Promoting Inclusion Through Evidence-Based Alternatives to Restraint and Seclusion

Abstract

The use of restraint and seclusion in schools has been identified repeatedly as an approach that is overused, misused, and potentially dangerous. In this article, we emphasize the importance of an approach to supporting students with significant problem behavior that focuses on prevention, evidence-based intervention procedures, heightened levels of monitoring, and documented professional development. While the need for the use of restraint in emergency conditions will remain, the overall rate at which restraint and seclusion are used needs to be reduced and the quality of support for students with significant problem behavior needs to improve. An example of one district that is adopting a comprehensive alternative approach is provided.

Seclusion and Restraint of Students With Disabilities: A 1-Year Legal Review

“…A school district should have clear regulations as to how the use of seclusion and restraint should be used and documented. Trader et al (2017) provided six behavioral supports for students with significant disabilities:(a) the use of comprehensive academic, mental health and behavioral assessments; (b) individualized support for students with a focus on evidence-based practices that increase quality of life as well as decrease students’ problem behavior and improve adaptive behavior; (c) support provided by trained professionals; (d) use of data for ongoing decision making; (e) administrative leadership with district- and state-level support; and (f) responsive adaptation of practices and procedures to the needs of staff and students. (p. 79)…”

Involvement and Participation of Students With Severe Disabilities in SWPBIS

“…However, students with ESN frequently demonstrate problem behavior (O’Neill, 2004). Because presence of problem behavior likewise increases chances for both being removed from general education and experiencing aversive practices such as restraint and seclusion (Trader et al, 2017), more concerted efforts must be made to prepare all school personnel to prevent and respond to problem behaviors for this group of students. For example, the principles of applied behavior analysis (ABA) and specialized instruction suggest the effectiveness of behavior intervention plans, and these plans should include crisis plans whenever necessary.…”

Correlates of psychiatric staff's attitude toward coercion and their sociodemographic characteristics

“…Therefore, they may utilize the concepts of this study to facilitate further positive changes by leaving off the archaic style of forcefully restraining or secluding patients with mental illness against their will. The efficacy and safety of coercive measures remain questionable on the faces of physical harm and deaths 8 …”

“…Therefore, the benefits of using restraint and seclusion remain questionable . 7 One of the systematic review studies revealed that there is limited evidence for the psychiatric researchers to decide whether the use of coercive measures such as restraint and seclusion is considered ethical, effective and safe for the short‐term management of aggressive behavior that associated with psychiatric patients in psychiatric clinical settings 8 …”

“…In brief, coercive measures are now widely recognized as a last resort measure when all other alternatives do not yield the intended outcomes with negative consequences for the psychiatric patients and staff involved 5,8 . Nevertheless, these interventions continue to be used frequently in psychiatric settings internationally 23 .…”