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Testimony: 

Before the Committee on Education and Labor, House of Representatives: 

United States Government Accountability Office: 
GAO: 

For Release on Delivery: 
Expected at 10:00 a.m. EDT:
Tuesday, May 19, 2009: 

Seclusions And Restraints: 

Selected Cases of Death and Abuse at Public and Private Schools and 
Treatment Centers: 

Statement of Gregory D. Kutz, Managing Director: 
Forensic Audits and Special Investigations: 

GAO-09-719T: 

GAO Highlights: 

Highlights of GAO-09-719T, a testimony before the Committee on 
Education and Labor, House of Representatives. 

Why GAO Did This Study: 

GAO recently testified before the Committee regarding allegations of 
death and abuse at residential programs for troubled teens. Recent 
reports indicate that vulnerable children are being abused in other 
settings. For example, one report on the use of restraints and 
seclusions in schools documented cases where students were pinned to 
the floor for hours at a time, handcuffed, locked in closets, and 
subjected to other acts of violence. In some of these cases, this type 
of abuse resulted in death. 

Given these reports, the Committee asked GAO to (1) provide an overview 
of seclusions and restraint laws applicable to children in public and 
private schools, (2) verify whether allegations of student death and 
abuse from the use of these methods are widespread, and (3) examine the 
facts and circumstances surrounding cases where a student died or 
suffered abuse as a result of being secluded or restrained. 

GAO reviewed federal and state laws and abuse allegations from advocacy 
groups, parents, and the media from the past two decades. GAO did not 
evaluate whether using restraints and seclusions can be beneficial. GAO 
examined documents related to closed cases, including police and 
autopsy reports and school policies. GAO also interviewed parents, 
attorneys, and school officials and conducted searches to determine the 
current employment status of staff involved in the cases. 

GAO found no federal laws restricting the use of seclusion and 
restraints in public and private schools and widely divergent laws at 
the state level. Although GAO could not determine whether allegations 
were widespread, GAO did find hundreds of cases of alleged abuse and 
death related to the use of these methods on school children during the 
past two decades. Examples of these cases include a 7 year old 
purportedly dying after being held face down for hours by school staff, 
5 year olds allegedly being tied to chairs with bungee cords and duct 
tape by their teacher and suffering broken arms and bloody noses, and a 
13 year old reportedly hanging himself in a seclusion room after 
prolonged confinement. Although GAO continues to receive new 
allegations from parents and advocacy groups, GAO could not find a 
single Web site, federal agency, or other entity that collects 
information on the use of these methods or the extent of their alleged 
abuse. 

What GAO Found: 

GAO also examined the details of 10 restraint and seclusion cases in 
which there was a criminal conviction, a finding of civil or 
administrative liability, or a large financial settlement. The cases 
share the following common themes: they involved children with 
disabilities who were restrained and secluded, often in cases where 
they were not physically aggressive and their parents did not give 
consent; restraints that block air to the lungs can be deadly; teachers 
and staff in the cases were often not trained on the use of seclusions 
and restraints; and teachers and staff from at least 5 of the 10 cases 
continue to be employed as educators. The table contains information on 
four of these cases. 

Table: Examples of Case Studies GAO Examined: 

Victim information: Male, 14, diagnosed with post traumatic stress; 
School: Texas public school; 
Case details: 
* 230 lb. teacher placed 129 lb. child facedown on floor and lay on top 
of him because he did not stay seated in class, causing his death. 
* Death ruled a homicide but grand jury did not indict teacher. Teacher 
currently teaches in Virginia. 

Victim information: Female, 4, born with cerebral palsy and diagnosed 
as autistic; 
School: West Virginia public school; 
Case details: 
* Child suffered bruising and post traumatic stress disorder after 
teachers restrained her in a wooden chair with leather straps—described 
as resembling a miniature electric chair—for being “uncooperative.” 
* School board found liable for negligent training and supervision; 
teachers were found not liable, and one still works at the school. 

Victim information: Five victims, gender not disclosed, aged 6 and 7; 
School: Florida public school; 
Case details: 
* Volunteer teacher’s aide, on probation for burglary and cocaine 
possession, gagged and duct-taped children for misbehaving. 
* No records that school did background check or trained aide. 
* Aide pled guilty to false imprisonment and battery. 

Victim information: Male, 9, diagnosed with a learning disability; 
School: New York public school; 
Case details: 
* Parents allowed school to use time out room only as a “last resort,” 
but school put child in room repeatedly for hours at a time for 
offenses such as whistling, slouching, and hand waving. 
* Mother reported that the room smelled of urine and child’s hands 
became blistered while trying to escape. 
* Jury awarded family $1,000 for each time child was put in the room. 

Sources: Records including police reports, court documents, and 
interviews. 

[End of table] 

View [hyperlink, http://www.gao.gov/products/GAO-09-719T] or key 
components. For more information, contact Gregory Kutz at (202) 512-
6722 or kutzg@gao.gov. 

[End of section] 

Mr. Chairman and Members of the Committee: 

Thank you for the opportunity to discuss the use of restraints and 
seclusions on children and teens in public and private schools and 
selected treatment centers. In the context of this testimony, a 
restraint is defined as any manual method, physical or mechanical 
device, material, or equipment that immobilizes or reduces the ability 
of an individual to move his or her arms, legs, body, or head freely. 
Seclusion is the involuntary confinement of an individual alone in a 
room or area from which the individual is physically prevented from 
leaving. [Footnote 1] 

In certain circumstances, teachers and other staff may decide that it 
is necessary to restrain or seclude children in order to protect them 
from harming themselves or others. For example, some doctors and 
teachers contend that using seclusions and restraints can reduce injury 
and agitation and that it would be very difficult for organizations to 
run programs for children and adults with special needs without being 
able to use these methods. However, GAO has previously testified that 
these techniques can be dangerous because they may involve physical 
struggling, pressure on the chest, or other interruptions in breathing. 
[Footnote 2] We found that children are subjected to restraint or 
seclusion at higher rates than adults and are at greater risk of 
injury. Even if no physical injury is sustained, we also testified that 
individuals can be severely traumatized during restraint. In addition, 
as part of our prior investigations of residential programs for 
troubled youth, we highlighted cases where staff at some programs 
employed unsafe restraint techniques, resulting in the death and abuse 
of teens in their care.[Footnote 3] Recent reports by advocacy groups 
indicate that similar restraint techniques have been used at public and 
private school throughout the country. For example, in January 2009, 
the National Disability Rights Network issued a report documenting 
dozens of instances where students with disabilities were abusively 
pinned to the floor for hours at a time, handcuffed, locked in closets, 
and subjected to other traumatizing acts of violence. Just a few weeks 
ago, the Council of Parent Attorneys and Advocates, an organization 
that works to protect the civil rights of children with disabilities, 
issued a report describing similar examples of injury and abuse. In 
some of the cases described in these reports, the restraints and 
seclusions resulted in death. 

Given these prior reports and testimony, you asked us to (1) provide an 
overview of federal and state laws related to the use of restraints and 
seclusions in public and private schools; (2) verify whether 
allegations of student death and abuse from the use of these techniques 
are widespread; and (3) examine the facts and circumstances surrounding 
selected criminal, civil, or administrative cases where a student died 
or suffered abuse as a result of being secluded or restrained. 

To conduct our work, we first searched for all federal and state laws 
pertaining to the use of seclusions and restraints in public and 
private schools. To verify whether allegations of student death, 
injury, and abuse from the use of these techniques are widespread, we 
gathered available data on allegations made over the last two decades 
by interviewing relevant experts and officials from state agencies; 
performing extensive Internet and LexisNexis searches; reviewing 
federal and state court documents related to civil and criminal 
litigation; and seeking leads from state investigators, agency 
officials, attorneys, and parent advocacy groups. Except for the case 
studies discussed below, we did not attempt to verify the facts related 
to the allegations we reviewed, nor did we attempt to evaluate cases 
where the use of restraints and seclusions may have been necessary or 
beneficial. 

To select our case studies, we searched for restraint and seclusion 
cases from the last two decades in which there was a criminal 
conviction, finding of civil or administrative liability, or a large 
financial settlement. As part of the selection process, we focused on 
cases involving children from public and private schools or treatment 
programs in which residents attended classes; we excluded cases 
involving children in psychiatric facilities or juvenile detention 
centers. Ultimately, we selected 10 cases from 9 different states for 
further review. To the extent possible, we conducted interviews with 
related parties, including current and former school staff and 
officials, attorneys and law enforcement officials, and the parents of 
the victims. We also attempted to obtain training policies on 
restraints and seclusions followed at each school and treatment center 
involved in the cases. Further, where applicable, we reviewed police 
reports; witness statements; autopsy reports; state agency oversight 
reviews and investigations; and court documents, including trial 
transcripts, depositions, and plaintiffs' complaints and defendants' 
answers. We also conducted searches to determine whether the 
individuals who restrained or secluded the children in our case studies 
had previous criminal histories and whether they are still teaching or 
working with children. Finally, in addition to the 10 new cases we 
selected for this testimony, we also included 3 cases involving the use 
of face down restraints from our previous work on residential treatment 
programs for troubled youth. We performed our work from February 2009 
to April 2009 in accordance with standards prescribed by the Council of 
Inspectors General for Integrity and Efficiency (CIGIE). 

Overview of Federal and State Laws Related to the Use of Restraints and 
Seclusions: 

Overall, we found no federal regulations related to seclusions and 
restraints in public and private schools and widely divergent laws at 
the state level. We also identified at least five states that currently 
collect and report information related to the use of seclusions and 
restraints in public and private schools. 

At the federal level, the Children's Health Act of 2000 amended Title V 
of the Public Health Service Act to regulate the use of restraints and 
seclusions on residents of certain hospitals and health care facilities 
that receive any type of federal funds as well as on children in 
certain residential, non-medical, community-based facilities that 
receive funds under the Public Health Service Act. CMS has issued 
additional regulations regarding the use of restraints and seclusions 
on patients of hospitals that participate in the Medicare and Medicaid 
programs. However, there are no federal laws restricting the use of 
restraints and seclusion in public or private schools. With regard to 
children with disabilities, the Individuals with Disabilities Education 
Act (IDEA) requires that eligible students be educated in the least 
restrictive environment. IDEA also mandates that special education 
students have an Individualized Education Program (IEP), a written 
document that in part explains the educational goals of the student and 
the types of services to be provided. IEPs are developed by parents and 
school personnel and may contain instructions related to the use of 
strategies to support the student. These could include, for example, 
instruction approaches and behavioral interventions such as the use of 
seclusion and restraints. 

Furthermore, state laws and regulations in this area vary widely. For 
example, nineteen states have no laws or regulations related to the use 
of seclusions or restraints in schools.[Footnote 4] Other states have 
regulations, but they may only apply to selected schools in certain 
situations. For example, seven states place some restrictions of the 
use of restraints, but do not regulate seclusions.[Footnote 5] 
Seventeen states require that selected staff receive training before 
being permitted to restrain children.[Footnote 6] Thirteen states 
require schools to obtain consent prior to using foreseeable or non- 
emergency physical restraints,[Footnote 7] while nineteen require 
parents to be notified after restraints have been used.[Footnote 8] Two 
states require annual reporting on the use of restraints.[Footnote 9] 
Eight states specifically prohibit the use of prone restraints or 
restraints that impede a child's ability to breathe.[Footnote 10] For 
an overview of applicable seclusion and restraint laws and regulations 
in all fifty states and the District of Columbia, see appendix 1. In 
addition to these legal requirements, we found at least four states 
that are currently collecting and reporting information from school 
districts on the use of restraints and seclusions, including Kansas, 
Pennsylvania, Texas, and Rhode Island. 

Allegations of Death and Abuse Related to the Use of Seclusions and 
Restraints at Public and Private Schools: 

Although we could not determine whether allegations of death and abuse 
were widespread, we did discover hundreds of such allegations at public 
and private schools across the nation between the years 1990 and 2009. 
[Footnote 11] Almost all of the allegations we identified involved 
children with disabilities.[Footnote 12] While this number represents a 
small share of all children in public and private schools nationwide 
over these years, these allegations raise serious issues for a 
significant number of children, families, and those entrusted with 
their education and care. Although we continue to receive new 
allegations from parents and advocacy groups, we could not locate a 
single Web site, federal agency, or other entity that collects 
comprehensive information on this issue. For example, the Department of 
Education's Office of Civil Rights receives complaints about the 
inappropriate use of restraint and seclusion on children with 
disabilities, but officials said their case management system does not 
have the ability to single such complaints out for tabulation. In 
addition, the Department of Health and Human Services funds the 
collection of information about investigations conducted by state child 
protective services agencies through the National Child Abuse and 
Neglect Data System, but it does not have a code to indicate whether 
perpetrators are teachers or staff at public and private schools. 

