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LYNN NEARY, host:

This is TALK OF THE NATION. I'm Lynn Neary in Washington sitting in for Neal Conan.

Cedric Napoleon suffered years of childhood abuse. At 14 he suffered from post-traumatic stress disorder. He was in a special education program in Texas when, federal investigators say, in an effort to quiet him down his teacher performed, quote, "a therapeutic floor hold." She laid on top him, and when she got off he was dead. Cedric's story, among others, prompted the Government Accountability Office to issue a report this week on the restraint and seclusion tactics used to control children in schools, primarily in special education classes.

Teachers and school staff sometimes restrain and seclude students with disabilities to prevent the children from harming themselves and those around them. But some educators say this can be dangerous and the emphasis should be placed on prevention. Do you work with children with behavioral disorders, autism or other disabilities, or are you the parent of one? We'd like to hear from you. What has worked for you when it comes to controlling violent behavior? Tell us your story. Our number here in Washington is 800-989-8255. The email address is talk@npr.org, or join the conversation at our Web site. Go to npr.org and then click on TALK OF THE NATION.

Joseph Shapiro covers disability and health for NPR and he has been following the recent activity on the Hill regarding children with behavioral disorders, and he joins us know in Studio 3A. Good to have you with us, Joseph.

JOSEPH SHAPIRO: Thanks, Lynn.

NEARY: So let's start with a story. It's a story that you included in a piece which aired this week on MORNING EDITION about a child named Moses. Tell us about him.

SHAPIRO: Oh, yeah. He had one of those terrible, horrible…

NEARY: No good.

SHAPIRO: …no good very bad days.

NEARY: Yeah.

SHAPIRO: This was an 11-year-old boy in a middle school in San Antonio and on this day in February it ended up with Moses being handcuffed to a chair in the school security guard's office, and his mother, in my story, Annette Maldonado(ph), talks about coming to the school and seeing him crying and bruised and handcuffed and she says, you know, it just broke my heart. He is not an animal, he is a human being. And I went - I found the police report and it just - what comes through, what struck me is that this was one of these cases where you just see how easy it should have been to just have avoided all this.

It started - some of the kids and Moses in special education class apparently were acting up. The teacher asked them to write a letter to her, talking about their behavior. They made negative comments about the teacher, the assistant principal, and the police officer gets summoned. Moses gets frustrated. He says, You don't listen to us anyway. He curses, he takes his pen. He flings it in the direction of the police officer. It lands harmlessly, but she takes him out of the room and says, All right, that's it, you're not getting your snack today. And he just gets - they kept escalating - everything got escalated. And it ends with the officer - a few minutes later she says he is banging his head against the wall - the door in our office and she handcuffs him, but -to try to keep him safe.

But I think this was a case I picked because it sort of showed that too often the discipline between kids in special education is based on some kind of confrontation between adults and kids. And I know today we're going to hear from some of our guests about some of the things that are successful alternatives to break this sure cycle of confrontation.

NEARY: Well, give me a sense of how widespread this - the use of these kinds practices, this restraint is.

SHAPIRO: Well, we don't know for sure, but this week the House Committee on Education and Labor held a hearing and they asked the Government Accountability Office, a congressional investigatory arm, to do a report. They found that it is pretty widespread. We don't know exactly how often it happens because states don't - generally only five states keep records on this. But the GAO found lots of cases, lots of cases where it's used. It's supposed to be - these are things that are supposed to be used as a tool when a child is in some danger to himself or to others.

It is supposed to be used as ideally a last resort, but the GAO found that it's used widely and it's misused. There are two - the GAO report looked at two states that do require our schools to self-report when this is used, 33,000 cases in one school year, in two states, Texas and California. Now, we don't know how often those had bad outcomes, if they were the right - used correctly. But the GAO report suggests that a lot of times, too often there's abuse.

NEARY: And what about the use of seclusion, isolating a child?

SHAPIRO: Right, well, that's also - that's included in those numbers…

NEARY: Yeah.

