Maine reviews school policies on restraining

[Oscar]

Maine reviews school policies on restraining, Maine Sunday Telegram

Judith Herb got a call in January that would propel her into the state and national debate over the use of physical restraints on schoolchildren.

She was summoned to Pleasant Hill School in Scarborough because her 7-year-old son, Zeke, had been in a minor scuffle with another student during recess. The situation had quickly escalated out of control and Zeke, a smart and sensitive boy who has autism, was extremely upset. He had cursed at a teacher and knocked off her glasses. Staff members had been struggling for 25 minutes to calm him down.

Herb entered the school and found Zeke was being held, face down and screeching, on a muddy doormat. Two teachers and an education technician were on top of him. She told them to get off and knelt beside her son.

"I grabbed him and flipped him over," Herb recalled. "His lip was split. I just hugged him and talked to him. Within three or four minutes he was calm enough that we walked out of the school and went home."

Shaken by what she saw, Herb began investigating the controversial practice of restraining students who are physically out of control and in danger of hurting themselves or others, a practice known as "therapeutic restraint." She challenged Scarborough school officials to change their restraint practices and policies, which they have started to do, according to Superintendent David Doyle.

Herb also has agreed to sit on a panel that's being convened by the Maine Department of Education to update restraint regulations that many say are unclear, lack necessary oversight and are potentially harmful to children. At the same time, Congress is considering a bill, known as the "Keeping All Students Safe Act," that would establish the first minimum federal standards for how teachers can restrain or seclude students.

The Maine panel has been in the works since May 2009, when a bill to prohibit face-down restraints failed to win support in the Legislature's education committee. The committee asked the department to review its regulations and investigate disparities in how restraint policies are implemented across the state. A report is expected early next year.

"There shouldn't be any surprises in public education," said state Sen. Justin Alfond, D-Portland, who sponsored the bill. "Why are some districts using restraints often and others not at all? It's creating a cloud of uncertainty for all parties involved -- students, parents and teachers."

It's unclear how many restraints occur in Maine or the United States each year, or how many of them have resulted in injury or death, because the federal and state education departments don't keep track. Maine's regulations do, however, require districts to document restraints and report them to parents.

Last year, Scarborough schools recorded 27 restraints, Portland had 59, South Portland had 63 and Westbrook had 31, according to superintendents of each district. But because education department definitions aren't specific about what constitutes a physical restraint or hold, or how they should be reported, it's unclear whether these counts are complete or accurate.

This issue pertains to all students, parents and school personnel. Under education department rules, special education students may be restrained by trained staff members if it's allowed in their individual educational plan. In addition, any student may be restrained by any school staff member in an emergency, under Maine statutes that allow the use of "reasonable force" to control a disturbance.

The Disability Rights Center of Maine received 40 calls last year from parents concerned about the way their children were being restrained at school, said Diane Smith, a lawyer at the center. Various officials said they believe that no child has died while being restrained in a Maine school.

"Our hope is to prevent that from happening," Smith said.

The state education department delayed forming a review panel because, in part, it didn't want to duplicate work being done at the federal level. The federal legislation follows a May 2009 report that found hundreds of children were abused and some died as a result of inappropriate restraint or seclusion in public and private schools. The House voted 262-153 to approve the bill in March. The Senate's version remains in committee.

Maine officials aren't waiting any longer. Interim Education Commissioner Angela Faherty recently invited various stakeholders to join the long-planned review panel. It could convene as early as November, according to David Stockford, the department's policy director and special services team leader.

"It doesn't appear that anything is going to happen soon (at the federal level)," Stockford said. "We want the language in these rules to be clear and consistent, and we're trying to do it in a way that's responsible and well-informed by best practices."

What constitutes best practices will likely generate serious discussion. Most agree that restraints should be a last resort used only by trained personnel when all other efforts to calm a child have failed, as required under state department rules.

Once amended, the state rules likely will include stronger language directing districts and the state to keep track of restraints, including who does them and how, and any complaints that may result, Stockford said.

But opinions vary on how restraints should be performed. In general, it involves one or more adults taking hold of a child in a prescribed way and keeping the child's body still for a limited period. Training programs in several restraint methods are available, and those methods have evolved in recent years.

Since last spring, 50 Scarborough staff members have been trained in intervention and restraint techniques using the Safety-Care method.

"The bulk of the training is about all the things you can do to avoid using restraints," said Doyle, Scarborough's superintendent.

Westbrook also adopted the Safety-Care method, increasing the number of staff members trained to do restraints from 27 to 47, said Superintendent Reza Namin. South Portland has 59 staff members trained in the Mandt method, said Superintendent Suzanne Godin. Portland has 110 personnel trained in Therapeutic Crisis Intervention.

Opposition is growing to face-down, or prone, methods like the one used on Herb's son, because they can restrict breathing and speech, especially for students who are obese or have asthma. Some districts have stopped doing face-down restraints, including Scarborough, South Portland and Westbrook. Other districts, including Portland, still allow them to be done by trained staff members as long as they are careful not to restrict breathing or speech.

"If done properly, carefully and briefly, (a prone restraint) can keep a kid safe," said Peter McCormack, a Portland school administrator and certified TCI trainer who has trained dozens of his co-workers.

Regardless of the method, McCormack advises educators to use restraints only when all other efforts to calm a child have failed. Performing a restraint can be heart-wrenching and exhausting for teachers, McCormack said, so much so that he sometimes sends them home afterward.

Critics say it's difficult, if not impossible, to do a face-down restraint without restricting a child's breathing or speech. "A prone restraint can't be done right," said Smith, of the Disability Rights Center. "There's just a larger margin of error with that method."

The education department issued an administrative letter in September reminding district superintendents that it "strongly supports the effort to prohibit" restraints that result "in the student lying face down on the floor while pressure is applied to the student's back." It updated a similar administrative letter sent in July 2009.

The latest letter said the department would go further than the proposed legislation to prohibit any restraint that restricts normal breathing or speech. It also directed districts to amend local policies accordingly. But some local school officials are concerned about revising policies absent solid action at the federal or state level.

"This issue has statewide implications," said Portland Superintendent Jim Morse. "Do they really want each district developing individual policies that will perpetuate inconsistencies? If they want a consistent response from school districts, they should be taking the lead in providing clear regulations so districts can develop clear, consistent policies."

Even the long-accepted clinical term, "therapeutic restraint," is being called into question. The proposed federal legislation explains the shift in thinking: "Research confirms that physical restraint and seclusion are not therapeutic, nor are these practices effective means to calm or teach children, and may have an opposite effect while simultaneously decreasing a child's ability to learn."

"There's nothing therapeutic about it," said Smith, of the Disability Rights Center. "Having such a positive label is misleading."

After seeing her son face down on a muddy doormat, Judith Herb agrees. She was disturbed to learn how often children were being restrained in Scarborough and other Maine schools.

She believes Zeke suffers from post-traumatic stress as a result of being restrained at Pleasant Hill School. He still has nightmares about it and he cringes whenever they drive near the school, although that doesn't happen often anymore.

She removed Zeke from Pleasant Hill School in March, after he experienced eight holds in as many months. In May, the Scarborough district transferred him to the specialized Collaborative School in New Gloucester, where teachers work to identify and limit sensory and communication issues that can trigger outbursts, Herb said. Zeke has been restrained three times since being transferred, she said.

"It was what he needed," Herb said. "At Pleasant Hill School, they loved Zeke, but it was clear that they weren't adequately trained to handle him. It seemed that they were going to humiliate him into behaving, and that doesn't work for a child like Zeke. It really doesn't work for any child."