese saying-"The nail that sticks up get's hammered down." The other one's a saying that's commonly used in surgery-"When all you've got is a hammer, everything looks like a nail."

I think that both of these principles have come to govern the use of seclusion and restraints in special education. For too many years, in too many places, children who have occasional outbursts in schools have been seen as disruptions, nuisances, drains on resources, undisciplined, bad, and generally problems to be controlled. And the tools that have been most often resorted to to remedy the situation have been the ones seen to be most expedient-the use of restraints and seclusion rooms.

It was recognized over 50 years ago in psychiatric hospitals that use of seclusion rooms and restraints increased, rather than decreased, the incidence of behaviors. Why, then, does the use of these rooms persist into modern times in schools?

People must use them because they believe it's the best alternative. But what leads them to believe this, and what are the real facts?

In a monograph written for the Council for Children with Behavioral Disorders written in 2000, Michael P. George, the author and a special educator, refers to potentially damaging assumptions that he believes are present amongst special educators are the following:

Children with emotional and behavioral disorders (E/BD) come from bad homes, and since we cannot change the homes, we cannot succeed with the children in our schools.

Children with E/BD are incapable of controlling their behavior or regulating their emotions, and it is up to us, the professionals, to control them.

Most children and youth with E/BD are so aggressive and violent they can be educated only in very restrictive settings.

The more serious the misbehavior of the children and youths under our care, the more intrusive and severe our methods must be in treating them.

Seclusion time-out and physical restraint are necessary interventions for the most serious and intractable of these youths.


He then asks the obvious question of how those beliefs guide practices and methods, and concludes that many in the field accept the use of seclusion and restraints because they are believed to be effective. Meanwhile, the obvious side effects of using violence to treat violence (anger, resentment, fear, resistance, feelings of hate, and even death) were being ignored.

George then describes how the culture of the school was changed, which resulted in a year to year difference of a decrease in the use of physical restraints by 69%, and a decrease in the number of minutes spent in seclusion by 77%.

Ryan et al., in an study entitled "Reducing the Use of Seclusion and Restraint in a Day School Program", describes how


The majority of students placed in seclusion during both school years came from elementary and middle school. High school students were rarely placed in time-out during either year (10.7% and 12.4% respectively). Restraints were also performed much more frequently among younger students during both years. During the 2002–2003 school year, the preponderance of all restraints (80.9%) were performed on elementary students. Students in middle school were much less likely to be restrained (14.7%), while high school students rarely (4.4%) experienced this procedure. During the second year, the elementary grades still represented the majority (67.9%) of all restraints performed, while no restraints were performed on high school students.



The median age of those placed in seclusion was 13, while the median age of those restrained was 8, even though the study group included children up through high school (approximately 18 years of age). He attempts to explain these findings thru positing the following possibilities:


1. their possessing fewer mechanisms for coping with frustration,
2. staff may believe intrusive procedures may be more developmentally appropriate for younger children, or
3. that staff may be apprehensive to perform these procedures on larger and stronger individuals.


Whatever the reason, it seems apparent that it's generally considered OK to restrain and abuse kids in special education, especially when they're young.

Dr. Stuart Ablon, Associate Clinical Professor of Psychology at Harvard Medical School in Massachusetts (yes, the same state that houses the Judge Rotenberg Center) is the Director of a program called "Think:Kids" in the Department of Psychiatry at Massachusetts General Hospital. This program espouses collaborative problem solving (CPS) with kids who have behavior problems, instead of the use of restraints and seclusion rooms. As one might expect from the name, CPS helps kids and adult caretakers work together to resolve problems in a mutually satisfactory manner. They try to identify specific cognitive skills that individuals lack (executive skills, emotional regulation skills, social skills, etc.) and find ways to teach them.

Unlike the assumptions cited above that special educators often have, they teach a different approach based on respect and collaboration. This approach was first laid out by Dr. Ross Greene in the book "The Explosive Child". Dr.'s Ablon and Greene collaborated on another book on the subject, "Treating Explosive Kids". While I'm not too wild about the use of the term "explosive" in the titles of these books to describe kids (are they about to literally blow up?) I am all for the philosophy and recommendations they make in their books.

