Students Suffer Abusive Restraint, GAO Says

Cindy Kilmer will never forget the look of that chair. Worn, leather straps crisscrossed over its high-back, wooden structure—one strap to hold the head and additional straps to restrain the chest, waist, knees, ankles, and wrists. It resembled an electric chair, Kilmer says. The chair is designed to support someone who cannot sit up on his own, but special education teachers at one West Virginia elementary school used it to restrain Kilmer's then 4-year-old daughter, Christy, who has cerebral palsy and autism, for being "uncooperative," according to the findings of an investigation conducted by the Government Accountability Office. Kilmer says she saw the chair in her daughter's classroom while picking her up from school.

Christy attended preschool for only nine days before Kilmer learned of the restraint and removed her daughter from school more than 10 years ago, but the effects of the alleged abuse are still evident today. Doctors diagnosed Christy with post-traumatic stress disorder that causes her to experience extreme bouts of anxiety and anger, GAO investigators found. Though she was fully potty-trained before her teachers restrained her, Kilmer says Christy, at age 15, will wet her pants if she hears her name and the word teacher spoken in the same sentence. Christy becomes agitated when she is driven past her old school, and Kilmer need not look farther than her own home—the broken furniture and the fist-size holes dotting the walls—to see the costly manifestations of her daughter's anger. "We can deal with the beatings and the broken walls," Kilmer says. "But how can we heal her brain? I can't take the abuse out of her."

The Government Accountability Office found that many special education teachers use potentially dangerous restraint practices to control minor student misbehaviors such as speaking out of turn or refusing to remain seated. According to a GAO report released in May, investigators identified hundreds of allegations of abuse that resulted in emotional trauma, physical injury, and even death among special education students across the country. They also found that many of the allegedly abusive teachers are still working in the classroom—at least one of the three teachers responsible for restraining Christy was still teaching at her former school.

Though the GAO report could not statistically quantify the scope of the abuse because no federal agency (or private entity) gathers data on use of the techniques, two other reports released this year call the problem both widespread and underreported. One of these reports, written by the Council of Parent Attorneys and Advocates, discusses a survey the organization conducted in March and April 2009 that identified 155 school-age children from across the country (more than half of whom are 6 to 10 years old) who had allegedly been restrained or secluded in an abusive manner at school. The other report, written by the National Disability Rights Network, highlights accounts of alleged abuse from nearly all the regional offices it operates across the country. The rise of reported abusive incidents is leading some school administrators to use alternative techniques for resolving confrontation, such as positive reinforcement.

The National Disability Rights Network began advocating against abuse of restraint and seclusion techniques in institutions for the mentally and physically disabled 30 years ago, but when executive director Curt Decker realized the abuse had crept into the nation's special education classrooms, he was stunned. The first instance of in-school abuse Decker can recall happened about eight years ago when a girl who has Down syndrome was strapped to a chair and put in a closet by her teacher. NDRN provided legal services for the girl's family. Since then, the protection and advocacy centers NDRN operates in each state have seen steadily increasing numbers of similar cases.

The reports of abuse reached a critical mass last summer: A conference call among NDRN representatives from every state produced "a horrendous litany of five cases of abuse, 10 cases of abuse, injured kids, dead kids," Decker says. So NDRN decided to raise awareness of the problem in a different way. 

In January, the organization released a report on restraint and seclusion that caught the attention of California Rep. George Miller, chairman of the House Education and Labor Committee, who subsequently asked the GAO to investigate the issue. Miller held a committee hearing on the issue in May and has since pledged to propose legislation by summer's end that would protect students against the potential hazards of restraint and seclusion techniques. Secretary of Education Arne Duncan plans to investigate how states are preventing abuse at the state level. "We wrote the report so there would be no more argument about whether this was anecdotal, abhorrent behavior isolated to one school," Decker says. "Now the public knows the problem is deep-seated, pervasive, and growing."

Roger Pierangelo, executive director of the National Association of Special Education Teachers, attributes teachers' abuse of restraint and seclusion techniques to a combination of inexperience, stress, and the lack of proper training. Though his students in the special education and literacy department at Long Island University are taught not to use the techniques under any circumstances, some teachers in programs at other universities are given no formal guidance on the dangers of the techniques yet still will use them in moments of frustration with students. Although such moments can come frequently for special education teachers, stress is not an excuse for abusing a student, Pierangelo says. And many of the teachers who use the most dangerous restraints, ones that restrict students' breathing, often fail to try other, less harmful techniques first, he added. "[Teachers'] use of the restraint is often a reactive response, an impulse, not a decision made using logic."

