PRACTICE FORUM

Ethical issues regarding the use of restraint and seclusion in schools

Ambulatory or physical restraint is the most common form of restraint currently being used with students that exhibit aggressive and self-injurious behavior in the school setting

By Brian M. Yankouski, Thomas Masserelli, and Sandra S. Lee

Given the passage of recent federal legislation, such as the Individuals with Disabilities Education Improvement Act (2006) and No Child Left Behind Act (2002), students with significant disabilities, emotional or behavioral problems, and mental health disorders have increased in numbers in mainstream classrooms (McLeskey, Landers, Hoppey, Williamson, 2011; McLeskey, Landers, Williamson, Hoppey, 2010). Students with significant disabilities or disorders often have a history of serious psychiatric and behavioral problems that require varying levels of academic, behavioral and psychological supports (Koppelman, 2004). With this trend, the restraint and seclusion procedures once restricted to psychiatric institutions have moved with these students from these medical settings into public schools with much controversy (Ryan & Peterson, 2004).

There are different forms of restraint and seclusion that are used with individuals who pose a danger to self or others. Ambulatory or physical restraint is the most common form of restraint currently being used with students that exhibit aggressive and self-injurious behavior in the school setting (Ryan & Peterson, 2004). This is when one or more individuals physically use their bodies to restrict the movement of a student as a means of re-establishing behavioral control in order to maintain safety for the acting-out person, other students, and staff (American Academy of Pediatrics Committee on Pediatric Emergency Medicine, 1997; American Academy of Child and Adolescent Psychiatry, 2000). Seclusion is when a student is involuntarily confined alone in a room and is physically prevented from leaving for any period of time (American Academy of Pediatrics Committee on Pediatric Emergency Medicine, 1997). Restraint and seclusion are often associated with each other as school personnel will have to use restraint to move a student to a secluded environment (Ryan, Peterson, Tetreault, & Van der Hagen, 2007).

Recently, the use of these procedures in educational settings have been questioned due to hundreds of reports nationwide of alleged abuse and death of students by school personnel improperly using restraint and seclusion in schools (GAO-09-719T: Seclusions and Restraints, 2009; Ryan & Peterson, 2004). There is mounting evidence to suggest that abuse and death of many special needs students can be related to a lack of training by school personnel using restraint procedures and, in many cases, the absence of regulations to monitor their use in schools (GAO-09-719T: Seclusions and Restraints, 2009). This could be in part due to the fact that the same federal regulations governing the use of restraint and seclusion that protects the rights of psychiatric patients does not apply to schools (Ryan & Peterson, 2004). Some examples of these regulations that protect patients’ rights include that staff must be trained in the appropriate use of restraint and seclusion to assist in assuring patient safety during the use of these procedures, patients must be monitored at all times face-to-face during restraint and/or seclusion, and that there are time limits on how long a patient can be secluded (Crisis Prevention Institute, 2010; Centers for Medicare and Medicaid Services, 2008). Currently, there are no guidelines or systems in place to monitor or regulate the use of restraint and seclusion in schools.

The proposed federal legislation titled Keeping All Students Safe Act (2011) is the first attempt at providing federal guidelines for the use of restraint and seclusion in schools. If passed, the legislation would: (1) provide minimum safety standards in schools; (2) require states to develop policies and reporting procedures on restraint and seclusion; (3) allocate grant funding to states to disseminate to schools for professional development and crisis intervention training of school professionals and the development of Positive Behavior Support programs in schools; (4) require schools to have a team of professionals properly trained and certified in the use of restraint and seclusion; and (5) mandate each state to submit reports annually to the United States Department of Education on the use of restraint and seclusion in their schools (Klotz, 2011). Since the bill’s introduction in 2010, many states have proposed or implemented state legislation to provide guidance for schools and school professionals on the use of restraint and seclusion; however, the content of these guidelines and policies vary greatly with no set standards for practice (GAO-09-719T: Seclusions and Restraints, 2009; Ryan, Robbins, Peterson, & Rozalski, 2009; U.S. Department of Education, 2010).

