RESTRAINING RESTRAINTS: DECREASING THE USE OF RESTRAINTS ON
INDIVIDUALS WITH SPECIAL NEEDS
Heather Arlene Gold
B.S., University of California Davis, Davis 2006
PROJECT
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF ARTS
in
EDUCATION
(Special Education)
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
SPRING
2011
© 2011
Heather Arlene Gold
ALL RIGHTS RESERVED
ii
RESTRAINING RESTRAINTS: DECREASING THE USE OF RESTRAINTS ON
INDIVIDUALS WITH SPECIAL NEEDS
A Project
by
Heather Arlene Gold
Approved by:
__________________________________, Committee Chair
Rachael Gonzales, Ed.D.
____________________________
Date
iii
Student: Heather Arlene Gold
I certify that this student has met the requirements for format contained in the University format
manual, and that this project is suitable for shelving in the Library and credit is to be awarded for
the project.
__________________________, Graduate Coordinator
_________________
Bruce Ostertag, Ed.D.
Date
Department of Special Education, Rehabilitation, School Psychology, and Deaf Studies
iv
Abstract
of
RESTRAINING RESTRAINTS: DECREASING THE USE OF RESTRAINTS ON
INDIVIDUALS WITH SPECIAL NEEDS
by
Heather Arlene Gold
The use of restraints on individuals with special needs has been increasing over the past
decade, especially among law enforcement agencies. Even though, improper use of restraints can
lead to severe harm and even death there are no federal guidelines on the proper use of restraints
in school systems. However, there are organizations, such as the Council for Exceptional
Children (CEC), that propose guidelines that agencies can follow. This study describes the
current controversies, policies, and use/abuse of restraints by law enforcement agencies. The aim
of this study is to develop awareness and to train law enforcement agencies on the use of
restraints with individuals with special need. The training provided to a select group of police
officers, focused on understanding the importance of restraining restraints, naming the different
types of restraints, identifying characteristics of different disabilities, learning de-escalation
strategies, and how to employ safe “restraints.”
, Committee Chair
Rachael Gonzales, Ed.D.
______________________
Date
v
DEDICATION
To my family; your support, love and encouragement have been instrumental.
You have pushed me to reach all the goals I have set. You have inspired me by your
drive and motivation. You have never doubted my abilities and for that, I am grateful. To
my friends, for always being there for me and believing in me when I no longer did.
Lastly, to my dad; even though you are not here to see my success, I know you are proud.
I love you all and truly appreciate all you have done. Thank you from the bottom of my
heart.
vi
ACKNOWLEDGEMENTS
To my professor and advisor, Dr. Gonzales, for working diligently with me
throughout this process and for always encouraging me- my project would not have been
accomplished without you. Thank you to all of the police officers, especially my sister,
for volunteering your time and expertise. Your honesty and opinions contributed greatly
to the success of this study. Lastly, to my students, for motivating me and reminding me
every day to advocate for what is right.
vii
TABLE OF CONTENTS
Page
Dedication .......................................................................................................................... vi
Acknowledgements ........................................................................................................... vii
Chapter
1. INTRODUCTION .......................................................................................................... 1
Background of Problem ...................................................................................... 2
Statement of Problem .......................................................................................... 3
Statement of Purpose .......................................................................................... 4
Definitions of Terms ........................................................................................... 4
Assumptions........................................................................................................ 6
Justifications ....................................................................................................... 6
Limitations .......................................................................................................... 7
2. REVIEW OF LITERATURE ......................................................................................... 8
Introduction ......................................................................................................... 8
State Regulations ................................................................................................ 8
Death by Restraint............................................................................................. 12
Model of Best Practices .................................................................................... 15
Grafton Winchester Facility.............................................................................. 15
Luiselli’s Study ................................................................................................. 18
Controversy on the Use of Restraints ............................................................... 19
3. METHODOLOGY ....................................................................................................... 24
Participants ........................................................................................................ 25
Training Design ................................................................................................ 25
Pre-Survey......................................................................................................... 27
Training ............................................................................................................. 28
Part 1: Background Information ....................................................................... 29
Part 2: Identification Training ........................................................................... 30
viii
Part 3: De-escalation Strategies ........................................................................ 31
Part 4: Safe Restraint Research ......................................................................... 32
Part 5: Restraint Training .................................................................................. 32
Layout ............................................................................................................... 33
Post Survey ....................................................................................................... 34
4. CONCLUSION/RECOMMENDATIONS ................................................................... 35
Recommendations ............................................................................................. 37
Apendix A. Police Officer Training Pre-Survey............................................................... 39
Apendix B. Restraining Restraints Training PowerPoint ................................................. 42
Apendix C. Welcome to Holland ...................................................................................... 82
Apendix D. Police Officer Training Post-Survey ............................................................. 83
References ......................................................................................................................... 85
ix
1
Chapter 1
INTRODUCTION
There are too many cases of unexpected deaths and injuries that are the outcome
of untrained, inhumane, and in some cases even legal uses of restraint on children (Ryan,
Robbins, Peterson, Rozalski, & Robbins, 2009). There is little research on the abuse or
death caused by law enforcement and school staff because of the use of restraints on
children, specifically kids with special needs. The need to address the issues is essential
as for, hundreds of kids are subjected to improper and unacceptable use of restraints
(Ryan et al., 2009). In a statement by Rocky Nichols (1999), executive director of the
Disability Rights Center, he references ‘cases where kids have been sat on by gym
teachers, rolled up in gym mats, had their hands duct-taped together, and have even been
placed in little boxes as a form of restraint.
The author of this research has personally experienced on the overuse and/or
“abuse” of restraints used on juveniles. On numerous occasions, the author observed
peace officers relying heavily on restraints, such as handcuffs, to get juveniles with
special needs to obey their and/or he teachers orders. According to the author, peace
officers put forth very little if any effort in using non-restraint methods such as, deescalation or “safe” restraint strategies to try and resolve the issue at hand. In one case, a
9-year-old boy was demanded twice to comply and when he refused the officer forcibly
pulled the student by his arm, from the classroom and restrained him using handcuffs.
Luckily, in this case the student was not killed or injured; however, that is not always the
case.
2
Background of Problem
There is no published data the author could find that specifically shows the
number of police brutalities against kids with special needs, yet in recent years there has
been an overwhelming increase of media attention on police related abuse against this
population of individuals. For example, on April 24, 2009 in Chicago a 16 year old boy
(Guzman) with autism was allegedly struck by an officer who ignored the boys and
family’s plea that he was a “special boy” (Rozas, 2009). The boy was standing on the
sidewalk taking a break from working in his family’s fast-food restaurant, when two
police officers pulled up and started asking him questions. Confused, Guzman walked
away. The officers went after him, promoting the boy to run back into the restaurant,
yelling “I’m a special boy.” Despite, Guzman plea with the cops that he was special and
his parents yelling at the officers that he had “special needs” one of the officers hit
Guzman over the head with their baton, creating a gash that required eight staples.
According to the family, Guzman who has the mental capacity of a 5th grader, mumbled
again and again, “I’m sorry, I’m sorry, I submit, I submit.” At the time of the news report
the Chicago police refused to discuss the incident, but relatives of Guzman alleged
assault and said “[it] was an example of why more officers need to be trained in handling
people with special needs” (Rozas, 2009). This is only one of many cases that have
stormed the media headlines across the country.
The Government Accountability Office (GAO), however, has documented
hundreds of allegations of abuse involving restraint or seclusion in schools (Kutz & US
Government Accountability Office, 2009). Of those allegations, Texas and California had
3
a combined 33,095-reported instances in the 2004 school year. This did not include the
hundreds of cases that went undocumented. In addition, the report detailed 10 specific
cases, four of which ended in death. In one of those cases, a 9-year-old boy with learning
disabilities was confined to a dirty small room over 75 times in a six month period for
whistling, slouching and hand-waving. In another case in Florida, a paraprofessional
gagged and duct-taped five boys to their desks and in Texas a 14-year-old boy died when
a special education teacher lay on top of him because he would not stay seated (Kutz &
US Government Accountability Office, 2009).
Unlike hospitals or residential treatments centers, there is not a federal system that
regulates how restraints should or should not be practiced in schools or by law
enforcement in regards to juveniles with special needs (U.S. Department of Education,
2010). Instead, it is left to the individual states government. There are numerous
behavior management methods, as well as research on effective de-escalation and safe
restraint strategies, which all provided knowledge and tools to help support the successful
fulfillment of safely resolving conflict with special needs individuals. Law enforcement
agencies, however, receive minimal if any training on using these strategies.
Statement of Problem
Law enforcement agencies lack the training needed in order to successfully
interact and resolve challenging situations with individuals with special needs. Peace
officers receive little if any training on how to identify individuals with special needs, deescalation strategies and safe restraints. Although, the numbers of individuals born with
special needs are drastically increasing, the amount of training that peace officers are
4
receiving is not. According to the Child Welfare League of America (2002), eight to ten
deaths occur every year because of improperly performed restraint on children.
Statement of Purpose
The purpose of this project is to develop awareness and to train law enforcement
agencies and their officers on the use of restraints with individuals with special needs.
The training focuses on understanding the importance of restraining restraints, naming
the different types of restraints, identifying characteristics of different disabilities,
learning de-escalation strategies, and how to employ safe “restraints.” In order to
construct a successful universal training program it is essential to learn effective research
based strategies that can be employed by the law enforcement agencies. Most
importantly, this requires a solid understanding of the different types of disabilities, a
detailed explanation of behaviors that are associated with these disabilities, and strategies
that are effective with different individual needs. This training will equip the target
audience with strategies, which will allow them to deal with a variety of challenges and
situations.
Definitions of Terms
Restraint
According to the International Society of Psychiatric and Mental Health Nurses
(1999), restraint is any method of restricting an individual’s freedom of movement,
physical activity, or normal access to his or her body. There are three types of restraint:
mechanical, chemical and physical.
5
Mechanical Restraint
According to Ryan and Peterson (2004) mechanical restraint uses a device or
object, such as: a harness, flexible handcuffs or tape, to restrict an individual’s movement
in order to manage or prevent aggressive behavior.
Chemical Restraint
Chemical restraint involves using medication or sprays to control or restrict and
individual’s freedom of movement. Chemical restraint involves using medication or
sprays to control or restrict and individual’s freedom of movement.
Physical Restraint
Physical restraint is using one or more staff member’s bodies to restrict an
individual’s body movement as a way to establish behavioral control and maintain safety
for the individual and/or his/her peers and staff. Physical restraint is the most commonly
used in schools and according to CEC (2009) guidelines it should be the only type of
restraint performed in a school setting.
Special Needs
Refers to individuals who have been diagnosed with a specific learning disability,
such as auditory, visual and sensory processing, as well as individuals diagnosed with
autism (Shapiro, Church & Lewis, 2002). The Individuals with Disabilities Education
Act of 1997 (Pl 105-17) defines specific learning disability as:
A disorder in one or more of the basic psychological processes involved in
understanding or in using language, spoken or written, which disorder may manifest in
6
imperfect ability to listen, think, speak, read, write, spell, or do mathematical
calculations.