There are alternatives teachers can use to handle classroom confrontations with students. George Sugai teaches at the University of Connecticut's Neag School of Education and is one of the country's leading advocates for policies that promote the encouragement of positive student behaviors. For example, teachers following such policies will go out of their way to compliment students who succeed at minor tasks like walking down the hall quietly or raising their hands in class to get permission to talk. When students misbehave or become unruly, teachers calmly explain what the students are doing wrong and what they should do to correct their behavior, a simple approach that teaches positive behavior through encouragement and can quell bad behavior without the use of force, Sugai says. While restraint and seclusion should be among schools' emergency procedures, Sugai says he does not condone use of the techniques on a regular basis because no research exists to suggest they can effectively alter student behavior. A long history of research does, however, validate the worth of policies that promote positive student behavior. Some of this research has been conducted by the Center for Positive Behavioral Interventions and Supports, a research and training facility affiliated with the Office of Special Education Policy that Sugai codirects.   

Data from the approximately 9,000 schools whose faculty and staff members have been trained by the center to teach and encourage positive student behavior show decreased numbers of office referrals, suspensions, and students needing specialized instruction among the school's special education students. The data also show improved student attendance and increased time spent on academic instruction, while teachers, students, and parents affiliated with the schools' special education programs report an improved school climate and stronger relationships between students and staff.

One Pennsylvania school for severely disabled and emotionally disturbed students that began using positive reinforcement techniques exclusively about 10 years ago appears to be reaping the benefits. When Michael George accepted a new job as director of Lehigh University's Centennial School in 1998, he stepped into the most violent environment he says he has ever encountered at work or in his personal life. Centennial students often behaved aggressively, and teachers routinely responded in turn—sometimes two or three at a time—by holding down the kicking, thrashing, screaming students in dangerous physical restraints, according a 2005 article published in Psychology in the Schools by University of Albany psychology professor David Miller, Centennial School psychologist Julie Fogt, and George. Though the school had a population of just about 80 students, teachers performed 1,064 physical restraints during the academic year before George arrived—an average of about 13 restraints per student throughout the year, the article states. When teachers used more than 100 restraints in the first 20 days of George's first school year at Centennial, he decided to put an end to the conflict. 

George expected policies that promote positive student behavior to work at Centennial because the system had been successful at his old school, but when he told teachers of his goal to eliminate the use of restraint and seclusion altogether, they laughed. "Some teachers thought I was turning the institution over to the inmates, so to speak," George says. "My detractors placed bets on how long I would last." 

By the end of his second school year at Centennial, George had achieved his goal of decreasing the number of restraints to zero and getting all of Centennial's teachers to take the positive reinforcement method seriously, an accomplishment detailed in the 2005 article. Some teachers unwilling to change left the school, but those who stayed learned to address their students and one another with a new attitude. Today, teachers say, "I really like how you did that" when a student behaves properly, and teachers make sure students feel valued by telling them, "We care about you and your future," Miller says. If students behave aggressively, teachers do not restrain them. Instead they make every effort to calm students, reminding them of their strengths as individuals, not their misbehavior. In the rare case of an emergency when a student continues behaving aggressively and that student's disability does not prevent him from understanding right from wrong, teachers reserve the right to involve local authorities. And the teachers' consistency is working. The number of student suspensions has decreased by half compared with 10 years ago, George says, and Centennial students' achievement on standardized tests now surpasses the scores posted by many average public school students. 

George prides himself on Centennial's success, but he worries that few other schools are willing or able to replicate it. Many of the educators he consults with about Centennial are impressed with the school's achievements but skeptical that they could make the positive method work as well for their kids. "People ask, 'Do you have kids with ...' and list off a host of medical diagnoses, and I tell them, 'Yes, we have kids with all the same conditions your kids have,' " George says. "But the students' conditions don't matter. We treat them all the same, encourage them all the same, teach them at a level where they can be challenged but also achieve all the same because when they walk in the door they are ours. We will work with them, and we will succeed with them, no matter the circumstances."

Clarification added on 07/10/09: The article was expanded to note that since changing to the positive reinforcement system, Centennial School has rarely had to call for police assistance.