EDUCATION AND TREATMENT OF CHILDREN Vol. 32, No. 3, 2009
Review of State Policies Concerning the Use of Physical Restraint Procedures in Schools Joseph B. Ryan Clemson University Katherine Robbins University of Southern Indiana Reece Peterson University of Nebraska - Lincoln Michael Rozalski State University of New York at Geneseo Abstract Recent injuries and fatalities among students due to the use of physical restraint procedures in schools, and the resulting media a�ention and litigation have started to place pressure on many state and local education agencies to develop policies or guidelines concerning their use in schools. The authors investigated existing state policies and guidelines concerning the use of physical restraint procedures in educational se�ings across the United States. Currently, thirty-one states were identified with established guidance concerning the use of these crisis intervention procedures. Several states are either developing or revising their existing policies or guidelines. The authors reviewed the policies and guidelines which were identified in order to compare common content elements found in these documents, and make recommendations for states, schools or districts interested in developing their own policies or guidelines.
A
lthough there is currently no reliable data on the number of deaths and injuries resulting from physical restraints, the Child Welfare League of America (2002) estimates that between 8 to 10 deaths occur each year as a result of improperly performed restraint procedures. An investigative report by the Hartford Courant identified 142 restraint-related deaths across 30 states within schools and mental health facilities over a decade long period. Of these deaths, it is believed that over one-third were due to the improper implementation of these procedures, resulting in death by asphyxia or suffocation Correspondence to Joseph B. Ryan, Clemson University, 228 Holtzendorff Hall, Clemson, SC 29634-0702; e-mail:
[email protected]
Pages 487–504
488
RYAN et al.
(Weiss, 1998). More recently, Mohr, Pe�i and Mohr (2003) reviewed medical research investigating the leading causes of death associated with physical restraint. Their findings showed fatalities were most commonly a�ributed to either: (a) positional asphyxia, in which a person’s respiratory process is inhibited by being placed in a prone (face down) position on the floor, or when staff members place their body weight on a student’s back or chest area to help maintain control of the student when s/he resists; (b) aspiration, resulting from being restrained in the supine (face up) position; and (c) blunt trauma to the chest, experienced during the “take down” or initiation of restraint procedure, resulting in cardiac arrhythmia leading to sudden death. The authors also mentioned other risk factors including pre-existing medical conditions (e.g., heart conditions), obesity, and side effects of psychotropic medications. The la�er is especially important given that drug therapy has become a common medical intervention for treating children and adolescents with emotional and behavioral disorders (Connor, Boone, Steingard, Lopez & Melloni, 2003), with medication prevalence rates reaching as high as 76% (Connor, Ozbayrak, Harrison, & Melloni, 1998; Ryan, Reid & Ellis, in press). Specifically, neuropleptic (antipsychotic) medications increase the risk of sudden death by 2.39 times, while antidepressants can increase the heart’s QT (electrical cycle) interval which is frequently associated with sudden death. In addition, many medications inhibit the body’s cooling mechanisms which can lead to heat exhaustion or stroke during the prolonged exertion of a restraint (Mohr et al., 2003). This potential risk of injury and death has long been associated with restraint procedures ever since its inception within the psychiatric institutions of France over two centuries ago (Sturmey, Lo�, Laud & Matson, 2005). The use of restraint procedures has since migrated from institutional se�ings, to less restrictive environments such as residential facilities and special day schools. Over the past few decades with the increased practice of including students with emotional and behavioral challenges in the general education environment, the use of restraint has now emerged in public schools. Additionally, schools have become very sensitive to student behavior problems, and on how they will respond to potential aggression as a result of widely publicized incidents of school violence. Physical restraint has become a tool for potential use by schools as a mechanism for controlling violence. While the use of physical restraint procedures remains controversial, federal law (Children’s Health Act, 2000), several accreditation guidelines (e.g., Joint Commission on Accreditation of Healthcare Organizations), and professional organization policies (e.g., National Association of Psychiatric Treatment Centers for Children) guide
