|
A question of restraint
Parents and educators battle over methods used to control autistic
children.
By CYNTHIA McCORMICK
STAFF WRITER
MELANIE LYON figured
Barnstable public schools had special strategies to teach her son
Matthew, who has autism and can barely speak.
Jean Bowden, left, and Melanie Lyon, both of Marstons Mills, are
pushing for changes in the way public schools control their
autistic children. "If I did that to Matthew, they'd put me
in jail. It's abusive," Lyon says.
(Staff photo by Steve
Heaslip)
|
When she found out that included pushing him face-down on the floor,
pressing his hands against his back and straddling him, her confidence
turned to outrage.
The Marstons Mills mother
thought physical restraint was only used on students who were violently
out-of-control.
"The school system said
they only use a restraint if the child is in danger of hurting himself
or someone else," she said after viewing a video of an incident
involving her then 11-year-old.
"But the teacher looked
right at the camera and said if he's 'noncompliant' for five minutes,
we're going into a floor restraint. That's for not doing his work. It's
not for hitting anybody. If I did that to Matthew, they'd put me in
jail. It's abusive."
Another parent, Jean Bowden
of Centerville, was so outraged by the repeated use of restraints on her
daughter Abbie, who also has autism, that she filed a police complaint
and is considering suing the Barnstable School Department.
Abbie Bowden is held down by a special-education teacher at the
Centerville Elementary School in a videotape made in January
1998.
|
"I see the teacher and aide being very rough with her and totally
disregarding her bad chest cold," Bowden said of a classroom
videotape showing Abbie being restrained 14 times in one day.
"Pressing her down on the floor with her arms up behind her back
like a take-down in a drug bust. We are talking about a little frail
64-pound child with the mind of a 2- to 3-year-old. This teacher and
school are taking a big chance with another's life and safety."
If Bowden sues, she won't be
alone.
Just as there is a national
trend toward training teachers and counselors in the use of
wrestling-type holds to restrain unruly students and patients, there is
a swell of lawsuits charging that the restraints are abusive or
dangerous.
Abbie was put face-down in a "floor-restraint" about
10 times in the video, for reasons including refusing to take a
"time-out," pushing a teacher and refusing to get up.
|
Prompted by the death of a 16-year-old boy in a special state
residential program last year, Massachusetts lawmakers have filed two
bills that would severely curtail the use of physical restraints in
schools, psychiatric facilities, group homes and nursing homes.
The legislation also would
completely outlaw the use of prone, or face-down floor restraints, on
children and elderly people. Bowden plans to testify on behalf of both
bills, which are being heard at 1 p.m. April 14 at the Statehouse in
Boston.
"I thought what they did
was so bizarre and so dangerous I don't want any child to have the risk
of going through this or dying," she said.
The controversy comes as a
surprise to James Shillinglaw, the director of the Barnstable schools
special education program. His school program for autistic children,
started in the early 1990s, has been something of a model for keeping
children - who used to be institutionalized - in their own communities
for as long as possible.
After being restrained seven times, Abbie kicks and yells when
told to get off the floor.
|
The trend toward keeping
children with autism in their community schools began 25 years ago with
a national law designed to protect the rights of children with
disabilities.
Prior to 1974 children with
autism were institutionalized, typically at age 6 or 12, depending on
the severity of the disorder, said Barbara Cutler of New Autism
Consultants in Arlington.
She said the problem with
some public school programs for autism is they focus too much on
disciplining the child rather than focusing on how the child learns.
"They need to look more closely at the child."
Shillinglaw said the staff is
well-trained in instructing autistic children and only uses restraints
"as a last resort," with proper attention to safety, such as
not putting weight on the children.
"Both parents (Bowden
and Lyon) really wanted to keep their kids in the community as much as
possible. Abbie had had several successful years in the elementary
setting," he said.
But in a special pullout
program for middle-school-age children with severe pervasive
developmental delays - mainly autism - Abbie was acting out by pinching,
slapping, smearing feces and ripping papers. Her teacher, who was
trained at May Institute in Chatham and follows a meticulous charting
system, counted up to 140 attempted aggressions in one day, Shillinglaw
said.