In addition to the lack of public policy on this issue for schools, there has been minimal research conducted on the use of restraint and seclusion practices in these settings. Of those studies examining restraint and seclusion, all of them have focused on the roles of teachers or paraprofessionals in using restraint and seclusion (Ryan et al., 2004; Ryan & Peterson, 2004; McAfee, Schwilk, & Mitruski, 2006; Ryan et al., 2009). With the scarcity of research in this area, no research to date has examined the school psychologist’s role in restraint and seclusion. Furthermore, no research has looked at the ethical issues involved for school psychologists or has offered recommendations for school psychologists on this topic.

The role of the school psychologist

Fagan and Wise (2007) present several key points on the roles of school psychologists as it relates to working with students with disabilities. School psychologists are typically viewed as the mental health expert in the school and are often called upon to provide behavioral consultation and crisis intervention. Often school psychologists will be asked to provide behavioral consultation for a teacher that may have a student who is exhibiting dangerous behaviors toward self or others. Therefore, school psychologists will often have to conduct behavioral assessments and aid the teacher in developing a Behavior Intervention Plan (BIP) for a student. School psychologists may have to include crisis intervention procedures in the plan to protect the safety of the child (O’Neill, Horner, Albin, Sprague, Storey, & Newton, 1997). It could also be argued that school psychologists are more likely to be the individual in the school that works with all of the classified students, therefore, potentially putting them at risk of dealing with students with aggressive or self-injurious behaviors (Fagan & Wise, 2007). Thus, it could result in them having to use physical restraint or seclusion when these students are under their care. This in turn could pose many ethical dilemmas for school psychologists.

Ethical dilemmas for school psychologists

School psychologists should make use of the ethical and legal decision-making model in order to process ethical dilemmas surrounding the use of restraint and seclusion in schools. This model entails the following steps: (1) describing the problem situation, (2) defining the potential ethical-legal issues involved, (3) consulting available ethical-legal guidelines, (4) consulting with supervisors and colleagues, (5) evaluating the rights, responsibilities, and welfare of all affected parties, (6) considering alternative solutions and consequences of making each decision, and (7) making the decision and take responsibility for it (Williams, Armistead, & Jacob, 2008, p.16). There are numerous ethical dilemmas that restraint and seclusion could cause for school psychologists. School psychologists are trained to adhere to both the National Association of School Psychologists’ (NASP) Principles for Professional Ethics and the American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct. The next sections will outline the primary ethical codes that may be brought into question regarding a school psychologist’s involvement in the use of restraint and seclusion in schools.

NASP’s principles for professional ethics

Under NASP’s Principles for Professional Ethics there are specific subsections and strands under the major principles that are relevant to the use of restraint and seclusion by a school psychologist. These subsections and strands fall under the following principles: Principle I: The Dignity and Rights of All Persons, Principle II: Professional Competence and Responsibility, and Principle IV: Responsibility to Schools, Families, Communities, the Profession, and Society (NASP, 2010). Each of these subsections and strands will be examined in the subsequent paragraphs.

Principle I.1. Autonomy and self-determination (consent and assent)

This subsection mentions that “School psychologists respect the right of persons to participate in decisions affecting their own welfare” (NASP, 2010, p. 3). This is an ethical dilemma for school psychologists because a student typically will not have a say in whether or not they are to be restrained or secluded when having a behavioral incident. It is, however, recommended that the school psychologist present the student with choices of behavioral alternatives to alleviate the need for using restraint and seclusion. Choice is viewed as one of the central principles to delivering ethical behavioral services (Cooper, Heron, & Heward, 2007). If a student is non-verbal or has limited expressive language it can present a challenge for school psychologists as these students may have difficulty in expressing their decisions or concerns regarding their own welfare. Therefore, it is suggested that school psychologists should make use of picture symbols (e.g., Picture Exchange Communication System [PECS]), augmentative communication devices, or other alternative methods to assist the student in communicating what is wrong and help them to calm down before the behaviors escalate to a point where restraint and seclusion may be necessary.

