Tuesday, April 26, 2011

When Restraint Abuse Warrants Little Concern And Less Attention: Is Florida Paying Any Attention?

 On April 14, I wrote an article about the improper demonstration of a full-body restraint system being used in a Florida public school on disabled children. I followed up this article with a series of emails to Gillen Industries, who manufactures the restraint device to the school principal and to the Associate Superintendent of Exceptional Student Education for Orange County Public Schools, and to the bureau chief for Exceptional Education  & Student Services

Last year Florida passed a law regarding restraint and seclusion of disabled students, and parents ought to be concerned, especially if the number of restraints that Orange County has engaged in this year, are indicative of the concern for the rights of their most vulnerable charges. According to the Orlando Sentinel, students in Orange county were restrained “1,910 times this school year — representing nearly a quarter of the 8,222 cases in Florida. No school district employed the method nearly as much as Orange, where some students were restrained repeatedly, according to new data from the Florida Department of Education.”

Leslie Postal and Lauren Roth, the reporters of the Orlando Sentinel piece on Orange County restraints, quote Ross Green:
“‘That's proof that what we're doing isn't working,’ said Ross Greene, a psychiatry professor at Harvard Medical School.
An expert on child behavior, Greene works to reduce restraint at schools and residential programs.
‘Restraints are inappropriate 99.9 percent of the time they are used,’ he said."

The piece also contains the assistant principal demonstrating how to use the “wrap mat” restraint. Not only is the restraint used incorrectly, with the person placed face down rather than face up, the assistant principal has engaged in a euphemism, renaming the “Ultimate Restraint” system the much more friendly sounding “wrap mat.”
According to Gillen Industries and PXDirect, the restraint system is available in three sizes, of which the smallest will fit individuals 4’8” and over. Readers will no doubt find tremendous comfort in Gillen’s pride in the fact that this restraint system “Can be cleaned easily for quick turn around service.” provides information on this restraint and notes that it is for use with "combative/violent psychiatric patients" in psychiatric hospitals on the East Coast. Is this really an appropriate device for disabled students to spend hours in?: “Several times this year, students at Magnolia were held in these devices more than two hours.”

Below is my email to the principal, W. Thomas Oldroyd:

I have several questions regarding your school's use of the restraint device as demonstrated by your assistant principal in a news video.

I believe that this is the restraint device showed in the video

 That's a grown woman being shown to the mat, but she's too small for it. In addition, the woman is placed face down into the mat, which would put the individual at risk for suffication. Is this how the mat is being used? It's not how it's intended to be used.

What ages are the students at risk of being placed in this particular restraint and what particular safeguards are being used?

 If the assistant prinicipal can't even demonstrate it correctly, what is the training of the individuals who place students in this?

What level of supervision is used while the student is in the restraint device? How long is a student left in the device?

What behaviors merit the device? Who makes the decision on when to use the restraint and what level of accountability is in place to protect students from unnecessary restraint?

At what point are parents informed that their child is in restraint?

Thank you for answering the questions. I appreciate it.

Kim Wombles
Concerned parent and educator

I then followed up my letter to the principal with a letter to Dr. Anna Diaz, the Associate Superintendent of Exceptional Student Education for Orange County Public Schools:

Dr. Diaz,

I am a mother of three on the spectrum, an educator, and am active in advocacy for the disabled, mostly through the use of scholarly pieces on Science 2.0 and on the Autism Blogs Directory, and a personal blog, Countering. My writing partner and I have been examining the Orlando Sentinal video of Assistant Principal Denise Calio demonstrating the use of the ultimate restraint system, and I am currently working on a piece for Science 2.0 on the use (and misuse) of restraints in Magnolia School.

I am including below the email I sent the principal of Magnolia School. I have not heard back from him.

I would appreciate answers to the questions I pose below to the principal, as well the following:

How many children under the height of 4'8" have been put in the ultimate restraint system? The restraint shown appears to be adult sized and was too large for the woman put in.