STATE POLICIES ON RESTRAINT
489
the use of these procedures in hospitals, institutions and residential treatment facilities. Unlike the medical and psychiatric fields, public school se�ings do not have similar federal regulations, accreditation requirements on this topic, or professional organization guidelines that influence the use or development of physical restraint procedures. Consequently, schools may be more susceptible to improper implementation, misunderstanding, and abuse of restraint practices (Ryan & Peterson, 2004). Some states have responded by creating state policies (mandatory procedures) or guidelines (recommended procedures) for districts to follow when using restraint procedures in school se�ings. The purpose of our research was to determine the current status of state policies and guidelines concerning the use of physical restraint procedures in schools, and to provide guidance to those states, schools or districts interested in developing their own policies or guidelines. Definition Restraint is defined as any physical method of restricting an individual’s freedom of movement, physical activity, or normal access to his or her body (International Society of Psychiatric and Mental Health Nurses, 1999). The American Academy of Pediatric Emergency Medicine (1997) lists three types of restraint procedures: mechanical, chemical, and physical (also known as manual or ambulatory restraint, or therapeutic holding). Mechanical restraint involves the use of an object or device, such as harnesses, flexible handcuffs or tape, to limit an individual’s movement to prevent or manage out-of-control behavior. Chemical restraint uses medication to control behavior or restrict an individual’s freedom of movement. Last, physical restraint (which in the authors’ opinion is the most commonly used procedure in schools), involves one or more staff members using their bodies to restrict an individual’s body movement as a means for re-establishing behavioral control and establishing and maintaining safety for the individual, his/her peers and staff. Because chemical restraints (e.g., Haldol and Thorazine) are directly monitored and controlled by physicians and guardians, our research focused on state policy regarding physical and mechanical restraint used in public school se�ings. Issues and Advocacy Related to Restraint While many advocates call for the elimination of physical restraint (Sturmey, et al., 2005), others support the procedure as a means of preventing individuals from hurting themselves or others. In their review of literature, Sturmey and colleagues (2005) indicated the use of restraint as a behavioral treatment can be an effective reductive
490
RYAN et al.
procedure, but that its use raises many ethical and practical concerns. The four major concerns include: (a) restraint has the potential to function as a positive reinforcer for some clients’ behavior, and thus may be a counter-habilitative practice that maintains rather than reduces maladaptive behavior; (b) use of restraint when no efforts have been made to identify the underlying function of the behavior; (c) absence of positive behavioral interventions prior to or in conjunction with the use of restraint; and, (d) continued use of restraint despite its ineffectiveness in reducing the target behavior. More recently, concern has also been voiced in the mental health community that physical restraints may actually cause psychological harm by triggering reactions related to prior trauma such as physical or sexual abuse. Additionally, child mental health and disability advocacy organizations have developed positions strongly opposing the use of physical restraints in child-caring agencies including schools due to ethical and moral concerns about the loss of dignity and rights these procedures may entail in addition to the previously mentioned concerns (Williams & Finch, 1997). One federal governmental agency, the Substance Abuse and Mental Health Services Association (SAMHSA), has gone on record as calling for the elimination of these procedures. These positions, along with numerous court cases and complaints related to apparently inappropriate use of physical restraint, have focused a�ention on the need for guidelines for the use of these procedures in all se�ings including schools. Consequently, state education agencies and schools are becoming aware of the need to regulate and provide