Youth/Juveniles
Youth and juveniles are one in the same. They refer to children 0-12 years of age.
Assumptions
There are a few assumptions in regards to the training that was developed through
this project. First, the training will support peace officers by answering any questions
they have regarding juveniles with special needs. Second, peace officers will actively use
the training as soon as they receive the skills and knowledge, so they can actively support
juveniles with special needs. Lastly, law enforcement agencies will follow up with
frequent trainings to insure all officers are up to date with the most current strategies and
disabilities.
Justifications
With the ongoing increase of deaths caused by restraints in schools, treatment
facilities, and detention centers there is an overwhelming need for further research on
interventions and alternative methods that can be used instead of physical restraints.
The outcome of this project will first handily benefit law enforcement agencies by
providing them with safe and effective strategies while working with kids with special
needs. The training will indirectly benefit educators by providing them an additional
trained source to help in emergencies. In addition, youth with special needs and their
families will benefit because there will be less possibility for injures to the student. With
the increase of individuals with special needs, it is imperative that public service workers
7
are receiving training on identifying individuals with special needs, as well as learning
strategies that are effective in working with these individuals. Learning these techniques
will help decrease the need to use mechanical, chemical and physical restraints thus
decreasing the number of injuries and deaths to individuals with special needs.
Limitations
There are various limitations that exist within this project. Only a small number
of peace officers were given a pre-survey and even a fewer number of officers were
provided the training and post-survey. All but two of the officers were working for one
demographic, small rural area. Lastly, one of the peace officers was a relative of the
author and had prior knowledge of the reason for the training.
8
Chapter 2
REVIEW OF LITERATURE
Introduction
The review of literature focuses on two primary studies that discuss effective
strategies that decrease the use of restraints used on individuals with special needs and
mental illness. This review also includes state restraint policies that have been
implemented in schools. The review shows the controversy associated with the use and
non-use of restraints, as well as, the lack of research on law enforcement use of restraints
on individuals with special needs.
State Regulations
The practice of using restraints on students with disabilities has slowly emerged in
public school systems as the increased number of students with emotional and behavioral
challenges are included in general education. Over the past two decades, schools have
grown concerned on how to respond to student behavior problems, especially those that
are aggressive. Schools have leaned to physical restraint as a tool to use to help control
violence (Ryan & Peterson, 2004). There has been many reported incidences of the
improper use of restraints which has led to death and injures thus sparking a need for
state policies and regulations (Baker, 2009).
The Government Accountability Office (GAO) has documented hundreds of
allegations of abuse involving restraint or seclusion, of those allegations Texas and
California had a combined 33,095 reported instances in the 2004 school year (Kutz & US
Government Accountability Office, 2009). This did not include the hundreds of cases
9
that went undocumented. In addition, the report detailed 10 specific cases, four of which
ended in death. In one of those cases in New York, a 9-year-old boy with learning
disabilities was confined to a dirty small room over 75 times in a six month period for
whistling, slouching and hand-waving. In another case in Florida a paraprofessional
gagged and duct-taped five boys to their desks and in Texas a 14-year-old boy died when
a special education teacher lay on top of him because he would not stay seated. Unlike
hospitals or residential treatments centers, there is not a federal system that regulates how
restraints should or shouldn’t be practiced in schools (Kutz & Government
Accountability Office, 2009). Instead, in 2009 U.S Secretary of Education, Arnie
Duncan, wrote a letter encouraging Chief State School Officers to require schools in to
put in places polices (Duncan, 2009).
In their review of state policies concerning the use of physical restraint procedures
in schools, Ryan et al. (2009) found that thirty-one of the fifty states had established
guidelines for crisis intervention procedures, including restraint. The extent of the
regulations provided, however, varied greatly. Only four states provided very extensive
guidelines, while other states were much less detailed and provided little guidance to
schools and districts. Conversely, several states are still in the process of developing and
or revising their policies and guidelines. An alarming fourteen states reported not having
a policy or guidelines in the use of restraints (e.g., Alaska, Arizona, Arkansas, Idaho,
Indiana, Missouri and Ohio) and instead designated the responsibility to the individual
school districts. The one commonality found among the thirty-one states that had
guidelines set in place was the language specifying that restraints were only authorized
10
for emergency situations, and/or when the student poses a threat to themselves or to
others. In addition, there was an apparent presumption that restraint procedures would be
used primarily with students with disabilities.
The results of the reports by Ryan et. al (2009) as well as, the results by the
Government Accountability Office 2009, the Council of Parent Attorneys and Advocates
(2000), and the National Disability Rights Network (2009), trigged national attention and
a hearing by the U.S House of Representatives Committee on Education and Labor on
May of 2009 (Peterson, 2010). As an outcome of the reports and hearing, two bills were
introduced to the U.S. Congress. In December 2009, Representative George Miller and
Cathy McMorris introduced to the House of Representatives the “Preventing Harmful
Restraint and Seclusion in Schools Act” (H.R. 4247, 2010), which requires all school
staff using restraints be trained to the House. In March 2010 the bill passed. The very
similar congress bill S. 3895, however, is still in Senate committee (S.2860, 2010).
Proponents of the bill believe that the Keeping All Students Safe Act, stalled in
Senate, because it was significantly different than the House bill in that it allows schools
to include restraint and/or seclusion in the Individuals Education Plan (IEP) and Behavior
Support Plans (BSP) (Handle With Care Newsletter, 2011). Although, there is still no
federal regulations on restraints, experts believe that portions of the bill will at some time
become federal law and are encouraging states and their school districts to develop and
implement policies and procedures in regards to restraint (Peterson, 2010).
Some states and departments of education (DOE) have taken the experts’ advice
and developed state and district policies. One DOE is Nebraska. Although, Nebraska has
11
seen very little restraint abuse, the Nebraska Department of Education developed a
technical assistance document, which highlights the policies and procedures that
Nebraska schools should implement in order to avoid restraint abuse. The Nebraska
Department of Education believed that putting in place consistent polices as well as
appropriate training for staff members would help avoid problems that may arise in the
future (Peterson, 2010).
The technical assistance document created by the Nebraska Department of
Education detailed the ten essential elements of the policies and procedures that address
restraints and seclusion (Peterson, 2010). The document stated that the components can
be reordered, but the policy must incorporate all ten. The ten were as follows: 1.
Definitions of key terms. 2. A rational for the need of the policy. 3. The focus of
prevention (how interventions will be implemented to decrease the need of restraints). 4.
The purpose of employing restraints or seclusion. 5. Staff training requirements. 6. Time
lines or the amount of time restraints or seclusion should be used. 7. Documentation of
the incident. 8. Debriefing on what happened and what could have been done better. 9.
Reporting to parents. 10. The supervision and oversight of the incidence. Although, the
Nebraska Department of Education has implemented policies and regulations for their
school districts to follow, there has been no state policy implemented (Peterson, 2010)
Nebraska is one of many states who have yet to develop laws regarding restraints.
According to policy makers such as, Secretary Duncan (2009) it is only a matter of time
before states will be required by federal law to have policies in place. Therefore, school
12
districts should begin to modify or draft policies now “rather than rushing through
creation of such policies following future federal mandate” (Peterson, 2009).
Death by Restraint
Every year people die while being restrained (Kutz & US Government
Accountability Office, 2009). According to the work of Paquette (2003), the majority of
these deaths occur with restrained individuals, while being taken into custody by law
enforcement. Other sudden deaths by restraints involve people in detention or residential
treatment programs.
Although, there is no reliable data on the number of injuries and deaths that are
caused by restraints on children, the Child Welfare League of America (2002) estimates
that between eight to ten deaths occur every year as a result of improperly performed
restraint procedures. One report identified 142 restraint-related deaths across 30 states in
schools and mental health facilities over a ten-year period long period. A recent series by
Hartford Courant, a Connecticut news team, reported 50-150 deaths of all age groups
each year as a result of deaths (Goldman, 2007). Of these deaths, it is believed that about
a third were due to the improper implementation of restraint procedures, resulting in
death by asphyxia or suffocation (Child Welfare League of America, 2002). However,
there is a great deal of confusion about the cause and circumstances’ surrounding
restraint-related sudden death, one explanation is “in-custody death syndrome.” What is
known, however, is that there is a higher rate of sudden death during restraint encounters.
According to Paquette (2003) ‘in-custody’ death syndrome was first used to
describe deaths where there was no apparent cause other than a police arrest. Law
13
enforcement agencies argued that these individuals exhibited a form of behavioral
disturbance that went beyond the distressed state that they normally face. This extreme
behavioral is referred to as "excited delirium" and includes behaviors such as agitation,
excitability, paranoia, aggression, great strength, and numbness to pain (Mash et al.,
2009). When confronted, these individuals can become oppositional, defiant, angry,
paranoid, and aggressive (Castelo, 2003). Dr. Corey Slovis, an emergency medicine
professor at Vanderbilt University of Medical Center, described the “excited” individuals
as, “Wild and Bizarre [and] are often running down the streets, screaming, and sweating
until dehydration” (Goldman, 2007).
There are many known causes of severe behavioral disturbance like: infection,
brain tumors, heat exhaustion, and illegal drugs, psychiatric medications, but according to
Paquette (2003) excited delirium is an unknown medical condition that is not recognized
by the American Medical Association as a medical or psychiatric condition. The
National Association of Medical Examiners, however, does recognize it and it is used by
medical examiners in many major cities (Paquette, 2003).
A study by Mash et al. (2009) supports the National Association of Medical
Examiners notion that excited delirium is in fact a medical condition. The study showed
that excited delirium is a medical condition that can be detected by apostasy and
“unexplained” deaths are not always a result of “excessive use of force” by law
enforcement. The study (Mash et. al., 2009) argues that there is often a “tendency to
confuse proximity with causality, [especially]…when the necropsy fails to disclose an
anatomic cause of death.”
14
Mash’s et. al (2009) reviewed 90 excited delirium cases and reported that
although none were reported to be anatomic deaths, each case reported one or more of the
following: “catecholamine-induced cardiac arrhythmias, restraint or positional asphyxia,
or adverse cardio-respiratory effects of conductive energy devices (e.g., TASER).”
Mash’s et al., concluded that excited delirium can be medically found by the
“identification of postmortem biological markers” specifically the analysis of the
dopamine transporter and the heat shock protein. Combined this with the descriptions of
the decedent's behavior prior to death--one can reliably associate the sudden death with
the excited delirium syndrome. The study continued by stating that those who die
suddenly by excited delirium are already medically unstable and in a rapidly declining
state and already have a high risk of mortality even with medical attention or the absence
of restraints. Despite the recorded research by Mash et al., there is a lot of controversy in
regards to the use of this syndrome/theory to explain sudden death while restrained.