It is important to emphasize that allegations should not be confused 
with proof of actual abuse. However, in terms of meeting our objective, 
the hundreds of allegations we found came from a number of sources, 
including our own research, advocacy groups, news accounts, parents, 
and attorneys. We often identified multiple allegations from each of 
our sources; for example, an attorney based in South Carolina said his 
office has worked on at least 15 school cases involving the restraint 
and seclusion of children during the last 3 years, including a 
student's being shut in a classroom closet. Other examples of death and 
abuse claims are as follows; we do not know the outcomes of these 
cases. 

* A 13-year-old boy with attention deficit hyperactivity disorder at an 
alternative public school hung himself in a seclusion room weeks after 
threatening to commit suicide, using a cord a teacher reportedly 
provided him to hold up his pants. 

* A 7-year-old girl died at a private day treatment center after being 
held for hours in a face-down, or prone, restraint on the floor by 
multiple staff members. The staff was allegedly unaware she had stopped 
breathing until they rolled her limp body over and discovered she had 
begun to turn blue. 

* A 9-year-old boy in foster care died at a public charter school after 
his teacher took him to a "time out" room and restrained him using a 
"basket hold," which in this case was described as an adult standing 
behind a child, holding the child's crossed arms and taking him to the 
floor. Purportedly, the boy began to make a noise like he was vomiting, 
then slumped over after being released. The teacher testified that she 
initially thought he was playing dead and joked with other staffers 
about planning his funeral. 

* A 17-year-old boy reportedly died from an asthma attack while being 
restrained by a counselor at a private school for emotionally disturbed 
teens. 

* Disabled children as young as 6 years old were allegedly placed in 
strangleholds, restrained for extended periods of time, confined to 
dark rooms, prevented from using the restroom causing them to urinate 
on themselves, and tethered to ropes in one public school district. 

* A special education teacher at a public school was accused of using 
bungee cords and duct tape to fasten children as young as 5 years old 
to chairs designed to support kids with muscular difficulties. 
According to parents, their children sustained injuries such as broken 
arms and bloody noses while in this teacher's class. A teacher's aide 
told investigators that the woman used the restraints on a daily basis 
to punish the children. 

* According to the father of an 8-year-old autistic boy, his son 
suffered from scratches, bruises and a broken nose after being put in a 
prone restraint by his public school teacher and aide. 

* A sixth-grade special education student reportedly had his leg broken 
by the public school teacher who was trying to restrain him. 

* A 12-year-old girl allegedly had her arm fractured by a special 
education teacher who put her in a "therapeutic hold," described as 
being similar to a "bear hug" or hold a student's arms behind their 
back. 

* An autistic student at a public school claims he was strapped with 
his pants pulled down onto a toilet training chair for hours at a time 
over several days. 

In addition, we were able to obtain data showing that thousands of 
public and private school students were restrained or secluded during 
the last academic year. These data do not show the inappropriate use of 
restraints and seclusions, but rather the number of times the 
techniques were used during an academic year. Specifically, Texas and 
California, two states that together contain more than 20 percent of 
the nation's children, collect self-reported information from school 
officials on the use of these methods. Texas public school officials 
stated they restrained 4,202 students 18,741 times during the September 
2007 through June 2008 academic year. During the same time period, 
California officials reported 14,354 instances of students' being 
subjected to restraint, seclusion or other undefined "emergency 
interventions" in public and private schools. Other states that 
currently collect and report this type of information include Kansas, 
Pennsylvania, and Rhode Island, but we did not obtain data from these 
states. 

Cases of Death and Abuse Related to the Use of Restraints and 
Seclusions: 

Children, especially those with disabilities, are reportedly being 
restrained and secluded in public and private schools and other 
facilities, sometimes resulting in injury and death. The 10 closed 
cases we examined illustrate the following themes: (1) children with 
disabilities were sometimes restrained and secluded even when they did 
not appear to be physically aggressive and their parents did not give 
consent; (2) facedown or other restraints that block air to the lungs 
can be deadly; (3) teachers and staff in these cases were often not 
trained in the use of restraints and techniques; and (4) teachers and 
staff from these cases continue to be employed as educators. In 
addition to the 10 cases we identified for this testimony, 3 cases from 
our previous testimonies on residential treatment programs for troubled 
youth also show that face down restraints, or those that impede 
respiration, can be deadly. 

Case Studies from Current Investigation: 

For our current investigation, we identified 10 seclusion and restraint 
cases occurring at public and private schools and selected treatment 
centers over the past two decades. Common themes related to the cases 
studies are as follows: 

Children with Disabilities: Although we did not specifically limit the 
scope of our investigation to incidents involving disabled children, 
most of the hundreds of allegations we identified related to children 
with disabilities. In addition, 9 of our 10 closed cases involve 
children with disabilities or a history of troubled behavior. The 
children in these cases were diagnosed with autism or other conditions, 
including post traumatic stress disorder and attention deficit 
hyperactivity disorder. Although we did not evaluate whether the 
seclusion and restraint used by the staff in our cases was proper under 
applicable state laws, we did observe that the children in the cases 
were restrained or secluded as disciplinary measures, even when their 
behavior did not appear to be physically aggressive. For example, 
teachers restrained a 4 year old with cerebral palsy in a device that 
resembled a miniature electric chair because she was reportedly being 
"uncooperative." In other cases, we found that teachers and other staff 
did not have parental consent prior to using restraints and seclusions. 
For example, an IEP for a 9 year old with learning disabilities 
specified that placement in a timeout room could be used to correct 
inappropriate behavior, but only as a last resort. However, teachers 
confined this child to a small, dirty room 75 times over the course of 
6 months for offenses such as whistling, slouching, and hand waving. 
Parents in another case gave a teacher explicit instructions to stop 
restraining their 7-year-old child and secluding her for prolonged 
periods of time. Despite these instructions, the restraints and 
seclusions continued. In another case, a residential day school 
implemented a behavior plan, without parental consent, that included 
confining an 11-year-old autistic child to his room for extended 
periods of time, restricting his food, and using physical restraints. 
The child was diagnosed with post traumatic stress disorder as a result 
of this treatment. Currently, thirteen states require schools to obtain 
consent prior to using foreseeable or non-emergency physical 
restraints.[Footnote 13] 

Death from Face Down Restraints or Restraints that Block the Airway: Of 
the hundreds of allegations we identified, at least 20 involved 
restraints that resulted in death. Of the 10 closed cases we examined, 
4 involved children who died as a result of being restrained. In all 4 
cases, staff members used restraint techniques that restricted the flow 
of air to the child's lungs. In one of these cases, an aide sat on top 
of a child to prevent him from being disruptive and ultimately 
smothered him. The other cases related to the use of different types of 
prone restraints, a technique that typically involves one or more staff 
members holding a child face down on the floor. Although some of the 
teachers and staff involved in these cases were trained on the use of 
prone restraints, the children in their care still died as a result of 
its use. However, we did not attempt to evaluate the types of training 
they received or whether they actually implemented the procedure 
according to the training. Currently, eight states specifically 
prohibit the use of prone restraints or restraints that impede a 
child's ability to breathe.[Footnote 14] 

Untrained Staff: Although we did not evaluate specific training 
methods, evidence we gathered suggests that the teachers and other 
staff involved in our 10 closed cases were often not trained in the use 
of restraints. For example, staff involved in the death of a child in 
one case acknowledged that they were inadequately trained. A principal 
in another case testified that she did not know whether a substitute 
teacher who taped children to their chairs to make them sit still had 
ever been provided with the school policy on restraint. A local school 
board in a fourth case was found civilly liable for negligently 
supervising and training teachers after a 4-year-old girl was strapped 
to a chair for allegedly being uncooperative. A school district agreed 
to implement policy changes to improve training in a fifth case as part 
of a settlement agreement after a teacher repeatedly restrained a frail 
7 year old. Lastly, in a sixth case, a volunteer teacher's aid with a 
history of armed burglary and cocaine possession was allowed to tape 
first graders to a blackboard and seal their mouths shut; we found no 
evidence that the school trained this aide or even conducted a 
background check on her before letting her into the classroom. 
Currently, seventeen states require that staff receive training before 
being permitted to restrain children.[Footnote 15] 

Continued Employment in Education: Although we did not evaluate 
specific state licensing requirements, we did observe that in at least 
5 of our cases, the teachers or other staff involved in the injurious 
restraint or seclusion of children continued to work with students or 
had licenses to do so. For example, a 230 pound teacher in Texas who 
fatally restrained a 129 pound teenage boy facedown on a mat currently 
works as a public high school teacher in Virginia. The Texas Department 
of Family Protective Services (DFPS) placed the teacher's name on a 
Texas registry that lists individuals found to have abused or neglected 
children. An administrative law judge later ruled that the woman used 
unnecessary force on the special education student, sustained the 
DFPS's abuse finding, and affirmed that the teacher's information 
should be released through the registry. Despite this listing, she is 
currently licensed in Virginia to instruct children with disabilities. 
In another example, the assistant principal who fatally restrained a 
child after holding him facedown on the floor for approximately an hour 
currently works as a principal at another public school in the same 
district. In addition, one of the teachers who strapped the 4-year-old 
child to a chair for allegedly being uncooperative still teaches at the 
school where the incident occurred, while the teacher who repeatedly 
restrained the frail 7 year old left her school but immediately began 
teaching in another district in the same state. Finally, the substitute 
teacher who taped children to their chairs and was found guilty of 
unlawful restraint and battery in July 2008 still holds a state 
substitute teaching certificate, which does not expire until June 2009. 

Table 1 provides a summary of the cases we examined; a more detailed 
narrative on each of the cases follows the table. 

Table 1: Summary of Case Studies: 

Case: 1; 
Student information: Male, 14, had a history of disruptive behavior; 
Location and type of institution: Pennsylvania; private, nonprofit 
residential treatment center; 
Year of incident(s): 1998; 
Case details: 
* Two staff members trained in the use of restraints pinned the student 
facedown on the floor for 20 minutes after he tried to attack a 
counselor; 
* Student died from a brain injury as a result of a lack of oxygen; 
* Death ruled an accident and no criminal charges were filed; 
* Facility settled with student's mother for over $1 million with no 
admission of liability; 
* Pennsylvania banned prone restraints in 2008. 

Case: 2; 
Student information: Male, 14, diagnosed with post traumatic stress and 
other disorders; 
Location and type of institution: Texas; public school; 
Year of incident(s): 2002; 
Case details: 
* 230 lb. special education teacher placed 129 lb. student into a prone 
restraint and lay on top of him because he would not stay seated; 
* Student died as a result of compression of the trunk; 
* Death ruled a homicide, but no criminal charges filed; 
* Teacher currently teaches in Virginia and is licensed to instruct 
children with disabilities. 

Case: 3; 
Student information: Male, from the age of 11 through 13, diagnosed as 
mentally retarded and autistic; 
Location and type of institution: New York; private residential school 
and state facility for children with developmental disabilities; 
Year of incident(s): 2004 and 2007; 
Case details: 
* Case involves two residential facilities; 
* Without notifying parents, child "ignored" and secluded in his room 
for extended periods of time at first facility and had access to 
regular meals restricted; 
* Parents removed child from the school alleging neglect; case resulted 
in state law granting parents full access to investigative records in 
abuse cases; 
* At second facility, student died by suffocation after an aide sat on 
top of him because he was being disruptive while riding in a van; 
* The aide and driver of the van stopped at a game store and one of the 
employee's houses while the child lay unconscious in the backseat; 
* The aide was convicted of manslaughter and is currently in prison. 

Case: 4; 
Student information: Male, 15, diagnosed as autistic; 
Location and type of institution: Michigan, public school; 
Year of incident(s): 2003; 
Case details: 
* Student suffered a seizure and lost control of his extremities and 
bladder and later became uncooperative; 
* Assistant principal and other staff did not provide medical attention 
for the seizure and instead placed student in a prone restraint for 
approximately an hour, resulting in death; 
* Death ruled an accident and no criminal charges filed; 
* Mother settled a civil suit with the school district for $1.3 
million; 
* Assistant principal is now a principal at another school in the 
district. 

Case: 5; 
Student information: Female, 4, born with cerebral palsy and diagnosed 
as autistic; 
Location and type of institution: West Virginia; public school; 
Year of incident(s): 1998; 
Case details: 
* Child was "uncooperative," so teachers restrained her in a chair with 
multiple leather straps that resembled a "miniature electric chair"; 
* Child suffered bruising, wet the bed, and had temper tantrums. Doctor 
later diagnosed child with post traumatic stress syndrome; 
* Jury in civil case did not find teachers liable for any wrongdoing 
but found school board liable for negligent supervision and training in 
the use of restraints and awarded the family $460,000; 
* West Virginia has since banned the use of restraints on pre-
kindergarten children; 
* At least one of the three teachers responsible for the restraint 
still teaches at the school. 

