Preventing Harmful Restraint & Seclusion

Dear Chairman Harkin and members of the Committee:

We the undersigned are writing to you as a united group of parents, family members, teachers, and friends of children with Autism regarding S.2860: Preventing Harmful Restraint and Seclusion in Schools. Our students are among that subset of children with Autism who engage in serious aggressive or self-injurious behavior on a regular basis. This may include biting themselves, beating themselves in the face until bruised, ripping out their hair, or attacking others by biting, choking, kicking, and punching. We know the potential risks of restraint and seclusion; we live them every day. We also know the power that these interventions can have in reducing dangerous behavior when used safely as part of a comprehensive function-based behavior plan. We are thankful that S.2860 will address both the need for staff to be highly trained in these procedures as well as the need for our students to be protected from the unnecessary and dangerous use of these procedures. We are also thankful that S.2860 recognizes that restraint or seclusion may sometimes be necessary as a last resort to protect a child from harming himself or to protect others from harm. The students that this bill protects are OUR students.

We would like to suggest some language that we believe would strengthen the bill by ensuring that parents have the right to request and explore the full range of effective behavioral treatment options for their children. In the spirit of further protecting this vulnerable subset of children, we ask that Section 5 paragraph 5 be amended to read as follows:

The use of physical restraint or seclusion as a planned intervention shall not be written into a students education plan, individual safety plan, behavioral plan, or individualized education program (as defined in section 614(d) of the Individuals with Disabilities Education Act (20 U.S.C. 1414(d))), unless the following conditions are met: the plan to utilize restraint or seclusion is created only after a functional behavioral assessment (FBA) has been completed and is based upon the results of that assessment; the plan is created only after the results of the FBA have been shared with parents or legal guardians; the plan is created only after a medical assessment has been completed to determine any medical conditions that may exacerbate the target behavior, and if such conditions are discovered the plan must include strategies to mitigate their impact; a qualified medical professional has determined that the use of restraint or seclusion is not contraindicated for the particular student; informed consent is obtained in writing first from parents or legal guardians after they are provided with complete, accurate, and understandable information about all intervention techniques recommended for use with the student, including information regarding evidence of the effectiveness of the techniques, their risks, and the risks and benefits of all alternative interventions and of no intervention for the problem behavior;  the plan includes specific appropriate alternative behaviors and/or functional communication strategies to replace the dangerous behaviors; the plan includes an individualized positive reinforcement plan to reinforce these appropriate alternative behaviors; the plan includes specific strategies to prevent the targeted dangerous behaviors from happening; the plan gives exact criteria for when and how to implement the restraint or seclusion, including the exact type of restraint if applicable, where the seclusion will take place if applicable, how the child will be monitored, how staff shall respond if the child escalates further, and specific criteria for releasing the restraint or terminating the seclusion.

The above list of requirements may seem long, but these requirements represent best practices within the field of behavioral education and it is entirely possible to create individualized behavior plans that address every single one of them. It can be done -- qualified behavior analysts do it every day. Some parents want the use of restraint or seclusion to be written in a behavior plan because they know that when carefully monitored and used appropriately in conjunction with positive reinforcement, these interventions can eliminate or greatly reduce dangerous behaviors. Eliminating or reducing dangerous behaviors not only allows children to be educated to their fullest potential, but it returns to them a dignity that was once lost. When the above best practices are followed, over time many students who once required restraint or seclusion no longer need these procedures (or need them less often) because they no longer engage in dangerous behavior. Parents should have the right to discuss and plan for these interventions with their childs team if they so desire.

Watching a child bite himself, punch himself, tear out his hair, or attack someone else is a very disturbing sight. It can trigger an emotional response in even the most experienced staff. In the absence of a clear written plan for a particular child, staff may make dangerous decisions driven by panic and fear in the heat of the moment. We believe that implementing restraint or seclusion without an individualized plan will lead to an increase in the number of children and teachers injured during emergency situations. No two children with Autism are the same; we cannot expect that they will require the same type of restraint, the same duration of restraint or seclusion, respond to the same exit criteria, or have the same patterns of escalation and de-escalation. It would be unwise to ask teachers to make all of these decisions on the spot as reactive measures once the crisis is already under way. IDEA goes to great lengths to provide individualized education for students with disabilities, yet the current language of S.2860 prohibits individualized crisis management for these same students.

Crisis management for students who engage in frequent aggression or self-injury must be individualized the same way that education for these children is individualized. We realize many people are concerned that if restraint or seclusion are written into a behavior plan, these interventions will be used as a first response rather than last resort. However, if a child has a written plan with parental consent stating the specific positive methods to be used first as well as procedures to follow in an emergency, teachers will be required to use those positive methods first. Teachers will also be more likely to remain calm in an emergency because they have a specific plan to follow.

We truly believe that children with Autism and other severe behavioral challenges would be best served by the inclusion of the above proposed language or a similar version thereof in the bill. Thank you for the opportunity to share our position with you and for your dedication to improving education for all children.