Continuing under principle I.1

Autonomy and Self-Determination (Consent and Assent), Standard I.1.2 states “It is ethically permissible to provide psychological assistance without parent notice or consent in emergency situations or if there is reason to believe a student may pose a danger to others; is at risk for self-harm; or is in danger of injury, exploitation, or maltreatment” (NASP, 2010, p. 4). While parents or guardians do have a say on behalf of their child as to whether or not restraint and seclusion may be used, under extreme circumstances their child may still be restrained without their consent if the child is posing an immediate danger to self or others. It is the authors’ contention that questions whether or not restraint and seclusion procedures fall under the auspice of psychological assistance when dealing with extreme behavioral situations. This wording does not indicate a clear resolution for school psychologists on restraint and seclusion practices and ethical obligations. We recommend that if a student is restrained or secluded in an emergency situation without parental consent, then the school psychologist, who is usually part of the crisis intervention team, and/or school administrator (e.g., school principal) should call the parents/guardians immediately to notify them of the incident. Best practice dictates that school psychologists who are involved in case management of students with severe disabilities contact parents when severe behavioral incidents occur in school (Fagan & Wise, 2007). We recommend that a follow-up meeting should be scheduled to discuss what occurred during the crisis and a written plan should be formulated in which all parties agree to in writing on how to handle a crisis situation with that student again in the future. We suggest that this plan be retained in the case management notes for the student and placed in the student’s file.

Standard I.1.5 under this subsection goes on to further indicate that “School psychologists respect the wishes of parents who object to school psychological services and attempt to guide parents to alternative resources” (NASP, 2010, p. 4). With this ethical standard, the question becomes whether or not restraint and seclusion falls under the umbrella of traditional school psychological services. It could be argued that these procedures do because they are within the realm of crisis intervention, which is part of school psychological services. Therefore, if they are considered a part of psychological services then with this standard, the next question becomes what are school psychologists supposed to do if a student poses a significant danger to self or others and they need to use restraint and/or seclusion with them, but a parent/guardian objects to these services or procedures being used with their child? The following case study illustrates an example of this ethical dilemma.

Parents of a child with a severe developmental disability, who has a long history of self-injurious behavior (i.e., punching herself in the side of her head with a closed fist) does not want their child to be restrained as she had been restrained in all other schools that she had attended and the parents felt that these procedures never helped her. The school psychologist tries to explain to them that those procedures are used as part of crisis intervention in order to protect her from hurting herself, but the parents still state that they do not want their child to be restrained. The child begins her new placement within the school and the school psychologist is called to observe the student’s self-injurious behavior. It is observed by the school psychologist that the student’s behavior occurs with enough intensity that could cause head trauma and vision loss. The school psychologist contacts the parents to let them know about the behaviors and that the staff would like to be able to perform restraint to protect their child from serious injury. The parents still do not consent to the use of restraint and informs the school that they would rather have the behavior continue than have their child restrained.

In this case example, it is difficult because if restraint and seclusion are part of school psychological services and the parents object to these procedures being used, this ethical standard clearly states that the school psychologist has to respect the parents’ wishes, however, at what cost to the student’s safety? Therefore, we recommend that school psychologists work closely with the school’s administration to develop sound school policies on restraint and seclusion, which indicate that any student could be subjected to restraint or seclusion under specific emergency conditions, such as posing a significant danger to self or others. Schools technically do not need parental consent to use restraint and seclusion to prevent a student from suffering severe injury or death in a highly dangerous, unforeseen emergency (The Association for Persons with Severe Handicaps [TASH], 2011). In fact, it would be considered criminally negligent of school personnel to allow a student to suffer serious physical harm while under their care (TASH, 2011). Therefore, in the case example above, while the school psychologist did the right thing by contacting the parents for permission and notifying them of the severity of the behavior, the school psychologist should have told the parents to either come pick up the child or emergency services would be contacted to have the child hospitalized and that staff may end up using restraint to maintain the child’s safety. A follow-up meeting should have then been scheduled with the child study team, administration, and the parents to discuss alternative options to keep the student safe in the future.