Case: 6; 
Student information: Four males under 6, all in special education class 
and one diagnosed with a condition similar to Down syndrome; 
Location and type of institution: Tennessee public school; 
Year of incident(s): 2003 to 2004; 
Case details: 
* To prevent a child with a Down syndrome-type condition from 
wandering, the teacher used sheets to strap the boy to a cot while he 
was wearing a 5lb., lead physical therapy vest; 
* The teacher also hit the children with a flyswatter, a ruler, and her 
hand; 
* Teacher pleaded guilty to felony child abuse, neglect, and 
misdemeanor assault and was placed on 3 years probation. 

Case: 7; 
Student information: Male, 8, diagnosed with attention deficit 
hyperactivity disorder; 
Location and type of institution: Illinois public school; 
Year of incident(s): 2006; 
Case details: 
* Substitute restrained child to a chair with masking tape and also 
taped his mouth shut because the boy would not remain seated; 
* Substitute found guilty of unlawful restraint and aggravated battery. 
He was sentenced to 2 years probation, community service, and a 
psychological evaluation; 
* Substitute still possesses an Illinois substitute teaching 
certificate, which expires in June 2009. 

Case: 8; 
Student information: Five students, gender not disclosed, aged 6 and 7; 
Location and type of institution: Florida public school; 
Year of incident(s): 2003; 
Case details: 
* Volunteer teacher's aide, a felon on probation for armed burglary, 
grand theft and cocaine possession, gagged and duct-taped children to 
their desks as punishment for misbehaving; 
* There is no record that the school trained aide or conducted a 
background check before allowing aide into the class room; 
* Aide pled guilty to false imprisonment and battery, was placed on 5 
years probation, and ordered to attend anger management classes; 
* Aide was later arrested again for possession of cocaine. 

Case: 9; 
Student information: Female, 7, diagnosed with Asperger's syndrome, a 
form of autism; 
Location and type of institution: California public school; 
Year of incident(s): 2001 to 2002; 
Case details: 
* Teacher secluded child in a walled off area because she refused to do 
work, sat on top of her because she was wiggling a loose tooth, and 
repeatedly restrained and abused her; 
* The student was awarded $260,000 in a civil settlement, although the 
school and teacher did not admit liability; 
* Teacher left the school but began teaching again in a different 
school district. 

Case: 10; 
Student information: Male, 9, diagnosed with a learning disability; 
Location and type of institution: New York public school; 
Year of incident(s): 1992 to 1993; 
Case details: 
* School was only supposed to use timeout room as a last resort to 
correct inappropriate behavior but put child in the room 75 times over 
a 6 month period for hours at a time for offenses such as whistling, 
slouching, and hand waving; 
* The room was unlocked, but a staff person would hold it shut to 
prevent the child from leaving; the child's hands became blistered 
while trying to escape; 
* Mother reported that the room was dirty and smelled of urine; 
* A jury in a civil suit awarded family $75,000: $1,000 for every time 
the child was placed in the room. 

Source: Records including police reports, court documents, and 
interviews. 

[End of table] 

Case 1: The student was a 14 year old male. He was living in a private, 
non-profit, residential treatment center for troubled children in 
Pennsylvania and attending a private school operated by the center when 
he died in 1998 as a result of being physically restrained. He had been 
placed in the custody of the non-profit by the New Jersey Department of 
Youth and Family Services in 1995. 

According to a report by the District Attorney, on December 10, 1998, 
following a fight with a fellow student at a school on the treatment 
center's campus, the 14 year old returned to his dormitory room. A 195 
pound male counselor entered the room to counsel the 125 pound boy 
about the fight. The boy was agitated and attempted to stab the 
counselor at least three times with a pen. To prevent further attack, 
the counselor applied a prone restraint in which the boy ended up face 
down on the floor with the counselor's left knee on the left side of 
his body and the counselor's right leg across his back. At this point, 
the boy no longer had the pen in his hand. The counselor locked the 
boy's arms behind his back. A female counselor heard the boy say, "I'm 
sorry I hit you" and "I hate you all." While being physically 
restrained on the floor, the boy continued to yell, kick, and struggle. 
A 155 pound male counselor also entered the room and placed a vinyl mat 
under the boy's head to prevent injury. The treatment center's records 
reveal that the boy had previously been physically restrained 17 times. 
The treatment center would not release the boy's treatment plan. 

After approximately 12 minutes, the 195 pound counselor became tired 
and the 155 pound counselor took his place, locking the boy's arms 
behind the boy's back and positioning his body so that it lay off to 
the left side of the boy. The 155 pound counselor physically restrained 
the boy for approximately 8 minutes during which time the boy continued 
to struggle and scream "Get the [expletive] off me, get off me." 
Another child reported hearing the boy yell, "Stop it, I can't 
breathe." The 195 pound counselor responded, "You'll be able to breathe 
if you stop struggling." After approximately 20 minutes of physical 
restraint, the student lost consciousness, and CPR was administered. 
The boy was taken to the hospital where he died a day later. The 
autopsy determined the cause of death as hypoxic encephalopathy due to 
compressional asphyxia, a brain injury sustained as a result of lack of 
oxygen due to the compression of the student's chest. 

Each of the counselors who applied the restraint that led to the boy's 
death were trained and certified in applying physical restraints. 
According to an instruction manual, employees at the center were 
trained in applying multiple restraints, two of which required the 
student to remain face down on the floor in a prone position. In his 
report, the District Attorney concluded that the treatment center's 
policy did not appear to have any inherent flaw in the technique and 
that the policy was well designed and appeared to have been followed by 
all the counselors involved. The coroner ruled that the death was 
accidental and the District Attorney did not file charges against the 
counselors. 

In May 1999, the boy's mother sued the treatment center and two of the 
counselors who applied the restraint that led to the boy's death, 
alleging negligence. She claimed that the counselors used excessive 
force, and that the treatment center did not adequately train their 
counselors to deal with respiratory distress during a physical 
restraint. The defendants denied these allegations and said the 
restraint was employed for the protection of everyone involved in the 
situation. The counselors further stated that they acted with due care 
and safety of the boy. 

In May 2006, before the case went to trial, the boy's mother, the 
treatment center, and the two counselors reached a settlement. 
According to the terms of the settlement, the boy's mother would be 
paid over $1 million. The treatment center and the two counselors did 
not admit any liability in the boy's death as part of this settlement. 
The two counselors who physically restrained the boy did not have 
criminal histories. They no longer work at the treatment center, but we 
were unable to determine whether they currently counsel children. 

In October 1999, less than a year after the boy's death, the 
Pennsylvania Department of Public Welfare enacted regulations that 
prohibit child residential facilities and day treatment centers from 
administering restraints that apply pressure or weight on a child's 
respiratory system. Consequently, we requested the treatment center 
provide its current policies and training manuals regarding restraints. 
In response, the treatment center sent us a letter stating it no longer 
uses prone restraints. In addition, it provided us a copy of its policy 
allowing physical restraints in residential treatment facilities and 
education programs and a workbook used to obtain certification in 
physical restraints. The center's policy states trained staff members 
are authorized to use physical restraint methods. According to the 
workbook, staff can apply physical force that reduces or restricts 
mobility while an individual is in an upright or seated position, lying 
face up, or in the transport of an individual from one location to 
another. 

Case 2: The victim was a 14-year-old male who died in 2002 from being 
restrained by his middle school teacher at a public school in Texas. He 
was taken from his family at the age of nine after the Texas Department 
of Family and Protective Services (TDFPS)[Footnote 16] received reports 
that the boy and his siblings were being neglected and emotionally and 
physically abused, according to his foster care records. He described 
having to feed himself by taking food from trash cans and grocery 
stores. He was placed in his last foster home after being hit in the 
head with a shovel at the residential treatment center where he 
resided. Less than a year before he died, he told his therapist that 
his idea of a safe place was a cave with solid rock walls, a steel 
door, and lots of food. His most recent psychological assessment noted 
that the boy suffered from posttraumatic stress disorder, conduct 
disorder, oppositional defiance disorder, attention deficit 
hyperactivity disorder, and narcissistic personality disorder. The 
child also had a fear of not being allowed to eat and often horded food 
as a result of his prior abuse, according to TDFPS. The boy was in a 
special education class that focused on behavior management. We were 
unable to obtain the child's individual education plan. 

The day the child died, he had been denied his lunch by school staff as 
a form of punishment, according to an investigation by TDFPS. Reports 
differ on what prompted this disciplinary action. The classroom teacher 
told police she gave him a "delayed lunch" because he had stopped 
working at about 11 a.m. and started asking if he could eat. She said 
this was a common occurrence. A teacher's aide also told police that he 
placed the child on "delayed lunch" at about 1 p.m. after the boy tried 
to steal candy. The child became agitated at about 2:30 p.m. and left 
the classroom, according to TDFPS. The aide ran after the boy and 
brought him back to the classroom, but he would not remain seated. The 
teacher warned him to sit down at least twice before forcibly placing 
him in his chair. She told police that she used a "basket hold" 
restraint on him while he remained seated, standing behind him and 
grabbing his wrists so his arms crossed over his torso. He continued to 
struggle, so the teacher told police she rolled him onto a mat face 
down into a "therapeutic floor hold" and lay on top of him. A student 
said his arms were pinned beneath him. The child was 5 feet 1 inch tall 
and weighed 129 pounds. The teacher was about 6 feet tall and weighed 
in excess of 230 pounds. An aide, meanwhile, held the boy's feet. The 
boy kicked and cursed. He repeatedly said that he could not breathe and 
that he was going to pass out. Multiple witnesses told investigators 
that he also said, "I give." After the boy became silent, the teacher 
continued to restrain him. An assistant principal who had entered the 
classroom while the boy was still struggling asked the teacher to 
release him, saying 15 minutes had passed. School district policy 
required administrator approval for extending restraint past this time 
period. The teacher and an aide put the child's limp body back in his 
chair, and the aide wiped drool from his mouth. The assistant principal 
told police that they thought he had been "playing possum." Once the 
assistant principal noticed that the child was unresponsive, she said 
she asked for the school nurse. The nurse arrived and performed CPR 
while someone phoned 911. The child was taken to the hospital and 
pronounced dead. A dozen students in the classroom had witnessed the 
incident. 

Medical examiners performed an autopsy and determined that the boy died 
from mechanical compression of the trunk. His death was ruled a 
homicide and local police investigated the incident for possible 
prosecution. During the investigation, the teacher told authorities 
that the school district trained her on how to restrain students. 
School policy stated that restraint can be used if the child is an 
immediate danger to himself or others or if the child is trying to exit 
the classroom with the intent to leave school premises. One school 
district restraint trainer told police that the teacher had a very 
difficult classroom--the worst in the district. She also said she had 
reviewed the teacher's previous "therapeutic floor holds" and found no 
problems with the way the teacher executed the procedure. 

A grand jury decided not to take action on the boy's death. TDFPS 
launched their own investigation and found "reason to believe" the 
teacher physically abused the student on the day he died. TDFPS placed 
her name on the department's "Central Registry," which lists 
individuals found to have abused or neglected children. The teacher 
appealed the listing to the State Office of Administrative Hearings. An 
administrative law judge found that the child's actions prior to being 
restrained did not put himself or anyone else in danger. The judge also 
determined that the boy had already been returned to the classroom 
uneventfully. The judge also found that the teacher employed the 
restraint as an inappropriate disciplinary tactic, using excessive, 
unnecessary force out of proportion to the minimal risk posed by the 
child's action. The teacher also ignored pleas and warnings that the 
child could not breathe and continued to hold him after he became still 
and quiet, the judge noted. Under these circumstances, the judge 
determined the teacher's action to be reckless and the child's death 
not an accident. The judge sustained the department's abuse finding and 
allowed the information to continue to be released to upon request to 
officials responsible for children. The teacher does not have a 
criminal record and currently works as a teacher at a public high 
school in Virginia. Her Virginia teaching license lists endorsements 
for the instruction of students in grades K-12 who have specific 
learning disabilities, emotional disturbances and mental retardation. 
We have referred this matter to the Virginia Department of Education 
for further investigation. 

Case 3: The student was 11 when he was first abused at a private 
facility in New York before being smothered to death 2 years later by 
an employee at a state facility who restrained him in a van. The child 
was non-verbal and had been diagnosed as mentally retarded and 
autistic. 