guidance for the use of physical restraint procedures, if they are to be used at all. Several states are currently in the process of revising and updating their policies (e.g., Iowa, Kansas, Minnesota, Tennessee and Wyoming). Methods To ascertain the current state policies and/or guidelines on restraint, a systematic search of the fi�y State Education Agencies’ (SEA) websites was conducted. Search engines were used to locate the SEA websites, and the websites were recorded to a spreadsheet. Once websites were located, the home page was examined and/or the search option was used to trace state policy on restraint. Each state’s website was searched by three independent researchers. On the SEA website, keywords including restraint, physical restraint, discipline, special education, regulations, and policies were used. When information pertaining to a state’s restraint policy was not located by searching the SEA website, an e-mail was directed to the state education agency requesting copies or references of their state policy or guidelines on
STATE POLICIES ON RESTRAINT
491
the use of restraint in public schools. Follow-up telephone calls and additional e-mails were then placed to state education agencies which did not reply to the original e-mail request. Individual contacts and personal communication were also used to obtain information. Once located, state policies were copied and pasted to a word processing program for the authors to examine. Components of the policies and guidelines were then recorded and coded in a spreadsheet. The policies identified were specific to the use of physical restraint in public school se�ings. It is likely that many states also have policies regulating the use of restraint in other agencies which provide child care or child services such as foster care, residential treatment se�ings, hospitals or correctional facilities. Most o�en these policies do not apply to public school se�ings; therefore, we did not a�empt to identify, nor include policies which did not appear to apply to public educational se�ings. Results Through this study, we were able to identify 31 states which have documented policies or guidelines on the use of restraint in school districts. Twenty-two states (California, Colorado, Delaware, Florida, Hawaii, Illinois, Iowa, Maine, Maryland, Massachuse�s, Minnesota, Mississippi, Montana, Nevada, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Texas, Vermont and Washington) have established policies for school districts to follow regarding the use of restraint. Nine additional states, (Connecticut, Kansas, Michigan, New Mexico, North Dakota, Tennessee, Utah, Virginia, and Wisconsin) have issued guidelines for school districts to consider in their use of restraint. State guidelines provide school districts recommendations concerning the use of these procedures, but do not mandate that they be implemented. Conversely, fourteen states reported having no policy or guidelines to direct the use of restraint, with seven of those states (i.e., Alaska, Arizona, Arkansas, Idaho, Indiana, Missouri and Ohio) specifically designating the responsibility to individual school districts. Of the fi�y states, there were only two, Alabama and Kentucky, where we failed to obtain any information from any of our means of inquiry. However, due to the difficult nature of locating policies on restraint, it is possible that these states may have policies or guidelines that we were not able to locate. Table 1 provides a list of the states, and for those that have policies or guidelines, it also identifies a website link to those documents. When policies or guidelines existed, most o�en they were included within the context of special education regulations, and in some cases (e.g., North Dakota) were specifically directed towards
492
RYAN et al. Table 1 Websites of Current State Restraint Policies (P) and Guidelines (G) for Education
State
Type
Web Site (Note 2)
Alabama
None
SOE did not respond & no policy could be located
Alaska
None
Responsibility for policy directed at school districts
Arizona
None
Responsibility for policy directed at school districts
Arkansas
None
Responsibility for policy directed at school districts
California
P
h�p://law.justia.com/california/codes/edc/56520-56525. html Amplification of procedures by State Superintendent: h�p://www.cde.ca.gov/sp/se/lr/om110707.asp?print=yes
Colorado
P
h�p://www.cde.state.co.us/spedlaw/download/ RestraintRules.pdf
Connecticut
G
h�p://www.sde.ct.gov/sde/lib/sde/PDF/DEPS/Special/ SEDguide.pdf
Delaware
P
h�p://delcode.delaware.gov/title14/c007/index.shtml
Florida
P
h�p://www.fldoe.org/eias/dataweb/database_0607/ appendp.pdf
Georgia
None
Hawaii
P