SHAPIRO: …and seclusion, we're not talking about detention, we are talking about time out, asking a kid to put his head down on his desk or go off to the - out in the hallway for a bit, or go to the peace corner. Those sort of things work. But we're talking about seclusion. They are looking at the practice of putting a kid in a secluded room, sometimes a locked room, sometimes for many hours. And in fact in one of the cases that's come up recently was a 13-year-old boy who talked about committing suicide. He was put in a seclusion and indeed he committed suicide.

NEARY: And this case that we mentioned at the beginning of this show, where a child died, the teacher was using a therapeutic floor hold. The teacher sat on top of him or laid on top of him, but that phrase, therapeutic floor hold, makes it sound like it's something very official.

SHAPIRO: A nice euphemism for something that's actually very dangerous, but in this case a very large adult sat on a 14-year-old boy who was getting fidgety. In fact - and this is another case where you're wondering couldn't this have been avoided. A 14-year-old boy had been abused by his parents and - physically and emotionally. One thing they did was they used to withhold food. They wouldn't give him food. So he had developed this behavior through his short life of stealing of food and hording food. And the teacher this day, to punish him, didn't let him eat lunch.

At 2:30, he gets up, he tries to get up and leave and she - and she tells him not to leave. And the report from the state officials in Texas was that she put him in this hold, that she sat on him. He struggled, she kept him down. And he died. One thing that was actually very surprising that came out of this hearing this week was that this woman was then put on - the teacher was put on a - was not allowed to teach anymore in the state of Texas. It turns out she's teaching not far from here in special education…

NEARY: Well, this is what I wanted to ask you. So these are accepted techniques of discipline. It sounds like you're saying - are there guidelines when they should be used? But it's not like these are sort of rouge teachers who are just - these are accepted techniques.

SHAPIRO: That's right. The GAO found that there are no federal laws about this and the state guidelines are - there are few state guidelines. And I talked to a representative of the American Federation of Teachers and she said, well, one problem is that we don't get good training on this. We get very little training. So even though this is used, people don't know how to do it properly and there are other groups that are saying, you know, we should - this is the debate, whether this is something that should be used as a last resort or can it be used as a last resort. When do you use it? If you have it at your disposal, how you make sure it's not being abused and used too much?

NEARY: All right. I want to bring Deborah Ziegler into the conversation now. She has worked with children with behavioral disorders and other disabilities for many years and she is now the associate executive director for policy and advocacy at the Council for Exceptional Children. And she is also here with us in Studio 3A. Good to have you with us.

Ms. DEBORAH ZIEGLER (Council for Exceptional Children): Thank you very much.

NEARY: So we've heard Joe describe a couple of terrible situations and his impression is, I think in both cases, that this could have been prevented. How? How would you suggest that something like these cases could be prevented?

Ms. ZIEGLER: Yeah, absolutely. I think that we have effective practices. We know what works with children. Certainly many of the children I suspect that are in - have been reported in the GAO study are students who don't have severe challenging behaviors but have some behaviors that nonetheless need to be managed and managed well. And so many schools across the nation are using a program called School-Wide Positive Behavioral Interventions and Supports, PBIS.

It's a program that looks at data collection, it looks at positive outcomes for students, it looks at the practices that are geared to the child's level and his interests, and also system-wide support, so that this is a whole-school approach.

Everyone in the school becomes involved in the interventions for students, including the students themselves, so not only the special-ed teacher, the general-ed teacher, the principal, the school food workers, the transportation folks, the bus drivers, etc. So it really can and has been demonstrated to be a very successful preventative program.

NEARY: What can a teacher do, though, in the moment if a child is acting out badly, if the teacher feels threatened or if the teacher feels that the child may be threatening other kids in the classroom? I mean what - it has to begin there, and they may be alone at that moment.

Ms. ZIEGLER: Exactly. In many classrooms teachers are alone with perhaps 30 children, 25 to 30 children in classrooms, may have several children with challenging behaviors in their classroom, and so I think there are a lot of techniques. And it's not at the moment. I think that's a key point.

Yes, children have moments of behavior that's not acceptable, but we need to prevent the moment from happening.

NEARY: I see what you're saying.