In January 2003, the family enrolled the child at a private, nonprofit 
residential school paid for by Medicaid. According to his parents, they 
were struggling to toilet train their son and had heard the school had 
been very successful with these situations. Initially, he appeared to 
be doing well, successfully using the toilet about 50 percent of the 
time. In the summer and fall of 2004, the boy became increasingly more 
aggressive and began sporadically taking off his clothes. Without 
parental notification or consent, the school implemented an adjusted 
behavioral support plan,[Footnote 17] called "planned ignore." As part 
of this plan, the child had restrictions placed on his access to 
regular meals. According to school documents, he was required to be 
dressed in order to eat his meals. If he did not get dressed after one 
prompt from the staff, he was not allowed to eat his meal and received 
only yogurt, milk, juice or water for breakfast, lunch, and dinner. 
State investigations subsequently found that in a 1 month timeframe, 
the child missed almost 40 percent of his regular meals. When the child 
refused to get dressed, he also was secluded in his room for extended 
periods of time, while an employee held the door closed. The child's 
isolation prevented him from participating in meals, school, and 
leisure activities. One staff member described the school's protocol 
for the student as "putting him in a dark hole and giving him nothing." 
During this time he missed approximately 2 weeks of classes. The school 
also suspended the family's visitation rights. 

In October 2004, the father said he found his son disoriented and lying 
naked in his own urine. The window in his son's room was taped, 
pictures and toys had been removed and his son, noticeably thinner, was 
covered in bruises. Although the parents had not consented to any form 
of restraint being used against their son, school injury reports 
confirm that the staff did use physical restraint. The reports cite 
bruising and scrapes over the student's entire body, documenting the 
bruises as "too numerous to count." As a result, the parents removed 
their son from the school and took him home. The parents said their son 
seemed "emotionally damaged" and according to his psychiatrist, was 
suffering from post traumatic stress disorder. 

As a result of allegations by the family, several New York state 
agencies and the district attorney's office initiated investigations of 
the abuse and of the school's regulatory compliance. Although the 
school was required to correct deficiencies of care identified in these 
investigations, no actions were taken against any of the staff involved 
in the incidents, and we were unable to determine whether the staff 
members are still working at the school. The parents then filed a 
complaint with the New York State Inspector General (IG) asking that it 
review the quality of the agencies' investigations. The IG ultimately 
found deficiencies related to each investigation and recommended, in 
part, that the relevant state agencies take steps to ensure that abuse 
cases are investigated thoroughly. The IG report further stated that 
there is no justification for a child in a private, state-certified 
facility to be afforded less protection from abuse than a child in a 
state run facility. In addition, the child's family worked to pass a 
state law, named in their son's honor, requiring parents or guardians 
to be notified within 24 hours of an incident that affects the health 
and safety of their child. The law, which became effective in 2007, 
also grants parents and guardians full access to records relevant to 
investigations of patient abuse and increases fines for state licensed 
facilities that do not comply with applicable rules and regulations. 

Unfortunately, before this law was passed, the family suffered an even 
greater tragedy. In the fall of 2005, their son's emotional problems 
escalated. He was experiencing rages and, after several trips and weeks 
spent in the hospital, the family could still not stabilize his 
behavior. In October 2005, the child was transferred from an upstate 
New York hospital and placed in a state-operated facility for children 
with developmental disabilities. 

Sixteen months later, the child was on a field trip when he began 
acting up and was smothered to death by one of the school's health 
aides. Police records indicate that during the van ride, the child got 
out of his seatbelt and began grabbing at another student. According to 
his parents, their son's behavior plan included the use of a seatbelt 
buckle guard, a device that prevents the wearer from disengaging the 
buckle. However, to their knowledge the buckle guard allegedly was not 
being used that day. Instead, one of the health aides got in the back 
seat of the van and first tried to restrain the child by pulling his 
arm's across his chest while he was in a seated wrap position. When 
that did not calm the child, the aide sat on the child. Although the 
family had consented to the use of some restraints against their son, 
this improper restraint caused the child to lose consciousness and stop 
breathing. 

After the child fell unconscious, neither of the employees in the van 
performed CPR or first aid. Instead they continued to drive around, 
stopping at a game store and one of the employee's houses before 
finally going back to the school. In a statement made to police, the 
aide said "[he] realized that [the child] had stopped breathing when he 
stopped moving" but didn't call anyone for help because he and the 
other aide were afraid of losing their jobs and going to jail. The 
child had been unconscious for over 30 minutes when CPR rescue efforts 
first began. The autopsy report cites the cause of death as 
cardiorespiratory arrest due to compressive asphyxia. The aide 
responsible for smothering the child was convicted of second degree 
manslaughter and is scheduled to be released from prison in 2012. 

Case 4: This 15-year-old male died on the first day of school in August 
2003 after being restrained by staff at a Michigan public high school. 
The student had been previously diagnosed with autism and had an 
Individual Education Plan (IEP) signed by his mother that summer which 
stated that his disability affected his ability to perform socially or 
academically at his grade level. The plan described him as being 
inquisitive, artistic and motivated to please. It also stated that the 
boy enjoyed verbal praise and positive adult attention. 

On the day of his death, an aide accompanied the student to a choir 
class with approximately 20 other students. In addition to the student, 
there was one other autistic student and three special education 
students. About 15 to 20 minutes into the class, the student's eyes 
rolled back into his head, his body began to convulse, and he lost 
control of his bladder. The aide stated that she believed the student 
was having a seizure. She placed the student on the floor and after 
several minutes, another aide pressed the room's emergency button. The 
school's assistant principal responded to the classroom and decided 
that the student did not need medical attention. He instructed another 
staff member to call the student's mother to pick him up. 

Approximately 10 minutes after the seizure, the student got up but 
seemed unsteady so the instructional aide tried to assist him into a 
seated position. At this point, the student jumped up and began 
flailing his arms. The choir teacher, who had moved her students to 
another part of the room to continue the class, made another call for 
assistance and the assistant principal returned, this time accompanied 
by another aide. Shortly thereafter, the student began to scream and 
flail his arms again. According to the assistant principal's written 
statement, he believed that the student might hurt himself or others, 
so he and the two aides placed the student in a full restraint facedown 
on the floor. Specifically, the assistant principal was holding the 
student's arms behind his back, one of the aides held his legs down, 
and the other was holding his shoulders. The assistant principal went 
on to state that it was very difficult to hold onto the student and 
that every time they relaxed the restraint, he would begin to struggle 
again. They restrained him in this manner for approximately an hour, 
but did not call any medical professionals to attend to the student 
during this time. 

The assistant principal and the aides eventually stopped the restraint 
when a man and woman who were friends of the mother arrived to pick the 
student up. The male friend tried to talk to the student but he did not 
respond. Both the assistant principal and the two friends thought the 
student looked strange and asked the school staff to call 911. The 
assistant principal checked the student and said he felt a pulse, but 
the female friend stated that he was not breathing. The assistant 
principal checked again for a pulse and found none, so the female 
friend started CPR. The assistant principal, who had an expired CPR 
certification, assisted by pinching the student's nose closed. Police 
and firefighters arrived and continued CPR for an additional 30 minutes 
until paramedics transported the student to a hospital, where he was 
pronounced dead. In the autopsy report, the medical examiner concluded 
that the student had suffered an apparent seizure and further wrote 
that "restraint in the prone position of emotionally and physically 
agitated individuals is recognized as being associated with sudden 
death, even without significant chest or neck compression." The 
official cause of death was listed as "prolonged physical restraint in 
prone position associated with extreme mental and motor agitation." His 
death was ruled an accident and no criminal charges were filed. 

In 2006, the student's mother settled a civil case against the school 
district and the regional educational services agency for $1.3 million. 
In her deposition, the choir teacher stated that she had no idea the 
student was autistic until she saw him walk into the class with his 
aide and that she had no prior information on the student. In his 
deposition, the school's principal testified that neither he nor the 
assistant principal had received training about the dangers of 
restraining an individual on the floor. The aide who had held the 
student's feet to the floor also testified in a deposition that he was 
never given any advice or information on restraining students. Further, 
according to an instructor who had provided training that included the 
use of restraints to both the Regional Educational Service Agency 
(RESA) and school district staff testified, the instructional aide who 
accompanied the student into the class had last received such training 
in 1987. At the time of the incident, the instructor said that 
training, which includes the use of restraints, was offered to school 
district employees but the decision about who had to be trained was 
left to principals or program supervisors. 

As of April 2009, the assistant principal who made the decision to 
restrain the student currently serves as the principal of the 
district's middle school and one of the other staff members who 
restrained the student is currently employed by the district's regional 
educational service agency. We were unable to determine whether the 
other staff members are still employed by this or any other school 
district. None of the staff members who restrained the child had any 
criminal histories. 

As a result of this student's death, and another student death in 2003 
caused by improper restraint, a member of the Michigan State Board of 
Education (SBE) told us that SBE changed its recommended policies on 
the use of restraints and seclusions. However, though the policy 
encourages local school districts to collect and report data on the use 
of these techniques to the Michigan Department of Education, the board 
member expressed doubt that this was actually done. In each year since 
the policy was enacted, the member said that she has requested any 
statistics or reports on the use of seclusion and restraints but has 
never received any information. 

Case 5: The child in this case was an adopted, 4-year-old female who 
was strapped to a chair by her teacher at a West Virginia public 
school. The child was born with cerebral palsy and was later diagnosed 
with autism. In February 1998, she started special education classes 
and shortly thereafter, began to have tantrums and wet her pants at 
school. According to the child's mother, these behaviors continued at 
home and, even though the child was toilet trained. Her mother also 
said that the girl began coming home from school with bruises covering 
her calves, chest, and wrists. 

According to the school and teachers, after the girl was enrolled in 
school for just 10 days, her mother arrived at school to pick her up 
and was told by a teacher's aide that she was being uncooperative and 
had been restrained in a chair for medically fragile children. The 
mother later claimed that, because the child was autistic, she would 
act up when she needed to use the bathroom. The school and teachers 
stated that they put her in the chair because she was "uncooperative." 
According to the mother, the chair resembled an electric chair and was 
high backed with multiple leather straps across the arms, chest, lap, 
and legs. The mother told the school to never use the chair again. 

That same day, the child's mother removed her daughter from the West 
Virginia Elementary School and reported the bruises and use of the 
restraint to the State Board of Education. When the Board provided no 
help, the mother sued the school district alleging, among other things, 
that the school's actions directly and proximately caused and will 
continue to cause her daughter great psychological and emotional 
stress, developmental delays, trauma, fears, and pain and suffering. 
The jury found that the defendants did not discriminate against the 
child, violate the child's constitutional rights, commit assault and 
battery against the child, or falsely imprison the child. However, the 
jury did find the school board liable for negligently supervising and 
training three teachers in the use of restraints, which proximately 
caused injury and awarded the mother and child $460,000 for mental pain 
and suffering and the mother's lost wages. 

We contacted the school district to see if any corrective actions have 
been taken to prevent similar incidents from occurring. According to 
the school's superintendent, the school district no longer uses 
restraints. Unrelated to the case, West Virginia also promulgated a 
state regulation stating that school personnel in a pre-kindergarten 
classroom may not restrain a child by any means other than a firm grasp 
around a child's arms or legs and only for as long as necessary. 

According to the family's attorney, a doctor diagnosed the child with 
post traumatic stress disorder as a result of the restraint. Although 
she is now 15 years old, her mother says that she has still not 
returned to school and suffers anxiety when she sees a school or hears 
the word "teacher." In addition, she will not use public restrooms 
because she believes that it is wrong to urinate in public. At least 
one of three teachers responsible for restraining the child is still 
teaching in the same school. 

Case 6: The four students, all males all under 6 years old, attended a 
special education class in a Tennessee public school, where they were 
assaulted and physically restrained by their teacher between early 
December 2003 and mid-March 2004. One of the children was diagnosed 
with a condition similar to Down syndrome, according to his parents. 

The school had received complaints about the teacher after the 2002 to 
2003 school year, prompting the Director of Special Education for the 
county to initiate an inquiry. As a result of these complaints, the 
school system developed a corrective action plan, which included 
installing a surveillance camera in the teacher's classroom, mentoring, 
and direct supervision by the school's Special Education Director. 

Despite these corrective measures, the teacher's interactions with the 
children did not improve during the following school year. 
Specifically, to prevent the child from wandering, the teacher tied the 
child suffering from the Down syndrome type-condition to a cot with a 
sheet while he was wearing a 5 pound lead physical therapy vest, which 
was supposed to be used to help with the child's posture. The child's 
mother asked that school staff not restrain her son since it would be 
difficult to free him in the event of a fire. Despite her request, the 
teacher allegedly continued to restrain the boy, sometimes so tightly 
that a teacher's aide would spend 5 minutes or more trying to unravel 
the knots. In addition to the restraint there were claims that the 
teacher hit the children with a flyswatter, ruler, and her hand, 
according to a complaint filed with the Tennessee Department of 
Children's Services. 

