Restraints And Seclusion

Nationwide, since 1993, at least 64 children died and thousands were injured while being restrained in face-down and other methods. About half of the restraints that caused deaths were unnecessary, a review of restraint deaths by Cornell University Residential Child Care Project found.

Cornell's trainers, who have worked with Parmadale, teach both the face-up and facedown techniques as a part of their Therapeutic Crisis Intervention system but warn neither is safe. Facilities choose which methods suit their philosophy. Some choose never to use restraints.

"Every single restraint assumes a certain level of risk, including death," said Michael Nunno, the project's principal investigator. "You never want your intervention to be more risky than what the child is doing."

According to the coroner's ruling, Faith was restrained after an "outburst of disruptive behavior."

Faith had been tossing things around her room and may have approached the staff aggressively, said Parma police and Parmadale officials.

That type of behavior alone is not enough to restrain a child, Nunno said.

Workers often get into power struggles with kids they supervise, especially if the atmosphere in the facility is chaotic. Staff involved in such struggles should remove themselves from dealing with the children, he said.

According to police records and other sources, the situation in Parmadale's Cottage 14, where Faith lived, was particularly tense.

In the days leading up to her restraint, several children escaped, one stole a car, a child-care worker was injured by a teen and -- just before Faith died -- another girl in the cottage was beaten so badly, she was taken to the hospital.

People can be trained and tested over and over, Mullen said, but in the heat of a situation, it's hard to maintain control of an agitated child who is struggling with staff.

"What people need to understand is that these are interactions between humans," he said.

Bellefaire JCB in Shaker Heights, which also treats troubled children, uses restraint as a last resort, said Jeffrey Cox, clinical director.

"For us, disruptive is not enough," he said. If a child were to punch a staff member and walk away, that would not be a restraint situation because the immediate danger would be over, he said.

When restraints are used, the child's vital signs are carefully monitored, and children are not left alone immediately after being restrained, Cox said.

Faith was allowed to rest on the floor after she was released from the restraint, and workers later discovered her breathing was shallow. Parmadale staff lacked access to life-saving measures such as an automatic defibrillator to try to restart her heart.

The number of restraint-related injuries in Ohio is unclear because no agency collects the data. Information about major incidents, such as deaths or serious injuries, is supposed to be reported to the agency or agencies that license a facility. But that information is not shared.

In 2006, the Ohio Association of County Behavioral Health Authorities, an umbrella group that includes county mental health boards, pleaded for the creation of a statewide system to report child injuries in facilities.

The report pointed out that thousands of restraint-related injuries each year, including rug burns, black eyes, bloody noses and broken teeth, are not required to be reported. It concluded that fear of liability and the potential of losing facilities, which are already in short supply, were reasons that reforms were not being pushed.

"We tinker around the edges, but nobody is biting the bullet and fixing this problem," Cheri Walter, CEO of the group, said at the time.

Asked this week if any changes had been made since the 2006 paper was printed, Walter said, "Frankly, nothing has changed."

But now, officials are facing the death of a 17-year-old.

"It's unfortunately taken kids' deaths to prompt these kinds of changes," Nunno said.


--------------------------------------------------------------------------------

CBS 5 Investigates: School 'Quiet Rooms' Continue Advocates Push For Restraint And Seclusion Law Changes

http://cbs5.com/investigates/Quiet.Rooms.kids.2.898717.html (Click on the link to watch the video)

Reporting Anna Werner

SAN FRANCISCO (CBS 5) ― Holding school kids down to the floor or closing them in so-called "quiet rooms" are practices advocates say can have dangers for the children and should be reduced or even eliminated.

But they're still allowed under California law, despite those advocates' efforts.

Naomi Liron says of her son, "He came home with three big pinch marks on his arm."

Liron says her 11-year-old son Reuben sustained injuries at school, like bruises on an arm, a rug burn on his face and emotional pain.

"He was depressed, very anxious and very depressed," says Liron.

Diagnosed with conditions including bipolar disorder and ADHD, Reuben attended the private Lincoln Child Center in Oakland, a school for children with special educational needs, for five years.

But his mother says it wasn't until earlier this year that she reallyunderstood what was happening with Reuben.

"I cried, when I read the incident reports," Liron said.

Those incident reports show how center staff at times restrained Reuben on the floor, in one report, holding him down for "ten minutes" after he misbehaved.

And on other occasions, how staff closed him into the "quiet room", where they noted he was "banging" and "ramming his body against the door."

In one report, a therapist wrote that he pleaded with her before being put in the room, "I love you, don't leave me, don't hurt me."

His mom says, "That's the one I cried the most about, because he's so desperate, and he's so scared."

Lincoln Child Center declined an on-camera interview about the case, citing confidentiality. In a statement, it says its ultimate goal is to keep children safe.

And under California law, restraining and even keeping children in those quiet rooms can be legal.

Which is why attorney Maggie Roberts, with Disability Rights California says, "I have great concerns."

Roberts is working on Reuben's case for Disability Rights California (formerly Protection and Advocacy).

According to Roberts, "They are reporting things that show that a child is very traumatized, and yet they continue to do it."

And a CBS5 investigation found similar incidents reported in schools across California and around the nation, in both public and private schools. Children have been locked in closets, or restrained, one even tied down with duct tape.

So last year, Roberts' group tried to change California law to limit those practices, and eliminate seclusion entirely. But Governor Arnold Schwarzenegger refused to sign the bill authored by Senator Sheila Kuehl.

The governor said the bill could stop school employees "from intervening in an emergency and place more students at risk."

But disability rights' Leslie Morrison says:

"By vetoing the bill and allowing these practices to continue we have put teachers and students at great risk."

Morrison says her group is looking into still more cases even now, like that of a 12 year old girl held repeatedly in asmall room with bare walls and no windows in San Diego and an injury sustained by a 9 year old boy on his backside, after being dragged by a classroom aide in a district north of Los Angeles.

http://www.caica.org/RESTRAINT_AND_SECLUSION_CAICA.htm