The Use of Isolation and Seclusion Rooms
Kristjan Kay, Training Specialist
The use of isolation and seclusion rooms is an important topic of conversation around the country by schools and organizations. These conversations and discussions center around their purpose, use, and ethics as a de-escalation tool for students and youth with disabilities.
Service Alternatives does not support, practice, or teach leaving an escalated individual alone as they go through their escalation.
Isolation is defined by Service Alternatives, as placing an individual alone in an area without a means of egress and without any supervision, monitoring, or interaction.
Seclusion is defined by Service Alternatives, as placing an individual in an area without a means of egress, while under constant supervision, monitoring, and continued de-escalation.
The RIGHT RESPONSE “assess, adapt, and attend” cycle ensures a non-escalated person always stays with the escalated person to help them through their coping process. Service Alternatives believes complete isolation as a safety technique in schools is more harmful than beneficial. Schools should focus on short-term interventions that prioritize the needs of the escalated individual with staff kept present throughout the process. Long-term strategies to prevent situations from escalating to the point of feeling the need to use such interventions, must be a core focus.
Any kind of escalation must be understood as a process; a series of steps that someone goes through to either gain or avoid something. There must also be an acknowledgment that “every child and adolescent has different needs that can change over time. If professionals are able to continuously recognize and respond to the (changing) needs of children and adolescents, this helps the child or adolescent to stay in or return to a calm state” (van Dorp, et al., 2023, p. 107231). Just because seclusion happens to meet the needs of one child, one time, does not mean that it will meet the needs of every child every time it is used.
Students should feel safe in school.
In an international study, researchers Barrance & Hampton (2023) found that safety was the most agreed-upon factor in student perceptions of well-being in school (p. 5). When students do not feel safe, they may act out to gain a sense of control in their environment, which can lead to schools using seclusion or restraint. While the intention is to maintain the safety of both students and staff, these techniques can intensify the students’ feelings that they are unsafe at school. The result may be reactionary behaviors yet again. This vicious cycle of students feeling unsafe and staff using seclusion feeds itself. It creates more and more resentment of the seclusion room in the student and more and more dependence on the seclusion room for the staff.
Seclusion as a technique negatively impacts vulnerable populations, especially students with disabilities at a much higher rate.
The U.S. Department of Education reports that “over 100,000 students annually have been restrained or secluded in U.S. public schools and approximately 80% were students with disabilities” (Bell & Craig, 2023, p. 1). This disproportionate use of seclusion on students with disabilities demonstrates one of the reasons it is such a dangerous technique to use. It leaves the escalated person alone to ‘sort it out for themselves.’
The reason however that they are lashing out to the point where they need to be put into a room by themselves, is that they are unable to ‘sort it out for themselves’. Students with disabilities who may have challenges with communication may be unable to understand the idea that the seclusion room is being used as a tool to maintain safety. This can lead to thinking that they are being punished for their inability to cope. The result is further escalations, as the student can perceive the seclusion room as a punishment for an inability to cope with their emotions.
A 2022 national review of discipline regulations found that “in addition to not helping children learn positive behavioral alternatives, isolating, confining, or secluding a child poses a risk of inflicting longer-term negative consequences such as continued undesired behaviors, trauma, psychological problems, and future difficulty in schooling” (Buell, et al, p. 2).
Parents of students who are being secluded at school are also negatively affected.
A 2023 study found that “the trauma associated with their child’s school punishment led [parents] to develop physiological and psychosomatic health challenges, such as depression, hypertension, stroke, peri-traumatic emesis, and other health impairments” (Bell & Craig, p. 1). Multiple narratives from parents of students with disabilities report “disturbing incidents in which students reported being dragged to the seclusion room, placed in the seclusion room and neglected for extended periods of time, bruised due to improper restraint tactics, and traumatized” (Bell & Craig, 2023, p. 8). Stories like this should never be coming out of a school setting.
Seclusion does not address the underlying issues that cause undesirable behaviors. When seclusion continues to fail, it can cause schools to believe the only option for a child who continues displaying undesired behaviors is expulsion.
Seclusion fails because it does not meet the needs of the student.
Seclusion only maintains the safety of the student, staff, and the environment in the strictest of terms and creates resentment that only causes further escalations.
When considering our path forward for addressing school behavior, the use of seclusion rooms must be addressed. To prevent the need for such extreme measures, the focus should be shifted away from increasing severity after seclusion fails to understanding why it fails as a technique in the first place.
Students are not just “safe” or “unsafe”. All students range in physical, intellectual, and emotional levels of development and no student is wrong for being where they are at. Article 12 of the United Nations Convention on the Rights of Children states that countries must “assure to the child who is capable of forming [their] own views the right to express those views freely in all matters affecting the child.”