Opponents of excited delirium theory, such as The American Civil Liberties
Union (ACLU) (2009) say there is no proof that someone can be “excited to death”. The
ACLU believes that the theory is “being exploited and used as a scapegoat for police
abuse” (Castello, 2003). They do not believe that these people die from some
“mysterious” syndrome but from abuse, and inappropriate and overuse of force and
restraints that should have been avoided. The ACLU believes’ that being confronted with
excessive force results in psychological stress, which causes further physiological
reactions like, adrenaline release, increased heart rate, temperature, and strength, thus
15
resulting in death (Castello, 2003). The ACLU (2009) strongly believes that most incustody deaths are the result of excessive force and improper restraint techniques.
Model of Best Practices
Minimizing the use of physical restraints on students with special needs should be
a key goal for both schools and law enforcement agencies. There are two main studies,
which describe the implementation of an intervention program to decrease the use of
restraints. Both studies were proven successful in their endeavors.
Grafton Winchester Facility
According to research conducted by Sanders (2009) using a multi-component
intervention program will help to reduce the use of physical restraints thus decreasing the
possibility of bodily harm and psychological effects. Sanders (2009) study described the
outcome of a 2004 mandate that challenged Grafton’s Winchester facility to create an
individualized facility plan to minimize restraints. The facility served approximately 73
children and 43 adults in both a day school and residential program. The children ranged
from 7 to 21 years of age and had varying levels of autism and/or intellectual disabilities,
including psychiatric conditions and significant behavioral challenges. The participants in
this study were from 21 community based group homes and two school sites. They
lacked safety awareness and displayed severe aggressive behaviors thus requiring a 24
hour residential support. The facility used de-escalation strategies; however, when those
failed they used physical restraints to maintain safety in emergency situations. Prior to
the mandate, the Winchester facility employed 260 restraints equaling about 3800
minutes during a one month period.
16
The Winchester facility created a four-component intervention process. The first
component consisted of a reporter, who was responsible for talking to employees about
reducing the use of physical restraints. The reporter would then take the feelings,
reservations, concerns and or suggested tools to the chief executive to design an action
plan. The next three components were staff training, increased management support, and
a formal system to monitor restraints. Although, all of these components are important,
staff training and management support were viewed as being the most effective.
The facility found that training was a vital component. It became apparent that if
restraints were to be eliminated then it needed to be replaced with another tool. Staff
members underwent a 2 hour training, which taught philosophical perspectives and
various non-physical strategies (Sanders, 2009). The foundation of the training focused
on learning how to support and comfort an individual experiencing emotional distress
versus trying to control the individual. The training reviewed in Sanders research (2009)
was based on work by Huckshorn, who stated:
If you are looking at facilitating the growth or rehabilitation of kids who have
already been traumatized and have not had good role models, and you’re trying to
make them productive adults, you don’t do that by forcing, coercing, controlling,
and ruling them (Sanders, pp 218, 2008).
In addition to the philosophy training, employees underwent extensive training
that consisted of lecture, demonstration, and practice on ‘extraordinary blocking’
techniques instead of restraints. Extraordinary blocking techniques include, using
pillows, cushions, bean bags and other soft objects to support the individual, but also
17
protect the staff members involved. The items are to be used by holding them up to
lessen the impact and or deflect kicks, hits, slaps, bits etc. The training taught basic
techniques and stressed the importance of each treatment team to identify what works
best for each individual. These techniques, however, were not full proof. For example,
Sanders (2009) found that staff still complained that they were being scratched on their
hands, which were not protected.
The third component, which was also viewed as being very essential to decreasing
the use of restraints, is the physical presence and support by the management. This
meant that management officials, such as the executive director and administrators,
would be there to support staff members in an emergency situation, in addition to the
normal on-call schedule. In order for this to be successful staff members were instructed
to call for assistance when clients were first showing signs of difficulties. Restraints
could then be avoided with additional support to assist in de-escalating the situation. The
managers were there to provide both direct support, and also to observe the staff
members and give positive feedback and guidance. Sanders (2009) research found that
this component was successful because at any given moment during any time of the day
or night a manager could be contacted.
The last component involved creating a formal system of processing restraints.
The goal of the system was to debrief the individuals who were involved. The process
included how to avoid similar situations in the future and how to identify what additional
supports were needed. Questions such as “How did you de-escalate the situation?” and
18
“What would you need next time to be able to effectively use extraordinary blocking?”
were asked during the debriefing (Sanders, 2009).
The four-component program studied by Sanders (2009) almost eliminated
physical restraint. There was a 99.4% reduction in physical restraints from 2005 to 2008.
Although, it is difficult to say which component contributed most to such dramatic
results, it can be concluded that the four-component interventions, which did not require
the use of restraints was extremely effective.
Luiselli’s Study
Another study conducted by Luiselli (2009) also found non-restraint interventions
effective. As in Sanders (2009) study, Luiselli’s study found that early intervention was
essential. The study focused on assessing antecedent conditions associated with restraint
and changing them so that they no longer produced restraint-provoking behavior. The
staff members were taught how to detect behaviors that indicated that the individuals
were becoming upset, which often predicted aggression. When observing the antecedent
behaviors the staff used individualized strategies such as: taking time away until the
individual was composed, allowing access to novel activities, and strategically placing
students so there is less interaction with peers. In addition to staff training, students also
underwent functional communication training, which taught them how to request a break
from situation that causes them to become frustrated.
Another approach used by Luiselli (2009) was to decrease the duration of restraint
because maintaining physical restraint can be problematic if a person is unable to calm
down quickly. One way she proposes to do this is by establishing a fixed-time criterion.
19
Her research showed that a person’s total exposure to physical restraint could be
minimized by stopping the procedure after a fixed-time has elapsed, instead of waiting
until certain behavior is exhibited. This is similar to findings by Singh & And (2009)
who found that a brief one minute physical restraint was more effective than a three
minute physical restraint, in controlling self-injurious behaviors in a 16-year-old
profoundly retarded girl. In other words, the end results of the study found that if
restraint is necessary it is more effective if the restraint lasts less than 2 minutes.
Controversy on the Use of Restraints
Physical restraints, which are used to help reduce or eliminate a student’s
aggressive behavior is a very controversial topic. Professionals, who use restraints in
schools, argue resolve the crisis better than other interventions and are thus needed in
emergencies when an individual becomes a threat to him/herself or to others (Miller et
al., 2006). Studies such as those conducted by Lamberti & Cummings, 1992; Measham,
1995; Miller et al., 2006; Rolider, Willimas, Cummings & Van Houten, 1991 assert that
when a student becomes extremely aggressive there is no other way to de-escalate the
situation, but to use restraints (Handle With Care, 2011). They argue that physical
restraint is effective in decreasing self-injurious and aggressive behavior and are
necessary in order to insure the safety of the individual or those around him/her.
According to research by Fahlber (1991), physical interventions, such as
restraints, play an important and beneficial role in re-parenting youth, who were not
taught how to set limits because of the absence of parenting. The student thus learn that
actions have consequences. Proponents also point out that there are many positive
20
outcomes of successful restraint that are overlooked. For example, there have been
many reports where teachers had to use restraints in order to protect a student from
assault from another student. They say that the teachers’ right to restraint insures safe
environment for all kids. (Handle With Care Newsletter, 2011). Therefore, proponents
for restraints argue that they are used to benefit the individual (Stirling & McHugh,
1998).
Police departments are also advocates for restraints. According to research by
Brave & Peters (1994) all police departments use some form of restraint. The type of
restraints must follow the standards created by law. The use of restraints are controlled
by federal law, state law, county and departmental policies, as well as manufacturer
instructions (Brave & Peters, 1994).
The federal law states that placing a person in handcuffs impinges on that person's
fundamental right of liberty. Police can only use handcuffs when there is a lawful
justification for doing so. An officers use of force against a citizen must be
“…objectively reasonable, based upon the totality of circumstances” (Brave & Peters,
1993). There are three factors that determine the “totality of circumstances.” The
severity of the crime and the immediate threat to the safety of officers and others must be
considered, as well as, whether the suspect is resisting or attempting to evade arrest. If
the officer uses more force than necessary, the officer is in violation of the Fourth
Amendment right to be free from unreasonable seizures or use of force. If found liable
the officer could face Federal prosecution (Deprivation of Rights Under Color of Law).
21
In addition to federal laws, state laws also exist. State laws typically follow
federal mandate, however some states will require officers to use leather straps on
mentally ill patients instead of metal handcuffs. Departments are also allowed to make
requirements for their officers and their requirements are usually more specific, but they
have to be in accordance of federal and state law. For example, the Chandler Police
Department of Arizona (2010) have a manual that describes the proper used of handcuff
restraints. According to their department statue, handcuffs are to be used on all prisoners
except when: doing so knowingly aggravate an injury during transport, or when based on
legitimate reasons and sound officer discretion. The policy also details the proper cuffing
technique. The department requires the officers to place prisoners hands behind their
backs, check the tightness of the handcuff- stipulating that they should be lose enough to
slide up and down the arms without slipping off their hands and requires that even if the
person is handicapped, sick, and/or injured: if they can be transported in a patrol car then
they need to be restrained. They do, caution their officers to not place prisoners in
restraints if they are in a position that will restrict the person's ability to breathe. The
Chandler Police Department (2010) also encourages officers to consider bringing the
suspects hands to the front of their body if they are in a patrol car for more than an hour.
In order to insure totalities of circumstances are considered, some departments
give very detailed instructions when circumstances include juveniles, pregnant woman,
ill, injured, intoxicated person or an obese person. For example, a Seattle Police
Department (2011) requires pregnant women to be handcuffed in front rather than the
22
back and obese individuals be hand cuffed using two sets of cuffs attached together to
avoid strain.
Police departments argue that policies and procedures are always in place, and
officers undergo extensive training in the use of restraints. They believe that restraints
are not only necessary, but essential for the protection of the officers, the restrained
prisoner and third party individuals.
Opponents of restraints, such as the Council for Exceptional Children (CEC),
argue, that they are used too often in public school settings and should have no place in
schools. They state that applying restraints are not only invasive, but can cause injury to
the person being restrained, as well as the individuals implementing them
(www.cec.sped.org). In addition to the risk of bodily harm, a number of adverse
psychological effects are associated with physical restraint, such as dehumanization,
withdraw, agitation, depression, trauma and re-traumatization (Sanders, 2009).
According to Luiselli (2009) physical restraints can also provoke, and in some cases
maintain, problem behaviors because it functions as a positive or negative reinforcement.
Ryan & Peterson (2004) agree, stating that there is very little research that proves
physical restraint as a behavior modification strategy. They believe that proponents use
these techniques despite the lack of research because it has historically been used for this
purpose and they don’t know other strategies.
Opponents of restraint instead believe that schools should create new, or modify
existing policies and procedures in regards to physical restraint, as well as offer non-
23
restraint training to all staff members involved in students with aggressive behaviors
(Peterson, 2010).
