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The Secret Carer
Features Writer
@TheSecretCarer
4:39 PM 2nd July 2021
family
Opinion

A Damaged Child – Part 2 - Restraint, Seclusion And Humiliation

M.T ElGassier on Unsplash
M.T ElGassier on Unsplash
When you read about restraint and seclusion occurring in special schools and other institutions, it almost always refers to a single shocking occurrence which, if it goes to court, is usually argued to be a single, momentary lack of judgement by one member of staff.

However, these aren’t one-off incidents: restraint and seclusion are common occurrences happening daily in our schools.

It is even more important to stress that the incidents are usually the culmination of months and sometimes years of restraint and seclusion. To a child, it must feel like mental and physical torture inflicted by the adults who are supposed to be caring for them.

Behaviour is a form of Communication

One of the most well-known sayings within Special Needs circles of the past ten years, is that learning disabled and autistic children who are exhibiting ‘challenging’ behaviour are trying to communicate. Behaviour is a form of communication, especially for children with special needs for whom ‘normal’ communication may be difficult or impossible.

These children do not choose to have a meltdown: it is distressed behaviour. Something is wrong. They have needs - whether physical, medical, emotional, sensory or psychological - which are going unmet. It should be the primary focus of every special school to identify the underlying needs and hence what triggers any behavioural responses. They can then make a holistic plan which incorporates effective strategies for pre-emptively recognising and de-escalating problems. By doing this, there would be far less need for reactive strategies such as restraint and seclusion.

Ofsted Inspection

Shockingly, five months after my son was forced out of his old school, an Ofsted Inspection upheld the school’s outstanding rating, and wrote, “Staff have worked hard to change the way they react and respond to pupils’ behaviour. They now look at behaviour as a form of communication and work out what the pupil is trying to say.”

This is extraordinary. Only now do they look at behaviour as a form of communication? What were they doing before? For a special school, this should be basic knowledge. I still struggle to believe an ‘outstanding’ school didn’t already know this. It demonstrates an outstanding gap in their knowledge and expertise that they did not. More worryingly, how many more special schools are not aware of this fact?

New Survey Questionnaire

According to the RRICS survey by ICARS/PABSS, there are currently over 1600 family accounts of restraint and seclusion in schools in the UK, and the numbers are only increasing. It may be too late for my son, but by raising awareness of these problems it may help other children, their parents and carers.

That is why currently a new survey aims to collect more information from families about experiences of restraint and seclusion in schools throughout the UK. The more evidence is gathered, the greater the possibility of stopping this abuse continuing and of bringing schools to account.

To participate in the ICARS/PABSS Case Study U.K. 2021 please go to (https://www.surveymonkey.com/r/UKCaseStudy)

Restraint and Seclusion – My Son’s Story

In Part 1, I outlined what we as parents were led to believe was happening at my son’s old school. The Subject Access Request (SAR) made after my son’s removal from the school told us an entirely different story.

Incident Forms

We discovered more than eighty recorded instances outlining restraint and seclusion during our son’s final six months at the school. In the majority of cases, staff failed to recognise the triggers for his behaviour when my son started to become distressed, and then made the situation worse by demonstrating minimal and ineffective de-escalation strategies. We had no idea that there had been so many incidents and I am certain there will have been just as many unrecorded incidents, particularly of seclusion and persistent hand restraint. How could a school recording this amount of restraint not recognise that something was going badly wrong? How could they not recognise that they needed to change their approach and seek professional advice? A child with special needs and learning disabilities will have significant difficulties comprehending and processing information so their ability to adapt, learn from and modify their actions is impaired, unlike a school of adult professionals. When restraint and seclusion are clearly making things worse, teaching staff should be able to change their responses - you don’t double-down on a response that is already ineffective.

Legally, schools do not need to write an incident form or inform parents about an incident, although it is seen as ‘good practice’ to do so. For us, at least we now had some indication of what had been happening at school and how frequently and why our son had started exhibiting increasing anxiety and distress even at home. Unfortunately, the incident forms were so poorly written there was no indication or even an attempt at determining what might have triggered the behaviour, and little evidence or explanation of how staff had attempted to de-escalate.