Of course, “some children and adolescents sometimes request seclusion, because they feel that it helps them calm down” (van Dorp, et al., 2023, p. 9), but in these cases, students are maintaining their autonomy of decision making and their choices are being respected. Additionally, if a student requests time to calm down, they do not have to do so in a locked room that deprives the student of their rights. The same study found that “an environment in which children and adolescents are encouraged to make their own decisions and learn from the consequences that stem from that decision, can reduce (future) agitation and prevent escalation” (p. 8).
Schools can better prepare for escalations and minimize the risk of traumatization by encouraging students to be part of their own response plans.
Six common elements can help reduce the need for seclusion (van Dorp, 2023, p. 7-9):
- Recognizing and responding to individual needs
- Encouraging autonomy
- Investing in the relationship
- Having transparent and open communication
- Involving parents or caretakers, and
- Offering a wide range of activities
These elements demonstrate a necessary shift from reaction-only plans to prevention plans through improved student support. We should stop asking “when do I need to use seclusion techniques?” and begin asking “how do I create a setting or environment that minimizes the need for seclusion?”
Parents should be made aware of state and school policy and should be encouraged to become part of the conversation. As part of their conclusion on the role support staff play in suspension rates of students with disabilities, Jenkins found that “by thoroughly engaging families of children with disabilities in behavioral assessments, interventions, and evaluations, school personnel can assure parents and the wider community that they have an essential role in school disciplinary decisions” (Jenkins, et al., 2022, p. 8). This is a great example of how the decision-making power in an escalated situation can be evenly distributed throughout the wider community.
A study into the use of seclusion in residential care settings found as part of its research that “all professionals agree that it is important to aim for zero seclusions in inpatient psychiatric care and residential treatment centers for children and adolescents” (van Dorp, et al., 2023, p. 9). Service Alternatives believes that schools should also aim for zero seclusions.
What can be done to help escalated individuals regulate and successfully de-escalate?
In RIGHT RESPONSE, we use the assess, adapt, attend cycle.
This assess, adapt, attend cycle not only applies to the individual but to us and the environment as well. In this cycle, we stay present through the entire de-escalation process, using the following tools:
- We repeatedly check on the escalated individual by monitoring their ability to cope, their safety with themselves, others, and the environment around them, and applying their understanding of the student to judge their general level of escalation.
- We choose and apply appropriate tools to help the individual regain control of their emotions.
- We reassess the situation and evaluate if the tool helped de-escalate the individual.
By using this cyclical approach, the support person can change or adjust their techniques to best meet the needs of the escalated individual as they arise. While support staff may find one technique that is very effective for an escalated individual, we must remember that escalations can come from a variety of situations. Having a toolkit of multiple de-escalation techniques is the best way to feel prepared and confident in supporting an escalated individual.
Ensuring support staff stays with the escalated individual allows the staff to quickly adapt to changes in the student’s behaviors and continue to help students through their coping process. This is vastly more effective than locking an escalated student in a room that they are not allowed to leave until they calm themselves down. The assess, adapt, attend cycle allows support staff to better prepare themselves for escalation.
Complete seclusion as a tool fails our staff, our students, and our students’ parents. With RIGHT RESPONSE de-escalation training, staff can develop the tools to safely and holistically support escalated students.
References
Barrance, R. & Hampton, J. (2023). The relationship between subjective well-being in school and children’s participation rights: International evidence from The Children’s Worlds Survey. Children and Youth Services Review, 151, 107038. https://doi.org/10.1016/j.childyouth.2023.107038
Bell, C., & Craig, M. O. (2023). Suspended, restrained, and secluded: Exploring the relationship between school punishment, disability, and black and white parents’ health outcomes. Children and Youth Services Review, 153, 107119. https://doi.org/10.1016/j.childyouth.2023.107119
Buell, M., Fidel, R., Hustedt, J. T., Kuntz, S., & Slicker, G. (2022). From time-out to expulsion: A national review of states’ center-based child care licensing exclusionary discipline regulations. Children and Youth Services Review, 141, 106623. https://doi.org/10.1016/j.childyouth.2022.106623
Jenkins, M. R., Ansong, D., Banks, A., & Dangleben, T. D. (2022). Regional trends and the role of school support staff in suspensions of students with disabilities. Children and Youth Services Review, 141, 106622. https://doi.org/10.1016/j.childyouth.2022.106622
UN Doc. A/Conf.: 157/23. Vienna Declaration and Programme of action. (1993). https://www.ohchr.org/en/instruments-mechanisms/instruments/vienna-declaration-and-programme-action.
van Dorp, M., Nijhof, K. S., Popma, A., & Mulder, E. A. (2023). Common elements to reduce seclusion in child and adolescent residential care settings: A synthesis of literature and semi-structured interviews. Children and Youth Services Review, 155, 107231. https://doi.org/10.1016/j.childyouth.2023.107231