Principle II.1: Competence

This principle states that school psychologists engage only in activities that they are qualified and competent to practice (NASP, 2010, p. 6). Standard II.1.1 goes on to further explain that school psychologists also recognize the strengths and limitations of their training and experience (NASP, 2010, p. 6). School psychologists typically do not receive training at the graduate level that involve them learning various restraint procedures or provide them with certification in any of the training programs that are available (e.g., Crisis Prevention Institute’s Non-Violent Crisis Intervention® or Handle With Care® Behavior Management System). School psychologists may learn about seclusion in graduate courses that focus on behavior modification techniques, but may never have to actually apply such procedures. Therefore, it is important for school psychologists to not use restraint or seclusion if they do not have the necessary training. However, school psychologists may still find themselves in situations within the school where they may need to use restraint and seclusion to protect students or staff. This can present an ethical dilemma since this goes beyond the scope of their professional training. Therefore, it is recommended that school psychologists seek professional development training in restraint and seclusion as well as preventative techniques such as Positive Behavior Supports. We suggest that if a school psychologist finds him/herself in a situation where they may have to restrain a child without having proper training that they do not actually attempt to restrain the student. Instead, they should do their best to block any assaults from the student and yell for help from another staff member (who might be trained to perform restraint) or follow their school’s procedure on how to access assistance (e.g., calling the main office for a school resource officer or contacting local emergency services).

Furthermore, Standard II.3.9 under this subsection mentions that school psychologists are to only use interventions that are research-based and considered evidence-based practices (NASP, 2010, p. 8). As discussed earlier, there is relatively little research supporting the use of restraint or seclusion and its efficacy in reducing aggressive behavior in schools. However, the research literature on restraint and seclusion in psychiatric facilities does illustrate that restraint and seclusion is effective in preventing injury and reducing agitation and that it is nearly impossible to operate a program with severely aggressive individuals without some type of seclusion or restraint procedure (Fisher, 1994). Due to the differences in populations, clinical disorders, and settings we may not be able to generalize such findings to the school system. Therefore, school psychologists may want to use Positive Behavior Supports, which is rooted in evidence-based practices and has been shown to reduce the need for restrictive procedures such as restraint and seclusion (Horner & Sugai, 2009).

Principle IV. 2. Respect for law and the relationship of law and ethics

This subsection mentions that school psychologists are knowledgeable of the laws pertinent to the practices of school psychology and that they consider the relationships between their code of ethics and the law (NASP, 2010, p.12). In addition, Standard IV.2.2 under this principle goes on to further explain that school psychologists are to respect the law and the civil and legal rights of students and other clients (NASP, 2010, p. 12). This standard presents a challenge for school psychologists because, as mentioned earlier, the same legal rights that apply to psychiatric patients regarding restraint and seclusion do not carry over into the school (Ryan & Peterson, 2004). Further, no federal legislation provides guidelines on restraint and seclusion in schools so as to protect the civil and legal rights of students. However, most state laws allow teachers and others in the school setting to use reasonable physical force as deemed necessary to protect people from immediate physical danger or to protect property (Hinchey, 2003; Jacob, Decker, & Hartshorne, 2011). Therefore, it could be argued that school psychologists could use restraint and seclusion as part of a prescribed behavioral treatment plan with students in order to protect the welfare and safety of other students as well as the acting-out student.

APA’S Ethical Principles of Psychologists and Code of Conduct

Under APA’S Ethical Principles of Psychologists and Code of Conduct there are two major principles that are relevant to the use of restraint and seclusion by a school psychologist. The first is Principle A: Beneficence and Non-Maleficence and the other is Principle E: Respect for People’s Rights and Dignity. In addition, a pair of ethical standards are relevant to this topic: Ethical Standard 1.03: Conflicts Between Ethics and Organizational Demands and Ethical Standard 3.06: Conflict of Interest (APA, 2002).

Principle A: Beneficence and Non-Maleficence. This principle states that “Psychologists strive to benefit those with whom they work and take care to do no harm and that their professional actions seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons” (APA, 2002, p. 1062). School psychologists are in a difficult position because the use of restraint or seclusion could potentially do harm both physically and psychologically to the students they aim to serve. However, this principle could also be interpreted as school psychologists could use restraint or seclusion since they are procedural safeguards to be used to protect the welfare of the student that they are working with as well as other students in the school.