The use of restraints is a very controversial topic and both proponents and
opponents have founding arguments. It can be concluded that proponents believe the use
of restraints are affective and necessary in emergency situations especially in regards to
criminals being taken into custody. Opponents, however, state restraints used on
juveniles, especially with those whom have special needs, should only be used for a
minimal amount of time and only when all other options have been exhausted.
24
Chapter 3
METHODOLOGY
The purpose of this study was to address the use of restraints by law enforcement
agencies on students with special needs and provide training on alternative researchbased methods that can be employed.
The author has personally experienced the overuse and/or “abuse” of restraints
used on juveniles. On numerous occasions, the author observed peace officers relying
heavily on restraints, such as handcuffs, to get juveniles with special needs to obey their
and/or the teachers orders. In one case, a 10 year old boy was detained using mechanical
restraints and escorted off school grounds even though he was fully complying with the
school staff and police officer.
The author being very distraught over continual situations like the before
mentioned, started to ask peace officers general questions about the amount of training
they received on working with juveniles and more specifically with juveniles with special
needs. The author relied heavily on her sister, who was a peace officer for answers. The
author discovered from interviewing her sister and from informal questions that her sister
sought from fellow officers, that both new and senior officers received very little training
in working with juveniles with special needs and they all thought the training would be
very beneficial.
The author, a special educator, has a personal commitment to ensure that students
from different cultures and learning abilities feel cared for, stimulated and challenged and
most importantly feel respected, safe, and are treated with dignity. The author, shocked
25
by the informal answers given by the peace officers and by the increase of headlines of
kids with special needs being a victim to alleged police brutality, knew that research had
to be conducted in order to develop awareness and training for peace officers.
Participants
The ten participants for this research were chosen from Tehama County. All of
the officers that participated in this project (exception of 2) at one time worked for
Tehama County. Tehama County is located in rural Northern California.
Tehama County was the focus location because the author was able to recruit
volunteers to participate. The author had difficulty-getting approval from a law
enforcement agency to implement the training because it had to be presented to the City
Council for approval. Since, the City Councils agenda’s were filled, the author sought
volunteers. All the participants (exceptions of 2) in this study volunteered because they
knew and/or at some point worked with the author’s sister, whom is a peace officer. The
participants who volunteered were fully aware that the training they received was not
department approved. Although, most of the peace officers were from the same location,
the academies where they received their initial training and their prior law enforcement
experience varied. For the purpose of confidentiality officers names have been changed.
Training Design
The design for this study was developed through the authors personal
observations of the overuse of restraints on juveniles with special needs at her school, as
well as, informal conversations with the author’s sisters, whom is a police officer, and
with the author’s school districts police department.
26
As previously mentioned, after talking to the peace officers, the author learned
that the officers did not “know what to do.” One officer stated that when he receives
calls from schools in regards to special needs children he relies heavily on the special
education teacher and administrator for assistance because “they [special educators] have
been trained” and he “[has] not.” This concerned the author, who is a special educator,
because she was not trained in restraint and was instead directed to call law enforcement
in “out of control” situations. Shocked by learning that peace officer had little if any
training in regards to juveniles with special needs/mental illness probed her to research
the amount of training and the type of training officers received on working with
individuals with special needs.
The author began to conduct informal interviews as well as in depth research on
effective behavior management techniques as well as safer and less invasive forms of
restraint in order to develop a effective, comprehensive program that would apply to all
peace officers. After the initial research, the author developed a survey to get an in depth
understanding of the training peace officers received in working with kids with special
needs.
The results of the survey drove the content and the organization of the training.
The training program consists of five parts: background information, identification, deescalation strategies, safe restraints research, and safe restraint training. When
developing the five parts of the training it was essential to use appropriate research-based
theories and teaching strategies gained from the literature review. In order for the target
audience to develop the skills necessary to de-escalate a challenging situation and/or
27
safely restrain an individual with special needs, it was imperative in the training to
present a historical perspective of the problem in regards to restraints, so the trainees
could see that the information is founded by research. Participants all needed ample time
to practice the target skills because they are multifaceted and mastery is essential. Most
importantly feedback was given, so a comprehensive understanding was gained and
improvements were made.
The intended learning outcome of this project was that peace officers would have
a solid understanding of the nature of learning disabilities, behaviors that are associated
with the disabilities, types of restraints, effective de-escalation strategies, as well as safe
restraint techniques. The skill and task training will apply to any peace officer and will
provide a foundation they can use when working in challenging situations with juveniles
with special needs or mental illness.
Pre-Survey
The author developed a survey to give to peace officers, using Survey Monkey
(See Appendix A). Survey Monkey, is an online survey program, which allows the
designer to create, distribute and analyze surveys. The author choose Survey Monkey
because of the ease of accessibility. The author worked closely with her sister, who is a
police officer, to make sure the survey questions and answers were relevant. For
example, in regards to amount of training officers received, the author choose to give
hourly options, because police officer trainings are usually always 4 hours (half day), 8
hours (full day), or 9+ hours (more than a day). The survey consisted of nine multiplechoice questions and one fill in question, making the survey simple, yet very
28
informational. The purpose of the pre-survey was to collect information on the amount
of training officers have had in working with juveniles with and without with special
needs, as well as the amount of non-restraint training, such as de-escalation strategies
they have received. The author also wanted to know how confident the officers felt when
responding to calls involving juveniles with special needs. Most importantly, the author
needed to know if they felt a training on working effectively with juveniles with special
needs would be beneficial. The answers the officers provided were the foundation for the
training.
Training
The information collected from the survey and research conducted was compiled
into a solid structured training program for police officers. The training is called,
Restraining Restraints: Decreasing the Use of Restraints on Individuals with Special
Needs and Mental Illness” and it specifically targets law enforcement personnel. The
training set forth below, applies to behaviorally problematic situations with kids who
have special needs.
The training was a PowerPoint presentation (See Appendix B, pp 42) that was
broke into five parts: Part 1 Background Information, Part 2: Identification, Part 3: Deescalation strategies, Part 4: Safe Restraints Research and Part 5: Safe Restraint Training.
When developing the five parts of the training it was essential to use appropriate
research-based theories and teaching strategies gained from the literature review. In
order for the target audience to develop the skills necessary to de-escalate a challenging
situation and/or safely restraining an individual with special needs, it was imperative to
29
build background knowledge, so they could see that the need of training was sparked by
both historical research and officer request. It was critical to provide time for the
officers to practice the target skills learned and most importantly give feedback. The
PowerPoint training provided the trainer with a day-to-day agenda as well as the
sequence of the training.
The training is appropriate for peace officers of any group size, with the
understanding that active participation of attendees is vital. A projector and projector
screen was required, as well as internet access. The training took place in a large location
with seating for each attendee, as well as a designated area for practicing safe-restraint
techniques. All participants had a print out of the PowerPoint training and a writing
utensil to take notes. In order to insure that each concept covered was understood and the
desired learning outcome was met, the training was introduced across two eight-hour
days. The training session covered the following topics:
Day 1
Part 1: Background Information (See Appendix B, pp 43)
Day one began with the objectives of the training, a brief snap shot of why it was
important and also the definitions of key terms that were going to be used throughout the
training. After a brief introduction of the training, the trainer presented the officers with a
more in depth look at why the training was essential. The trainer introduced statistics and
research obtained from the author’s literature review. The most controversial topic
presented was the “Excited Delirium” theory.
30
Both proponents and opponents of the theory were introduced (See Appendix B,
pp 223). During the proponents section, all three officers discussed that they believe the
theory to be true. In fact one officer stated that he became aware of the theory after he
had been involved in an “altercation with a criminal that suddenly died for no known
reason.” During the opponents section the officers were upset by the ACLU’s position
that police were using the theory as a “scapegoat for police abuse.” One officer stated,
“[He] was sick of people blaming cops for criminal’s actions.” Another cop continued
saying, “[They] were tired of citizens thinking cops are on power trips and want to
intentionally physically harm people.” The trainer reminded the participants that it is
important to understand both positions in order to be able to make a better argument for
or against the issue.
Part 2: Identification Training (See Appendix B, pp 50)
The trainer started the second part of the training by reading, “Welcome to
Holland, (See Appendix C, pp 81)” a story written by a parent on what it’s like to raise a
child with a disability. After reading the story the trainer asked officers what they
thought about it. Officer Holmes stated, “[She] felt that raising a child with a disability
would be stressful and beyond difficult,” but added that “the way the parent embraced the
situation was honourable and could be applied to many difficult situations in life.” The
trainer continued with the different types of disabilities and how to identify each. The
officers seemed very interested in the different types of disabilities and asked questions
such as, “How do you diagnose an individual with a learning disability?” “Do they look
31
different they me and you?” and “What are some reasons that individuals end up with
learning disabilities?” to name a few.
After the officers received an overview of the different types of disabilities and
the characteristics associated with each, the trainer provided the officers with a few
scenarios in which they had to identify the learning disability. Officer Jackson, stated
that the “Scenarios helped [him] apply what he learned....and [he] liked it.” Officer
Holmes and Angley agreed. The day concluded with a summary of the day.
Day 2
Part 3: De-escalation Strategies (See Appendix B, pp 62)
Day 2 started with the trainer reading a quote called, “Attitude” (See Appendix B,
pp 62 ) and continued by introducing de-escalation strategies that should be used when
working with an “angry” or “out of control” individuals, especially ones with a learning
disability. The trainer then discussed the importance of managing oneself. Officer
Jackson asked, “Why should I have to worry about myself, shouldn’t I be worrying about
the situation at hand?” The trainer explained, “...People react instinctively to anger and
when we do so, we typically react inappropriately and if we can learn to calm ourselves
down, then we enter the exchange with more control.” The officers responded with nods
of agreements.
The training continued with presenting strategies such as, relating to the
individual in crisis, tone of voice, body language, response time, repeat of directions etc...
At one point, officer Angley stated that, “[He doesn’t] have time to sit there for 15-20
minutes to try to de-escalate a situation.” The trainer replied, “[She] understands that
32
officers are overworked, but if using de-escalation strategies are working, it shouldn’t
matter if it takes 15 minutes or an hour because all individuals have a right to be
protected and respected and all the time in the world is worth saving someone’s life.”
The training ended, with the trainer providing time for the officers to practice the newly
taught de-escalation strategies.
Part 4: Safe Restraint Research (See Appendix B, pp 69)
The trainer presented the participants with two case studies that showcased
effective and efficient alternatives to restraints. The trainer emphasized that the methods
presented should always be tried first before other restraints methods (physical, chemical,
and mechanical), be used unless immediate danger and/ or threat is present. Officer
Holmes, commented that, “The research was impressive..., but was concerned that [they]
are not equipped with the props needed for safe blocking techniques.” The trainer
responded by stating that the officers could, “Carry a small pillow with a hand strap sewn
on the back...or could use whatever soft objects they had in reach.” The officers and
trainers adjourned for a 45 minute lunch break prior to the physical restraint training.
