Tied up and isolated in the schoolhouse

The use of restraints or seclusion in the school setting

It is the position of National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) is an essential advocate for the health and well-being of all students. Promoting a safe and secure environment is vital to the educational success and emotional development of children. The use of restraints or seclusion can potentially cause injury or death and therefore should be used only as a brief intervention where there is the risk of imminent danger to the child, staff, or classmates (Mohr, LeBel, O’Halloran, & Preustch, 2010; United States Department of Education [USDE], 2012).

The contribution of children's temperamental fear and effortful control to restraint and seclusion during inpatient treatment in a psychiatric hospital

The current study examined temperament characteristics as risk factors for restraint and seclusion (R/S) events in psychiatrically hospitalized youth, extending work that has sought to identify R/S risk factors and research examining temperament-behavior problem associations that has largely relied upon community samples. It was anticipated that children with poor effortful control (EC) and greater frustration would have more instances of R/S during psychiatric hospitalization. The contribution of children's fearfulness to R/S was also examined. A measure of temperament was completed by youths' clinicians and youths (n = 52) completed objective measures of EC. The frequency of R/S events for each participant was obtained from hospital records. After controlling for R/S risk factors, lower EC and higher fearfulness predicted increased R/S occurrences during the first 2 weeks of hospitalization and over the course of children's entire hospitalization. These findings indicate that temperament should potentially be considered in individualized treatment plans targeting the prevention and/or reduction of R/S. Additional implications of the findings are also discussed.

Restraint and seclusion use in U.S. school settings: recommendations from allied treatment disciplines

Restraint and seclusion (R&S) are high risk, emergency procedures that are used in response to perceived violent, dangerous situations. They have been employed for years in a variety of settings that serve children, such as psychiatric hospitals and residential treatment facilities, but are now being recognized as used in the public schools. The field of education has begun to examine these practices in response to national scrutiny and a Congressional investigation. The fields of mental health and child welfare were similarly scrutinized 10 years ago following national media attention and have advanced R&S practice through the adoption of a prevention framework and core strategies to prevent and reduce use. A review of the evolution of the national R&S movement, the adverse effects of these procedures, and a comprehensive approach to prevent their use with specific core strategies such as leadership, workforce development, and youth and family involvement in order to facilitate organizational culture and practice change are discussed. Proposed guidelines for R&S use in schools and systemic recommendations to promote R&S practice alignment between the child-serving service sectors are also offered.