Indeed, one incident form concerned a situation where our son couldn’t complete his work. The response was that he had to be made to do it. This is an absurd attitude to take with any child with special needs. But for a child with catastrophic epilepsy, it is scandalous. On many days, my son cannot think straight or understand what is being asked of him because of constant epileptic activity in his brain. He also gets distressed when he cannot manage something or is feeling pressurised. And school were aware a year earlier of his frustration and inability to maintain concentration and complete many tasks due to his increasing seizure activity. Forcing a child to do work when they are unable to do so is the very opposite of how staff should have been responding. It is certainly not a de-escalation strategy in anyone’s book.

In addition, the incident reports were often not objective, and the descriptions of restraint were incomplete or vague. Antecedents were recorded incompletely or not at all, and the injuries my son suffered went similarly unrecorded.

It is absolutely crucial that these incident forms are both mandatory and standardised so all the information necessary is outlined. Otherwise, how can a school look back, learn from them and revise behaviour plans and responses? A child with learning disabilities, executive processing difficulties and limited understanding will often have little or no ability to change their behaviours. But a school and its staff can learn and change. In my son’s case there is no evidence that his school reviewed or updated his behaviour plan until shortly before they forced him to leave; and when they did modify the plan, it was only to increase the level of restraint on my son rather than devising strategies to de-escalate or identify what was causing his distress!

Illegal Restraint

In addition, I was unaware that schools were allowed to exercise any level of restraint as long as they think it is ‘necessary, reasonable and proportionate’. On reading these incident forms, it was clear the school was doing all manner of restraint, including ‘T-wraps’ (also known as ‘basket holds’). These should never have been used, as the risk of positional asphyxia – suffocation – resulting from these was already known. (My understanding is that a report for Team Teach* by Bleetman in 2018 recommended the use of T-wraps be discontinued.)

Also included in the accounts of restraint was a ‘two person caring C around the ears’. Don’t be fooled by the use of the word ‘caring’. Can you imagine this? That’s two adults holding onto a child’s head from either side. I don’t believe such a move is described or advocated in any ‘Team Teach’ handbook.

When I first read and signed my son’s ‘Positive Intervention Plan’ (PIP), I had no knowledge of the restraint culture inherent in so many special schools. My son had never been subjected to this type of restraint before the age of 14 when his epileptic seizures took a dramatic turn for the worse as puberty hit, and his mental state and understanding spiralled down with it.

Terms such as ‘caring C’ (cupped hand position around the elbow), to guide him ‘gently’ around during transitions, and moves such as ‘gentle embrace’ seemed acceptable. In reality, they were far from it. There is a special language within these forms where words do not have their natural meanings. When they describe ‘supporting’, they mean restraining children and holding them down, while ‘guide’ means to physically move them. No doubt it makes the treatment sound more acceptable to a parent or carer; and possibly tries to rationalise and soften the impact for those practising it.

Beth Morrison, founder of PABSS, reported that one former member of staff in a SEN school sent her a message decrying the use and terminology of the “Caring C”: “Sorry... theres no such thing as a caring c.. it’s another word for grabbing the child in our school... I felt my colleagues were manhandling children not keeping them safe. I saw abuse... they saw a disruptive child!"

Restrictive Interventions

To properly understand what restraint and seclusion really involves, you need to know there are several types of restrictive intervention:-

Physical Restraint

This involves ‘any direct physical contact where the intervener’s intention is to prevent, restrict, or subdue movement of the body, or part of the body of another person’. There are different types and levels of restraint and it can involve one or more people. It can range from what I would regard as low level – holding a child’s hand down on a table or moving them around school by the elbow or linked arms – to a much higher level, such as several people placing a child into a prone position, i.e. face down on the floor.

However, what I didn’t realise back then was that any form of restraint, however seemingly minor, is restricting a child’s liberties. These holds should be used for as little a time as possible, and only as a last resort in order to keep people safe. You may recall last year, George Floyd was restrained in a prone position with a knee on his neck for nine minutes, leading to his death. Children have also died whilst being put into positions such as these. In 2004, whilst in a detention centre, Gareth Wyatt, aged 15, was put into a ‘seated double embrace’ by 2 adults for 6 minutes; he died of positional asphyxia, choking on his own vomit.