Part 5: Restraint Training (See Appendix B, pp 77)
When the group re-assembled the trainer had the three officers’ work together to
simulate a possible emergency situation. One officer acted like the “out-of-control”
individual, while the other two officers worked together to try resolve the situation using
all the methods they were taught. The officers were instructed to first use de-escalation
strategies, then blocking techniques, and lastly safe restraints, which included a basket
hold-lasting only 2 minutes or less. The officers took turns in each position.
33
According to the trainer, the hardest aspect of the training was having an officer
act “out-of-control.” The officers were very timid and gave little resistance. On a couple
of occasions the trainer had to step in and play the part. Officer Jackson commented that
he felt the training was “beneficial” and he felt more “confident and prepared.” Officer
Holmes, added that she thought she could “...apply the strategies to most of [her] calls”
even those that are not “associated with juveniles or individuals with special needs.”
Officer Angley, agreed with the other two officers and was “...eager to employ the
strategies.”
Layout
Throughout the training, the trainer provided ample time for questions and
clarification. In addition, after parts 2-4, time was given to practice the newly taught
strategies covered. The training ended by combining the de-escalation and safe restraint
strategies together in a role playing exercise.
The training was completed in two consecutive days. Ideally, if the training could
not be completed in two consecutive days, then it could be spread across one week. This
schedule will insure a complete understanding of the background information, concepts,
and techniques taught, and allow the time necessary for practice.
The two training session included direct instruction utilizing lecture, discussions
and role playing. Participants were expected and encouraged to actively participate in
discussions and role plays, as well as any activities that were set forth in the training.
Participants took notes and were required to apply the new concepts and strategies to
outside experiences. At the conclusion of each part, the trainer asked questions to assess
34
understanding, as well as required participants to respond to scenarios using the newly
gained concepts. The trainer asked participants to volunteer, as well as, called on random
participants to share their answer to the scenarios. For Part V: Safe Restraint Training, the
author coached the officers by showing and reminding them the skills they were taught.
The author also shadowed the police officers making sure she was readily available for
questions or if she needed to make adjustments to the holds or positions of the officers.
Lastly, the author provided feedback to the participants, so they knew what worked and
what needed continued practice.
Post-Survey
After the training, each participant was required to take a post-survey. The author
developed a survey to give to peace officers participants, using Survey Monkey (See
Appendix E, pp 81). Survey Monkey, is an online survey program, which allows the
designer to create, distribute and analyze surveys. The author chose Survey Monkey
because of the ease of accessibility. The author used the pre-survey, as well as the target
learning outcome, as a guideline for the post-survey questions. The post-survey also
consisted of nine multiple-choice questions and one fill in question, making the survey
simple, yet very informational. The questions were very similar to the pre-survey, but
instead focused on the police officers confidence level working the juveniles with and
without special needs after receiving the training. The author also asked how confident
they feel (after the training) in implanting safe restraints and de-escalation strategies.
Most importantly, the post survey had officers rate the success of the training and the
expertise of the trainer. Chapter 4
35
Chapter 4
CONCLUSION/RECOMMENDATIONS
The need for this research came about when the author observed the overuse
and/or “abuse” of restraints used on juveniles. According to the author, on numerous
occasions, peace officers were observed putting forth little if any effort in using nonrestraint methods such as, de-escalation or “safe” restraint strategies to resolve conflicts
with juveniles with special needs.
The author, a special educator, has a personal commitment to ensure that students
from different cultures and learning abilities feel cared for, respected, safe, supported and
are treated with dignity. The author being very distraught over continual situations like
the before mentioned, started to ask peace officers general questions about the amount of
training they received on working with juveniles and more specifically with juveniles
with special needs. The author discovered that both new and senior officers received very
little training in working with juveniles with special needs and they all thought the
training would be very beneficial.
The author shocked by the informal answers given by the peace officers and by
the increase of headlines of kids with special needs being a victim to alleged police
brutality, knew research and training for police officers was crucially needed. The author
used the informal interviews to develop a survey, using Survey Monkey, for police
officers, so she could gain a better understanding of the training they have undergone in
relation to juveniles, juveniles with special needs and on non-restraint and “safe” restraint
36
techniques. The author also wanted to know the officers confidence level in working
with the before mentioned population and using non-restraint and safe restraint strategies.
The purpose of this research was to address the use of restraints law enforcement
agencies on students with special needs and provide training on alternative researchbased methods that can be employed. The author found through her research that both
unseasoned and veteran peace officers reported receiving very little training in working
with juveniles, and even less in working the individuals with special needs. Although, 8
out of 10 officers reported that they would feel “confident” when responding to an
elementary school call regarding an “out of control” student whom was in special
education, zero officers reported feeling “very confident.” Despite the majority of
officers feeling confident in responding to emergencies involving kids with special needs
all ten officers felt that training on identification of special needs, de-escalation strategies,
and “safe” restraint techniques would be “very beneficial.”
Three out of ten officers who took the initial survey volunteered to partake in the
two day Restraining Restraints training. During the training the author was confronted
with many heated discussions. The main issue that continued to arise was officers stating
that they “Don’t have time” to “de-escalate” situations. The author reminded the officers
that it was their civil duty and the 4th amendment rights of the students to have all
strategies exhausted before using mechanical, physical or chemical restraints. The author
also asked the officers how they would feel if their child with special needs was
handcuffed, maced or physically restrained by an adult without trying other strategies.
This analogy by the author seemed to be very effective in getting the officers to
37
understand the importance of using de-escalation strategies. Although, there were times
the officers were resistant, at the end of the training they seemed to appreciate and
recognize the need to use other methods/strategies and to not rely so heavily on restraints.
After the training the officers took a post-survey, using Survey Monkey. The
survey showed that the three officers reported an increase of confidence in working with
juveniles, juveniles with special needs and using non-restraint techniques such as, deescalation strategies, and “safe” restraints techniques, such as blocking. The three officers
also agreed that the training was very beneficial and the professionalism and knowledge
of the presenter was excellent. In conclusion, the Restraining Restraints: Decreasing the
Use of Restraint on Individuals with Special Needs, training was effective in increasing
the confidence level of peace officers when working with individuals with special needs.
Recommendations
It is strongly recommended that further research in the area of police officers nonrestraint and “safe” restraint techniques on students with special needs, be continued.
Future training should include a larger and more diverse population. Continued training
should be provided over the years to match new research based methods and meet the
very large and diverse special needs population. Police academies should implement
training on identification of individuals with special needs, as well as de-escalation and
safe restraint strategies. Police departments should mandate and include in their
department handbooks, guidelines to follow when working with juveniles with special
needs. The department chief/sergeant should ensure the implementation of these polices.
38
It is also strongly recommend that every state establishes written laws and
protocols which require law enforcement agencies to follow. Every police department
should make the policies available to the public, so parents and school personnel are
aware of the protocol. The department should specifically identify how calls involving
juveniles with special needs are monitored. Incidents, especially those involving injures,
should be reported to an outside agency on a regular basis. Departments need to assess
the accuracy of the data and set in place interventions if needed when data indicates
overuse or potential abuse of restraints involving students with special needs. States
should also develop policies for schools regarding restraints, so they can assist law
enforcement in emergency situations.
39
APPENDIX A
/w EWDgLirdKQA
/w EPDw ULLTIw M
Police Officer Training PRE-Survey
Exit this survey
1. About how many hours of TRAINING (not what you have learned by
experience, but what you have been directly taught) have you received on
working SPECIFICALLY with individuals who have disabilities, (e.g.
Autism)?
None
1-4
5-8
9 or more
Other (please specify)
2. About how many hours of training have you received on working
SPECIFICALLY with juveniles (ages 0-12)?
About how many hours of training have you received on working
SPECIFICALLY with juveniles (ages 0-12)? None
1-4
5-8
9 or more
Other (please specify)
3. About how many hours of training have you received on working
SPECIFICALLY with juvenile individuals with mental illnesses (e.g.
Oppositional Defiant Disorder)?
None
1-4
5-8
9 or more
40
Other (please specify)
4. Considering the training you have received, how confident do you feel
working with children ages 1-12 whom have disabilities, such as Autism?
Not Confident
Somewhat
Confident
Very Confident
Confident
5. Considering the training you have received, how confident do you feel
working with children ages 1-12 with mental illnesses, such as
Oppositional Defiant Disorder?
Not Confident
Somewhat
Confident
Confident
Very Confident
6. Considering the training you have received, how comfortable would/do
you feel if/when responding to a elementary school call regarding an “out
of control” student who they tell you is in a special education class?
Not
Comfortable
Somewhat
Comfortable
Comfortable
Very
Comfortable
Comment:
7. How beneficial would a training be, that was SPECIFICALLY designed for
teaching de-escalation strategies and “Safe” restraints (e.g. blocking, the
basked hold etc…) for juveniles with disabilities, such as Autism, and
mental illness?
Not Beneficial
Beneficial
Somewhat Beneficial
Very Beneficial
Comment:
8. How many hours of “safe” restraint training (e.g. blocking, the basket
hold etc…) have you undergone?
None
1-4
5-8
9 or more
Other (please specify)
41
9. How many hours of de-escalation strategy classes have you undergone?
None
1-4
5-8
9 or more
Other (please specify)
10. How many years of service do you have?
OPTIONAL: What county do you work for?
How many years of service do you have? OPTIONAL: What county do you work
for?
Done
Powered by SurveyMonkey
Create your own free online survey now!
42
APPENDIX B
Restraining Restraints Training PowerPoint
43
Restraining Restraints
Decreasing the use of Restraints
on Individuals with Special Needs
and Mental Illness
By: Heather Gold
B.S. Human Development
Multiple Subjects Credential
Mild/Moderate Credential
Part I
Background Information
• Objectives of training
• Why is this training important?
• Definitions
• Types of Restraint
44
Part I
Background Information
• Statistics
• How and why deaths are occurring?
• Controversy of restraints
• Pros and Cons of restraints
Objectives of Training
Continued
• Identify the characteristics of different
disabilities
• Learn de-escalation strategies
• Employ safe “restraint” techniques
Why is this Training Important?
• The use of restraints on individuals with
special needs and mental illness has been
increasing over the past decade.
45
Why is this Training Important?
• Every year people die while being
restrained and the majority of these deaths
occur while being taken into custody by law
enforcement (Paquette, 2003).
Training Important continued…
• Although, there is no reliable data on the
number of injuries and deaths that are
caused by restraints on children, the Child
Welfare League of America (2002)
estimates that between eight to ten deaths
occur every year as a result of improperly
performed restraint procedures.
Definition of Youth/Juveniles
• Youth and juveniles are one in the same
• They refer to children 0-12 years of age
46
Definition of Special Needs
• Special Needs during this training refers to
individuals with a disability (to be defined later)
and/or mental illness (to be defined later).
Chemical
• Chemical restraint involves using
medication or sprays to control or restrict
and individual’s freedom of movement
(Ryan et. al., 2009).