h�p://lilinote.k12.hi.us/STATE/BOE/POL1.NSF/0/ 7a48a8de86c79e030a256ba300643251?OpenDocument
Idaho
None
Responsibility for policy directed at school districts
Illinois
P
h�p://www.isbe.net/rules/archive/pdfs/oneark.pdf
Indiana
None
Responsibility for policy directed at school districts
Iowa
P
h�p://www.legis.state.ia.us/Rules/2001/iac/ 281iac/281113/281103.pdf (Revision of policy is underway)
Kansas
G
h�p://www.ksde.org/LinkClick.aspx?fileticket=Nm96F8 %2FM1Go%3D&tabid=2332&mid=5324
Kentucky
None
SOE did not respond & no policy could be located
Louisiana
None
Maine
P
h�p://www.maine.gov/sos/cec/rules/05/071/071c033.doc
Maryland
P
h�p://www.dsd.state.md.us/comar/13a/13a.08.04.05.htm
STATE POLICIES ON RESTRAINT
493
Table 1 (contd.) State
Type
Web Site (Note 2)
Massachuse�s
P
h�p://www.doe.mass.edu/lawsregs/603cmr46. html?section=all
Michigan
G
h�p://www.michigan.gov/documents/mde/Seclusion_ and_Restraint_Standards_180715_7.pdf
Minnesota
P
h�p://education.state.mn.us/mdeprod/groups/SpecialEd/ documents/Manual/001126.pdf (Being revised)
Mississippi
P
h�p://www.mde.k12.ms.us/lead/osos/ SchoolSafetyManual2005.pdf
Missouri
None
Responsibility for policy directed at school districts
Montana
P
h�p://www.opi.mt.gov/pdf/arm/16chapter.pdf
Nebraska
None
Nevada
P
h�p://www.leg.state.nv.us/NRS/NRS-388. html#NRS388Sec521
New Hampshire
None
Policy in process of development
New Jersey
None
New Mexico
G
h�p://www.ped.state.nm.us/seo/guide/Restraint.Policy. pdf#search=%22physical%20restraint%20policy%22
New York
P
h�p://www.vesid.nysed.gov/specialed/behavioral/ amendments.pdf
North Carolina
P
h�p://www.ncleg.net/Sessions/2005/Bills/House/HTML/ H1032v6.html
North Dakota
G
h�p://www.dpi.state.nd.us/speced/guide/ED_doc3_7_ 07_1.pdf. P.35 Responsibility for policy directed at school districts
Ohio
None
Responsibility for policy directed at school districts
Okalahoma
None
Oregon
P
h�p://www.ode.state.or.us/pubs/sped/ tarestraintseclusion.doc
Pennsylvania
P
h�p://www.pacode.com/secure/data/022/chapter14/ chap14toc.html
Rhode Island
P
h�p://www.rules.state.ri.us/rules/released/pdf/DESE/ DESE_3826.pdf
494
RYAN et al. Table 1 (contd.)
State
Type
Web Site (Note 2)
South Carolina
None
South Dakota
None
Tennessee
G
h�p://www.statesurge.com/bills/20738-hb1186-tennessee
Texas
P
h�p://www.tea.state.tx.us/rules/commissioner/ adopted/0302/89-1049a-two.pdf
Utah
G
h�p://www.schools.utah.gov/sars/manualsglines/pdfs/ 08lrbi.pdf
Vermont
P
h�p://www.state.vt.us/educ/new/pdfdoc/resources/ model_restrictive_behavior.pdf
Virginia
G
h�p://www.doe.virginia.gov/VDOE/sess/ EmergBehaviorGd.pdf
Washington
P
h�p://www.k12.wa.us/SpecialEd/pubdocs/wac/WAC_ 392-172a.doc
West Virginia
None
Wisconsin
G
h�p://dpi.wi.gov/sped/doc/secrestrgd.doc
Wyoming
None
Development of policies on this topic is currently underway.
Note. Given SOE websites are frequently revised, we will maintain updated links to the state restraint web pages at the STAR project webpage: h�p://www.geneseo. edu/~rozalski/res_star.php.
educators who serve students with emotional or behavioral disorders. The apparent presumption of these policies and guidelines was that restraint procedures would be employed primarily with students with disabilities. Nevertheless, seventeen states have acknowledged that these procedures might be used with a more general population, and therefore have these policies or procedures in more general sections of their school policies. At least one state, Iowa, is moving its policy within the larger school accreditation sections of its educational policy. Furthermore, the extent of the regulations provided by states varied greatly. While some were quite extensive (e.g., Illinois and Wisconsin), providing specifics regarding when and how restraints should be used, others were much less detailed and provided li�le guidance to educators and school districts (e.g., Indiana). One commonality found among 26 of the states with either a policy or guideline was language specifying the use of restraint was authorized only for emergency situations, and/or only when the students pose a threat to themselves or others. Twenty seven states with either a policy or guideline provided
STATE POLICIES ON RESTRAINT
495