Principle E: Respect for people’s rights and dignity

This principle states “Psychologists are to respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination (APA, 2002, p. 1063). The use of restraint and seclusion with students could have negative effects on their relationships with peers and school personnel (e.g, fear, mistrust, humiliation, etc.) (National Disability Rights Network, 2009). Therefore, school psychologists will want to consider least restrictive methods or alternatives before employing such intervention strategies with students. On the other hand, the principle further states “Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making” (APA, 2002, p. 1063). This could be interpreted as school psychologists must protect not only the acting-out student but also the other students in the classroom. Therefore, if the acting-out student cannot come to an appropriate decision for alternative behavior, then the school psychologist might have to make a decision for the student, which could include restraint and seclusion.

Ethical Standard 1.03: Conflicts between ethics and organizational demands

For school psychologists there may be an ethical dilemma when the organization (i.e., the school) asks a school psychologist to perform restraint or seclusion and the school psychologist does not feel comfortable doing so because they view it as an ethical concern. Thus, this may create tension between the school psychologist and administration. Hence, school psychologists must do their best to adhere to their ethics code and try to explain the situation to administration and, if necessary, consult with their ethics board. However, there may also be a dilemma if a school psychologist feels that the school should implement restraint and seclusion protocols but there is no program or protocol in place and the school administration does not favor having such a program. This could be an issue especially if the school is serving more aggressive students than before, thus resulting in an increase in student or staff injuries due to the absence of such a program. In this case, the school psychologist may want to collect data on student and staff injuries as well as student data on aggressive behaviors to demonstrate a need for training.

Ethical Standard 3.06: Conflict of interest

For a school psychologist to use restraint or seclusion with a student that is currently on their caseload can present a clear conflict of interest. This is particularly true if the school psychologist is currently providing the student with counseling or other psychological services. The following case study example provides a clear illustration of this ethical dilemma.

One day while in class, a student classified as being multiply disabled ended up going into crisis because of problems that had occurred at home. The student became physically aggressive toward his classroom teacher and other staff (i.e., instructional aides). The child’s counselor (i.e., the school psychologist) was called to come and assist the student during the crisis. Since the student was posing a danger to the safety of the staff, the school psychologist and the classroom teacher had to place the student into a two-person standing restraint in order to maintain their safety. During the restraint the school psychologist and the teacher verbally deescalated the student until he was able to calm down. Once calm, the student was released from the restraint and discussed with the school psychologist what had occurred at home that was making him upset. However, the student also expressed anger and resentment toward the school psychologist for restraining him and he felt as though he could no longer trust the school psychologist. The next few counseling sessions had to be taken to process this with the student so he could understand that the school psychologist had to restrain him in order to prevent him and the other staff from getting seriously hurt.

In the case study example, the school psychologist could have found himself in a situation that could have potentially damaged the student/counselor relationship that had been established with that student, depending upon how he had intervened with him. We suggest that school psychologists instead consult with other staff and seek out supervision with their administrator(s) to come to an agreement that someone else in the school would have to perform restraint or seclusion with the student in order to avoid a situation like the one mentioned above.

Discussion

The use of restraint and seclusion in schools is controversial in nature. School psychologists are placed in a difficult position, as the NASP Principles for Professional Ethics (2010) and the APA’s Ethical Principles of Psychologists and Code of Conduct (2002) do not offer general principles regarding professional practice for school psychologists in using restraint and seclusion in schools. It is recommended that school psychologists try to resolve any ethical dilemmas that might arise while doing their best to adhere to the ethical standards of the profession. Furthermore, it is recommended that school psychologists review their state’s legislation on restraint and seclusion, if one exists, for guidance on this issue. Lastly, school psychologists should review what research is available on restraint and seclusion in schools to become familiar with best practices in this area. Please see Table 1 for a list of suggested readings on this topic.

School psychologists should consider some limitations regarding the use of restraint and seclusion in schools. First, there has been minimal research conducted at this point examining restraint and seclusion in schools, with few focusing on teachers and paraprofessionals and none focusing on school psychologists or other school personnel (Ryan et al., 2004; Ryan & Peterson, 2004; McAfee et al., 2006; Ryan et al., 2009). Secondly, this is a topic that in the past school psychologists did not have to face because students exhibiting severe behavior problems were rarely educated in schools. Instead, these children and adolescents were often placed in mental health facilities such as psychiatric hospitals and residential treatment facilities (Ryan & Peterson, 2004). As a result of federal legislation, such as IDEIA, it is only of recent that these students with severe behavior problems have made their way back into the public schools (Ryan & Peterson, 2004). Also, with the current movement of many public school districts removing students from privatized special education schools due to fiscal constraints and placing these students back in the public schools, this topic will be of greater concern for school psychologists in the public sector in the future (Ryan et al., 2009).