Beth Morrison’s learning-disabled son, Calum, aged 11 incurred petechial haemorrhaging “most likely caused by extreme pressure on his chest whilst being restrained face down on the floor”. The Guardian reported that “Dr Brodie Paterson, a specialist in handling vulnerable people, published a report claiming Calum’s injuries were “inconsistent” with the correct restraint techniques, and that he had “previously only come across such petechial haemorrhaging in fatalities associated with restraint application”. He claims that Calum was exposed to a potentially fatal level of risk that was “grossly disproportionate”.” (Guardian 2019)

Can you imagine the outcry if, like Floyd, one of these incidents or deaths had been caught on camera? Is this what it has to take before people start to listen? It is an outrage. Where is the anger? Why have these practices not been banned outright?

Any position which restricts breathing is classed as dangerous. Use of the T-wrap, which involves holding the child in a sitting position from behind with arms crossing the torso, should have been discontinued in 2018 after Bleetman’s report, I believe, as I mentioned earlier; and yet four different types of T-wrap were still mentioned on my son’s PIP in 2019 and used on my son on several occasions. And, incidentally, the T-wrap is recommended for smaller children, not a 15 year old boy.

School’s example of restraint

So let us start to examine one of the school’s incident forms. On this occasion my son was distressed and ‘dysregulated’ (school’s term). Having failed to identify or understand why this might be happening and try to de-escalate, staff instead told him he was going to be taken to the ‘Blue Room’ (i.e. the isolation room). At this point, he threw himself to the floor. This was because he was scared of the Blue Room. His experience was that they kept him there for long periods in the dark, holding a timer directly in front of his eyes. He – of course! – did not want to go in there.

Whilst sitting or lying on the floor, he was in no danger to himself or indeed anyone else. Staff could have stepped back and allowed him to calm down. Instead, one member of staff restrained him from behind (a ‘seated t-wrap’) while another pinned his legs down. By doing so, they put both my son and themselves in danger of injury. My son was left with extensive bruises over his lower legs, though with the risk of positional asphyxia things could easily have been much worse. We later discovered that my son was developing scoliosis of the spine, which would have increased the risk. The school had carried out no medical assessment of the risks to my son before performing these moves.

There is then no record of how they took him out of the room from this position and into the isolation room. Carrying a child is not a permitted action according to Team Teach. I would say, however, that my son has talked on many occasions subsequently of being picked up and carried by his legs and arms.

It never seems to have occurred to staff that the situation rapidly deteriorated because of their threats and their previous use of isolation. Instead of de-escalation, they used fear and intimidation. Why not simply stand back and wait for him to calm?

A different approach

Recently, I spoke to another experienced professional trained in restrictive intervention techniques who works with learning disabled and autistic children. His approach was entirely different. In the whole of the previous year, he said that he had only once had to restrain a child – and that was to prevent the child taking an action that would have endangered their life. He said that he would never restrain a child when they are on the floor – they are in no danger there.

His attitude was that if someone is distressed or having a meltdown, and de-escalation techniques have failed, then if the child is not in any danger he will stand back and let them calm down and regulate themselves in their own time. He said that it didn’t matter when this happened - whether it was just before lunch and he is hungry, or at the end of the day and he is tired and wants to go home - he will stay with that child and support them until the storm is over.

This is the approach of someone who is intelligently thinking about what is the best course of action and has the mental health of the child in mind. Thankfully, there are practitioners out there like this. Unfortunately, however, instead of restraint being used as an absolute last resort, for many it appears to be the immediate default response in all too many cases. I recall seeing a comment from a teacher on the TES Community Forum several years ago saying “I am not one of those restraint happy members of staff who always jump in with the TT restraint!!!”, suggesting there are indeed some teachers who do resort to restraint far too quickly. If mandatory recording of each restraint incident was required and CCTV compulsory in every classroom and corridor, perhaps schools would think twice about engaging in it.

Mechanical restraint

This involves ‘the use of a device to prevent, restrict or subdue movements of a person’s body, or part of the body, for the primary purpose of behavioural control’. Examples include strapping a child into a wheelchair or chair to prevent them moving around, but can also include strapping a small child into a buggy. It can involve pushing a chair up to a table so children cannot get up and using arm splints, handcuffs, spit hoods and restraint belts on vulnerable learning-disabled children. Disturbingly these measures are often used when the child is already in crisis! Imagine how much extra distress that must cause a child.

