On July 25, 2019, Alex Campbell stood up to speak at the Virginia Board of Education meeting. The 13-year-old introduced himself as an advocate for people with disabilities who has autism.
“When I was in elementary school, I was subjected to restraint and seclusion,” Campbell said to the board.
He wasn’t nervous at all. Instead, he was fired up. So fired up that when the three-minute timer rings for him to wrap up, Alex ignores it and goes on for another six minutes. It wasn’t Alex’s first time sharing his story. In fact, he’s shared his story so many times before that he’s lost track. But he felt like this was one of the most important times.
The board was voting on final regulations for the use of seclusion and restraint in public schools. They were weighing whether or not to prohibit face down or “prone” restraint.
“How many of you have actually been in a prone restraint by a show of hands?” Campbell questioned board members. “Well, I have.”
According to a GAO report from 2009, of the hundreds of allegations identified, “at least 20 involved restraints that resulted in death. Of the 10 closed cases we examined, 4 involved children who died as a result of being restrained.” The study examined allegations at public and private schools across the country between 1990 and 2009
One teacher in Texas initiated a fatal restraint after a 14-year-old student “did not stay seated in class.” A 7-year-old girl, her location not identified, died after multiple staff held her for hours in prone restraint.
Virginia’s Board of Education ultimately voted to ban prone restraint in public schools during that July meeting. The practice was already prohibited in private schools, through 2015 regulations. (There are two different sets of state regulations, propagated through two separate legislative processes. Legislation in 2010 brought about changes to the regulations for private schools, while 2015 legislation started the regulations for public schools, which are still being finalized.)
VPM can’t say for sure how many schools were using prone restraint and will have to change their training practices as a result of the prone ban, because Virginia’s Department of Education doesn’t keep track of the different trainings used by schools. And, there are no state standards and limited oversight when it comes to the content of seclusion and restraint training used in schools across the state.
“I want to be comfortable and understand that the individuals out there have the necessary training,” said Virginia Board of Education member Diane Atkinson during the July 2019 meeting. “And right now I'm not sure that that's happening.”
State compliance reports show evidence of inadequate staff training. A 2017 report on the Sarah Dooley School for Autism in Richmond noted that “staff used physical interventions to remove a child from the classroom when the student was disruptive. School administrators are advised to review with staff the importance of professional interactions with students and the policy regarding physical interventions.” The school was advised to review their training calendar to make sure all staff members received the necessary, required training. The review also directed administrators to review how to write incident reports with staff “to include more details and to use specific language regarding the type of restraint that was used.” In an email response to VPM, the school said “staff are in compliance with required trainings,” and added that their incident report forms include “complete descriptions of the type of intervention used.”
A 2018 state report on the Rivermont School in Hampton stated “it is not evident if Rivermont - Hampton is complying with the regulations requiring certain staff development will occur within a certain number of days following a staff member’s begin date.” State code requires paraprofessionals and other ancillary staff like teaching assistants to have “two years of work experience with children or completed two years of coursework in a related field, or upon employment complete within 60 calendar days of hire training specific to the assigned student population and job duties as they relate to the academic and behavioral progress of students.” The school did not respond to multiple requests for comment.
The 2018 report also noted that at the Rivermont School in Hampton, “time out rooms are being utilized as a cool down space,” and that staff were calling those rooms “the box.” The report said additional staff training was needed “on utilizing other spaces around the building for students who are not requiring that level of intervention” and “to help [staff] refrain from the use of the term ‘the box.’”
Virginia regulations consider time out and seclusion as two different forms of restriction. They define time out as “assisting a student to regain control by removing the student from his immediate environment to a different open location until the student is calm or the problem behavior has subsided.” The regulations also require schools to document their use of time out, and state that staff should “check on the student at least every 15 minutes and more often depending on the nature of the student's disability, condition, or behavior.” The regulations, however, do not require VDOE to collect data from schools on the use of time out.
A Long Road To Oversight
Earlier this year, the Virginia Department of Education (VDOE) started collecting data about the use of seclusion and restraint from private day schools. VDOE is now attempting to standardize data collection for both private and public schools. According to department spokesperson Charles Pyle, “moving forward, once an electronic data-collection system is in place for both private and public schools, this information will be collected periodically during the course of the year in concert with the Student Record Collection system.” When exactly that electronic data-collection system will be in place is unclear. The department hasn’t yet taken steps to centralize the data that it’s already collected from private schools over the last four school years.
Meanwhile, there isn’t an effort to standardize training for teachers and staff who use seclusion and restraint at schools across the state that enroll children with often severe behavioral challenges and little to no verbal communication. State regulations from 2015 make reference to “proper training” but that’s not elaborated on. VPM asked VDOE for training documents through a public records request. The department said they do not request these materials from schools.
As part of the new public school regulations, the department does plan to create an online training for schools. A spokesperson for VDOE says it will help school divisions fulfill regulatory training requirements, but could not elaborate on what exactly that training will include.
“There's an entire industry around this,” said Juliet Hiznay, northern Virginia-based education attorney and advocate. “There are people who develop these models and they've commercialized those models and they're making money off of these models.”
At least one company used by Virginia schools, Handle with Care, has been advocating to keep prone restraint as an allowable technique. VPM obtained a letter the company sent to Virginia’s attorney general arguing that the prone ban violates the state constitution.