Restraint Continued
• Physical Restraint is most commonly used
on youth in a school system and there is
NO federal law on regulating restraints.
• Law enforcement uses all three types of
restraint as a way to try and establish
behavior control.
47
Statistics
• In 2004 California and Texas had a
combined 33,095 reported allegations of
abuse involving restraint or seclusion
(Government accountability Office, 2009)
• The report also detailed 10 specific cases,
four of which ended in death.
How/why are Deaths Occurring?
• Excited Delirium:
– Law enforcement agencies argue individuals
exhibit a form of behavioral disturbance that
went beyond the distressed state that they
normally face. This extreme behavioral is
referred to as "excited delirium" and includes
behaviors such as: agitation, excitability,
paranoia, aggression, great strength, and
numbness to pain.
How/why are Deaths Occurring?
• Excited Delirium:
– Law enforcement agencies argue individuals
exhibit a form of behavioral disturbance that
went beyond the distressed state that they
normally face. This extreme behavioral is
referred to as "excited delirium" and includes
behaviors such as: agitation, excitability,
paranoia, aggression, great strength, and
numbness to pain.
48
Excited Delirium Continued
• When confronted, these individuals can
become oppositional, defiant, angry,
paranoid, and aggressive.
• They eventually become excited to death.
• According to Paquette (2003) excited
delirium or ‘in-custody’ death syndrome was
first used to describe deaths where there
was no apparent cause other than a police
arrest.
Opponents to Delirium Theory
• Despite agencies trying to use the Excited
Delirium disorder the American Medical
Association does not recognize it as a
medical or psychiatric condition.
• They argue that there are many known
causes of severe behavioral disturbance
like: infection, brain tumors, heat
exhaustion, and illegal drugs, psychiatric
medications.
ACLU as an Opponent
• Say they have never seen any proof that
someone can be excited to death.
• The ACLU believes that the theory is being
exploited and used as a scapegoat for police
abuse.
• They don’t believe that most of these people die
from some mysterious syndrome but from abuse,
and inappropriate use of force and restraints that
should have been avoided.
49
ACLU Controversy Continued…
• They believe that being confronted with
excessive force results in psychological
stress, which causes further physiological
reactions like, adrenaline release,
increased heart rate, temperature, and
strength, thus resulting in death.
• The ACLU believes that most in-custody
deaths are the result of excessive force and
improper restraint techniques.
Controversy Conclusion
• There is a great deal of confusion about the
cause and circumstances surrounding
restraint-related sudden deaths. What is
known is that there is a higher rate of
sudden death during restraint encounters.
Controversy Conclusion
Continued….
• The need to address these issues is essential as
for, hundreds of kids are subjected to improper
and unacceptable use of restraints (Ryan,
Robbins, Peterson, Rozalski, & Robbins, 2009).
• Preparing appropriate responses to
potentially dangerous circumstances helps to
eliminate or minimize negative consequences.
50
Restraint Controversy
Pro
Argue that they are needed in emergency
situations when an individual becomes a threat
to him/herself or to others.
Youth becomes extremely aggressive there is no
other way to de-escalate the situation,
In order to insure the safety of the individual or
those around him/her.
Restraints are used to benefit the individual.
Restraint Controversy
Con
• Opponents of restraints, such as the Council for
Exceptional Children (CEC), argue that they are
used too often on youth with special needs.
• They state that applying restraints are not only
invasive, but can cause injury to the person being
restrained, as well as the individuals
implementing them (Luiselli, 2009).
• In addition to the risk of bodily harm, a number of
adverse psychological effects are associated with
physical restraint, such as dehumanization,
withdraw, agitation, depression, trauma and retraumatization (Sanders, 2009).
Con’s Continued
• Physical restraints can also provoke, and in some
cases maintain, problem behaviors because it
functions as a positive or negative reinforcement
(Luiselli, 2009).
• Opponents of restraint believe law enforcement
should create new, or modify existing policies and
procedures in regards to physical restraint of
youth with special needs and mental illness
• Employ non-restraint or “safe” restraint, and/or
de-escalation strategies when involved with
“Special needs” students with aggressive
behaviors.
51
Research on Current Training
• According to 10 officers surveyed. They
received minimal, if any training on safe
restrains and de-escalation strategies.
• They received on average less than 4 hours
of training specifically on youth, special
needs, and mental illness individuals.
Research Results Continued
• The research showed
that the officers
confidence in
responding to calls
regarding these
individuals is low
• 100% of the officers
who took the survey
stated that a training
on these topics would
be VERY beneficial.
PART II
Identification
• Welcome to “Holland” story of what its like
to raise a child with a disability.
• Types of disabilities
• Characteristics of disabilities
52
Types of Disabilities
• There are many different types of
disabilities.
• For the purpose of this training we will focus
on Specific Learning Disabilities and
Autism.
What is a Learning Disability?
• The Individuals with Disabilities Education
Act (IDEA) of 1997 defines it as:
• A disorder in one or more of the basic
psychological process involved in
understanding or in using language, spoken
or written, which disorder may manifest in
imperfect ability to listen, think, speak, read,
write, spell, or do mathematical calculation.
Continued…
• It must interfere with the child’s everyday
functioning at school, or home.
• In addition, to these general criteria other
factors such as age and development must
be considered.
•
Gelfand and Drew, 2003
53
Juveniles with SLD’s
• Are typically impulsive.
• Need structure and organized routines
• Disruption of routine will manifest intensely
into poor choices.
Memory Impairments
Associated with SLD’s
• Impairment in the ability to listen,
remember, and repeat auditory stimuli.
Adversely affects a students ability to choose
the appropriate strategy for solving a
problem.
As a result, the students ability to use
cognitive behavioral techniques may be
limited because he cannot remember a
sequence of problem-solving steps.
Auditory Processing Disability
• Auditory processing is how your brain recognizes
and interprets the sounds around you.
• The “disorder” part means that something is
adversely affecting the processing or
interpretation of the auditory information.
54
APD Continued
• APD, also known as central auditory processing disorder
(CAPD), affects about 5% of school-aged children.
• These kids can't process the information they hear in the
same way as others because their ears and brain don't
fully coordinate.
• Something adversely affects the way the brain
recognizes and interprets sounds, most notably the
sounds composing speech.
• Kids with APD often do not recognize subtle differences
between sounds in words, even when the sounds are
loud and clear enough to be heard.
APD Continued
• These kinds of problems are exacerbated
when background noise is present, which is
in most environments.
• In other words kids with APD have difficulty
understanding any speech signal presented
under less than optimal conditions.
• They can not process auditory information
normally.
What is APD Like?
• Children with APD often do not recognize subtle
differences between sounds in words, even
though the sounds themselves are loud and
clear.
• For example, the request “Tell me how a chair
and a couch are alike” may sound to a child with
“Tell me how a cow and a hair are alike.”
• Again this kind of problem is more likely to occur
in a noisy environment or when listening to
complex information.
55
Auditory Processing
• The cause of APD is often unknown.
• APD may be associated with conditions such as
dyslexia, attention deficit disorder, autism,,
specific language impairment, pervasive
developmental disorder, or developmental delay.
•
• Students with APD can hear. APD is NOT
do to an inability to hear or deafness.
Auditory Processing
Symptoms
• Have trouble paying attention to and
remembering information presented orally
• Have problems carrying out multistep
directions
• Have poor listening skills
• Need more time to process information
• Have low academic performance
Auditory Processing
Symptoms
• Have behavior problems
• Have language difficulty (e.g., they confuse
syllable sequences and have problems
developing vocabulary and understanding
language)
• Have difficulty with reading,
comprehension, spelling, and vocabulary
56
Strategies
When Working with Juveniles with APD
• Since most kids with APD have difficulty hearing
amid noise, it's very important if possible to
reduce the background noise.
– This can be done by having the juvenile sit in the cop
car
– Take him/her to a separate room
– Remove any extra stimulus or bystanders from the
area.
Strategies
When Working with Juveniles with APD
• Have the juvenile look at you when you're
speaking.
• Use simple, expressive sentences.
– “What is your name?”
– “Sit down”
– “Get in the car”
• Speak at a slightly slower rate and at a
mildly increased volume.
Strategies
When Working with Juveniles with APD
• Ask the juvenile to repeat the directions back to you and
to keep repeating them aloud (to you or to himself or
herself) until the directions are completed.
– Example, You command, “Turn around slowly”.
• Give the student a few seconds to process the information and
then ask “What did I ask you?”
• Have them repeat the directions so, you know they understand
what they are suppose to do.
• This will allow you to assess whether or not they are being noncompliant or are not understanding.
• If they the do not repeat the direction back correctly. Repeat the
direction again.
57
Strategies.
• Use visuals and or hand gestures as much as
possible.
For example: When you ask the juvenile
with APD to sit down. You can motion your hand
into the sit position.
Using visuals will help the juvenile comprehend
what you are asking them
APD Conclusion
• One of the most important things that police can do is
to acknowledge that APD is real.
• Symptoms and behaviors are NOT within the juvenile's
control.
References:
Kidshealth.org and National Institute of Deafness and other Communication
Disorder
Visual Processing Disability
• A visual processing disability (VPD), or
perceptual, disorder refers to a hindered
ability to make sense of information taken in
through the eyes.
• This is different from problems involving
sight or sharpness of vision (meaning they
can have perfect vision, but still have a
VPD. Difficulties with visual processing
affect how visual information is interpreted,
or processed by the brain.
58
VPD
•
•
•
•
•
•
Juveniles with VPD have difficulty with position of objects especially in
reference to other objects.
They have difficulty differentiating objects based on their individual
characteristics such as: color, form, shape, pattern, size, and position.
Visual discrimination also refers to the ability to recognize an object as
distinct from its surrounding environment.
The also lack the ability to identify or recognize a symbol or object when
the entire object is not visible.
Difficulties in visual closure can be seen when the juvenile is asked to
identify, or complete a drawing of, a human face.
This difficulty can be so extreme that even a single missing facial feature
(a nose, eye, mouth) could render the face unrecognizable by the child.
VPD
• Juveniles with VPD also have difficulty with gross and
fine motor development.
• Gross motor development are like Running, hopping,
skipping, balancing etc…
• Fine motor is penmanship (correct letter formation).
• These juveniles are often called "clumsy" because they
bump into things, place things on the edges of tables or
counters where they fall off, "miss" their seats when they
sit down, etc.
VPD Strategies
• Police officers should never rely solely on
the juveniles area of weakness.
• Officers should be aware that juveniles with
VPD may have great difficulty successfully
completing tasks that require them to
balance or perform gross motor movement.
• Officers should try to use mostly verbal
directions.
• Using gestures may confuse the juvenile.
59
Autism Definition
• A spectrum of neuropsychiatric disorders characterized by deficits in
social interaction and communication, and unusual and repetitive
behavior. Some, but not all, people with autism are non-verbal.
• Autism is normally diagnosed before age six and may be diagnosed
in infancy in some cases. The degree of autism varies from mild to
severe in different children. Severely afflicted patients can appear
profoundly retarded.