Ms. ZIEGLER: Yeah. So if you use some of our motivational techniques, you know the child, you have good communication with the child, you know what the child's triggers are for bad behaviors. You understand what the situations are in classrooms. You understand children that might set different children off. You look at situations where children may in fact be grouped with other children that may be more supportive. So there's some peer interventions, and children can support each other in these kinds of situations.

There are a lot of different kinds of techniques. So you want to really do a very thorough assessment on the child and keep data on what are the trigger points for this child. When does life become stressful for this child? And what are the measures that you as a teacher must use?

NEARY: And then in the case - as you were saying, it's a whole school approach. For instance, with Moses, it wasn't the teacher but it was I think you said a security guard who thought that he was going to hurt himself and so used the restraints. Is that right?

SHAPIRO: Right, and I believe - and Texas has a rule after the death of Cedric Napoleon, the other boy that you talked about, I believe they now have a law that says that teachers cannot do this kind of restraint, but the security officer can.

NEARY: Yeah, so - but then would teachers who - would personnel who are not in a classroom also be trained in…

Ms. ZIEGLER: Absolutely. Everybody's trained in the approach, including parents as well, so that they can follow up on those same techniques at home with the child so that everybody's consistent, and particularly for children with disabilities, consistency is the key.

NEARY: We're talking about methods used to restrain some special education students. Do you work with children with behavioral disorders or other disabilities? What's worked for you? Give us a call, 800-989-8255. Or email us at talk@npr.org. I'm Lynn Neary. It's TALK OF THE NATION from NPR News.

(Soundbite of music)

NEARY: This is TALK OF THE NATION. I'm Lynn Neary in Washington. Some children with disabilities have been handcuffed, pinned down, or locked in secluded rooms as a form of discipline. NPR's Joe Shapiro has been covering a government report that looks at the potentially dangerous methods of restraint and seclusion used in many schools. You can read and listen to his story at npr.org. Just click on TALK OF THE NATION.

Joe Shapiro covers disability and health for NPR, and he's with us in the studio. Also with us, Deborah Ziegler, associate executive director for policy and advocacy at the Council for Exceptional Children. She has many years of experience in special education.

Do you work with children with behavioral disorders, autism, other disabilities, or are you a parent of one? We'd like to hear from you. What has worked for you when it comes to controlling violent behavior? Tell us your story. Our number here in Washington is 800-989-8255. Send an email to talk@npr.org or join the conversation on our Web site. Go to npr.org and click on TALK OF THE NATION.

We're going to take a call now. We're going to go to Adam, who is calling from Jamaica Plains, Massachusetts. Hi, Adam.

ADAM (Caller): Hi.

NEARY: Go ahead.

ADAM: Hi, I'm calling - I've worked for about six years in a residential facility for emotionally disturbed children ages four to 14, and we do physical restraints. We just recently stopped using seclusion. Our seclusion was, it was called the safe room. It didn't have a door. The child would go into the safe room to settle. There's a chalkboard, and the staff would sit right by the door, doorway, and then, you know, when the child has settled, they come out.

And I guess I'm calling because I - first I have to take issue with - now, these individual cases sound different, but for us, a restraint or a seclusion is never a punishment. It's never the response of something he's done bad. It is a technique. A restraint is only used to keep a kid safe, and that is something that's reiterated to the kid even in the restraint, that, you know, we're doing this to keep you safe. As soon as you settle, you know, let us know, and then we begin the process of ending the restraint.

NEARY: Can I ask you, when you say restraint, are we talking handcuffs, or what are you talking about?

ADAM: Oh, we're talking physical - physical restraint where, you know, like if it's a smaller child, it's something like a standing up, and their arms are wrapped across their body, the adult standing behind them holding the arms, and there's another adult there in case, you know, the child is still violent.

With a bigger child, it's something that's called a two-person team restraint where there's an adult on the upper part of the child's body, and there's an adult on the bottom, and the child's lying prone on the floor.

NEARY: Hmm.

Ms. ZIEGLER: And - go ahead.

NEARY: I was just going to ask Deborah Ziegler to respond to what you're saying and to give us a sense of is this sort of the norm, is this - are these accepted ways of dealing with these kinds of issues with a kid in school?