Blanket restrictions

This involves not allowing children to walk, run or play with their peers. They are not allowed to be near them or interact with them. In my son’s case they put his table next to the door whilst all his friends and peers worked and socialised in the main area of the classroom.

Photo by Sharon McCutcheon on Unsplash
Photo by Sharon McCutcheon on Unsplash
Chemical restraint

This involves ‘the use of medication which is prescribed and administered for the purpose of controlling or subduing behaviour where it is not prescribed for the treatment of a formally identified physical or mental illness’. Some schools insist a child takes these before the start of each school day.

Environmental restraint

This involves ‘the use of obstacles, barriers or locks to prevent a person moving around freely’. There is one report of my son being put in a corner of a staff office, sitting with his back to the wall and a table placed across him, effectively cornering him in using the desk and made to complete his work.

Psychological restraint

Involves ‘depriving a person of choices, controlling them through not permitting them to do something, making them do something or setting limits on what they can do, without physically intervening. It includes the use of threats and coercion’. An example might be the threat of being taken to the “Blue Room” that was used to try to scare my son into compliance.

Seclusion

This involves ‘the supervised confinement and isolation of a person, away from others, in an area from which the person is prevented from leaving. There does not need to be a closed or locked door for someone to be secluded as long as they aren’t allowed to leave’.

I had no idea that this practice existed at my son’s school until I had to collect him from there one day towards the end of his time at the school. It was only after I had made a Subject Access Request that I found they were frequently using this isolation room, whenever he became ‘dysregulated’. It seems that whenever my son was in crisis, they would remove him from the classroom and take him to this isolation room, a tiny, windowless internal (store) room, dimly lit with black padded walls. There he was expected to sit until he calmed down, while a teaching assistant held ‘a timer 7 inches from his face’ until he complied, with the timer restarted each time he made a noise. I will reiterate here that my son has a mental age of five, with limited understanding of time, and suffering constant disruption to his thought patterns and mental state because of the constant epileptic activity in his brain. The school – bizarrely - insisted he found this ‘relaxing’. Indeed, it was so relaxing that when threatened with it, you may recall he threw himself to the floor in fear to try to avoid it happening again. It was so relaxing that the timer in front of his eyes was constantly stopped and restarted until he complied. Purely and simply, it was a punishment, and a grossly inappropriate one for a child with learning disabilities and epilepsy.

Image by Philip Wels from Pixabay
Image by Philip Wels from Pixabay
Humiliating and degrading treatment

And it wasn’t just seclusion and restraint that were inflicted on my son. We discovered there were degrading acts, seemingly used to punish behaviour and teach children a lesson. My son can spend significant time on the toilet for medical reasons. One incident recounts that he had been on the toilet for 30 minutes, during which time he had put a large amount of toilet paper into the lavatory. He would not have done this to be provocative or deliberately naughty: he would have no comprehension that it might even be a problem. And yet, as a result, a member of staff “gave him some gloves and a bag” and made him “clear it out”.

On other occasions, he was made to clean urine from the floor. I cannot believe that any adult could think this was remotely appropriate for any child, let alone one with learning disabilities and limited understanding. We only found out about these incidents as a result of the SAR. And though we did eventually receive an apology for this humiliating treatment, no-one was seemingly held to account for these actions. For a head teacher to have their staff believe this was remotely acceptable in a special school is a shocking indictment on the leadership and culture.

Constant restraint of the hands

Finally we came across the school risk assessment for our son, another document we had not been consulted about. This revealed that school had started holding his hands down at all times throughout the day: during class, they would hold his hands on the desk; and between lessons, staff would hold both his arms whilst moving him through the corridors. This is not use of restraint as a last resort. This is restraint used pre-emptively as a matter of routine. This would be bad enough for any child. For my son, who has a sensory need to frequently press his hands to his mouth, this must have been torture.