•
www.medterms.com
Autism Definition
Continued
• The cause (or causes) of autism are
not yet fully understood. However, it is
believed that at least some cases
involve an inherited or acquired
genetic as well an environmental
influences.
Autism Facts to Know
Permission was given from by author Susan F. Rzucidlo , to use these facts, as long as no wording was Altered.
• Individuals with autism can’t be identified by
appearance.
• They look the same as anyone else.
• They are identified by their behavior.
60
Autism Facts to Know
Medical Conditions
• Individuals with autism tend to have an
under developed upper trunk and are at
higher risk of positional asphyxiation.
• When restraint is required officers need to
be aware of this medical fact and act
accordingly and be sure to adjust position
often.
Autism Facts to Know
Medical Conditions
• Some individuals with autism do not have
the normal range of sensations and don’t
feel the cold.
• They may not seek shelter if lost out in the
cold.
• This will affect the way a search for a lost
child with autism is conducted.
Autism Facts to Know
Medical Conditions
• 40% of individuals with autism will develop
epilepsy or some other seizure disorder by
the end of adolescence.
• Know that when dealing with an individual
with autism, they may experience seizures.
61
Autism Facts to Know
Stimulatory Behavior
• Individuals with autism may engage in self
stimulatory behavior such as hand flapping,
finger flicking, eye blinking, string twirling,
rocking, pacing, making repetitive noises or
saying repetitive phrases that have no
baring on the topic of conversation.
• This behavior is calming to the individual,
even if it doesn’t appear calming to the
officer.
Autism Facts to Know
Stimulatory Behaviors Continued
• If these behaviors are NOT presenting as a
danger to themselves or others it is in the
officer’s best interest not to interfere with it.
• Allow it to continue as long as they are safe
and safe to be around.
• Trying to stop it may cause the individual to
act out aggressively.
Autism Facts to Know
Strategies
• Speak in short clear phrases “Get In,” “Sit Down,”
“Wait here.”
• An individual with autism may take longer to
respond to directives, and that can be because
they don’t understand what’s being demanded of
the, or even just because they’re scared
• They may not be able to process the language
and understand a directive when fearful.
62
Autism Facts to Know
• These individual may have a weak
understanding of cause and effect. They
have little concept of consequences.
• 50% of individuals with autism are
nonverbal throughout their life span
• 20% may present as nonverbal when highly
stressed.
Autism Facts
Names
• Autism is also known by other names
– ASD: Autism Spectrum Disorder
– Aspergers Syndrome
– PDD-Pervasive Developmental Delay
– PDD NOS- Pervasive Developmental Delay
Not Otherwise Specified
– Autism
Autism
Now we are going to watch a video of a child
with autism acting “out of control.”
• http://www.youtube.com/watch?v=_Q5Fdz
HaOuE
63
Attitude
• The longer I live, the more I realize the impact of attitude on life.
Attitude, to me, is more important than the past, than education, than
money, than circumstances, than failures, than success, than what other
people think or say or do.
• It is more important than appearance, giftedness or skill. It will make or
break an organization…a school…a home.
• The remarkable thing is we have a CHOICE everyday regarding the
attitude we will embrace for that day.
• We cannot change our past…we cannot change the fact that people will
act in a certain way. We cannot change the inevitable. The only thing
we can do is play on the one string we have. And that is our ATTITUDE.
I am convince that life is 10% what happens to me, and 90% how I react
to it. And so it is with you….
» Charles Swindoll
Part III
De-escalation Strategies
• What is Anger?
• Techniques for dealing with anger
Anger
• Anger is a very natural emotion and when
expressed appropriately it can lead to
greater self-confidence, as well as healthier
and stronger relationships.
• Anger is usually a reaction to:
– Embarrassment -Injustice
– Fear
-Unfairness
– Insults
64
Anger Continued…
• There are several strategies for dealing with
anger.
• These techniques provide a way to
REDUCE anger to a level that is more
comfortable
• Thus putting people at a place where they
can actively listen and most importantly
problem solve together.
•
-Conflict Resolution Panel
De-escalation Strategies
• Count to ten
– Typically we react instinctively to anger. We respond to
our own physical cues: blood pressure rising, adrenalin
flowing, muscles tensing.
– When we respond under these condition, we usually
respond INAPPROPRIATLEY
– We need to pay attention to our own signs, know when
our bodies are reacting to anger and stress, and try to
calm ourselves down, so that we may enter the
exchange with more control.
– Count to ten, take a few deep breaths and try to collect
and organize your feelings and needs.
–
Conflict Resolution Panels
De-escalation Strategies Continued
• Diagnose the threat
– A result of acting instinctively is we often
perceive a situation to be MORE threatening
than it is.
– Look at what is causing the anger (the
antecedent)
– By looking at what is causing the problem, we
may see that the problem is not as impossible
or bad as we initially thought.
65
De-escalation Strategies Continued
• Clarify and Diagnose
– Find out the source of anger.
– Ask for feedback, clarify needs and
expectations.
– It makes it easier to begin negotiating an
ACCEPTABLE solution, when all the feelings
and expectations are on the table.
De-escalation Strategies Continued
• Acknowledge their feelings
– Let the person know that you hear his/her
feelings.
– This lets them know that you are listening and
willing to respond.
– NEVER disaffirm someone’s anger, they have
a right to their feeling whether you agree or
not.
– Disaffirming someone’s anger usually
HEIGNTENS its intensity.
De-escalation Strategies Continued
• Restate/reframe what the person says
they are angry about.
– Making the person feel heard, will diffuse anger
because she/she no longer feels helpless or
hopeless about the situation
– Someone is now at listening and
understanding.
66
Restate/reframe Continued
• For example,
– A person yells, “I can’t believe my mom allows
my little brother to stay up until 10:00, but I
have to go to bed at 8:00.”
– You say, “You are really angry because your
mom won’t let you stay up as late as your
brother.”
De-escalation Strategies Continued
• Ask what specifically about the situation
makes the person angry.
– A person can be “globally angry-mad at the
world.
– Asking specifics about the anger, slows
him/her down and makes him/her think about
what he/she is saying
– Then proceed to get to the “underground” or
“real” feelings, such as: hurt, lonely, left out
etc…
– These feelings tend to be “softer” than anger
and easier to respond to.
Ask Specifics Continued…
• For example,
– A child screams, “I have absolutely had it! My
teacher always blames me for everything. It’s
always my fault even when I don’t do anything.
She hates me.”
– You say: “Just what about this situation makes
you so angry?
67
De-escalation Strategies Continued
• Agreeing with a person’s right to feel
angry.
– Acknowledge the person’s feelings
– When you do this you validate their feelings
and take him/her out of the combative mode, in
other words you let them know they have a
RIGHT to have those feelings
– At the same time, you REFRAME what she/he
says to make room for alternate possibilities
Agree With their Feelings Continued
• For example,
– A child bellows, “And this morning I walked into
the classroom and saw my eraser missing from
my desk, and I just know George did it to ‘get
back’ at me for winning him at basketball.
– You say, “You must be feel very angry and
violated.”
De-escalation Strategies
Continued…
• Acknowledge the anger in the tone, even if
the individuals does not say she/he is
angry.
– The strategy is used to clarify and move along
the dialogue
– The individual needs to separate feelings from
thoughts
– Clearly identifying and naming the anger will
sufficiently diffuse the situation thus allowing
you to proceed to other questions.
68
Acknowledging Anger Continued…
• For example,
– A child says, “I went out to recess and Bobby
threw my papers all over the ground, so I threw
him on the ground and started punching him.”
– You say, “It must have made you really
mad/angry to have responded so dramatically.”
De-escalation Strategies Continued
• Gestures and Body Use: Can be used to
diffuse and/or contain anger.
– Count to ten: breathe deeply and slowly to
counteract your own anger/fear to response
– Slow down your rate of speaking and lower
your tone of voice.
– Hold up your hand in the stop
– If everyone else is seated, standing up sends a
message that calls for attention and a stopping
of the anger.
De-escalation Strategies Continued
• Do:
– Be aware of your tone and body language
– Be specific
– Set expectations
– Show respect for the other’s dignity
• Ethnically and Culturally
– Attack the problem, not the person
– Give 3-5 positives for every negative
– Use “I statements”
69
De-escalation Strategies
Continued…
• Don’t’
– Don’t assume your message is clear
– Don’t monopolize the conversation
– Don’t attack the person
– Don’t say, “I know how you are feeling.”
– Don’t use “You statements”
De-escalation Strategies
Continued…
• Last Resort Statement
– If the individual continues to call names, make threats,
shout etc…
– You say, “I came here to help you and hear your side,
but I will not take abuse. When you shout I can’t
listen. I will have to use other means if we can not
discuss this situation calmly. I am here to help you.”
– The most important thing to remember when making a
statements is to use “I statements”, which are how
you feel.
– Using “You statements” points blame, and will undo
the validation and negations you did accomplish.
De-escalation Strategies Review
• Take the time needed to
–
–
–
–
Count to ten
Get centered
Take deep breaths
Lower tone of voice
• Clarify/Diagnose the threat (what is causing the
reaction)
• Acknowledge their feelings
• Restate/Reframe why they are angry
• Use gestures and body language
• Last resort statements
• Never say “I understand how you are feeling.”
70
Part IV
Safe Restraint Research
• What research shows
• Safe restraint strategies
– What works, what doesn’t
• What methods were employed
Regulations/Policies
• 10 specific cases, four of which ended in death.
• In one of those cases in New York, a 9-year-old boy with
learning disabilities was confined to a dirty small room
over 75 times in a six month period for whistling,
slouching and hand-waving.
• In another case in Florida a paraprofessional gagged and
duct-taped five boys to their desks and in Texas a 14year-old boy died when a special education teacher lay
on top of him because he would not stay seated.
Regulations/Policies Continued
• Unlike hospitals or residential treatment centers, there is
not a federal system that regulates how restraints should
or shouldn’t be practiced in schools (Kutz & Government
Accountability Office, 2009).
• Instead, in 2009 U.S Secretary of Education, Arnie
Duncan, wrote a letter encouraging Chief State School
Officers to require schools in to put in places polices.
71
Regulations/Policies Continued
• In their review of state policies concerning the use of
physical restraint procedures in schools, Ryan et al.
(2009) found that thirty-one of the fifty states had
established guidelines for crisis intervention procedures,
including restraint.
• Only four states provided very extensive guidelines, while
other states were much less detailed and provided little
guidance to schools and districts.
• An alarming fourteen states reported not having a policy
or guidelines in the use of restraints (e.g., Alaska,
Arizona, Arkansas, Idaho, Indiana, Missouri and Ohio)
Regulations/Policies Continued
• The one commonality found among the
thirty-one states that had guidelines set in
place was the language specifying that
restraints were only authorized for
emergency situations, and/or when the
student poses a threat to themselves or to
others.