Future directions

It is apparent that there is still significant work that needs to be done on restraint and seclusion in schools. For one, more research should be conducted on restraint and seclusion in schools and the direct implications for school psychologists and other school personnel should be formally addressed. Also, empirical research should be conducted to explore the effects of restraint and seclusion on students and school personnel as well as to determine its efficacy in dealing with severe problem behaviors in the schools. Next, national psychological associations such as NASP and APA should develop guidelines for school psychologists on the use of these procedures in schools. In conclusion, the ethical dilemmas and recommendations presented in this paper should be seriously considered by school psychologists as it seems this topic will continue to be a concern for school psychologists in the present and the future.

Recommended reading

Articles

Couvillon, M., Peterson, R.L., Ryan, J.B., Scheuermann, B., & Stegall, J. (2010). A review of crisis intervention training programs for schools. Teaching Exceptional Children, 42(5), 6-17.

Horner, R., & Sugai, G. (2009). Considerations for seclusion and restraint use in school-wide positive behavior supports. Retrieved from http://www.pbis.org/seclusion/restraint/default.aspx

McAfee, J.K., Schwilk, C., & Mitruski, M. (2006). Public policy on physical restraint of children with disabilities in public schools. Education and Treatment of Children, 29(4), 711-728.

Ryan, J., & Peterson, R. (2004). Physical restraint in school. Behavioral Disorders, 29(2), 154-168.

Ryan, J., Robbins, K. Peterson, R., & Rozalski, M. (2009). Review of state policies concerning the use of physical restraint procedures in schools. Education & Treatment of Children, 32(3), 487-504.

United States Department of Education. (2012). Restraint and seclusion: Resource document. Retrieved from http://www2.ed.gov/policy/seclusion/restraints-and-seclusion-resources.pdf (PDF, KB)

United States Department of Education. (2010). Summary of seclusion and restraint statutes, regulations, policies, and guidance by states and territories. Retrieved from http://www2.ed.gov/policy/seclusion/seclusion-state-summary.html

Books/book chapters

Johnson, S.F. (2010). Preventing physical restraints in schools: A guide for parents, educators, and professionals. Warner, NH: Education Law Resource Center, LLC.

Ryan, J., Peterson, R., Tetreault, G., & Van der Hagen, E. (2004). Reducing the use of seclusion and restraint in a day school program. In M. Nunno, D. Day, & L.B. Bullard (Eds.), For our own safety: Examining the safety of high-risk interventions for children and young people (pp. 201-217). Atlanta, GA: Child Welfare League of America, Inc.

References

American Academy of Child and Adolescent Psychiatry. (2000). Policy statement on the prevention and management of aggressive behavior in psychiatric institutions with special reference to seclusion and restraint. Washington, DC: Author.

American Academy of Pediatrics Committee on Pediatric Emergency Medicine. (1997). The use of physical restraint interventions for children and adolescents in the acute care setting. Pediatrics, 99(3), 497-498.

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57(12), 1060-1073.

Centers for Medicare and Medicaid Services. Hospitals – Restraint/seclusion interpretive guidelines and updated state operations manual. Retrieved from http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/SCLetter08-18.pdf  (PDF, KB)

Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc. Crisis Prevention Institute. (2010). Joint commission standards on restraint and seclusion/Nonviolent Crisis Intervention® training program. Retrieved from http://www.crisisprevention.com/CPI/media/Media/Resources/alignments/Joint-Commission-Restraint-Seclusion-Alignment-2011.pdf

Fagan, T.K., & Wise, P.S. (2007). School psychology: Past, present, and future (3rd ed.). Bethesda, MD: National Association of School Psychologists.

Fisher, W.A. (1994). Restraint and seclusion: A review of the literature. The American Journal of Psychiatry, 151(11), 1584-1591.

GAO-09-719T: Seclusions and restraints-selected cases of death and abuse at public and private schools and treatment centers: Testimony before the Committee on Education and Labor, House of Representatives, 111th Cong. 3 (2009) (testimony of Gregory D. Kutz).