more explicit provisions for when restraint could be implemented. Over half of the states that have policies and/or guidelines (16 states) stated physical restraint was permissible if students were damaging property, 10 states stated it was permissible in the case of self-defense, and 7 states stated it was authorized when students possess a weapon or other dangerous object. It is interesting to note that only three states endorse the use of escort techniques to remove a child from the area. In addition, only one state, Hawaii, allowed restraint to “restrain a student from wrongdoing.” Interestingly, nearly a third of the policies (9 states) specifically forbid the use of mechanical restraints while five (Colorado, Michigan, Nevada, Pennsylvania, and Utah) allowed for its use but only under specific conditions, including: (a) self-injurious behaviors, (b) when stipulated in the individual education plan, (IEP), and (c) on the bus (bus harness). Nearly three quarters of those states with policies or guidelines (22 states) either required or suggested staff training in restraint techniques, yet only one, Wisconsin, recommended that staff using physical restraint also be trained in CPR and first aid. Given the potential risk factors associated with restraint (e.g., asphyxia, aspiration), training staff to be able to respond to a medical emergency appears to be a prudent requisite. Table 2 includes general requirements found for conditions under which physical restraint may be used (e.g., mandatory staff training), and the procedures schools must follow a�erward (e.g., parental notification). In addition to defining when it is appropriate for school districts to use restraint techniques, states that provided policy or guidelines also included procedural provisions. Nine states called for districts to have wri�en procedures in place regarding the use of restraint. Additional procedural provisions include acquiring wri�en permission from parents in circumstances for which restraint is likely to be used (5 states), while 11 states required the use of restraint procedures be included in the student’s IEP. Following the use of restraint, 18 states required parental notification within a twenty four hour period, and 17 states mandate administrator notification. Furthermore, 21 states call for wri�en documentation of the incident which includes periodic review of such documentation. Discussion It was evident through our findings that all 31 states with policies and guidelines in place recognize the potential risks of the use of restraint by including requisites that these procedures only be used in the event of an emergency, and/or when a student poses a threat to him/herself or others. Somewhat disconcerting, however, is that 16
496
RYAN et al. Table 2 Current State Policies and Guidelines on Physical Restraint: Allowable Circumstances
State
Allows for Safety of Student, Self/ Others
Allows for Property Damage
Allows for Escort Remove from Area
*
*
California Colorado
*
Connecticut Delaware
*
Florida
*
Hawaii
*
*
Illinois
*
*
Iowa
*
*
*
Kansas
*
Maine
*
Maryland
*
Massachuse�s
*
Michigan
*
*
*
Minnesota
*
Mississippi
* *
Montana Nevada
*
*
New Mexico
*
*
New York
*
*
North Carolina
*
North Dakota
*
Oregon
*
Pennsylvania
*
Rhode Island
*
Tennessee
*
*
Texas
*
*
Utah
*
*
Vermont
*
*
Virginia
*
*
Washington
*
*
Wisconsin * Note 1. * = Required by policy/guideline Note 2. No = Specifically prohibited by policy/guideline Note 3. Blank = Not mentioned in policy/guideline
*
497
STATE POLICIES ON RESTRAINT
State
Allows Mechanical Restraint
Calls for Wri�en Procedures
California
Calls for Parental Notification *
Colorado
*
*
Connecticut
*
*
Delaware Florida Hawaii Illinois
* No
*
*
Iowa Kansas
No
Maine
No
* *
*
*
*
Maryland Massachuse�s Michigan
No
Minnesota
*
* *
*
Mississippi Montana
No
Nevada
*
*
New Mexico
No
*
New York North Carolina
* *
*
North Dakota Oregon Pennsylvania
* *
Rhode Island
*
*
Tennessee
No
*
Texas
No
*
Utah
*
*
Vermont
No
Virginia Washington Wisconsin
* *
* *
*
498
RYAN et al. Table 2 (contd.) Current State Policies and Guidelines on Physical Restraint: Allowable Circumstances
State
Calls for Administrator Notification
Calls for Inclusion in IEP / BIP
Colorado
*
*
Connecticut
*
California
Calls for Documentation of Procedure * * *
Delaware Florida Hawaii
*
Illinois
*
*
Iowa Kansas Maine
* *
*
Massachuse�s
*
*
Michigan
*
*
Maryland
Minnesota
*
*
*
*
Mississippi Montana Nevada
*
New Mexico
*
New York North Carolina
*
*
*
*
North Dakota Oregon
* *
* *
*
*
*
Pennsylvania Rhode Island
*
Tennessee
*
*
Texas
*
*
Utah
*
*
Vermont
*
Virginia
*
* * *
Washington
*
*
Wisconsin
*
*
Note 1. * = Required by policy/guideline Note 2. No = Specifically prohibited by policy/guideline Note 3. Blank = Not mentioned in policy/guideline
STATE POLICIES ON RESTRAINT
State
Calls for Staff Training
California
*
Colorado
*
Connecticut
*
Delaware Florida Hawaii Illinois
*
Iowa Kansas
*
Maine
*
Maryland Massachuse�s
*
Michigan Minnesota
*
Mississippi Montana Nevada
*
New Mexico
*
New York
*
North Carolina
*
North Dakota
*
Oregon
*
Pennsylvania Rhode Island
*
Tennessee
*
Texas
*
Utah
*
Vermont
*
Virginia
*
Washington
*
Wisconsin
*
499
500
RYAN et al.