"If we're at fault, it
was trying too long - hoping for a break in the pattern. Staff really
hates to give up on a kid," he said. The school program, based at
Centerville Elementary School, brought in additional staff so the
teacher could deal with Abbie one-on-one and also had Dr. Sue Thibadeau
of the May Institute review Abbie's tapes.
Currently, Barnstable schools
are educating 12 children with autism.
To people who criticize the
way restraints were used in Abbie's videotapes, Shillinglaw asks:
"Have these people ever observed the kinds of behavior we're
dealing with in public schools?"
And it's not only special
education students who sometimes require the use of restraints, he said.
Increasingly, mainstream students are acting out, defiant of authority.
Eight years ago a training session on restraints brought out about 10
teachers, all special education teachers in Barnstable, Shillinglaw
said. Last year, 36 people attended, including nine school staffers who
aren't in special education.
Barnstable educators say it's
rare for students to be restrained in the autism program. In Abbie's
case, it was a last resort after other strategies failed.
But state Rep. Demetrius
Atsalis, a former Barnstable school official who is trained in the use
of restraints, said what happened to Abbie appeared to be inappropriate.
"If you're 150 pounds, you shouldn't have to put a child on the
floor and sit on the child," said Atsalis, who viewed the tape at
Bowden's request. "In that situation it wasn't called for."
Atsalis previously worked as
an intervention specialist at Hyannis West Elementary School, where he
said he never had to put a child into a floor restraint. "What you
want to do when you restrain them is calm them down."
In Abbie's case, the repeated
use of restraints - by her teacher and a teacher aide - appears to
further upset her. In the video, she is restrained for refusing to sit
in her chair and for pushing a teacher's arm away. She kicks out at the
teacher and looks miserable.
Abbie's neuro-psychiatrist
asked the school to make the tape to document behavioral problems. She
said the doctor wanted to see if anything in the classroom was prompting
the behavioral changes.
After viewing the tape,
Bowden said she focused her attention on getting Abbie into a different
program and then started complaining to state officials and legislators.
According to current state
law, public schools aren't required to have a written policy regarding
their use of restraints. That would change under two legislative bills
filed by Sen. Frederick Berry, D-Danvers.
Barnstable has no written
policy regarding the use of restraints, but Shillinglaw said he is in
the process of developing one. He also said he'd like to have an
in-house mentor review restraint policies and practices.
Timothy Sindelar, senior
staff attorney at the Disability Law Center in Boston, who helped craft
the two bills, said there are extensive rules regarding the use of
restraints on people age 18 and over in state Department of Mental
Retardation and Department of Mental Health programs, but basically
nothing for school-aged children.
"Those same protections
don't exist for our kids, our most fragile population," Sindelar
said. Floor restraints, which would be outlawed under the state
legislation "is never, ever appropriate to be used on children.
It's contra-indicated for people of short stature, people with breathing
problems."
Richard Tallman of Barnegat,
N.J., said his 12-year-old son Jason died six years ago at a residential
treatment center for children with learning and emotional problems after
a counselor put him in a floor restraint.
"I think there should be
more accountability for it," he said. "They keep referring to
these things as therapeutic restraints. I don't see anything therapeutic
about a 200-pound person sitting on a 90-pound kid."
He and his wife settled a
civil suit against Kids Peace for an undisclosed amount.
A Hartford Courant
investigative report on the use of restraints and seclusion, called
"Deadly Restraint," confirmed 142 deaths nationwide.
The Courant report found
there are no national standards or minimum training standards regarding
the use of restraints - and that a disproportionate number of children
are dying from restraints, both wrestling-type holds and mechanical
contraptions.
Floor restraints are regarded
as more dangerous than the "basket" or seated restraint also
employed on Abbie in the Barnstable schools videotape. But earlier this
month a 9-year-old boy died in a North Carolina home for abused children
after being held in a basket restraint, in which a teacher gets behind
the child, crossing the child's arms and holding onto the child's
wrists.
Most of the deaths appear to
have occurred in residential treatment centers. But not all lawsuits
stem from deaths - in West Virginia, attorney Mary Downey won the right
in the state's highest court to sue a school district on behalf of a
child client with autism, whom Downey says was traumatized by
restraints.