Ms. ZIEGLER: Well, I think as Adam mentioned, these are never used as a punishment and are only used as a last resort, in safety situations. So our guidelines would agree with that, that we have published, only when the safety of the child or others are in danger. Both of those restraints used for younger children and older children are the acceptable restraints if used appropriately, if used according to time.

So in other words, you wouldn't want to hold that child in that restraint for, you know, a half an hour. You look at the child's behavior, you adjust the time, you adjust the kind of technique that you're using depending on how the child's behavior de-escalates over a period of time.

NEARY: And Adam, I have a couple of questions for you. One is what would be a situation where you would use those kinds of restraints, and also what kind of training did you get in the use of that kind of discipline technique?

ADAM: Well, the situation would really depend on the child. I mean, like the most important thing for us has been knowing your children, you know, because there are a lot of kids that are going to yell and they're going to get - you know, they're going to posture like they're going to fight, but there are also - you know, there are a lot of techniques to de-escalate them, whether it's humor, you know, maybe just being like come on, let's take a walk, things like that. There are kids that'll respond to that.

And then you know there are kids that are really, I mean, they're at that crisis point where they're really going to try and do real physical damage to themselves or someone else, and so I mean that I think just can't be emphasized enough, that it's really the individual child and knowing their behavior and what they're doing and how they're going to respond.

But the training I got was when I started the program, when I started working at the program, you know, you go through a week of training. You go through three days of just learning the restraints, and you know, the whole week is just all preventative stuff, things that, you know, things you can do to keep things positive. Because we have dorms of children. So a lot of it is issue of, like, keeping the group positive because if one kid gets upset, that can just do a whole domino effect.

So there's a lot of - the majority of the training, the emphasis is on prevention, and then there's also - you know, but restraints are taken really seriously and you're really trained in that and every year you get a refresher.

NEARY: All right, well, thanks so much for calling, Adam.

ADAM: Thank you.

NEARY: Appreciate it. So I guess I was - it didn't seem like a lot of training to me somehow, Deborah Ziegler, just a week. I think he said a week and then another three days. Is that what he said?

Ms. ZIEGLER: Yeah, and then a refresher course every year.

NEARY: Uh-huh. Right, okay.

Ms. ZIEGLER: Yeah, well, certainly in this particular institution the week-long training is certainly a lot more training that most public schools are providing to teachers. Whether it's sufficient or not, more training is always better, and so I think that certainly mentoring is a good technique used throughout the year so that you have - many schools now how have positive behavioral support counselors, and they support teachers.

They're experts on these techniques, and so they're mentoring general ed teacher and special ed teachers. So it's not just a one-stop-shopping week of training. Hopefully you're doing ongoing mentoring, but school districts across the nation are certainly not providing a week-long training for most teachers on these techniques. So that's certainly one recommendation we would have for the future is that more professional development is given to teachers and others in schools.

NEARY: All right. Let's go to Bill, who is calling from Cleveland, Ohio. Hi, Bill.

BILL (Caller): Hi, how are you today?

NEARY: I'm good, thanks.

BILL: Good, good. You know, I was listening, and I've been teaching for about six years now, and currently I teach in a resource room, special education in Ohio, and I recently read an article by Edelman and Taylor that spoke about this social skills curriculum and all the data that surrounds it and what it's providing for students in the classroom, and you know, that's one of the things that you were stressing is that it's so important to understand each student's disability, their history, and I just think this one isolated case or the few isolated cases in the short amount of time that special education has been around can often overlook how far we've come in this area.

NEARY: Joe Shapiro, you've been covering these kinds of issues for a while. What's your take on that? And thanks so much for your call, Bill. Appreciate it.

BILL: No problem.

SHAPIRO: Well, I think what the GAO report showed was that there is still a long ways to go. There's still abuse of this, and there's still bad outcomes, and when I talk to parents and when I talk to kids who've been in situations where there's been a lot of use of restraint and seclusion, there's not just physical injury, there's often just the feeling that school is not a safe place, not a place where they want to go.

And so this is why Deborah talked about using positive behavioral support, and this is something that's new, there's a lot of research on, and why more schools are going in that direction.

