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Trauma-Informed Care: Child Safety Without Seclusion and Restraint

Posted By Denise Marshall, COPAA, Wednesday, December 9, 2015

Guest Blog By:      

Fathia Muridi Ahmed,
Intern, JBS International

Jessica Dembe, Research Assistant, JBS International

Eileen Elias, Senior Policy Advisor, JBS International

Anne Leopold, Research Analyst/Project Manager, JBS International


Traumatizing experiences, which include the use of seclusion and restraint, can affect children’s brain development and behavior. Children with intellectual and/or developmental disabilities (IDDs) are at greater risk than the general population for experiencing abuse, neglect, and the associated trauma. Behaviors resulting from trauma can create challenging and sometimes dangerous situations for the child, providers, and educators. To help those working with children understand and create a trauma-informed environment, JBS International in partnership with the Georgetown University National Technical Assistance Center for Children’s Mental Health have created the web-based tool Trauma-Informed Care: Perspectives and Resources (available at http://trauma.jbsinternational.com/traumatool and http://gucchdtacenter.georgetown.edu/TraumaInformedCare.html). The tool aims to educate child-serving providers and educators about the impact of trauma, including trauma resulting from the use of seclusion and restraint, and how to become trauma informed. It provides information about best practices from experts in the counseling, social services, and education fields. This publicly available tool includes videos and resources to assist users in understanding and staying current on all aspects of trauma-informed care.


In 2015, two videos were added to the trauma tool—“Intellectual/Developmental Disabilities and Trauma” and “Safety Without Seclusion and Restraint.” Both videos can be found at http://bit.ly/1jHswEt. The seclusion and restraint video provides timely information on practices and lessons learned to eliminate seclusion and restraint for all children.

Historically, seclusion and restraint have been used to control the behavior challenges of children with mental health conditions[1] in psychiatric hospitals, treatment facilities, and schools. For decades, it was frequently thought that, without effective seclusion and restraint practices, children, youth, and adults were in danger of injuring themselves and others[2]. Children continue to be subjected to seclusion and restraint interventions at high rates and are at risk of injury from these practices[3]. The controversial practice of secluding or restraining children when they are agitated continues to be used in public schools. Even if no physical injury is sustained, children, especially those with an IDD, are at risk of traumatization and re-traumatization during and after use of seclusion and restraint. A child does not learn meaningful lessons on alternative ways to communicate or interact when a teacher or treatment staff member responds to the child’s challenging behavior with seclusion and restraint. For decades, policymakers, clinicians, teachers, school principals, and direct care providers in child-serving systems have been challenged with not just reducing but eliminating seclusion and restraint as control and safety interventions. Teachers must know how to replace these practices with effective, non-traumatizing practices.

Eliminating seclusion and restraint is a trauma-informed practice. Being trauma informed requires a paradigm shift for educators and other child-serving providers in addressing behavioral challenges. A trauma-informed approach requires providers to change the question from “What is wrong with you?” to “What happened to you?”[4] Trauma-informed practices help children, teachers, and providers feel safe, protected, and valued.

The elimination of seclusion and restraint is a recognized priority by federal agencies including the U.S. Departments of Education and Health and Human Services and the Government Accountability Office. In 2012, the Department of Education’s Office for Civil Rights revealed that at least 70,000 children were subjected to physical restraint and 37,000 experienced isolated seclusion. In addition, students with disabilities were restrained and secluded more often than their non-disabled peers[5]

To provide nationwide protection from seclusion and restraint use, Congress introduced several legislative bills between 2009 and 2014. Although these bills did not become laws, they served as catalysts for the enactment of many state laws that address a range of requirement to reduce the use of seclusion and restraint. Protecting students from seclusion and restraint practices is currently a state responsibility. Progress has been made, but children are still not protected from use of restraint and seclusion in all states[6].

