I’ll never forget the day that I walked into a seclusion room at the school where I worked and closed the door. In that brief moment, I imagined what it might be like to be put in that room against my will. Scratches on the walls, dents in the door… all evidence of the many students who had been there before, fighting with all of their might to calm down.
I cried then, and I still tremble when I think about it. It makes me sick to know that I’ve participated in this “intervention.”
For students with emotional and behavioral needs, the need for restraint and seclusion often becomes a consideration during the IEP process. These students usually have an aversive therapy plan that can be used in those “last resort” situations when the student is a danger to self or others. It’s easy to see why, for many of these students, school becomes such a threatening place and why anxiety sooner or later gets added to the list of diagnoses.
Despite extensive policies and standards designed to address issues with restraint and seclusion, there continue to be stories of injuries and even deaths. These stories often refer to a single incident in which teachers or staff were not properly trained and/or failed to respond appropriately. It’s much less common to hear about the everyday impacts of aversive interventions. What about those students who have experienced repeated restraint or seclusion over several years, and often multiple times per day? Even if teachers are doing everything by the book, there continues to be a tremendous cost.
Post-traumatic stress disorder: add that one to the list of diagnoses…. for the student, the teacher, the parents, and anyone else involved. What are we doing to address the mental health needs that inadvertently become the outcome of this “therapy?”
I think we can all agree that restraint and seclusion are traumatic. Yet our actions don’t always reflect that belief. When a student becomes agitated to the point of restraint or seclusion, the teachers and staff are trained to manage their emotions and to focus on de-escalation. As much as the adult may appear composed on the outside, what goes on internally may be a completely different story. Adrenaline will kick in at some point. Typically, following an incident like this, the student and the adult will have a conversation to “resolve” or “repair” what occurred before returning to class. The goal is to get back to class as soon as possible so that the student doesn’t miss out on any more instruction. The teacher must then put aside any emotion and focus on providing the instruction.
As much as I hate seclusion and restraint, I know that in some cases it is the only way to ensure safety in the moment. But these interventions rarely, if ever, result in new skills. If any therapy is possible with seclusion and restraint, then it is the intentional teaching and support that comes from a positive student-teacher relationship and teams who are committed to understanding what drives the behavior in the first place. Whenever there is an aversive intervention, there must be debriefing with the student and within the team. Debriefing must balance an honest evaluation of what led to the event, what occurred, and what was discovered in the process.
If I had my way, I’d say that every student who has been exposed to aversive interventions should have access to counseling support within the school system, as well as case management facilitation across other providers. Special education teachers and staff need access to ongoing, intensive training and in-the-moment coaching. More importantly, there needs to greater access to individual and group counseling support for anyone who participates or who has participated in restraint or seclusion.
The long term impacts of the everyday reality for these students and their providers cannot be ignored.