• Wed, Oct 24 2007

Padded Cells and Physical Restraints

A 6′ wide by 4′ deep space with a duvet cover stuffed with foam blocks on the floor, surrounded by concrete walls, dimly lit, and with a 2-to-3-foot gap amid a barrier of storage bins: Would you consider this a “safe” place? Would you consider this a place for a child—-a special needs child; an autistic child; an autistic child who is very upset; an autistic child who is very upset and is being physically restrained; an autistic child who is very upset, is being physically restrained, and is kicking/resisting/screaming/etc. even more and louder and fiercely than before someone attempted to restrain him?

Someone in the Cherry Hill, New Jersey, school district must think it is all right for a child to be placed in what is called a “safe zone” or “timeoutbox” and what could simply be referred to as a “padded cell.” Autism parent Kathi Magee went to a Parents Forum held by the Cherry Hill Special Education PTA last week and learned that there are such rooms in two schools in the district, and that they are being used. A parent mentioned the rooms; other parents had not known about these and were, to put it mildly, “horrified.” Magee provides details of the rooms in Cherry Hill’s Chokey! and asks “why” and “how” this could have happened:

First, the “why” questions:

  • Why were these closets turned into “quiet rooms” without telling parents in advance?
  • Why was this procedure not explained to parents in an IEP meeting if there was even the slightest chance that it may be utilized?
  • Why would a child be allowed to reach such a high level of distress?
  • Why would a child prone to meltdowns not have a positive behavior plan in place?
  • Why would we not have trained staff to spot the child whose frustration is escalating and intervene before a crisis?
  • Perhaps it did not occur to anyone that the best way to handle a crisis is to prevent it from happening in the first place!

    Now on to the “how” questions:

  • How do you justify the use of aversives when you did not make a plan to avoid this?
  • How is it that you go about “escorting” a child in a full blown rage out of a classroom? When they reach that level they are extremely combative. The mere act of trying to relocate them could bring injury to the child or even the staff attempting to physically move the child.
  • How is it that parents were not made aware of these questionable techniques prior to their use?
  • How are these “quiet rooms” actually used? Are non-compliant children placed in these padded cells (for lack of a better phrase!) or is it just for full blown rages? There seems to be some indication that they are used for more than “meltdowns.”
  • How is this explained to the other children in the room. Surely they are fearful and perseverating on the fact that it “could” be them next!
  • After reading about the padded cells in Cherry Hill, all I can say is what in the……

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    • http://compostermom.blogspot.com Daisy

      Frightening. Simply frightening. From both of my perspectives: the mom and the teacher.

    • mika

      This is frightening.
      I thought “Time Out” wasn’t a legal term anymore?
      I can understand having a quiet room. But not in these circumstances. In past classrooms there would always be a sensory room for our students.
      In CPI training are told to never remove a student from the classroom . Instead you relocate the other students for safety. Once they calmed down , we would walk them to the sensory room. There they could swing, bounce, be brushed or etc.. This really helped our students work it through. We also had a two way mirror in the room. So the aide and student could be observed. This padded cell seems illegal. Kristina, your right why wasn’t parents told about this room? And where is the behavior plan?

    • Regan

      Thank you for the article, and those are very good questions.

      What is appalling is that there was no notification to parents of the existence prior to use, and open discussion of application, emergency procedure and training of those using this. It makes me wonder where this is falling along a continuum of supports and intervention? Unfortunately, it is probably wiser to ask about the existence of these things upfront than to wait for official announcement.

      Giving it a euphemism, as I have seen, doesn’t change what it really is procedurally:
      The “sensory break” closet, as described = Isolationary Time-out

      See esp. questions 1 and 2.
      http://www.jimwrightonline.com/pdfdocs/timeout1.pdf

      “…Most abuses occur, experts say, when educators don’t understand the purpose of timeout, or overuse it (Lang, 1997). Intended only as a temporary measure, timeout quickly becomes ineffective and even dangerous when children are placed in small, enclosed places for long periods of time…”

      Wolf, T., McLaughlin, T.F. and Williams, R.L. (2006). TIME-OUT INTERVENTIONS AND STRATEGIES: A BRIEF REVIEW AND RECOMMENDATIONS . International Journal of Special Education. 21(3)
      http://www.internationalsped.com/documents/3wolf%20etc.doc

    • http://maternal-instints.blogspot.com Niksmom

      OMG. This raises so many questions for me about how my own district and state addresses these issues. I will be forwarding the article to all the autism parents I know!

      Did you happen to read through the comments? There is a link to “Ask the Attorney” which has informatino about how to find your own state’s policies. Here is the link:
      http://www.bridges4kids.org/AA/q43.html

    • http://www.autismvox.com Kristina Chew, PhD

      I just started to look at the comments—overwhelming, and this being an NJ school district, the story feels “too close for comfort.” The basket hold was used to restrain Charlie in a previous school district. We were never told in advance about this, if there were options—behavioral supports were devised in reaction to things that happened, rather than being put into place beforehand. I could kick myself for a long time that we did not act sooner about this than we did but I’d rather fuel that energy into informing others about these sorts of measures.

      Thanks for all the links—these are the kinds of issues I know I have to be 110+% on top of. One experience being restrained is too much.

