Seclusion and Restraint: America's Children with Disabilities in Crisis

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by Marcie Lipsitt
Tuesday, January 27, 2009

The National Disability Rights Network (NDRN), known to parents of children across America as their states' Protection and Advocacy agencies, has issued a formal call to action with their January 2009 report, "School is Not Supposed to Hurt: Investigative Report on Abusive Restraint and Seclusion in Schools." 

Parents are supposed to send their children to school with the basic belief they will return home; safe, sound and without physical or emotional signs of abuse.  This is not the case for thousands of America's students with disabilities in both public and private classrooms in schools that cross all socio-economic lines.  Physical and emotional abuse, seclusion, restraint, physical harm and even death, has no idea if your child is attending a private or public school; if this school is located in an urban, rural or suburban area, or if it is wealthy, middle class or economically-disadvantaged. 

So what is "seclusion and restraint?"  (Per the Centers for Medicare and Medicaid Services and Protection and Advocacy Agencies)

*** It is important to note that only the Children's Health Act, enacted by Congress in 2000, defines seclusion and restraint for the purpose of facilities receiving Medicaid and other types of federal dollars and has no reference to our public schools. The Centers for Medicare and Medicaid Services further clarified the definitions of "seclusion and restraint" in 2006.  IDEA 2004 (Individuals with Disabilities Education Act, originally the Education for All Handicapped Children Act) has no rules that explicitly prohibit the use of seclusion and restraint.

A "restraint" is-

• (A) Any manual method, physical, or mechanical device, material, or equipment that immobilizes or reduces the ability of the patient to move his or her arms, legs, body, or head freely.
• (B) A drug or medication when it is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition.
• (C) A restraint does not include devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a patient for the purpose of conducting routine physical examinations or tests, or to protect the patient from falling out of bed, or to permit the patient to participate in activities without the risk of physical harm.
• (D) ***Prone Restraint ("The Lethal Hazard of Prone Restraint: Positional Asphyxiation" published by Protection and Advocacy, Inc. 2002) - "A physical restraint in which an adult holds a child's face on the floor while pressing down on the child's back. Sudden fatal cardiac arrhythmia or respiratory arrest due to a combination of factors causing decreased oxygen delivery at a time of increased oxygen demand can occur through prone restraint."

"Seclusion" is-

            The involuntary confinement of a patient alone in a room or area from which the