It does take a lot of money. We talked about training. It takes a commitment by a school to do this kind of training and to teach people to really figure out what causes these triggers.

NEARY: Well, what I'm interested about with training is that when I heard him say he was trained for a week, to me it didn't sound like very much, and yet Deborah Ziegler, you're saying that's more than most people get. I mean, Joe, I found that surprising because I thought, well, all right, you're dealing with a population of students, you know, who you're going to have issues with and sometimes do act out really violently, and obviously you need to know how to deal with that, and it seems like you would need more than a week.

Ms. ZIEGLER: Yeah. Maybe clarifying a little bit - I don't want to speak for Adam, but I think what I understood him to say was there was a week-long training on how to use physical restraints and seclusion. Now, keep in mind that teachers, most - well, all have gone through, you know, a four-year degree program in special education, and so have a lot of training and expertise in behavior management techniques. Many have masters degrees, etc., and have had ongoing training in behavior management.

I mean, it's the number-one professional development activity that occurs, is around managing students' behaviors in classrooms. So I think the week-long training referred to physical-restraint training, if I understood Adam correctly.

NEARY: All right, and I just want to remind our listeners that we are talking about the use of restraint and other discipline techniques for dealing with kids who have behavioral problems, behavioral disabilities, and if you'd like to join our discussion, the number is 800-989-8255. If you're a student or a teacher - I mean a parent or a teacher who has had to deal with these kinds of situations, we'd be interested in hearing from you and what you have found that works well.

Again, 800-989-8255. We're going to take a call now from Anne, and Anne is calling from San Francisco, California. Hi, Anne.

ANNE (Caller): Oh, hi there.

NEARY: Hi. Go…

ANNE: Hi. Thank you for taking my call. I think this is a really important issue for parents, also. It's great to hear the perspective from the educators. But it's surprising to me how many parents have to deal with children, such as myself.

I have a child with sensory processing disorders, which is an autism spectrum disorder. And it took us years to figure out what was going on and why he was having, you know, such violent tantrums. And it took us a long time to figure out that restraint was not the way to deal with it.

We made a lot of mistakes in the process, but I think we really figured out like some of these other educators are talking about that…

NEARY: What do you do? What techniques do you use then, if not restraint?

ANNE: What I ended up figuring out what works the best when he would have his really violent tantrums was to bring him into a really quiet room where there weren't a lot of things, you know, because he would get into throwing things at us.

It would have to be a very quiet room where he wasn't by himself because he needed to be with somebody who could provide that calming force, calming voice, not, you know, not the struggle and not the restraint, but the calming force to bring him down from whatever the trigger was, which I think goes back what the other gentleman was saying, which is the triggers and being able to have prevent these things with these children that are - the triggers that cause them to start the violent behavior.

NEARY: Yeah. That sounds a little bit to me, perhaps, Deborah Ziegler, like the seclusion technique that you were talking about that might happen in a school.

Ms. ZIEGLER: Yeah. Actually, it sounds very much like a seclusion process that was being appropriate for students, where you would bring them into a room with adult supervision, with - interaction is appropriate.

For some kids, the communication at that time may not be the best technique, but in the case of Anne's young son, it was. And so again, knowing your child, knowing what triggers their behavior, and also knowing what helps to deescalate their behavior is really important.

But that - environment is an important aspect of it as well, so not having a lot of distractions, et cetera, in the room so the child can really concentrate on his own behaviors and self-manage those.

NEARY: All right. Thanks so much for your call, Anne.

ANNE: Can I add one more quick point?

NEARY: Sure. Mm-hmm.

ANNE: I just wanted to add that I think the difficulty for parents who are dealing with this kind of behavior is it's really easy to confuse the behavior with being a discipline issue. When you treat it as a discipline issue, you're not going to approach it the same way as you would if you were being emphatic and really paying attention to what the child needs.

It's a totally different approach than treating it as a discipline issue and a punishment.

NEARY: All right. Thanks so much for calling.

ANNE: Thanks.

NEARY: And I just want to remind our audience that you're listening to TALK OF THE NATION from NPR News.