Have they been put in face down? That's the incorrect positioning.

What behaviors lead to the use of this restraint and what is the longest someone has been in it?

Why do you wait 15 minutes before summoning a nurse to monitor the student?

What accountability are faculty and staff held to to justify the use of this restraint?

How do you account for the high number of restraints in this particular school and what are you doing to decrease the number?

Has any staff or faculty member been disciplined for using the restraint for times where it was not justified (let me tell you, if the assistant principal is deciding, since she couldn't demonstrate the device right, I'd be concerned about her ability to decide when it's appropriate. After all, she thinks they "can practice their relaxation techniques" in there).

Below is my email to the prinicipal. I appreciate your timely response to this matter. (The above email to the principal was included).
In response to my questions, sent both to W. Thomas Oldroyd, the Principal of Magnolia School, and to Dr. Anna Diaz, the Associate Superintendent of Exceptional Student Education for Orange County Public Schools, I received the following statement from Principal Oldroyd. Readers will note that none of my questions were really answered.

“Magnolia School Restraint
Magnolia School is a Special Day School.  The educational needs of students that attend Magnolia are extensive.   Some students that attend Magnolia have Behavior Intervention Plans. Behavior Intervention Plans are developed during an Individual Education Plan meeting with parents or guardians.
The intent of the video was to educate the public regarding the use of mechanical restraint as a safety intervention. It is used only as a last resort during times of crisis (continuous self injury or continuous physical aggression.) The mat in the video is one of several sizes made for Magnolia School and is used in accordance with the manufacturers guidelines.
Safeguards are put in place when implementing manual restraint or seclusion.  Safeguards include trained classroom staff in the use of restraint, behavior specialists/analysts, administrators, and experienced nurses. Data is collected and reported on the same day to parents and guardians via email and in writing as well as the Department of Education.”

After receiving this statement, I sent the following email to the bureau chief; the questions and answers are provided below.

Below are the questions posed to the bureau chief of Exceptional Education  & Student Services and the answers I received today.

    1.      I'm writing a follow-up article to the article ;, I wrote about the improper demonstration of a full-body restraint system at Magnolia School in Orange County. I was hoping you could either help me or direct me to the right person for summary and detail reports for the use of restraints in Florida schools this school year.
 -      Please see the two attached files. 
**One file breaks it down by district, Orange County had 1910 incidents involving 244 students.
** I'm inserting the word doc file that summarizes the restraints:

Incidents of Restraint and Seclusion Cumulative Through March 2011

Restraint Incidents Through March 2011,
districts reported
· 8,222 incidents of restraint involving 2,944 students
Distribution of Restraint Incidents by Grade Levels· Grades PK-3: 42%
· Grades 4-8: 40%
· Grades 9-12: 17%

Distribution of Restraint Incidents by Exceptionality

· Emotional/Behavior Disabilities: 46%
· Autism Spectrum Disorders: 22%
· Intellectual Disabilities: 10%
· Specific Learning Disabilities: 5%
· Other Disability: 16%

Seclusion Incidents Through March 2011, districts reported
· 3,386 incidents of seclusion involving 1,047 students

Distribution of Seclusion Incidents by Grade Levels· Grades PK-3: 35%
· Grades 4-8: 47%
· Grades 9-12: 18%

Distribution of Seclusion Incidents by Exceptionality

· Emotional/Behavior Disabilities: 69%
· Autism Spectrum Disorders: 10%
· Intellectual Disabilities: 11%
· Specific Learning Disabilities: 2%
· Other Disability: 8%
    2.      Also, I'm interested in what training has been given to faculty and staff who utilize the ultimate restraint system, what safeguards are in place to make sure that students aren't improperly restrained and if their is any video documentation of the classrooms where restraints are used.
 -      Regarding the training that the faculty and staff have received should be directed to the Orange County School District.  Dr. Anna Diaz, is the Associate Superintendent for Exceptional Student Education. Dr. Diaz may be reached at 407/317-3229.
 **I have a follow up request under FOIA into the specific school district.