    • http://maternal-instints.blogspot.com Niksmom

      This post on today’s Silicon Valley Mom’s Blog (http://svmomblog.typepad.com/silicon_valley_moms_blog/2007/10/draft-abcs-and-.html#more) is more general about IEP’s but it also speaks to the things that aren’t always addressed or that parents don’t always know to ask about.

    • http://joycemocha.livejournal.com joycemocha

      There are situations where this can be appropriate, however, in those situations it is also absolutely imperative that the parent is part of the discussion about the use and frequency of use of such a space. Additionally, I would want to use it only on student request. I’ve seen the use of such a space handled appropriately.

      During my student teaching days I spent one quarter in an autism classroom where one student had a small closet where he would retreat to when stressed to yell, scream, and strip his clothing off. This room was provided to him on *his* request, and his assigned aides would try to stave off the use of the “small room” as he called it. I believe working on reducing the number of times he wanted to retreat to that room was on his IEP, and the parents were fully aware of the situation.

      There was also a quiet space in that classroom–three dividers facing a wall, with a blanket over the top of it. It was nicknamed the “Bat Cave” and students were sent there when they started to get overloaded/signs of agitation. Sometimes they would put themselves in the Bat Cave. It was not used for every student, though.

    • http://miscthing.blogspot.com ange

      My son was placed in what they called a seclusion room, which was nothing more than a padded closet with a door. It’s a rather long story, but I still can’t talk about it without getting rather emotional. The school has two of them in what they call the “BD” room. Bubba was in KINDERGARTEN!

    • http://utterautism.wordpress.com/ Carol

      They have a padded ‘safe room’ at my son’s school as well. I didn’t know it existed until my son was placed in there about 2 weeks after he started at this new school. They called me on the phone for advice because his behaviors were getting worse instead of better after having been placed in the room ‘for the his safety as well as that of other students and staff’. DUH!
      I raced to the school and informed them it was NOT the way to deal with my son’s behaviors and that locking him in the room to calm him down would have an opposite effect. Later, that was noted in his behavior plan.

      I agree, it’s a scary thing when choices like these are made without consulting parents.

    • KimJ

      Wow. I pitch a fit if my son is sent to the principal’s office. The autism clinic at our school has a sensory room, which is just that. It has an incandescent light (dimmer than classroom flourescent lamps), a trampoline (the small kind), bean bag and some stuff to handle. I think OT’s may brush some students in there too. Mostly the special ed kids are taken out to walk laps around the school yard, something I’m trying to get them to do with my (mainstreamed) son.

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    • Cherry Hill parent

      I would also ask why the same school district (different school, but same district) would refuse (for several years) to do an FBA for a child on the spectrum with known diagnoses of OCD and anxiety, and allow that child’s issues to increase to a point where the compulsive skin picking and cutting of his arm and leg hair was so severe at school that they couldn’t stop him. Then, instead of calling an IEP meeting, doing an FBA or asking to speak with the child’s physicians, they called DYFS to investigate the family for the OCD behaviors that were occuring at school. How do the parents know it was them? Because they quoted e-mails from the parents, e-mails in which the parents and the teacher were working together to try to figure out what was causing the behaviors at school, if there was a particular subject or anything that was happening at school that was causing more stress, if it was occurring more at a particular time of day, and so on. It was happening at school, yet the parents didn’t call DYFS to report the school and accuse them of abuse or neglect. Yes, this occurred in October, too.

      I would also ask why the administrators don’t think it’s appropriate to question them on these topics, nor to ask for an apology.

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    • Regan

      The question of restraint and seclusion has been one that has bothered me for quite a while.
      If you can excuse several links, I would like to share these as some starting points that might be helpful in identifying acceptable (and unacceptable) practice and future directions.

      Education Law Resource Center
      State Laws on Restraint & Behavior Intervention in schools
      http://www.edlawrc.com/state_laws_on_restraint.htm

      CHILD WELFARE LEAGUE OF AMERICA
      Promising Models for State Regulations
      http://www.cwla.org/programs/behavior/stateregbehavcp2.pdf

      Achieving Better Outcomes for Children and Families: Reducing Restraint and Seclusion
      http://www.cwla.org/programs/behavior/achievebetter.htm

      Annotated Bibliography of Selected Empirical Studies
      Prepared by:
      Best Practices in Behavior Management
      CHILD WELFARE LEAGUE OF AMERICA
      October 2002
      http://www.cwla.org/programs/behavior/SAMSHAbib.pdf

      US Code
      Title 42, Chapter 6A, Subchapter III-A, Part 1,
      Section 290jj. Requirement relating to the rights of residents of certain non-medical, community-based facilities for children and youth
      http://caselaw.lp.findlaw.com/casecode/uscodes/42/chapters/6a/subchapters/iii-a/parts/i/sections/section_290jj.html

      Children’s Health Act of 2000, P.L. 106-310. This significant new law established national standards that restrict the use of restraint and seclusion in all psychiatric facilities that receive federal funds and in “non-medical community-based facilities for children and youth.”
      http://www.childwelfare.gov/systemwide/laws_policies/federal/pl106_310.cfm

    • http://www.autismvox.com Kristina Chew, PhD

      Regan, I am going to have to compile a list of all of your comments with all of these links, on this topic and others—this issue just does not get enough discussion and, when it does, it is “after the fact,” after a child has been restrained or placed in a padded room.

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