states (53% of those with guidelines and/or procedures) allow the use of restraint when a student is damaging property. With the potential risk of injuries to staff and students alike involved with the use of restraint, it is unclear why property damage would be viewed as a rationale for this type of intervention. Nevada and Tennessee have incorporated statements into their policies that restraint may be used if the destruction of property was of significant value, but these “clarifications” may only make the decision to restrain even more ambiguous. It is encouraging to see that nearly three quarters (23) of the states with existing policies and guidelines recommend staff training. However, given the possibilities of death or injury, it is unclear why any state policy or guideline would ever permit the use of these procedures without initial training and specific recertification procedures. Several of the programs (e.g., Michigan, Minnesota, Utah and Virginia) which include restraint training also teach alternate, more positive behavioral interventions and conflict de-escalation techniques in a�empts to minimize the number of restraints. It is our (authors’) belief that good professional practice would suggest that training is essential, and that staff would need to recognize the options for supports and interventions which might prevent the need for the use of restraint procedures. Given that asphyxia accounts for a significant portion of deaths related to restraint (Mohr, et al., 2003), we expected to see more than one state encouraging staff training in CPR and first aid. None of the policies for educational se�ings seem to suggest the need for medical monitoring of the persons being restrained (such as inexpensive pulse oximetry), or having available emergency equipment such as automated external defibrillators. Perhaps these policies predate the ready availability of these procedures and devices within school settings. One could expect that as policies are re-wri�en, consideration of these types of monitoring and planning for medical emergencies should be included. Given the number of injuries and deaths which seem to continue related to these procedures, school districts might wish to consult their a�orneys regarding liability if they do not have detailed training programs, wri�en policies and procedures, as well as emergency equipment in place if these procedures are to be used by staff. In addition, there are a number of commercial training programs available (e.g., Crisis Prevention Intervention and Therapeutic Crisis Intervention) that specialize in training staff members in conflict de-escalation as well as holds and procedures for physical restraint. Most of these programs evolved from training programs for staff at residential
STATE POLICIES ON RESTRAINT
501
treatment and psychiatric facilities/hospitals, but these organizations now offer their extensive training programs to various agencies, including schools. A�er the initial training, they provide recurrent training, sometimes through a local person certified in that particular program. Many mental health agencies have now greatly reduced or eliminated completely their use of restraint procedures within their programs. These include day, hospital and residential treatment programs serving both children and adults with a wide range diagnoses (Nunno, Day & Bullard, 2008). Given the lack of research data to support the contention that restraint procedures either increase or decrease safety, we expect that even where detailed comprehensive procedures are in place and being implemented in schools, that the rationale for using these procedures will continue to be challenged. While no state has banned the use of restraint procedures in schools, this remains a possibility in the future. Limitations Although, three independent searches of the SEA websites for each state were conducted by separate researchers, there is a possibility that some of the states had policies that were not easily identified (for example, Kentucky and South Carolina both have guidelines which are not posted on state web site and apparently do not have official standing). Other states are in the process of developing policies or guidelines (e.g., New Hampshire) or revising existing policies or guidelines (e.g., Iowa, Kansas, Minnesota, and Wyoming). Additionally, some states did not respond to either e-mails or phone calls requesting state policies further complicating the process. Implications The purpose of this study was to review state policies and procedures regarding the use of restraint in public schools to provide recommendations for states and school districts who are considering implementing regulations. With so many states having no policy (19) and some of those specifically leaving restraint policy to the individual school districts (7), Local Education Agencies (LEA) must alert themselves to the possible risks of: (a) injury to students and staff, and (b) potential for litigation. Since 31 states have established policies/guidelines (some quite extensively) concerning the use of restraint, LEA’s can review these guidelines for assistance in developing their own policies or guidelines. To begin this process we recommend LEA’s begin with the states whose policies we found to be most comprehensive and exemplar such as Colorado, Illinois, Massachuse�s, Rhode Island
502
RYAN et al.