The Board of Education suspended the teacher in March 2004 and 
dismissed her in June 2004. In June 2005, a grand jury indicted the 
teacher on 14 counts of child abuse and 14 counts of assault. The 
teacher, who had no prior criminal convictions, pled guilty to one 
count of felony child abuse and neglect and three counts of misdemeanor 
assault. In February 2007, according to the terms of her plea 
agreement, she was placed on 3 years of probation but did not serve any 
jail time. According to the assistant district attorney general who 
handled the case, it was challenging because state law requires proof 
that the children were harmed, such as pictures of bruises or 
statements from doctors and there was no such evidence. He also said 
that the teacher's guilty plea and subsequent felony conviction for 
child abuse guaranteed that she would never be able to teach again in 
Tennessee. Tennessee revoked her teaching license, but we were unable 
to determine whether she is teaching or otherwise interacting with 
children in any other state. 

Case 7: An 8-year-old boy was restrained by a substitute teacher who 
used masking tape to strap him to a chair and seal his mouth at an 
Illinois public school in March 2006. The child, who was diagnosed with 
attention-deficit hyperactivity disorder, attended a special education 
class with up to eight other students with various emotional or 
physical disabilities. 

On the day of the incident, the substitute told the 8 year old and 
another male student in the class that they would not be allowed to 
play during their free time and told them to draw at their desks. In a 
written statement, the substitute told police that he disciplined the 
boys because they were "acting up and causing problems." The substitute 
testified that the two boys still did not remain in their seats, so he 
told them to sit in their chairs and put their hands behind their 
backs, and then he wrapped masking tape around their arms. After the 
boys broke free, the substitute taped them again in the same manner. 
The substitute testified that the students were "laughing" so he placed 
tape over each of their mouths and returned his attention to the class. 
After the 8 year old began "mumbling," the substitute removed the tape 
from his mouth and the child told him "his arms hurt." In a hand- 
written note the substitute left for the class's regular teacher, he 
wrote "I hope I didn't do something wrong by masking taping [the boys] 
to their chairs for a couple minutes. They were laughing most of the 
time when I did it." 

The 8 year old reported the incident to his after-school daycare 
provider, according to the Illinois Department of Children and Family 
Services (DCFS). DCFS coordinated its efforts with law enforcement as 
well as the county's victim advocacy center and the State's Attorney 
Office and a grand jury ultimately charged the substitute with two 
felony counts of unlawful restraint and two felony counts of aggravated 
battery. During the trial, the school's principal testified that 
district policy allowed physical restraint in limited circumstances: to 
prevent students from harming themselves or damaging property or to 
remove a student who will not voluntarily leave an area. The principal 
also testified she did not know whether the substitute was ever given 
these policies. 

A jury found the substitute guilty of one count of unlawful restraint 
and one count of aggravated battery in July 2008. The substitute was 
sentenced to 24 months probation, fined $1,500, perform 80 hours of 
community service, and undergo a psychological evaluation. The 
substitute still holds an Illinois state substitute teaching 
certificate that expires in June 2009. Prior to this incident, the 
substitute had been arrested in 2001 for driving under the influence of 
alcohol. He was sentenced to 18 months supervision and treatment for 
alcoholism, and fined $1,500. 

Although this case was successfully prosecuted, individuals we 
interviewed from the State's Attorney Office and Equip for Equality 
(Illinois Protection and Advocacy Service) told us that seclusion and 
restraint cases involving children and adults with physical or mental 
disabilities typically have low rates of prosecution. The State's 
Attorney Office cited reasons such as the reluctance to further 
traumatize victims by having them testify, the stereotype that special 
needs children are unreliable witnesses, and sympathy for teachers and 
other staff seen as working with challenging individuals who might need 
to be secluded or restrained. In addition, Equip for Equality officials 
told us these incidents may also go underreported if children are not 
able to relate their experiences because they may be unable to 
communicate orally. 

Case 8: The students were five first grade children restrained by a 
volunteer teacher's aide at a public elementary school in Florida in 
August and September 2003. The volunteer aide, who had a prior criminal 
record, was charged with child abuse and false imprisonment for using 
tape to restrain and gag her students as punishment for misbehavior. 

The students, aged 6 and 7, were bound with tape in a variety of ways. 
The aide lashed their arms to their laps, tied their ankles together, 
strapped their bodies to their desks, fastened their heads to the 
blackboard and sealed their mouths shut. A portion of one child's hair 
was snatched off when the aide forcibly removed the tape. We could find 
no evidence to indicate that the school trained or conducted a 
background check on the aide, who was at the time a felon on probation 
for armed burglary, cocaine possession and grand theft. 

After the students filed a complaint with the police, the aide 
surrendered and was charged with five felony counts of child abuse. She 
pled guilty to four counts of false imprisonment and one count of 
misdemeanor battery in January 2005 and was placed on 5 years 
probation, with the possibility of early termination of this probation 
after 2 and a half years and completion of all special release 
conditions, which included serving 75 hours of community service, 
taking classes in parenting and anger management, and having no contact 
with the students. Approximately a year later the aide was again 
arrested, this time for possession of cocaine and drug paraphernalia. A 
law enforcement officer witnessed her with a crack pipe. 

Case 9: The student was a 7-year-old female enrolled in a special 
classroom at a public school in California when her teacher began 
secluding, restraining, and abusing her. The student, a small, frail 
girl weighing only 43 pounds, was diagnosed with Asperger's Syndrome, a 
form of autism characterized by language impairment and poor social 
skills. 

According to the student's mother, the teacher secluded the girl in a 
walled off area in the back of the classroom accessible by only one 
door because she refused to do her school work. The mother alleged that 
when the teacher discovered that her daughter was wiggling a loose 
tooth, the teacher physically restrained her by making her lie face 
down on the floor and sitting on top of her. When the student came home 
from school that day, she complained to her mother, "Mommy, Mommy, my 
teacher hurt me, and I couldn't breathe." In June 2001, the student's 
mother sent a letter to the teacher instructing her to discontinue all 
physical restraints on her daughter. Despite these instructions, the 
parents alleged that restraint and other physical abuse continued. They 
also alleged that the girl was frequently left in seclusion for 3 hours 
at a time for refusing to do work. In December 2001, the parents met 
with the principal and the teacher and ordered the teacher to stop all 
physical restraints and prolonged seclusions, placing these 
instructions in the child's IEP. 

The restraint and other mistreatment continued, according to the 
parents. In April 2002, the parents alleged that the teacher admitted 
to smearing the contents of a burrito all over the student's face and 
hair after she refused to eat. In July, the parents removed their 
daughter from the school after the teacher allegedly physically 
restrained her at least three times in one day during summer school. 
Furthermore, according to the parents' complaint, the teacher kicked 
the student, spun her around, and dropped her on her head. When her 
mother picked her up from school that day, the child had a severe 
abrasion to her arm, a one-inch diameter bruise on her right shoulder, 
and a bump on the right side of her head. The student told her mother 
she was "hurt all day" by her teacher. The teacher later said she 
restrained the student because she was a danger to herself and others. 
Furthermore, the teacher said the student had threatened her by waving 
a pair of scissors at her. According to the teacher, while she was 
restraining the child, her arm gave out and the student fell to the 
floor, injuring herself. The school's principal stated that the teacher 
received training once a year in applying restraints. However, this was 
not the first time the teacher had been accused of physically 
mistreating a child. Prior to the July 2002 incident, the teacher was 
accused of using excessive force while restraining another child in her 
classroom. However, the teacher did not have any prior criminal 
convictions. 

The student's family sued the teacher, multiple school officials, and 
the school district. At trial, the teacher and school's principal were 
found liable for negligence and civil rights violations and the school 
district was found liable for civil rights violations. The family was 
initially awarded $700,000 in damages. According to the student's 
attorney, to avoid an appeal by the school district, the family settled 
with the school district and school officials. As part of the 
settlement agreement, though, the school district and school officials 
did not admit any liability. The student's family was ultimately 
awarded $260,000. In addition, the parties agreed to a 2-year period of 
judicial oversight during which the school district would be required 
to institute policy changes related to the discipline and behavior 
management of special needs children in order to achieve the goals of 
training, supervision, and accountability. 

The school officials involved with this case are no longer employed 
with the school district, according to the student's attorney. However, 
in October 2002, the teacher began teaching in a different school 
district, where she remained until June 2005. She currently holds a 
valid California state teaching license, but we were unable to 
determine if she is employed as a teacher. The student is now home- 
schooled and living in a different state. According to the student's 
mother, the girl has never fully recovered from her experience. 

Case 10: The student was a 9-year-old male with a learning disability 
who was secluded in a time out room repeatedly while enrolled in second 
grade in a New York public school. As part of his educational plan, his 
mother agreed to an IEP to assist with his learning disability. The IEP 
specified that the school may put the child in a 'time-out' room to 
correct inappropriate behavior, but only as a last resort. However, 
school records show that the student was placed in the time-out room 
regularly--75 times over a 6 month period during the 1992-1993 school 
year, occasionally for an hour or longer. The reasons for the 
confinement logged by the teachers included behaviors that were not 
physically aggressive; examples include, "whistling," "slouching," and 
"waving hands." In order to reach the room, the child was escorted out 
of his classroom in front of his peers, down a hallway, and to a 
location by the school auditorium. Although the door to the room was 
unlocked, a staff person would hold the door of the room closed to 
prevent him from leaving, and the child's hands became blistered at 
least once while trying to escape. On at least one occasion, the child 
claims he was physically restrained facedown on the floor. The school 
district felt that this approach was reasonable; however, a 
psychologist said that the child suffered from attention deficit 
hyperactivity disorder (ADHD), and his attorney argued that perhaps he 
couldn't control the behaviors that led to his confinement. As shown in 
pictures taken by the child's mother, the time-out room was small-- 
approximately the length of an adult's arm span--and was lined with 
ripped and dirty padding. In addition, the student's mother reported 
that the room lacked ventilation and had an odor of "dirty feet and 
urine." When she visited the room and observed the conditions there, 
she requested that her son be transferred to another school. 

The student brought a civil suit against the school district, alleging 
false imprisonment, negligent infliction of emotional distress, and a 
violation of the prohibition against unlawful seizure under the Fourth 
Amendment of the U.S. Constitution. The court awarded $75,000 to the 
student's family plus legal fees--$1,000 for each of the 75 times that 
the child was placed in the room. Based on our investigation, none of 
the educators associated with this case appear to have a criminal 
history. We were unable to determine whether they are still teaching. 

Cases Involving Restraint from Previous Work: 

The following three cases from our previous work on residential 
treatment programs confirm the finding that face down or other 
restraints that block the airway can be deadly. In these cases, staff 
members restrained the victims by holding them face down in the ground, 
resulting in death by severed artery, suffocation, and abnormal 
heartbeat, respectively. In addition, all the teens in these cases were 
diagnosed with disabilities. 

Table 2: Summary of Cases from Previous Work on Residential Treatment 
Centers for Troubled Youth: 

Case: 1; 
Victim information: Male, 15, Oregon resident; 
Program attended: Oregon wilderness therapy program; 
Date of death: 2000; 
Case details related to use of restraint: 
* Refused to return to campsite but did not behave violently; 
* Restrained by staff and held face down to the ground for almost 45 
minutes; 
* Died of severed artery in neck. 

Case: 2; 
Victim information: Male, 12, Texas resident; 
Program attended: Texas residential treatment center; 
Date of death: 2005; 
Case details related to use of restraint: 
* Victim was angry and started banging his head against the ground; 
* A 5 feet, 10 inch, muscular staff member placed the 87-pound victim 
into a facedown restraint; 
* Several witnesses claimed they saw the staff member lying across the 
back of the victim; 
* Victim complained he couldn't breathe and eventually became 
unresponsive, at which point the staff member removed the restraint; * 
* Attempts to revive victim failed. 

Case: 3; 
Victim information: Male, 16, Pennsylvania resident; 
Program attended: Pennsylvania psychiatric residential treatment 
center; 
Date of death: 2006; 
Case details related to use of restraint: 
* Victim was placed under "intense observation" for attempting to run 
away from the program; 
* Victim was ordered to put the hood of his sweatshirt down so that 
staff could see his face, but victim refused; 
* Three staff members brought the victim to another room and placed him 
in facedown restraint; 
* After 10 minutes of the restraint, victim complained that he couldn't 
breathe; 
* Victim died at the hospital 3 hours later from an abnormal heartbeat. 