The Head teacher defended this, saying staff were only doing holding his hands lightly as reassurance. And yet one incident form records that “he broke free and lashed out”. You don’t ‘break free’ from a reassuring touch. You break free from forcible restraint. Presumably after several relentless months of restraint, seclusion and humiliating practices my learning-disabled son had started to physically say no to this treatment in the only way he had left.

Photo by Kasper Rasmussen on Unsplash
Photo by Kasper Rasmussen on Unsplash
Positive Behaviour Support

I could continue, outlining incident after badly managed incident carried out by school on my son. But even from these few it is clear that restraint doesn’t – and didn’t – solve the problem. Indeed, it does the opposite; it exacerbates the problem and leads to a downward spiral of confrontation and resistance.

And if a child is taken to a room against their will and isn’t allowed to leave when they chose, then this is isolation and seclusion, whether there is a lock on the door or not. What message is this giving a child? Padded walls, small windowless rooms, isolated from your peers, no way of leaving, and a timer held in front of your face to force you to comply. This is a punishment, a convenient place to put a difficult child out of the way instead of trying to understand the difficulties.

If you gave my son’s poorly written incident forms to a specialist to examine, they would find few, if any, of his actions justified restraint or seclusion. Indeed, the forms were so badly written that, even if school had wanted to, they could never have used them to reassess their approach, because they failed to consider or explain the antecedents or triggers; and there was little to show they tried to de-escalate problems before resorting to restraint or seclusion.

If you have logged more than eighty incidents in a few short months and all you do every time is increase the level of restraint, then the problem is with the school, not the child. You are not meeting their needs. You are not seeking to understand. You are forgetting that each child has special – that is, individual – needs. The incident forms we saw suggested the school had practitioners of Team Teach who seemed to have forgotten that de-escalation should be the first resort, with restraint the absolute last.

The school needed positive behaviour support training for their staff to teach them how to recognise the triggers causing a child’s distress in addition to the ability to effectively de-escalate using techniques such as Studio 3’s ‘low arousal’ approach, a crisis management strategy encouraging stress reduction and de-escalation.

Accountability

It is important to stress here that my vulnerable son is a child who has a severe learning disability, a complex neurodevelopmental condition and executive functioning difficulties. He also has to take epilepsy medication with side effects that alters his mind and brain function. His condition and his medication account for his behaviour. He is not malicious or trying to do wrong. He doesn’t have that understanding. What excuse do the adults at this school have for their actions? Would they restrain and isolate their own children? Do they never think about what they are doing and recognise that it is simply, morally wrong? And where are the whistleblowers?

Now is the time for schools to be fully accountable for their actions, with mandatory form filling to a high standard which notifies the parents each and every time an incident happens. They must seek to explain what led to incidents. They must set out exactly what steps they took to de-escalate. External professionals should regularly review and monitor these and advise best practice. And school classrooms and corridors should have CCTV to ensure the safety of everyone. My child received multiple injuries at the hands of adults in his school. Other children have suffered far worse. Without full knowledge and recording of incidents, schools will continue to act with impunity and the cruel and inhumane practices of restraint and isolation will continue.


Next time – A Direct Appeal To Parents – Why Schools Need To Seek External Professional Advice

ICARS/PABSS Case Study U.K. 2021 – if you wish to participate please go to this link https://www.surveymonkey.com/r/UKCaseStudy

SAR – Subject Access Request
Ofsted - the Office for Standards in Education, Children's Services and Skills
RRICS Report – Reducing Restrictive Intervention of Children and Young People
ICARS – International Coalition Against Restraint and Seclusion
PABSS – Positive and Active Behaviour Support Scotland
PIP – Positive Intervention Plan also known as Positive Behaviour Plan
*Team Teach – restrictive intervention training provider, advocating their intervention strategies were 95% de-escalation and 5% restraint.
Isolation room – also known as blue room, chill out room, snug, den, pod, inclusion room,
TES Community Forum – Times Higher Educational Supplement

Bleetman, A & Lifshitz, S (May 2020) Medical Risk Assessment of Team Teach Skills Syllabus

‘He was covered in bruises’: the vulnerable children being harmed in special schools. Simon Hattenstone and Eric Allison 2019 Guardian. (Link)

Definitions of restrictive interventions are taken from the British Institute of Learning Disabilities (BILD)