Chesapeake School Reported Significant Jump in Restraints; School Attributes Majority to One Student
Physical restraint is a long-used but often-debated method to contain aggressive behavior in students with disabilities. The topic is particularly controversial when the numbers of restraints are high.
One Virginia private school, Plan Bee Academy in Chesapeake, had a large increase in the number of restraints used on students from one school year to the next. In the 2016-2017 school year, Plan Bee reported 470 student restraints; in 2017-2018, the number was 6,754, according to data from Virginia’s Department of Education.
According to Plan Bee’s director, Wendy Fitch, there are two reasons for the increase. First, she said student enrollment had more than doubled, from 50 to 110 students from one year to the next.
Second, there was a very high number of restraints on one student who inflicted serious injuries on himself.
Fitch said the student attended Plan Bee both years, but restraint wasn’t initially part of his behavior plan. When this student would assault his own face with his fist, the staff tried using blocking methods, like mats, a helmet and arm splints. But it didn’t work, and the injuries were so intense, Fitch said the student required three eye surgeries.
To prevent continued injury, restraint became a part of this student’s individualized education plan, or IEP, in 2017. Fitch says he received over 5,000 restraints in one year. Plan Bee does not use seclusion.
Fitch said the staff at Plan Bee worked closely with the family of this student and the school division to get this self-injurious behavior under control, but “we just felt like we weren't able to serve him and get any kind of progress that we were looking for.”
This led Fitch to recommend the student be placed in a more intensive treatment facility, and he’s now at the Kennedy Krieger Institute in Baltimore, which has an affiliation with Johns Hopkins University. Kennedy Krieger is focused on research and treatment for complex disabilities. Fitch says the student is part of a study there for complex behaviors.
Interpreting the Numbers
The data released by VDOE only shows the total number of restraints and seclusions in each private school serving students with disabilities. It doesn’t show the number of students enrolled at each school.
To hear a student was restrained over 5,000 times in one school year might sound shocking. But Fitch says the data on restraints released by the state doesn’t capture a complete picture, like the type of restraint used, the duration of each restraint, or how the number of restraints is distributed throughout the school population.
At Plan Bee, restraints are generally limited to 30 seconds. If the injurious behavior doesn’t stop at that point, a second restraint will begin. Some restraints can be 10 seconds long, according to Fitch. Regardless of the length, at Plan Bee it will be counted as one restraint.
The VDOE recognizes that schools are not all defining restraint and seclusion in line with the definitions set forth in state regulations. The department is helping schools interpret the regulations more accurately, and Fitch has been in contact with them to get guidance on tracking and reporting its restraint data.
Aaron Parsons, the Vice President of Special Education at the Kennedy Krieger Institute, says while it’s valuable to note an increase in restraints and seclusions school-wide, the most important information when analyzing the numbers is individual student data. Parsons says the number of restraints used on each individual student should be decreasing if the therapy is working.
The raw figures released by VDOE also don’t compare the same groups of students from one year to the next. VDOE denied our request for anonymized, student-level data.
Christy Pearce, a veteran teacher at Plan Bee, said tracking student data is a major focus of her work. Pearce’s students might cuss, spit, kick or hit. Each time they do, it’s recorded in “red books” for each individual student.
Fitch said staff analyze graphs and charts of student behavior over time to see trends. Every student has personalized goals in the areas of behavior, academics and life skills. By tracking what students do, trends can be identified and the treatment plan can be critiqued.
For students who are restrained to avoid injury, the goal is to eliminate the aggressive behavior. Fitch said the reason the student who received over 5,000 restraints in one year was recommended to another program was because the behavior wasn’t decreasing.
Weighing Treatment Options
One of Plan Bee’s students is 10-year-old Ethan. On a visit to the zoo with the family, his dad, Aaron Morris, said Ethan likes to be free and run along the trails.
“He can run, he can play, he can not be held. So it's a great place for him,” said Morris, adding that he can also have chicken fingers at the snack bar, a big highlight of the visit.
Ethan was diagnosed with severe autism shortly after birth. He’s non-verbal, but uses a picture board to communicate. According to Morris, Ethan has a lot of energy and “was way more active than normal” even in the womb.