Sources: Records including police reports, court documents, and 
interviews. 

[End of table] 

Case 1: The victim was a 15-year-old male who died while being 
restrained by two counselors. According to the victim's mother, in 2000 
she enrolled her son in a wilderness program in Oregon to build his 
confidence and develop self-esteem in the wake of a childhood car 
accident. The accident had resulted in her son sustaining a severe head 
injury, among other injuries. According to her lawsuit, her son left 
the program headquarters on a group hike with three counselors and 
three other students. Several days into the multiday hike, the victim 
refused to return to the campsite after being escorted by a counselor 
about 200 yards to relieve himself. Two counselors then attempted to 
lead him back to the campsite. According to an account of the incident, 
when he continued to refuse, they tried to force him to return and they 
all fell to the ground together. The two counselors subsequently held 
the victim face down in the dirt until he stopped struggling; by one 
account a counselor sat on the victim for almost 45 minutes. When the 
counselors realized the victim was no longer breathing, they telephoned 
for help and requested a 911 operator's advice on administering CPR. 
While the mother was driving to the hospital, her son's doctor called, 
advised her to pull to the side of the road, and informed her that her 
son had died. The victim's mother told us that she was informed, after 
the autopsy, that the main artery in her son's neck had been torn. The 
cause of death was listed as a homicide. 

In September 2000, after the boy's death, one of the counselors was 
charged with criminally negligent homicide. A grand jury subsequently 
declined to indict him. 

In early 2001, the mother of the victim filed a $1.5 million wrongful 
death lawsuit against the program, its parent company, and its 
president. The lawsuit was settled in 2002 for an undisclosed amount. 

Case 2: The victim, who died in 2005, was a 12-year-old male. Documents 
obtained from the Texas Department of Family and Protective Services 
indicate that the victim had a troubled family background. He was taken 
into state care along with his siblings at the age of 6. As a ward of 
the state, the victim spent several years in various foster placements 
and youth programs before being placed in a private residential 
treatment center in August 2005. The program advertised itself as a 
"unique facility" that specialized in services for boys with learning 
disabilities and behavioral or emotional issues. The victim's 
caretakers chose to place him in this program because he was 
emotionally disturbed. Records indicate that he was covered by 
Medicaid. 

On the evening of his death, the victim refused to take a shower and 
was ordered to sit on an outside porch. According to police reports, 
the victim began to bang his head repeatedly against the concrete floor 
of the porch, leading a staff member to drag him away from the porch 
and place him in a "lying basket restraint" for his own protection. 
During this restraint, the 4 feet 9½ inch tall, 87-pound boy was forced 
to lie on his stomach with his arms crossed under him as the staff 
member, a muscular male 5 feet 10 inches tall, held him still. Some of 
the children who witnessed the restraint said they saw the staff member 
lying across the victim's back. During the restraint, the victim fought 
against the staff member and yelled at him to stop. The staff member 
told police that the victim complained that he could not breathe, but 
added that children "always say that they cannot breathe during a 
restraint." According to police reports, after about 10 minutes of 
forced restraint, the staff member observed that the victim had calmed 
down and was no longer fighting back. The staff member slowly released 
the restraint and asked the victim if he wanted a jacket. The victim 
did not respond. The staff member told police he interpreted the 
victim's silence as an unwillingness to talk because of anger about the 
restraint. He said he waited for a minute while the victim lay silently 
on the ground. When the victim did not respond to his question a second 
time, he tapped the victim on the shoulder and rolled him over. The 
staff member observed that the victim was pale and could not detect a 
pulse. All efforts to revive the victim failed, and he was declared 
dead at a nearby hospital. 

Although the Texas Department of Family and Protective Services alleged 
that the victim's death was because of physical abuse, the official 
certificate of death stated that it was an accident and a grand jury 
declined to press charges against the staff member performing the 
restraint. However, the victim's siblings obtained a civil settlement 
against the program and the staff member for an undisclosed amount. 

Case 3: The victim was 16 years old when he died, in February 2006, at 
a private psychiatric residential treatment facility in Pennsylvania 
for boys with behavioral or emotional problems. He was a large boy--6 
feet 1 inch in height and weighing about 250 pounds--and suffered from 
bipolar disorder and asthma. The cost for placement in this facility 
was primarily paid for by Medicaid. 

According to state investigative documents we obtained, the victim was 
placed in intensive observation after he attempted to run away. As part 
of the intensive observation, he was forced to sit in a chair in the 
hallway of the facility and was restricted from participating in some 
activities with other residents. On the day of his death, staff allowed 
the victim to participate in arts, crafts, and games with the other 
youth, but would not let him leave the living area to attend other 
recreational activities. Instead, staff told the victim that he would 
have to return to his chair in the hallway. In addition, staff told him 
that he would have to move his chair so that he could not see the 
television in another room. The victim complied, moving his chair out 
of view of the television, but put up the hood of his sweatshirt and 
turned his back toward the staff. The staff ordered him to take down 
his hood, but he refused. When one of the staff walked up to him and 
pulled his hood down, the victim jumped out of his chair and made a 
threatening posture with his fists, saying he did not want to be 
touched. The staff member and two coworkers then brought the victim to 
another room and held him facedown on the floor with his arms pulled up 
behind his back. The victim struggled against the restraint, yelling 
and trying to kick the three staff members holding him down. After 
about 10 minutes, the victim became limp and started breathing heavily. 
He complained that he was having difficulties breathing. One staff 
member unzipped his sweatshirt and loosened the collar of his shirt, 
but rather than improve, the victim became unresponsive. The staff 
called emergency services and began CPR. The victim was taken by 
ambulance to a hospital, where he died a little more than 3 hours 
later. In the victim's autopsy report his death was ruled accidental, 
as caused by asphyxia and an abnormal heartbeat (cardiac dysrhythmia). 

No criminal charges were filed in regard to the victim's death. The 
victim's mother filed a civil suit over her son's death against the 
facility. The suit was pending at the time we completed our 
investigation. 

Mr. Chairman and Members of the Committee, this concludes my statement. 
I would be pleased to answer any questions that you or other members of 
the committee may have at this time. 

Contacts: 

For further information about this testimony, please contact Gregory D. 
Kutz at (202) 512-6722 or kutzg@gao.gov. Contact points for our Offices 
of Congressional Relations and Public Affairs may be found on the last 
page of this testimony. In addition to the individual named above, the 
following individuals made key contributions to this testimony: Cindy 
Brown Barnes, John W. Cooney, Jennifer L. Costello, Paul R. 
Desaulniers, Eric G. Eskew, Georgeann M. Higgins, Christine A. 
Hodakievic, Jason Kelly, Barbara C. Lewis, Otis S. Martin, Flavio 
Martinez, Vicki R. McClure, James Murphy, Andrew A. O'Connell, Mary V. 
Osorno, Anthony A. Paras, Ramon J. Rodriguez, Kira Self, and Emily C.B. 
Wold. 

[End of section] 

Appendix I: Summary of State Laws Related to the Use of Restraints and 
Seclusions in Public and Private Schools: 

The following list provides an overview of laws related to the use of 
restraints or seclusions in public and private schools in all 50 states 
and the District of Columbia. 

Alabama: 

Ala. Code § 16-1-14 (Education; General Provisions): 

* Local school boards may prescribe rules and regulations, subject to 
State Board of Education approval, that isolate or separate pupils who 
create disciplinary problems in any classroom or other school activity 
and whose presence in the class may be detrimental to the best interest 
and welfare of the class as a whole. 

Alaska: 

Alaska Admin. Code tit. 4, §§ 07.010 - .900 (Education and Early 
Development; Student Rights and Responsibilities): 

* The use of corporal punishment in Alaska public schools is 
prohibited. However, the definition of corporal punishment does not 
include the use of reasonable and necessary physical restraint of a 
student to protect the student or others from physical injury, to 
obtain possession of a weapon or other dangerous object from a student, 
to maintain reasonable order in the classroom or on school grounds, or 
to protect property from serious damage or destruction. 

Arizona: 

None. 

Arkansas: 

005-18 Ark. Code R. § 020 (Department of Education; Special Education 
and Related Services): 

* Public agencies that provide education to children with disabilities 
must follow standards for use of a time-out seclusion room. Time-out 
seclusion should be used only for behaviors that are destructive to 
property, aggressive toward others, or severely disruptive to the class 
environment. Also, it should only be used as a last resort when less 
restrictive means are ineffective. Only necessary reasonable force may 
be used to place a student in such a room and, in general, time-out is 
not an appropriate intervention for classroom use with any students 
older than 12 unless they have made a contractual agreement for its 
use. Rooms must meet certain guidelines, such as minimum size 
restrictions, and provide for continuous visual and auditory 
monitoring. The door should be such that it cannot be locked. The use 
of seclusion time-out must be stated in the student's IEP and have 
parental consent with documented written procedures. Maximum time to be 
spent in the room varies from 5 to 20 minutes, depending on the grade 
level. Careful consideration must be taken in extending the prescribed 
length of the seclusion. Records must be kept of each use of the room. 
Personnel must be adequately trained and supervised. 

California: 

Cal. Code Regs. tit. 5, § 3052 (Education; California Department of 
Education; Handicapped Children; Special Education; Implementation): 

* Emergency interventions for special education students may only be 
used to control unpredictable, spontaneous behavior which poses a clear 
and present danger of serious physical harm to the individual or others 
and which cannot be immediately prevented by a response less 
restrictive than the temporary application of a technique used to 
contain the behavior. 

* Emergency interventions may not include locked seclusion, the use of 
force that exceeds that which is reasonable and necessary under the 
circumstances, or the employment of a device or material or object 
which simultaneously immobilize all four extremities, except that 
techniques such as prone containment may be used as an emergency 
intervention by staff trained in such a procedure. 

* Parents must be notified within one school day whenever an emergency 
intervention is used, and a Behavioral Emergency Report must be 
completed that includes details of the incident. The number of reports 
created annually is reported to the state Department of Education. 

* No intervention may be used which is designed or likely to cause 
physical pain; which denies adequate sleep, food, water; shelter, 
bedding, physical comfort, or access to bathroom facilities; that 
precludes adequate supervision of the individual; or which deprives the 
individual of one or more of his or her senses. 

Colorado: 

Colo. Rev. Stat. §§ 26-20-101 to -109 (Human Services Code; Protection 
of Persons from Restraint): 

* Certain state agencies, including the Colorado Department of 
Education, are subject to restrictions on the use of restraints. These 
include the requirement that restraints may only be used in cases of 
emergency and after the failure of less restrictive alternatives, 
unless such alternatives would be inappropriate or ineffective under 
the circumstances. Restraints may only be used for the purpose of 
preventing the continuation or renewal of an emergency, for the time 
period necessary, and with no more force than is necessary. However, 
the term "restraint" does not include the holding of an individual for 
less than 5 minutes by a staff person for the protection of the 
individual or other persons. 

* Physical restraints must not place excess pressure on the chest or 
back or impede the ability to breathe, and staff must check to ensure 
that the breathing of the individual is not compromised. 

* Agencies shall ensure that staff utilizing restraint are trained in 
its appropriate use, and agencies shall ensure each use of restraint is 
appropriately documented. 

* Additional restrictions apply to the use of mechanical or chemical 
restraints. 

1 Colo. Code Regs. § 301-45 (Department of Education; Colorado State 
Board of Education; Protection of Persons from Restraint): 

* Restraints shall only be used in an emergency and with extreme 
caution and are limited to situations in which there is serious, 
probable, and imminent threat of bodily harm. In addition to formally 
adopting the above statutes, the regulations specify that restraints 
must never be used as a form of discipline or as a threat to control or 
gain compliance of a student's behavior. Only trained staff may 
administer restraints, and restraints may not be used in such a way 
that the student is prevented from breathing or communicating. A 
restrained student must be continuously monitored to ensure breathing 
is not compromised, and a student shall be released within 15 minutes, 
except where precluded for safety reasons. When the restraint is no 
longer necessary to protect the student or the safety others, it must 
be removed. A student's behavior plan must address the specific 
circumstances, procedures, and staff involved if there is a possibility 
that restraint may be used as part of crisis management. When it is 
anticipated that restraint will be used in an emergency situation, 
written parental permission must be obtained. Staff training must 
include a continuum of prevention and de-escalation techniques, as well 
as techniques that allow restraint in an upright or sitting position. 
If a restraint is used, a written report must be submitted within one 
school day detailing the incident, the parents must be notified as soon 
as possible, and the incident must go through a review process. 