    3.      Does the state purchase the ultimate restraint system, the district or the individual school?
 -      No. The state does not purchase any restraint systems, nor does the state "purchase" training in crisis management for school district staff. Such purchases would be made by school districts.  
         4.      How many schools in Florida own and use this restraint system that the says is "designed for combative/violent psychiatric patients and is in use at various psychiatric care facilities on the U.S. east coast. Currently, the system comes with a stiff board that gives it rigidity.

-      We do not have this information.                

5. Does the state purchase the ultimate restraint system, the district or the individual school? How many schools in Florida own and use this restraint system that the says is "designed for combative/violent psychiatric patients and is in use at various psychiatric care facilities on the U.S. east coast. Currently, the system comes with a stiff board that gives it rigidity.
The manufacturer has a new model that was unavailable for review specific to Fire/EMS that can be used with a standard backboard"?

-      We have no information on this.             

 6.      The manufacturer has three standard sizes, with the smallest fitting no shorter than 4'8''; what safeguards are in place in the schools that use these restraints that the student is the appropriate size?

-      If a school district has acquired a specific system, then it would be incumbent on the district to make sure the restraint is being used appropriately.               

 7.      How closely is the state monitoring the restraints and investigating these restraints?

-      Beginning with the 2010-11 school year, school districts have been reporting data regarding the use of seclusion and restraint. The Bureau of Exceptional Education and Student Services (BEESS) has been reviewing this data received throughout the year. Additionally, school districts provided BEESS with copies of their policies and procedures related to incident reporting procedures, data collection, monitoring and reporting of data collected. Lastly, we have begun to field test on-site monitoring procedures.                 

8.      Does the state keep statistics on how often the ultimate restraint system is used, for how long, if it was used appropriately, and for what reasons it's used?

-      The Bureau receives information on the type, duration of the restraint, and the student’s behavior leading up to and precipitating the use of restraint. Because type of restraint is currently a text box, we are unable to aggregate and report data on the specific types of restraint used.  
I also spoke to John Gillen, the head of the company who makes the restraints, and he does not provide training or guidelines for the use of the restraints. He sells the ultimate restraint for face-up use, but acknowledges that institutions may and do use the restraint face-down with violent clients to protect the staff and the client from the client's aggression. He does not make the ultimate restraint smaller than the 4'8" size, but notes that the wraps are meshed nylon and that the top restraint does not have to be fastened.

After nearly two weeks of looking into this story and trying to find satisfactory answers that the device, when used, is being used correctly, I am left with no assurance that this is the case. The school system did not respond to my specific questions and the vague promise that guidelines are being followed is a cold comfort in light of the video demonstration that the school system had to know would be scrutinized. If they can’t acknowledge that they did nothing short of screw the pooch with that demonstration, then why should parents feel confident that when they do decide restraint is appropriate that their child is placed in the device properly and that appropriately supervised.

If the video demonstration is indeed how they’re using the device, then every parent of a child at Magnolia School should be seriously concerned about their child’s safety. With no consistent guidelines, no statewide supervision of the types of restraints purchased and the training provided, there's a definite problem of oversight and accountability.


kathleen said...

Well done! It would appear that no one in a position of power..from the superintendent down wants to take responsibility and instead give vague answers-I'm guessing they hope you will just go away. Perhaps questioning the state board of education and up may prove effective.

Adelaide Dupont said...

Really glad to see a "Florida families against seclusion and restraint" in the blog directory.

My thought is that more attention, and perhaps change, is going on in research than clinically and certainly teaching.

Happy Elf Mom (Christine) said...

This stuff needs to be treated as a last resort!! As in, cops have guns but don't fire them all the time doggone it!! And every time that gun goes off, there are reports made and review processes. There should be WAY MORE checks and balances for these children. NOTICE that none of the regular ed kids are getting smacked around and tied up on a regular basis like this.



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