Hinchey, P.H. (2003). Corporal punishment: Legalities, realities, and implications. Clearing House, 76(3), 127-131

Horner, R., & Sugai, G. (2009). Considerations for seclusion and restraint use in school-wide positive behavior supports. Retrieved from http://www.pbis.org/common/pbisresources/publications/Seclusion_Restraint_inBehaviorSupport.pdf

Individuals with Disabilities Education Improvement Act of 2004, Pub. L. 108-446., 118 Stat. 2647 (2006).

Jacob, S., Decker, D.M., & Hartshorne, T.S. (2011). Ethics and law for school psychologists (6th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

Keeping All Students Safe Act of 2011, H.R. 1381, 112th Cong. (2011). Retrieved from, http://thomas.loc.gov/cgi-bin/bdquery/D?d112:1:./temp/~bdp3Mf:@@@L&summ2=m&|/home/LegislativeData.php

Klotz, M.B. (2011). IDEA in practice: Restraint and seclusion bill reintroduced. Communiqué, 39(8), 8.

Koppelman, J. (2004). Children with mental health disorders: Making sense of their needs and the systems that help them. National Health Policy Forum Issue Brief, 799, 1-24.

McAfee, J.K., Schwilk, C., & Mitruski, M. (2006). Public policy on physical restraint of children with disabilities in public schools. Education and Treatment of Children, 29(4), 711-728.

McLeskey, J., Landers, E., Hoppey, D., & Williamson, P. (2011). Learning disabilities and the LRE mandate: An examination of national and state trends. Learning Disabilities Research and Practice, 26(2), 60-66.

McLeskey, J., Landers, E., Williamson, P., & Hoppey, D. (2010). Are we moving toward educating students with disabilities in less restrictive settings? Journal of Special Education. Advance online publication. doi: 10.1177/0022466910376670

National Association of School Psychologists. (2010). Principles for professional ethics. Retrieved from http://www.nasponline.org/standards/2010standards/1_%20Ethical%20Principles.pdf  National Disability Rights Network. (2009). School is not supposed to hurt: Investigative report on abusive restraint and seclusion in schools. Retrieved from http://www.napas.org/images/Documents/Resources/Publications/Reports/SR-Report2009.pdf (PDF, KB)

No Child Left Behind Act of 2001, Pub. L. 107-110., 115 Stat. 1425 (2002)

O’Neill, R., Horner, R., Albin, R., Sprague, J., Storey, K., & Newton, J. (1997). Functional assessment and program development for problem behavior: A practical handbook (2nd ed.). Belmont, CA: Brooks/Cole, Cengage Learning.

Ryan, J., & Peterson, R. (2004). Physical restraint in school. Behavioral Disorders, 29(2), 154-168.

Ryan, J., Peterson, R., Tetreault, G., & Van der Hagen, E. (2004). Reducing the use of seclusion and restraint in a day school program. In M. Nunno, D. Day, & L.B. Bullard (Eds.), For our own safety: Examining the safety of high-risk interventions for children and young people (pp. 201-217). Atlanta, GA: Child Welfare League of America, Inc.

Ryan, J., Peterson, R., Tetreault, G., & Van der Hagen, E. (2007). Reducing seclusion, timeout and restraint procedures with at-risk youth. Journal of At-Risk Issues, 13(1), 7-12.

Ryan, J., Robbins, K. Peterson, R., & Rozalski, M. (2009). Review of state policies concerning the use of physical restraint procedures in schools. Education & Treatment of Children, 32(3), 487-504.

The Association for Persons with Severe Handicaps. (2011). Shouldn’t school be safe?: Working together to keep every child safe from restraint and seclusion in school. Retrieved from http://tash.org/wp-content/uploads/2011/07/TASH_Shouldn’t-School-Be-Safe.pdf  United States Department of Education. (2010). Summary of seclusion and restraint statutes, regulations, policies, and guidance by states and territories. Retrieved from http://www2.ed.gov/policy/seclusion/seclusion-state-summary.html

Williams, B.B., Armistead, L., & Jacob, S. (2008). Professional ethics for school psychologists: A problem-solving model casebook. Bethesda, MD: National Association of School Psychologists.