“Virginia case law and Constitution give educators the right to defend themselves and others by all means reasonable. A reasonable standard is not a ‘serious bodily harm’ or ‘no prone’ standard,” Handle With Care wrote in the August 23, 2019 letter. “The legislature does not have the authority to direct nor does the BOE have the authority to enact regulations that violate a person’s civil liberties, natural rights, constitutional rights, Virginia Law and public policy.”
The company did not respond to VPM’s request for an interview.
Training Companies Compete For Schools
One of the most commonly used training models in Virginia, according to a 2014 report from the Disability Law Center of Virginia, is called The Mandt System, named after the company that created it, The Mandt System Inc.
According to that report, about 20 school districts in Virginia used the training in 2014. Now, about 30 school divisions in the state use it, like Loudoun County Public Schools and Henrico County Public Schools as well as Charterhouse Schools, run by United Methodist Family Services.
“We really want to create environments that people can say in this place - and with these people - I feel safe,” said Tim Geels, senior VP of instruction for Mandt.
Many companies, Mandt included, provide a train-the-trainer model. Schools send select staff to a physical training, and they later train other staff members. Trainers often go over select chapters in-person, and complete coursework of other chapters online. The certified trainers also attend “refresher” trainings. The cost for each new Mandt trainer is $875-$1,655, depending on the depth of training content, according to the company’s website.
Geels says the company’s focus on de-escalation and prevention sets Mandt’s training apart from competitors. For example, their training manual includes a chapter on trauma, and another chapter on PBIS, or Positive Behavior Intervention and Supports.
“We really do, I think, live up to the idea that we don't want to put our hands on people unless it's absolutely necessary,” Geels said.
Geels says in 2001, they made the decision to take floor holds and restraints out of their basic RCT (Relational, Conceptual, Technical) training and just include the holds in an advanced training. In 2009, they took the floor holds out of the advanced training as well. Geels says the company also decided to remove training material on the use of seclusion from advanced training materials around 2007 since not all states allow seclusion in schools. Geels says the company never included anything about seclusion in their basic RCT training materials.
“We used to actually have a section in our advanced course that even laid out, here's what your seclusion rooms look like, here's some dimensions, here's the way it should be. And we took that out, because the vast majority of our customer base had no interest in it at all, honesty,” Geels said. “And we've always felt that if it is a specific need and a specific niche, then we can go in and work specifically with them.”
He points to Maine, where Mandt worked to develop a guidance document for schools there that used seclusion.
Another company with one of the largest footprints in Virginia is the Crisis Prevention Institute (CPI). According to the company, they’re currently operating in over 40 school districts across the Commonwealth.
“One of the things we're most proud of is that our training is totally evidence-based,” said CPI president Susan Driscoll.
Still, there’s not a lot of oversight of these companies in Virginia and many other states. According to Charles Pyle, a spokesperson for Virginia’s Department of Education, their staff do look for evidence of training when they visit schools on un-announced, monitoring visits. But those visits often only happen once every three years, unless schools are placed on an improvement plan.
Merrill Winston runs the Florida-based Professional Crisis Management Association (PCMA), which provides training to about four elementary schools in Virginia. Winston says he’s in favor of additional regulations for companies seeking to work in schools and other state facilities.
“The state of Georgia said if you want to provide services in Georgia, you have to answer this 65 question questionnaire. That’s the first time we ever encountered it,” Winston said. “We couldn't believe it. And they asked: What was your system based on? Was there any research? How many days does it take to do the training? They had all these questions. I'd never seen anything like it. And I thought it was fabulous that they even thought to do it.”
A Push For More Oversight
Advocates like Cheryl Poe, founder of the Virginia Beach-based Advocating 4 Kids, want the state to be more involved in vetting the types of training for staff who implement seclusion and restraint. She also wants to see regulations that spell out what trainings should include.
“It's about keeping the teacher's association happy. It's about keeping the principal's association happy,” Poe said.“It's about doing everything for everyone else except for what they're tasked to do, which is to provide a law, regulations and guidelines, that keep kids safe.”
According to VDOE, the state doesn’t endorse any specific trainings, or training companies. The proposed regulations for public schools do require training to be evidence-based, but it’s not clear how the state plans to enforce that. Poe wanted the regulations to require more specifics about implicit bias training, trauma and counseling for students.
“If you're gonna do it [restrain or seclude students], at least have something in place that kind of helps the child to move forward,” Poe said. “And I don't think our regs do that.”
Neither regulations for public or private schools mention anything specifically about trauma. The private school regulations do require schools to track what techniques teachers tried before turning to seclusion or restraint. And the new public school regulations require staff to review a student’s file within 10 days of a seclusion or restraint.
“You know, how did the child become escalated in the first instance?” asked Juliet Hiznay. “I question whether or not the training that we have is too focused on ways to restrain and ways to seclude as opposed to ways to avoid getting children escalated.”
Hiznay is part of a statewide network called the Coalition for Trauma Informed Schools. They want trauma-informed training to be a required part of every training involving seclusion and restraint. Hiznay and others hope that will encourage more emphasis on de-escalation techniques. But to do all of that well, Hiznay argues, you need more than just good training for staff. You need a positive school culture.
“So if you have somebody who's in the leadership of the school, say a principal who has a very warm, very relationship approach to working with their staff, is supportive and in listening mode and we'll respond to concerns, then you will see that translate into the classroom,” Hiznay said, adding that “when you have a happy staff, you frequently see that you will have happy students too.”
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 final installment of our four-part series on seclusion and restraint in private day schools, WHRV’s Gina Gambony speaks with Virginia groups creating alternatives to seclusion and restraint.
