Thursday, December 18, 2008

Locked Seclusion for Our Misbehaving Children?

Ashley Fantz of CNN has recently written an article, Children forced into cell-like school seclusion rooms, about a 13-year-old male, Jonathan King, who committed suicide in a seclusion room at a school in Georgia. Jonathan had a history of being aggressive toward his peers and was frequently placed in "time-out," a concrete room latched on the outside. Jonathan was placed in time-out the day he died and hung himself with a cord a teacher gave him to hold up his pants. He apparently was not searched prior to being placed in this locked seclusion. On top of this, a substitute employee was in charge of watching the room on the day Jonathan died. This employee reported that he had not been trained in the use of seclusion and didn't know Jonathan had threatened suicide weeks earlier.

Should we use locked seclusion for our misbehaving children? Is it safe? Sometimes locked seclusion is necessary to address very severe, aggressive, behavioral outbursts. When a child becomes physically assaultive and dangerous, a limited use of locked seclusion may be necessary. It can be used safely when proper procedures are followed. However, locked seclusion should only be utilized by trained mental health and special education professionals. It should not be used by frustrated and untrained parents or teachers who have run out of other things to try.

This story is a tragic reminder that we are not addressing the severe challenges of many of today's youth with professional care and best practices. In Jonathan's case, this tragedy could have been prevented. He obviously had significant mental health and behavioral issues that could have been impacted positively by a professional team of providers, including a psychologist, psychiatrist, and trained special educator. Instead he was supervised by someone with no training at all. A more appropriate scenario would have included the following: Jonathan would have been searched for dangerous items prior to being placed in time-out. Trained staff would have constantly watched him since he had recently threatened suicide. Every 15 minutes, staff would have documented his mental status and other observations. A specific plan of how to use locked seclusion would have been formulated in advance by a multidisciplinary team. If these "best practices" procedures would have been followed, then Jonathan would most likely be alive today.

In all fairness to the school, there is an increasing number of children in the educational system who are quite aggressive and hard to manage. Since there are few affordable treatment programs, parents are forced to keep their child in a school placement where minimal treatment is delivered. Schools are forced to accept these children when it is not appropriate to do so. As a result, the children frequently receive inadequate care by untrained professionals. What these children need is a comprehensive treatment program that holistically addresses their emotional, behavioral, and academic needs. However, these types of programs are few and far between. If a family has money, then there are more options. However, even with money, it is still hard to find quality and effective care.

This story also provides a reminder that we as a society continue to view punishment as an effective way to raise our children. My career began in residential care with adolescents who had severe behavioral challenges. I have worked in inpatient child psychiatric settings and have been a treatment director of a long-term residential treatment facility. Throughout my experiences, I have witnessed staff who would rather place a child in locked time-out than work to promote positive behavior. I have seen parents who do not believe in the powerful approach of "catching children being good." In one of my first employment experiences at the former Capistrano by the Sea Hospital in Dana Point, CA, Larry Stednitz, Ph.D. of, taught me that children with the most severe difficulties can be changed through the use of engagement in activities and positive interventions. At Capistrano by the Sea, we worked with the severest of the severe with minimal use of seclusion and restraints.

Locked seclusion is necessary at times, but in my experience, it is vastly overused. Punishment is certainly necessary at times, but it should be used sparingly in a mild form. It is much more effective to use the principles of Re-Education, formulated by Nicholas Hobbs in his book, The Troubled and Troubling Child. Among these principles is a belief that we have to help kids be confident by establishing quality adult-child relationships and helping them develop a sense of competence with some type of skill or activity. When parents, teachers, and mental health professionals use these positive interventions with kids, the need for locked seclusion dramatically decreases.

In order to help all the other Jonathans in our country, we need to push for more cost-effective day treatment and residential treatment facilities that are staffed by trained mental health and special education professionals. We need to bring professionalism to this field and not accept educational programs that are staffed by people who do not know what they are doing. We need to keep educating others that positive interventions work with children and that severe punishment, such as the use of locked seclusion, should only be utilized as a last resort. We need more monitoring and regulation of programs that do use these restrictive behavior management techniques. We also need to support parents in helping them find quality care. When we help our troubled youth experience success, we experience success as well.