Until about a year ago, Ethan received special education services through Southeastern Cooperative Education Programs (SECEP) at Virginia Beach public elementary schools. But his condition became more complicated.
One of Ethan’s behaviors is that he will lay on the ground and kick his legs really hard. Morris calls it a meltdown.
The leg-kicking can trigger a syndrome called rhabdomyolysis, which is the breakdown of muscle fibers due to injury or excessive exertion; that releases proteins into the bloodstream that harm the kidneys. It can lead to renal failure.
Morris took Ethan to over a dozen specialists before figuring out the leg-kicking was causing this condition.
Morris had to find a way to keep this from happening, but he didn’t want to use behavior-altering medication, like risperidone. He said risperidone can cause permanent damage, like tremors and abnormal limb movements. And he doesn’t like the fact that it would affect Ethan all day long. He didn’t want to change Ethan’s personality “because of an hour’s worth of behaviors,” he said.
In order to stop the rhabdomyolysis, Morris wanted Ethan’s legs to be restrained during a meltdown.
But the program at the public school wasn’t allowed to restrain him. Instead, Morris says teachers would use rewards to try to keep him calm. It wasn’t working.
“When a child, like Ethan gets into a meltdown, the best thing you can do is ignore him because if he realizes he can't get the desired result from the meltdown, they learn not to do it,” said Morris. “No different than a human adult person who pitches a fit and doesn't get what they want. They eventually quit pitching a fit. But if we let him go, then he can kill his kidneys. So it becomes a behavioral therapy snafu.”
According to Ethan’s mom, a couple years ago their insurance provider was refusing to pay for the Applied Behavior Analysis (ABA) therapy Ethan received after school because it wasn’t working. His behavior was severe, and his medical condition disrupted the therapy. They couldn’t ignore the leg-kicking because of the medical risk, and the public school didn’t use restraint. Ethan’s Behavior Analyst recommended a residential treatment facility, and the insurance was willing to pay for that. But the Morrises were completely opposed.
And at first, they weren’t excited when the public school recommended Plan Bee. But Morris said, in retrospect it “turned out to be one of the best things that ever happened to Ethan.”
Plan Bee staff spent about a month figuring out the best way to restrain the movement of Ethan’s legs, according to Morris. If Ethan is on the floor, they straddle his legs and hold them down. If he’s in a chair, they hold his legs against the legs of the chair to keep them still. And they do this while also protecting Ethan’s head and keeping him from pinching or biting himself.
Morris said Ethan has only had one instance of rhabdomyolysis over the past year at Plan Bee, whereas he was experiencing it three or four times a month at the public school.
This doesn’t mean he hasn’t been kicking his legs. If Ethan’s in a good mood, Morris says it happens once or twice a day, sometimes not at all. A bad mood might mean seven or eight times a day. Every time it happens, his legs are held.
Morris said restraining a child might sound extreme to other people, especially those with children who don’t have these kind of challenges.
“It's something difficult for a parent to come to terms with,” said Morris. “And for the average populace whose picture in their head is a neuro-typical child, there's never any reason to hold down or restrain your child. So the sheer thought of it, especially from a parent, is hideous. No, there's gotta be another way. Well, sometimes there's not.”
Morris says his family has a different reality than the characters with high-functioning autism on tv, in shows like “Parenthood,”or “The Good Doctor.” People on the autism spectrum with challenges like Ethan aren’t often represented.
Plan Bee’s Wendy Fitch said many parents feel that way.
“A lot of the families have said, what about the dark side? You know, what about the dark side of autism? What about, what about my kid? You know, and the struggles that I've gone through.”
Everything about Ethan’s situation is complicated, Morris says. And that’s often the case with students in special education.
The data the Virginia Department of Education released shows the total number of restraints in each school for the 2016-2017 and 2017-2018 school years. There are multiple variables we can’t see, like the severity of behaviors in each school or the length of time each student has been attending.
For now, more specific data isn’t available to the public.
Do you have experience at a school that uses seclusion and/or restraint and want to share your story? Get in touch with us at [email protected].
In the next part of our series Behind The Numbers, VPM's Megan Pauly examines policies and standards for training teachers in schools that use seclusion and restraint.