Closer to home, the town of
Nantucket was sued several years ago after a special education student
was placed in a restraint. It's unclear how the case was resolved.
Cutler, the autism
consultant, said youngsters with autism are exquisitely sensitive to
light and sound and touch, as well as to changes in routine.
The day that Barnstable
school educators videotaped Abbie being restrained 14 times, the then
10-year-old had just come back from a sick day and had a bad cold.
Children with autism
"can't say 'I'm tired, can't do it, don't feel well.' What can they
do? Push the person away, not do the work," Cutler said. "To
me, it's 'What part of no don't you understand?' Basically it sounds to
me like they're punishing this kid for having a disability."
She said there are many
noncoercive alternatives to dealing with unruly behavior in children
with autism. An agitated child might be calmed by a walk around the
building. A child who smears feces might need more physical stimulation
and get relief through running her fingers through a pan of dried rice.
But there is money to be made
in training school personnel in the use of physical restraints, said
Malcolm Smith, executive director of the Peaceful Intervention Program
based in Lawrence, Kan.
He said companies come in and
train ever-larger numbers of teachers who need to be retrained and
recertified over time. "It's a crazy thing that's happened
unnoticed in a few years. School systems spend hundreds of thousands of
dollars keeping current their ability to restrain children."
Abbie's teacher was trained
at the May Institute, but the Barnstable public schools also participate
in eight-hour trainings put on by the South Coast Collaborative of
Seekonk.
Patricia Steele of South
Coast said she has trained hundreds of Cape Cod educators in the use of
restraints. She does not promote the use of floor restraints because of
the danger involved.
Trained by one of leaders in
the field - Crisis Prevention Institute - Steele said she tells teachers
about sudden death syndrome, when people in restraints lose their breath
and never get it back.
Shillinglaw noted that the
teachers and aides are trained not to show emotion when using physical
restraints.
But Smith, besides
criticizing the unrealistic chirpy voice used by Abbie's teacher, points
out when a teacher aide clenches up and tightens her downward grip after
Abbie scratches her. "The less verbal a child, the more tuned in
they are to your nonverbal behavior," Smith said.
There's another problem with
the "coercion model," Cutler said. "One day they're going
to be bigger than you. When that kid hits 5 foot, 6 foot, one day he's
going to strike back."
Lyon said that Matthew did
just that, but with her, not his teacher. When she ran out of a favorite
candy bar, Matthew tripped her and pushed her to the ground.
Shillinglaw said the school
district didn't break the state's law against corporal punishment
because both parents signed off on the use of physical restraints. Lyon
said she thought they were only being used when Matthew was violent;
Bowden denied she ever agreed in writing to use physical restraints.
Both Abbie, now 11, and
Matthew, now 13, currently are in residential treatment programs off
Cape. Abbie is at the Boston Higashi School; Matthew is at Archway in
Leicester. The programs cost $80,000 and $90,000 a year and are paid in
part by the local school district.
Matthew actually had been at
Archway several months before his mother viewed the tape of his being
restrained at the Centerville school, taken back in 1996.
Lyon said her videocassette
recorder was broken when the school district sent her the tape, which
she had assumed showed Matthew going through a normal classroom routine.
Having now viewed the tape,
she said, "I don't feel confident with Matthew ever going back to
the Barnstable school system."
At Archway, Matthew is
finally toilet trained and has learned to say "I love you,"
Lyon said. And Higashi has proved a good match for Abbie, who was
photographed smiling and raising her hand in class, Bowden said.
The women believe that there
is minimal or no use of restraints at their children's new schools. The
bills on which Bowden is prepared to testify would assure that.
Besides requiring schools to
develop policies on the use of restraints and forbidding floor
restraints on children, they would also require a written report to be
filed every time a restraint is used. "Once people have the power
to use restraint it's kind of a slippery slope," attorney Sindelar
said. "It's easy to use the restraints any time."
But the legislation would
give teachers and counselors a taste of being on the receiving end. It
says: "Training shall include the experience of being placed in
restraints."
|
|