and Wisconsin. Given the number of violent incidents that have taken place within our nation’s schools in recent years, a growing concern has emerged for the safety of the students in our schools resulting in societal demands for improved safety measures. If restraint procedures are to be implemented for such cases, the authors recommend states establish either a policy or guideline regarding the use of restraint to ensure the safety of both students and staff alike. Furthermore, it is the position of the authors that the use of restraint be reserved to only those situations where there is a threat to the safety of students or staff. States without official policies or guidelines should consider implementing policies to guide districts in the use of physical restraint. States with existing policies and guidelines may wish to examine their current policies and amend them as necessary to be more specific in directing when and how these procedures are implemented. As some state policies/guidelines currently endorse, it is our belief that staff training in proper restraint technique is imperative. Ideally, all staff should be trained, but schools should at least establish and train teams designated to serve as crisis prevention and intervention. Furthermore, procedural guidelines regarding documentation and notification should be implemented. It is our recommendation that a system of documentation should also include a periodic monitoring procedure by administrators or intervention teams to ensure proper techniques are being implemented, and to examine the effectiveness of the practice for individual students. It is our recommendation that if these elements are not in place, within state and district policies, that restraint procedures should be specifically banned by state policy for use in school se�ings. We also recommend that local districts which do not have these elements in place whether or not state policies exist, should discontinue any use of restraint procedures, and should specifically ban the use within their district. In our a�empt to identify state policy regarding the use of restraint in public schools, we identified 31 states that have established either policies or guidelines. Future research should investigate school district policy regarding restraint in the 7 states who have directed this responsibility to the LEAs. In addition, future research should study compliance of school districts with state policies and guidelines in those states that have established policies or guidelines.
STATE POLICIES ON RESTRAINT
503
References American Academy of Pediatrics Commi�ee on Pediatric Emergency Medicine. (1997). The use of physical restraint interventions for children and adolescents in the acute care se�ing. Pediatrics, 99(3). 497-499 Child Welfare League of America. (2002). Advocacy: Seclusion and restraints: Fact sheet, 1-2. Retrieved February 12, 2007, from h�p://cwla.org?advocacy/seclusionrestraints.htm Children’s Health Act of 2000 (P.L. 106-310), 42 U.S.C. 201, Title 32, Section 59. (Amends Title V of the Public Health Service Act [42 U.S.C. 290aa et seq.]. Connor, D. F., Boone, R. T., Steingard, R.J ., Lopez, I. D., & Melloni, R. H. (2003). Psychopharmacology and aggression: II. A metaanalysis of nonstimulant medication effects on overt aggression-related behaviors in youth with SED, Journal of Emotional and Behavioral Disorders, 11, 157-168. Connor, D. F., Ozbayrak, K. R., Harrison, R. J., & Melloni, R. H. (1998). Prevalence and pa�erns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment. Journal of Child and Adolescent Psychopharmacology, 8(1), 27-38. International Society of Psychiatric and Mental Health Nurses. (1999). ISPN position statement on the use of physical restraint and seclusion. Journal of Child and Adolescent Psychiatric Nursing, 14(3), 100-102. Mohr, W. K., Pe�i, T. A. & Mohr, B. D. (2003). Adverse effects associated with physical restraint. Canadian Journal of Psychiatry, 48(5), 330-337. Nunno, M., Day, D. & Bullard L. (Eds.) (2008). For our own safety: Examining the safety of high-risk interventions for children and young people. Washington, D.C.: Child Welfare League of America Press. Ryan, J. B. & Peterson, R. L. (2004). Physical restraint in school. Behavioral Disorders 29(2), 154-168. Ryan, J. B., Reid, R. & Ellis, C. (2008). A survey of special educator knowledge regarding psychotropic interventions for students with emotional and behavioral disorders. Remedial & Special Education, 29(5), 269-279. Sturmey, P., Lo�, J. D., Laud, R., & Matson, J. L. (2005). Correlates of restraint use in an institutional population: a replication. Journal of Intellectual Disability Research 49(7), 501-506.
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