Connecticut: 

Conn. Gen. Stat. §§ 46a-150 to -154 (Human Rights; Physical Restraint, 
Medication and Seclusion of Persons Receiving Care, Education, or 
Supervision in a School, Institution, or Facility): 

* Providers of education to special education students may not use life-
threatening physical restraints, defined as those restraints that 
restrict the flow of air into a person's lungs, whether by chest 
compression or other means. Involuntary physical restraint may not be 
used on special education students except as emergency intervention 
designed to prevent immediate or imminent injury to the person at risk 
or to others. The restraint may not be used for discipline or 
convenience and is not as a substitute for a less restrictive 
alternative. The use of physical restraint must be documented in the 
student's record, and parents must be notified. A special education 
student who is physically restrained must be continually monitored by a 
provider or assistant and regularly evaluated for indications of 
physical distress. Each incident must be fully documented, and all 
providers and assistant providers must be trained in the use of 
physical restraint, including de-escalation techniques, prevention 
strategies, types of physical restraints, differences between life- 
threatening restraints and other types, differences between permissible 
restraints and pain compliance techniques, and more. Incidents must be 
compiled and reported annually to the state. 

* Special education students may not be placed in seclusion except as 
an emergency intervention to prevent immediate or imminent injury to 
the person or to others. The seclusion may not be used for discipline 
or convenience and is not used as a substitute for a less restrictive 
alternative. The use of seclusion must be documented in the student's 
record, and parents must be notified. A special education student who 
is involuntarily placed in seclusion must be frequently monitored by a 
provider or assistant and regularly evaluated for indications of 
physical distress. Each incident must be fully documented, and all 
providers and assistant providers must be trained in the use of 
seclusions. Incidents must be compiled and reported annually to the 
state. 

Delaware: 

14-900 Del. Code Regs. § 929 (Department of Education; Special 
Populations): 

* While "restraint" or "seclusion" are not discussed directly, a 
school's "emergency intervention procedures" and "behavior management 
procedures" for children with autism must be reviewed by the state's 
Human Rights Committee and Peer Review Committee. Parents must give 
informed consent for the use of each behavior management procedure, and 
may withdraw that consent at any time. 

* District of Columbia: 

D.C. Code §§ 38-2561.01 - .16 (Educational Institutions; Special 
Education; Nonpublic Schools): 

* "Aversive intervention" includes a variety of practices, including 
the use of chemical restraints; withholding adequate sleep, shelter, 
clothing, bedding, or bathroom facilities; and withholding meals, 
essential nutrition, or hydration. Except in certain limited 
circumstances, no student whose education is funded by the D.C. 
government may be placed in a nonpublic special education school or 
program that allows the use of these aversive interventions. 

Florida: 

None. 

Georgia: 

None. 

Hawaii: 

Hawaii Rev. Stat. § 302A-1141 (Government; Education; Education; 
Provisions Affecting System Structure; Organization): 

* No physical punishment of any kind may be inflicted upon any pupil, 
but reasonable force may be used by a teacher in order to restrain a 
pupil in attendance at school from hurting oneself or any other person 
or property. 

Idaho: 

None. 

Illinois: 

105 Ill. Comp. Stat. 5/2-3.130 (Schools; Common Schools; School Code; 
State Board of Education - Powers and Duties): 

* The State Board of Education is required to promulgate rules 
governing the use of time out and physical restraint in public schools. 

105 Ill. Comp. Stat. 5/10-20.33 (Schools; Common Schools; School Code; 
School Boards): 

* Until rules are adopted by the State Board of Education, the use of 
physical restraints is prohibited except where the student poses a 
physical risk to persons, there is no medical contraindication to its 
use, and the staff applying it have been trained in its safe 
application. "Restraint" does not include momentary periods of physical 
restriction by direct person-to-person contact with limited force that 
is designed to prevent a student from completing an act that would 
result in potential physical harm to persons or damage to property, or 
to remove a student who is unwilling to leave an area voluntarily. Uses 
of restraint must be documented and parents notified. 

* Until rules are adopted by the State Board of Education, timeout 
rooms cannot lock other than with a mechanism that engages when a key 
or handle is being held by a person, cannot be a confining space such 
as a closet or box, and cannot be a room where the student cannot be 
continually observed. 

Ill. Admin. Code tit. 28, §§ 1.280, .285 (Education and Cultural 
Resources; Education; State Board of Education; Public School 
Recognition; Public Schools Evaluation, Recognition and Supervision; 
School Governance): 

* The restrictions listed in 105 Ill. Comp. Stat. 5/10-20.33 are 
repeated and adopted. In addition, physical restraint may only be used 
as a means of maintaining discipline and only to the extent necessary 
to preserve the safety of students and others. It may not be used as a 
form of punishment. Only specific, planned techniques are permitted. 

* Students are not subject to restraint for using profanity, verbal 
displays of disrespect, or verbal threats unless accompanied by a means 
or intent to carry out the threat. Except under certain limited 
circumstances, the use of mechanical or chemical restraints is 
prohibited. Use of restraint shall take into consideration the safety 
and security of the student, and it shall not rely on pain as an 
intentional method of control. If the student uses sign language or an 
augmentative mode of primary communication, the student shall be 
permitted to have the student's hands free of restraint for brief 
periods, unless the adult determines that such freedom appears likely 
to result in harm to self or others. The restraint must end as soon as 
the student is no longer in imminent danger of causing physical harm to 
persons. 

* Detailed records of each incident must be kept, and parents must be 
notified within 24 hours. Training must include alternatives to 
restraint, de-escalation procedures, the experience of administering 
and receiving a variety of restraint techniques, how to monitor for 
physical signs of distress, and retraining every 2 years. School 
districts must review the use of restraints annually. 

* Isolated time out may only be used as a means of maintaining 
discipline and only to the extent necessary to preserve the safety of 
students and others. It may not be used as a form of punishment. 

* Enclosures used for isolated time out must meet size requirements, be 
free of materials that can be used to cause harm, and be designed to 
permit continuous visual monitoring of and communication with the 
student. Doors, if used, must be steel or wood with a solid-core 
constriction, with an unbreakable viewing panel. An adult must remain 
within two feet and must be able to see the student at all times. If 
the enclosure has a locking mechanism, it must only be engaged when it 
is held in position by a person, or if electronically engaged, must 
automatically release if the building's fire alarm system is activated. 
A student may not be kept in isolated time out for more than 30 minutes 
after the problematic behavior has ceased. 

* Detailed records of each incident must be kept, and parents must be 
notified within 24 hours. School districts must review the use of 
isolated time out annually. 

Ill. Admin. Code tit. 23, § 401.250 (Education and Cultural Resources; 
Education; State Board of Education; Nonpublic Elementary and Secondary 
Schools; Special Education Facilities Under Section 14-7.02 of the 
School Code; Operations Requirements): 

* Private, special education facilities must have their staff trained 
in the use of isolated time out and restraint according to the 
requirements of Ill. Admin. Code tit. 28, §§ 1.280, .285: 

Indiana: 

None. 

Iowa: 

Iowa Admin. Code §§ 281-103.1 - .8 (Education Department; Protection of 
Children; Corporal Punishment Ban; Restraint; Physical Confinement and 
Detention): 

* Corporal punishment is prohibited, but does not include using 
reasonable and necessary force: in order to quell a disturbance or 
prevent physical harm to any person; in order to obtain possession of a 
weapon or other dangerous object; for the purposes of self-defense or 
defense of others; for the protection of property; to remove a 
disruptive pupil from class or school premises, or from school- 
sponsored activities off school premises; to prevent a student from the 
self-infliction of harm; or to protect the safety of others. 

* Physical restraint shall not be used as discipline for minor 
infractions and may be used only after other disciplinary techniques 
have been attempted, if reasonable. All school employees must receive 
adequate and periodic training, which must include alternatives to 
restraint, crisis prevention and intervention, de-escalation 
techniques, and its safe and effective use. The restraint must be 
reasonable and necessary in duration, and each occurrence must be 
documented. Parents must be notified of any occurrence the same day, if 
possible. 

* Prone restraints are prohibited, as is any restraint that obstructs 
the airway of any child. If the student uses sign language or an 
augmentative mode of primary communication, the student must be 
permitted to have the student's hands free of restraint for brief 
periods, unless an employee determines that such freedom appears likely 
to result in harm to self or others. 

* Physical confinement shall not be used as discipline for minor 
infractions and may be used only after other disciplinary techniques 
have been attempted, if reasonable under the circumstances. All school 
employees must receive adequate and periodic training, which must 
include alternatives to seclusion, and the safe and effective use of 
physical confinement. Parents must be notified of any occurrence the 
same day, if possible. 

* If a student is physically confined, the area of confinement must be 
of reasonable dimensions, and must be free from hazards and dangerous 
objects or instruments, considering the characteristics and condition 
of the student. There must be sufficient light and ventilation, a 
comfortable temperature, and reasonable break periods to attend to 
bodily needs. The time period must be reasonable considering the 
characteristics and condition of the student, and continuous adult 
supervision is required. If the room has a locking mechanism, it must 
only be engaged when it is held in position by a person, or if 
electronically engaged, must automatically release if the building's 
fire alarm system is activated or electrical power is interrupted. 

Kansas: 

None. 

Kentucky: 

None. 

Louisiana: 

None. 

Maine: 

Me. Rev. Stat. Ann. tit. 20, § 4502 (Education; Elementary and 
Secondary Education; Elementary and Secondary Schools; Basic School 
Approval): 

* Timeout areas must be well ventilated, sufficiently lighted, and may 
not be locked. The student must be either supervised by staff in the 
room or observed and heard by a person outside the room. 

05-071-033 Me. Code R. §§ 1.1 - 5.1 (Department of Education; General; 
Regulations Governing Time Out Rooms, Therapeutic Restraints, and 
Aversives in Public Schools and Approved Private Schools: 

* Local school administrative units and approved private schools must 
develop policies for isolated timeout rooms and therapeutic restraint 
consistent with these regulations. Policies must be reviewed at least 
annually. Each use shall be documented, and parents must be notified as 
soon practical. 

* Therapeutic restraint may be used by trained staff to prevent injury 
to the student or others. It may be used either as an emergency 
intervention or as part of an intervention plan, but only after less 
intrusive efforts have been attempted. The restraint shall use the 
least amount of physical contact necessary, and requires the presence 
of at least two adults, unless there is an emergency situation. 
Restraint shall not exceed one hour, unless the student is still 
presenting dangerous behavior. Mechanical and chemical restraints are 
prohibited. Individuals must be trained in the use of restraints, 
including de-escalation techniques. 

* Timeout rooms are used to reduce dangerous behavior and only after 
less intrusive interventions have failed. They may be used either as an 
emergency intervention or as part of an intervention plan, but not for 
punitive purposes, staff convenience, or to control minor misbehavior. 

* Use of the room shall not exceed one hour, unless the student is 
still presenting dangerous behavior. Students in a timeout room shall 
be directly observed at all times. Rooms must meet certain physical 
requirement, and have adequate light, hear, and ventilation. The door 
may not be locked, and must include an unbreakable observation window. 

Maryland: 

Md. Code Regs. 13A.08.04.01 - .06 (State Board of Education; Students; 
Student Behavior Interventions): 

* The restraint, exclusion and seclusion policies apply to public 
agencies and nonpublic schools. Restraint and seclusion may only be 
used: after less restrictive approaches have been considered; in a 
humane, safe, and effective manner; without intent to harm or create 
undue discomfort; and consistent with medical and psychological 
limitations and the student's intervention plan. Schools must review 
these policies annually. 

* Restraint does not include briefly holding a student to calm, 
comfort, or escort the student safely, moving a disruptive student who 
is unwilling to leave the area if other methods are unsuccessful, or 
intervening in a fight. The use of restraint is prohibited unless there 
is an emergency and the restraint is necessary to protect persons from 
imminent, serious, physical harm; it is permitted under the student's 
IEP; or the parents of a nondisabled student have provided written 
consent while a behavior plan is being developed. Only trained school 
personnel may apply restraints, and they may only use reasonable force. 
The use of mechanical restraints is prohibited except in specific 
circumstances. Each instance of restraint must be documented, and 
parents must be notified within 24 hours. 

* "Exclusion" means removing a student to a supervised area for a 
limited period of time. This may be used when the student's behavior 
unreasonably interferes with the student's or other's learning, or the 
behavior is an emergency and the exclusion is necessary to protect 
persons from imminent, serious, physical harm. School personnel must be 
able to see the student at all time, the exclusion area must provide 
adequate lighting, ventilation, and furniture, and the area must be 
unlocked and free of barriers. Exclusion periods may not exceed 30 
minutes. 

