Academic journal article Education & Treatment of Children

Review of State Policies concerning the Use of Physical Restraint Procedures in Schools

Academic journal article Education & Treatment of Children

Review of State Policies concerning the Use of Physical Restraint Procedures in Schools

Article excerpt

Abstract

Recent injuries and fatalities among students due to the use of physical restraint procedures in schools, and the resulting media attention and litigation have started to place pressure on many state and local education agencies to develop policies or guidelines concerning their use in schools. The authors investigated existing state policies and guidelines concerning the use of physical restraint procedures in educational settings across the United States. Currently, thirty-one states were identified with established guidance concerning the use of these crisis intervention procedures. Several states are either developing or revising their existing policies or guidelines. The authors reviewed the policies and guidelines which were identified in order to compare common content elements found in these documents, and make recommendations for states, schools or districts interested in developing their own policies or guidelines.

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Although there is currently no reliable data on the number of deaths and injuries resulting from physical restraints, the Child Welfare League of America (2002) estimates that between 8 to 10 deaths occur each year as a result of improperly performed restraint procedures. An investigative report by the Hartford Courant identified 142 restraint-related deaths across 30 states within schools and mental health facilities over a decade long period. Of these deaths, it is believed that over one-third were due to the improper implementation of these procedures, resulting in death by asphyxia or suffocation (Weiss, 1998). More recently, Mohr, Petti and Mohr (2003) reviewed medical research investigating the leading causes of death associated with physical restraint. Their findings showed fatalities were most commonly attributed to either: (a) positional asphyxia, in which a person's respiratory process is inhibited by being placed in a prone (face down) position on the floor, or when staff members place their body weight on a student's back or chest area to help maintain control of the student when s/he resists; (b) aspiration, resulting from being restrained in the supine (face up) position; and (c) blunt trauma to the chest, experienced during the "take down" or initiation of restraint procedure, resulting in cardiac arrhythmia leading to sudden death. The authors also mentioned other risk factors including pre-existing medical conditions (e.g., heart conditions), obesity, and side effects of psychotropic medications. The latter is especially important given that drug therapy has become a common medical intervention for treating children and adolescents with emotional and behavioral disorders (Connor, Boone, Steingard, Lopez & Melloni, 2003), with medication prevalence rates reaching as high as 76% (Connor, Ozbayrak, Harrison, & Melloni, 1998; Ryan, Reid & Ellis, in press). Specifically, neuropleptic (antipsychotic) medications increase the risk of sudden death by 2.39 times, while antidepressants can increase the heart's QT (electrical cycle) interval which is frequently associated with sudden death. In addition, many medications inhibit the body's cooling mechanisms which can lead to heat exhaustion or stroke during the prolonged exertion of a restraint (Mohr et al., 2003).

This potential risk of injury and death has long been associated with restraint procedures ever since its inception within the psychiatric institutions of France over two centuries ago (Sturmey, Lott, Laud & Matson, 2005). The use of restraint procedures has since migrated from institutional settings, to less restrictive environments such as residential facilities and special day schools. Over the past few decades with the increased practice of including students with emotional and behavioral challenges in the general education environment, the use of restraint has now emerged in public schools. Additionally, schools have become very sensitive to student behavior problems, and on how they will respond to potential aggression as a result of widely publicized incidents of school violence. …

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