Regulations/Policies Continued
•
As an outcome of the reports and hearing, two bills were
introduced to the U.S. Congress.
• In December 2009, Representative George Miller and
Cathy McMorris introduced to the House of
Representatives the “Preventing Harmful Restraint and
Seclusion in Schools Act (H.R. 4247, 2010),” which
requires all school staff using restraints be trained to the
House.
• In March 2010 the bill passed.
72
Regulations/Policies Continued
• The very similar congress bill S. 3895, however, is still in
senate committee (S.2860, 2010).
• Proponents of the bill believe that the Keeping All
Students Safe Act, stalled in Senate, because it was
significantly different than the House bill in that it allows
schools to include restraint and/or seclusion in the
Individuals Education Plan (IEP) and Behavior Support
Plans (BSP) (Handle With Care Newsletter, 2011).
Regulations/Policies Continued
• Although, there is still no federal regulations
on restraints, experts believe that portions
of the bill will at some time become federal
law.
• States and their school districts to develop
and implement policies and procedures in
regards to restraint (Peterson, 2010).
Police Regulations on Restraints
• Police departments are advocates for restraints.
• According to research by Brave & Peters (1994) all police
departments use some form of restraint.
• The type of restraints must follow the standards created
by law.
• The use of restraints are controlled by Federal law, state
law, county and departmental policies, as well as
manufacturer instructions (Brave & Peters, 1994).
73
Police Regulations on Restraints
• The federal law states that placing a person in handcuffs
infringes on that person's fundamental right of liberty.
• Police can only use handcuffs when there is a lawful
justification for doing so.
• An officers use of force against a citizen must be
“…objectively reasonable, based upon the totality of
circumstances (Brave & Peters, 1993).”
Police Regulations on Restraints
• The severity of the crime and the immediate threat to the
safety of officers and others must be considered, as well
as, whether the suspect is resisting or attempting to
evade arrest (Brave & Peters, 1993).
• If the officer uses more force than necessary, the officer
is in violation of the Fourth Amendment right to be free
from unreasonable seizures or use of force. If found
liable the officer could face Federal prosecution
(Deprivation of Rights Under Color of Law).
Police Regulations on Restraints
• In addition to Federal laws, State laws also
exist.
• State laws typically follow federal mandate,
however some states will require additional
safety precautions for certain individuals
and situations.
74
Police Regulations on Restraints
• For instance, they had special requirements
for: mentally ill juveniles, pregnant woman,
ill, injured, intoxicated person or an obese
person.
• For an obese individual they required that
two sets of handcuffs be used or the
individual be handcuffed in the front of their
body for safety.
Police Regulations on Restraints
• Some departments, like Chandler Police Department
(210), however, require that even if the person is
handicapped, sick, and/or injured: if they can be
transported in a patrol car then they need to be
restrained.
• They do, caution their officers to not place prisoners in
restraints if they are in a position that will restrict the
person's ability to breathe.
• They also encourages officers to consider bringing the
suspects hands to the front of their body if they are in a
patrol car for more than an hour.
Police Regulations on Restraints
• From the departments policies researched
there were not special requirements or
protocol for restraining individuals with
special needs and only a few departments
have policies in place for restraining
juveniles!
75
Extended Restraint
• A study by Luiselli (2009) found that if
restraints were needed in an emergency
situation it was essential to
• -decrease the duration of restraint because
maintaining physical restraint can be
problematic if a person is unable to calm
down quickly.
Extended Restraint
• One way she proposed to do this is by
establishing a fixed-time criterion.
• Her research showed that a person’s total
exposure to physical restraint could be
minimized by stopping the procedure after a
fixed-time has elapsed, instead of waiting
until certain behavior is exhibited.
Extended Restraint
• This is similar to findings by Singh & And
(2009) who found that a brief one minute
physical restraint was more effective than a
three minute physical restraint, in
controlling self-injurious behaviors in a 16year-old profoundly retarded girl.
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Extended Restraint
• In other words, if restraint is necessary it is
more effective if the restraint lasts less than
2 minutes.
Police Officers and Extended
Restraint
• It is important that police officers take the amount of time
a kid with special needs is restrained.
• Make sure to asses the child's breathing and behavior.
• If the child's behavior is escalating after being restrained
for more than a few minutes. It is not working.
• Let the child go. Most times releasing the child will help to
calm them.
• If needed restrain the child again for less than 2 minutes
• Continue this process until the child is de-escalated.
Restraint
• Many times students who are “out of
control” don’t remember what they did after
they calmed down.
• You need to try and help them calm down
by using de-escalation strategies and
continual restraint and release techniques.
• Make sure to use your best judgment in
these cases.
77
“Safe” Restraints
• Extraordinary blocking is a proven
technique that uses using soft objects such
as pillows, cushions, bean bags etc..to
support the individual, but also protect the
staff members involved.
• The items are to be used by holding them
up to lessen the impact and or deflect kicks,
hits, slaps, bits etc.
“Safe” Restraints
• These techniques, however, were not full
proof. For example, Sanders (2009) found
that staff still complained that they were
being scratched on their hands, which were
not protected.
“Safe” Restraints
• The most important thing to remember is:
–For the protection of property or
because the student is not
following directions of you or the
teacher is NOT a reason to
restrain a child.
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When to Restrain
• A juvenile with special needs should only
be restrained if:
– They are an immediate threat to themselves or
to others.
In most cases the immediate surroundings
should be able to be evacuated.
Proper Administration of Restraints
• Restraints that should be used when trying
to de-escalate a situation can include:
• Blocking techniques previously mentioned.
• The basket hold
• Hooking the arms by the elbows and
holding them loosely behind their backs
• Two people should always be present.
Part V
Restraint Training
• You will now undergo a 1 day hands on
training on safe restraint.
79
Part VI
Put it All Together
• You will need to use what you learned
about identifying disabilities, de-escalation
strategies, and “safe” restraints to resolve
the problem.
Vignette
•
You respond to a call to an elementary school and when you arrive Alan
a 10 year old boy is using exclusively repetitive speech with limited
communicative message. He is rocking back and forth and you can tell
he is very agitated. When you try to touch him his behavior exacerbates.
What do you do?
•
The de-escalation strategies are not working and Alan is starting to bang his
head on the classroom wall.
•
What do you try now?
•
Alan finally calms down.
Vignette
• You are patrolling the streets when you notice a
7year old girl walking by herself. When you stop
and ask her name. She looks at you confused
and continues to walk. You follow her and tell her
to “Stop, turn around, look at you, and say her
name.” The little girl continues to walk.
• What can you predict is her disability?
• What strategies would you try?
• When you implement your strategies you realize
that she has APD.
80
Conclusion
No child should be abused or killed because
of a teacher or police officer is trying to get
them to sit still, stop whistling etc…
Physical restraints should only be used in
clearly justified emergency situations when
there is no other way to prevent physical
harm to the individual or others.
Conclusion Continued…
Although, physical restraints can not be
entirely avoided schools and law
enforcement agencies should be aware of
the risks of restraints and have guidelines in
place to minimize those risks.
Guidelines should include what to do, when
to do it and how and why to do it.
“The Future is NOW”
“If we do what we have been doing, we will
continue to get what we have been getting.”
“Can we do better?”
81
Questions?
82
APPENDIX C
Welcome to Holland
I am often asked to describe the experience of raising a child with a disability to try to
help people who have not shared that unique experience-to understand it, to imagine how
it would feel. It’s like this…
When you’re going to have a baby, it’s like planning a fabulous vaction tirp to Italy. You
buy a bunch of guidebooks and make your wonderful plans. The Coliseum, the
Michelangelo David, the gondolas in Venice. You may learn some handy phrases in
Italian. It’s all very exciting.
After months of eager anticipation, the day finally arrives. You pack your bags and off
you go. Several hours later, the plane lands. The stewardess comes in and says,
“Welcome to Holland.” “Holland?” you ask. “What do you mean, Holland? I signed up
for Italy! All my life I’ve dreamed of going to Italy.” But, there’s been a change in the
flight plan. They’ve landed in Holland and there you must stay.
The important thing is that they haven’t taken you to a horrible, disgusting, filthy place,
full of pestilence, famine and disease. It’s just a different place. So you must go out and
buy new guidebooks. And you must learn a whole new language. It’s just a different
place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for
a while and you catch your breath, you begin to look around, and you being to notice that
Holland has windmills, Holland has tulips, Holland even has Rembrandts.
But everyone you know is busy coming and going from Italy and they’re all bragging
about the wonderful time they had there. And for the rest of your life, you will say, “Yes,
that’s where I was supposed to go. That’s what I had planned.” The pain of it will never,
ever, ever go away, because the loss of that dream is a very significant loss.
But if you spend your life mourning the fact that you didn’t get to Italy, you may never
be free to enjoy the very special, the very lovely things about Holland.
-Emily Pearl Kingsley
83
APPENDIX D
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/w EPDw ULLTIw M
Police Officer Training POST-Survey
Exit this survey
1.
1. Considering the NEW training you have received, how confident do you
NOW feel working with children ages 1-12 whom have disabilities, such as
Autism?
Not Confident
Somewhat
Confident
Very Confident
Confident
2. Considering the training you just received, how confident do you feel
working with children ages 1-12 with mental illnesses, such as
Oppositional Defiant Disorder?
Not Confident
Somewhat
Confident
Very Confident
Confident
3. Considering the training you just received, how comfortable would/do
you feel if/when responding to a elementary school call regarding an “out
of control” student who they tell you is in a special education class?
Not
Comfortable
Somewhat
Comfortable
Comfortable
Very
Comfortable
Comment:
4. How beneficial was this training in specifically teaching de-escalation
strategies and “Safe” restraints (e.g. blocking, the basked hold etc…) for
juveniles with disabilities, such as Autism. 5. How confident do you feel in
using the “safe” restraints (e.g. blocking, the basket hold etc…) you
learned?
Not Beneficial
Beneficial
Somewhat Beneficial
Very Beneficial
Comment:
84
5. How confident do you feel in using the “safe” restraints (e.g. blocking,
the basket hold etc…) you learned?
Not Confident
Somewhat
Confident
Confident
Very Confident
6. How confident do you feel in using the de-escalation strategies you
learned during this training?
Not Confident
Somewhat
Confident
Confident
Very Confident
7. How confident do you feel in identifying juveniles with special needs and
mental illness?
Not Confident
Somewhat
Confident
Confident
Very Confident
8. How essential would you say this training is in ensuring the safety of
both peace officers and juveniles with special needs and mental illness?
Not Essential
Somewhat
Essential
Essential
Very Essential
9. Would you recommend this training to other peace officers?
Would you recommend this training to other peace officers? Yes
No
Maybe
10. On a scale of 1-10, 1 being the worst and 10 being the best, would you
rate the trainers’ expertise, professionalism and delivery of the training?
5 Somewhat
10 Very
1 NOT at all
Knowledgeable
Knowledgeable
Knowledgeable
and
and
or Professional
Professional
Professional
85
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