Research confirms that seclusion and restraint practices re-traumatize children, increase rather than decrease challenging behaviors, and do not calm the child10. As discussed in the “Safety Without Seclusion and Restraint” video, the use of seclusion and restraint practices can decrease a child’s ability to learn self-control[7], destroys relationships between the child and provider, and can cause the child to resent the provider[8]. When used in a school setting, seclusion and restraint practices can have a negative impact on the child’s educational learning. Although challenging behaviors might lessen for a short period, the resulting re-traumatization can remain with the child over the long term. Challenging behaviors may intensify months after the use of seclusion and restraint if the child does not feel safe[9].

Increased public education and outreach are needed to inform all stakeholders—teachers, providers, consumers, family members, advocates, policymakers, and elected officials—on the importance of preventing the use of seclusion and restraint and on using appropriate trauma-informed alternatives[10]. A workplace that employs trauma-informed staff is critical for ensuring that children and staff are safe and cared for. Every child deserves to be treated with dignity, be free from abuse, and be treated as an individual with unique needs, strengths, and circumstances (e.g., age, developmental level, responses to life issues, medical needs)[11]. These principles are part of the 15 principles specified in the U.S Department of Education’s Restraint and Seclusion: Resource Document, a 2012 report on seclusion and restraint. To ensure these principles are consistently and effectively carried out, nationwide attention must become a matter of importance. Schools are behind in understanding their responsibility in eliminating seclusion and restraint. Through federal laws, supporting regulations, and state and county laws, the elimination of seclusion and restraint can foster safety and security for children and workers in all child-serving systems, which must include our nation’s schools.

Special thanks to Georgetown University’s Sherry Peters, Senior Policy Associate, and Diane Jacobstein, Senior Policy Associate, for their assistance in editing this article. They can be contacted at: Sherry Peters: slp45@georgetown.edu or Diane Jacobstein: jacobstd@georgetown.edu

[1] Haimowitz, S., Urff, J., & Huckshorn, K. A. (2006, September). Restraint and seclusion: A risk management guide. Retrieved from http://www.power2u.org/downloads/R-S%20Risk%20Manag%20Guide%20Oct%2006.pdf

[2] American Nurses Association. (2012, March 2). Reduction of patient restraint and seclusion in health care settings. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Reduction-of-Patient-Restraint-and-Seclusion-in-Health-Care-Settings.pdf

[3] Alliance to Prevent Restraint, Aversive Interventions, and Seclusion. (2008). In the name of treatment: A parent’s guide to protecting your child from the use of restraint, aversive interventions, and seclusion (2nd ed.). Retrieved from http://stophurtingkids.com/wp-content/uploads/2013/05/In-the-Name-of-Treatment_Second-Edition.pdf

[4] Alameda County Behavioral Healthcare Services. (2013. Trauma informed care vs. trauma specific treatment. Retrieved from http://alamedacountytraumainformedcare.org/trauma-informed-care/trauma-informed-care-vs-trauma-specific-treatment-2/

[5] U.S. Department of Education, Office for Civil Rights. (2014, March). Civil rights data collection—Data snapshot: School discipline (Issue Brief 1). Retrieved from http://www2.ed.gov/about/offices/list/ocr/docs/crdc-discipline-snapshot.pdf

[6] Butler, J. (2015, July 25). How safe is the schoolhouse? An analysis of state seclusion and restraint laws and policies. Retrieved from http://www.autcom.org/pdf/HowSafeSchoolhouse.pdf

[7] GovTrack. (2010). Text of the Keeping All Students Safe Act. Retrieved from https://www.govtrack.us/congress/bills/111/hr4247/text

[8] Sanders, K., Executive Director, Ukeru Systems, Grafton Integrated Health Network. Personal communication.

[9] Harvey, K. Assistant Executive Director, ARC Baltimore. Personal communication.

[10] Sullivan, A. M., Bezmen, J., Barron, C. T., Rivera, J., Curley-Casey, L., & Marino, D. (2005). Reducing restraints: Alternatives to restraints on an inpatient psychiatric service—Utilizing safe and effective methods to evaluate and treat the violent patient. Psychiatric Quarterly, 76(1), 51-65.

[11] U.S. Department of Education. (2012, May). Restraint and seclusion: Resource document. Retrieved from https://www2.ed.gov/policy/seclusion/restraints-and-seclusion-resources.pdf

Tags:  restraint  seclusion  trauma informed care 

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