All right. We're going to take another call now from Mark, calling from Charlotte, North Carolina. Hi, Mark.

MARK (Caller): Hi. How are you?

NEARY: I'm good. Thanks. Go ahead.

MARK: Actually, I agree with your last caller. She really said what I wanted to say. It's really not a discipline issue as much as it is a symptom. My son has Asperger's and, you know, we've gone to behavioral therapy. You know, we do a little bit of medication, trying to wean ourselves off that.

And we do a hold, and it's more to comfort him. And it actually does improve his behavior. I mean, you just stand behind him or you sit down with him and then you sort of wrap your arms around him.

If you have to sit Indian style to wrap his legs underneath yours, you do that as well. And it sort of gets him back in the right direction. And we're fortunate right now to be in first grade and have a lot of follow-up with the teachers. It has been wonderful. We're in public school. But every year, we sort of have to hold our breath and, you know, wonder what the next year will bring…

NEARY: Yeah.

MARK: …because of these behavioral issues.

NEARY: All right. Well, thanks so much for calling, Mark.

MARK: Thank you.

NEARY: Appreciate it. Let's go to Kurt now. Kurt is calling from Salt Lake City. Hi, Kurt.

KURT (Caller): Hello. I was - I grew up, you know, I was born in the early '70s. And so when I was in elementary school, you know, it's early '80s. And I was in the resource education as well, and I was, you know, at - my problem was is I was Attention Deficit Disorder. So most of the time, I was just out to lunch when, you know, the teacher was teaching.

And, you know, part of my punishment for, you know, not paying attention was to be put in a black room, is what they called it. And it was just a closet, if you will, no light and the door locked. And, you know, like five minutes after I was even put in that room, I had no clue why I was in there. I was more upset because I was in there and I couldn't get out and I could not, you know, resume, you know, the rest of the day…

NEARY: Yeah.

KURT: …so to speak. You know?

NEARY: This was in the '80s, you're saying, Kurt?

KURT: I'm sorry?

NEARY: This was in the '80s?

KURT: Yeah. Yeah. Probably '80s.

NEARY: I want Joe Shapiro to respond to this, because again, he's been covering this kind of thing for a while now and I would think that some progress has been made since then regarding the kind of experience that Kurt has, or maybe not.

SHAPIRO: Well, we now have 9,000 school systems using this positive behavior support. So that's - that happened, sort of, since the '80s. This is something - this idea of trying to figure out what it is that causes - as I think Kurt just said, or maybe it's more of saying it -looking at it as a symptom, trying to figure out what is it that causes this aggressive behavior or the anxiety or the problem and trying to get to that, to treat it not as a discipline issue. Treat it, see it as a symptom, just to say how do you deal with it. So we have progressed in that - a lot in that way.

NEARY: And I would think that we're talking, when we're talking about the report, the GAO report, we're talking about abuses of this.

SHAPIRO: Right.

NEARY: And where do we go with that? Where do we go from here just to conclude this (unintelligible)?

SHAPIRO: Right. And - well, where do we go? Well, it was interesting yesterday, the secretary of education, Arne Duncan, also was before the same House Education and Labor Committee, and he said that he has asked the school chiefs of education to report back to him by the end of summer about what they're doing to try to use some alternatives to restraint and seclusion, and that the department wants to help states do that. And a lot of states have already taken the lead in this. And the White House has convened a meeting for the first time, bringing educators and people on the Disability Committee together for the first time to try to see what can be done and what steps are next.

NEARY: And to make sure that these things are not abused…

SHAPIRO: Correct.

NEARY: …they're not using it abusively. Thanks so much for being with us, Joe Shapiro and Deborah Zeigler. Deborah Zeigler is the associate executive director for policy and advocacy at the Council for Exceptional Children. And Joe Shapiro covers disability and health for NPR.

Thanks again to both of you.

SHAPIRO: My pleasure.

Ms. ZIEGLER: Thank you.

NEARY: And coming up, the legacy of the Tamil Tigers, the group that pioneered the suicide bomb. Stay with us. I'm Lynn Neary. It's TALK OF THE NATION from NPR News.

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