I've referred before to how Ange is working hard at a grassroots campaign in Missouri against the use of seclusion and restraint rooms. If you haven't stopped by there before, please do and lend her some support. If you haven't signed any of the petitions below, then I would suggest that, too. And if you haven't written or called your lawmakers lately, remember that it might make a difference.


http://www.thepetitionsite.com/takeaction/831847137


http://autism.change.org/actions/view/end_the_use_of_aversives_restraints_and_seclusion

http://apps.facebook.com/causes/173391/22317452?m=b9452798


Let them know that there is a different and better way to treat our kids then seclusion and restraint.

7 comments:

Jeannie said...

Thanks for posting such an informative blog. I'll be looking forward to reading more as its published (and checking out older posting.)

Since I'm just starting (or I should say re-starting) blogging again, I'm just getting set up. I've checked out the Hub link and created my liscence thanks to you. Trying to learn a little bit every day.

Our families seem to have a lot in common. My Mr. Busypants has autism and is 6; Miss Chattyshoes is almost 2.

laurentius rex said...

It is a question of what gives first isn't it?

I recall that our household sometimes used to resound to what sounded like the cod philosophy of a chop suey Kung Fu movie as simile was argued against simile and traded against each other in reified argument.

Well here goes.

Some nails are very hard indeed, and it will be the hammer that breaks first, others are so brittle that one strike on the nail will break it off entirely.

I am probably one of the former who would walk across hot coals simply because someone told me not to, never mind what it does to my feet.

Whichever kind of nail you are, the same pertains, the hammer is a blunt instrument and sometimes when whacking away at the nail the hammerer misses and squashes his thumb.

I am arguing about hammers and nails here, but you can read into that what you like.

Best find a screwdriver or something more subtle eh :)

Club 166 said...

@Larry,

Assume by screwdriver you mean a tool, and not the alcoholic drink (which could, of course, be a type of tool)?

@Jeannie,

My daughter would love your very *pink* site. Thanks for stopping by, and welcome back to bloggerhood.

As an update to this issue, there was another article today in the St. Louis Post Dispatch..

Please go on by and politely add an educational comment or two to counter the ones that assume that all disabled kids are violent and should be locked up.


Joe (cut and paste link below if clicking doesn't work).

http://www.stltoday.com/stltoday/news/columnists.nsf/susanweich/story/0DA6FEE54A75FCD38625756B000A27D2?OpenDocument#tp_newCommentAnchor

Daisy said...

I recently re-trained in non-violent crisis intervention. I liked the trainer this time; she emphasized the prevention and the appropriate responses to intervene before restraint would be needed. In fact, she said that although we learned restraints, she hoped we would rarely or better yet, never had to use them.

Elaine said...

As you are very well aware, the prevalence of children being diagnosed with an Autism Spectrum Disorder is increasing at an alarming rate. We would appreciate your assistance in helping us try to identify if the use of epidural analgesia/anesthesia and Pitocin during childbirth have any association with the development of autism.

If you are willing to participate in a survey questionnaire, please email Elaine DeLack, RN at elaine@edmsllc.com and the questionnaire will be emailed to you for your completion.

Thank you in advance for your participation in this research.

Chris said...

Epic fail, Elaine!

Elaine DeLack spamming her silly study has already been told that the increase in diagnosis is not necessarily an increase in autism:
http://www.theness.com/neurologicablog/?p=454

And that the collection of anecdotes this way is a bad way to get data. It is a self-selected survey relying on old memories.

Daisy said...

The hammer as sole tool quote has been in my mind a lot lately. My class has many, many behavioral issues, and although I can't control the sources of their issues, I still have to teach the kids. I've been talking to people about feeling set up for failure because I have a near-impossible classlist and no new tools or support with which to teach them behavior.