* "Seclusion" means the confinement of a student alone in a room from 
which the student is physically prevented from leaving. The use of 
seclusion is prohibited, unless there is an emergency and the seclusion 
is necessary to protect persons from imminent, serious, physical harm; 
it is permitted under the student's IEP; or the parents of a 
nondisabled student have provided written consent while a behavior plan 
is being developed. Seclusion rooms must be free of objects that could 
cause harm, provide an adequate view of the student, and provide 
adequate lighting and ventilation. School personnel must view the 
student at all times, and reassess every 30 minutes. Each instance of 
seclusion must be documented, and parents must be notified within 24 
hours. 

Massachusetts: 

603 Mass. Code Regs. 18.05 (Department of Education; Program and Safety 
Standards for Approved Public or Private Day and Residential Special 
Education School Programs): 

* Schools providing special education services must provide to parents, 
prior to admission, a copy of the school's policies and procedure 
related to restraints, exclusion, time out, and other aversive 
procedures. Written informed consent from the parent is required prior 
to utilizing these techniques. 

* Day special educational programs, residential special education 
programs, and special education programs within mental health 
facilities must all comply with their respective regulations regarding 
the use of restraints and seclusion. 

* A school's behavior management policy regarding seclusion must 
include guidelines for staff, the duration of the procedure including 
higher approval needed for any period longer than 30 minutes, the 
requirement that students shall be observable at all times, a procedure 
for staff to directly observe the student every 15 minutes, 
documentation requirements, and the requirements that the room may not 
be locked and must be safe. 

603 Mass. Code Regs. 46.01 - .07 (Department of Education; Physical 
Restraint): 

* This regulation applies only to students in publicly funded 
elementary and secondary education programs. Physical restraints may 
only be used in emergency situations, after less intrusive alternatives 
have failed, and with extreme caution. Schools must develop written 
procedures that are reviewed annually and include an explanation of the 
method of restraint, training requirements, reporting requirements, and 
complaint procedures. 

* All staff must be trained within the first month of each school year 
on types of restraints with related safety considerations, and some 
staff must receive additional in-depth training that includes de- 
escalation procedures, methods for evaluating the risk of harm in 
individual situations, the simulated experience of administering and 
receiving restraint, and more. 

* Restraint may only be used when non-physical interventions would not 
be effective, and the student's behavior poses a threat of imminent, 
serious, physical harm to self or others. Only reasonable force may be 
used. Restraint may not be used as a means of punishment or as a 
response to property destruction, disruption of school order, refusal 
to comply with school rules or directives, or verbal threats that do 
not constitute a threat of imminent, serious, physical harm. Only 
trained personnel may administer restraints, except to protect persons 
from imminent, serious physical harm, and when possible the restraint 
must be witnessed by at least one other adult. The safest method 
available and appropriate must be used, and floor or prone restraints 
are prohibited unless the method is required and the staff member has 
received in-depth training. Restraint must be discontinued as soon as 
possible; if it continues for more than 20 minutes, additional 
reporting requirements apply. No restraint may be administered in such 
a way that the student is prevented from breathing or speaking, and 
staff must continuously monitor the physical status of the student. 
Each incident must be reviewed and documented, and restraint reports 
may be reviewed by the Department of Education. Parents must be 
notified as soon as possible. 

Michigan: 

Mich. Comp. Laws Serv. § 380.1312 (School Code of 1976; The Revised 
School Code; Boards of Education, Powers and Duties Generally): 

* Corporal punishment is prohibited. However, school personnel may use 
reasonable physical force: upon a pupil to restrain or remove a pupil 
whose behavior is interfering with the orderly exercise and performance 
of school district or public school academy functions, if that pupil 
has refused to comply with a request to refrain from further disruptive 
acts; for self-defense or the defense of another person; to prevent 
self-injury; to quell a disturbance that threatens physical injury to 
any person; to obtain possession of a weapon or other dangerous object 
upon or within the control of a pupil; or, to protect property. 

Minnesota: 

Minn. Stat. §§ 121A.58 -.67 (Education Code: Prekindergarten - Grade 
12; Student Rights, Responsibilities, and Behavior; Discipline, All 
Students): 

* Corporal punishment is not allowed. However, a teacher or principal 
may use reasonable force when necessary to correct or restrain a 
student or prevent bodily harm or death. 

* The Commissioner of the Minnesota Department of Education must 
promulgate rules that govern the use of aversive procedures on children 
with a disability. These rules must require that the planned 
application of aversive and deprivation procedures only be instituted 
after developing a behavior intervention plan, and that education 
personnel will notify parents on the same day that aversive or 
deprivation procedures are used. 

* Rules for the use of aversive procedures on children with a 
disability must also include requirements: that the use of locked time- 
out have standards such as requiring a safe environment, continuous 
monitoring, ventilation, adequate space, a locking mechanism that 
disengages automatically when not continuously engaged, and more; that 
the commissioner make unannounced on-site visits to monitor locked time-
out rooms; and that a student may only be placed in locked time-out if 
it is part of the student's behavior intervention plan, or it is an 
emergency and only for the emergency's duration. 

Minn. R. 3525.2900 (Department of Education; Children with a 
Disability): 

* In addition to adopting the above restrictions, students in time-out 
seclusion must have adequate access to drinking water and a bathroom 
for a time-out that exceeds 15 minutes. Documentation of the time-out 
is required. The time-out area must be a safe environment without 
hazards; have adequate light, heat, and ventilation; have an 
observation window; and meet size specifications that allow the pupil 
to stand, stretch arms, and lie down. 

Mississippi: 

None. 

Missouri: 

None. 

Montana: 

Mont. Code Ann. § 20-4-302 (Education; Teacher, Superintendents, and 
Principals; Teachers' Powers, Duties, and Privileges): 

* Corporal punishment is prohibited. However, school personnel may use 
physical restraint that is reasonable and necessary, even if it causes 
physical pain, to quell a disturbance, provide self-protection, protect 
persons from physical injury, obtain possession of a weapon or 
dangerous object from the pupil, maintain the orderly conduct of a 
pupil, or protect property from serious harm. 

Mont. Admin. R. 10.16.3346 (Department of Education; Special Education; 
Services): 

* "Aversive treatment procedures" include physical restraint and 
isolation time-out. Aversive treatment procedures may be used on a 
special education student who exhibits behaviors which pose a risk of 
physical harm to the student or others, a risk of significant damage to 
property, or significantly disruptive or dangerous behaviors. Aversive 
treatment procedures must be designed to address the behavioral needs 
of an individual student, be approved by the IEP team, and may not be 
used as punishment, for the convenience of staff, or as a substitute 
for positive behavioral interventions. Any procedure intended solely to 
cause pain is prohibited. 

* Mechanical restraints are prohibited, except in limited 
circumstances. 

* A student in isolation time out must be under direct constant visual 
observation of a staff person. Isolation in a locked room is 
prohibited. 

Nebraska: 

None. 

Nevada: 

Nev. Rev. Stat. Ann. §§ 388.521 - .5315 (Education; System of Public 
Instruction; Pupils with Disabilities and Gifted and Talented Pupils; 
Use of Aversive Intervention, Physical Restraint and Mechanical 
Restraint on Pupils with Disabilities): 

* Mechanical restraints are prohibited, unless under certain 
circumstances where a medical order authorizing its use has been 
obtained. Additional rules also apply to the use of mechanical 
restraints. 

* Physical restraints may not be used on a pupil with a disability, 
unless an emergency exists where the restraint is necessary to protect 
the physical safety of persons from an immediate threat of physical 
injury or to protect against an immediate threat of severe property 
damage. The restraint may be for no longer than is necessary, and the 
use of force may not exceed that which is reasonable and necessary 
under the circumstances. Instances must be documented and reported to 
the school district and the parents. Staff authorized to carry out 
physical restraints must be trained in its use. 

* "Aversive intervention" includes the placement of a person in a room, 
alone, where release from the room is prohibited. Aversive 
interventions are prohibited when used on a pupil with a disability. 

New Hampshire: 

N.H. Code Admin. R. Ann. Ed. 1113.04 - .09 (Board of Education; 
Standards for the Education of Children with Disabilities; Requirements 
for the Development and Operation of Programs for Children with 
Disabilities Administered by Local Education Agencies): 

* Public or private providers of special education may not employ 
aversive behavioral interventions, except in response to the threat of 
imminent, serious physical harm. These include any procedure intended 
to cause physical pain, placement of a child in an unsupervised or 
unobserved room from which the child can not exit, and physical 
restraint. However, if authorized in writing by a physician and an IEP 
team, then non-medical mechanical restraint and physical restraint not 
in response to imminent, serious, physical harm may be used. Staff must 
be trained to use procedures and in alternative de-escalation 
techniques, and the parents must give informed consent for the use of 
these procedures separate from the IEP consent. 

New Jersey: 

None. 

New Mexico: 

N.M. Stat. Ann. §§ 32A-6A-1 to -10 (Children's Code; Children's Mental 
Health and Developmental Disabilities Act): 

* "Aversive interventions," which includes interventions causing 
physical pain and isolation, are prohibited. When providing treatment 
or habilitation services to children with severe developmental 
disabilities, physical restraint and seclusion may not be used except 
in an emergency situation in which it's necessary to protect a child or 
another from imminent, serious physical harm or unless a less intrusive 
intervention has failed. Programs shall provide a copy of the restraint 
and seclusion polices and procedures to the child's legal custodian. 
Staff administering restraints and seclusions must be trained in 
positive behavior interventions, methods for identifying and defusing 
potentially dangerous behavior, and restraint and seclusion. Incidents 
of restraint and seclusion must be documented, and the child's legal 
custodian must be notified immediately. After the incident, there must 
be a debriefing with the child. 

* Only reasonable force as is necessary to protect the child or other 
person from imminent and serious physical harm may be used. The 
restraint must be reassessed at least every 30 minutes. Mechanical 
restraints are prohibited except under certain circumstances. 

* Seclusion may only be applied by trained staff, and the seclusion 
room must be free of hazards, provide staff an adequate and continuous 
view of the child, and provide adequate lighting and ventilation. Staff 
must view the child at all times, and must reassess at least every 30 
minutes. 

New York: 

N.Y. Comp. Codes R. & Regs. tit. 8, § 19.5 (Education Department; Rules 
of the Board of Regents; Education Practices): 

* Corporal punishment is prohibited. However, reasonable force may be 
used to protect oneself or any person from physical injury, to protect 
property, or to restrain or remove a pupil whose behavior is 
interfering with the orderly exercise and performance of school 
functions, powers and duties. 

* Aversive interventions, defined as interventions intended to induce 
pain or discomfort for the purpose of eliminating maladaptive 
behaviors, are prohibited. This includes movement limitations used as a 
punishment. 

N.Y. Comp. Codes R. & Regs. tit. 8, § 200.22 (Education Department; 
Regulations of the Commissioner; Handicapped Children; Children with 
Handicapping Conditions): 

* A behavioral intervention plan shall not include the use of aversive 
interventions, but a child-specific exception may be granted under 
certain circumstances where the student is displaying aggressive 
behaviors that threaten the physical well being of the student or 
others. The use of aversive interventions may only be done by trained 
staff and with parental consent. 

* Emergency interventions involving the use of reasonable physical 
force is permissible in situations in which alternative procedures 
cannot be reasonably employed. They may not be used as punishment, and 
staff must be provided with appropriate training in safe and effective 
restraint procedures. Each incident must be documented, and parents 
must be notified. 

* Time out rooms are only to be used in conjunction with a behavioral 
intervention plan, except for unanticipated situations that pose an 
immediate concern for physical safety. A student may not be placed in a 
locked room or in a room where the student cannot be continuously 
observed and supervised. The room must be adequate size to allow the 
student to move about and recline, it should be without hazards, and 
have adequate lighting, ventilation, and temperature. The room must be 
unlocked and the door able to be opened from the inside. 

* Schools must develop policies that include factors that precipitate 
the use of the room, time limitations, staff training, data collection, 
and information to be provided to parents. Staff must continuously 
monitor the student. A student's IEP must specify the use of a time out 
room, and parents must be given the opportunity to see the physical 
space and receive a copy of the school's policy. 

North Carolina: 

N.C. Gen. Stat. § 115C-391.1 (Elementary and Secondary Education; 
Students; Discipline): 

* School personnel must notify the principal of any use of aversive 
procedures, any use of physical restraint resulting in observable 
physical injury to a student, or any use of seclusion that exceeds 10 
minutes or the time specified in the behavior intervention plan. The 
student's parents must be promptly notified, and the incident must be 
documented. 

* Physical restraint is prohibited, except as reasonably needed to 
obtain possession of a weapon or other dangerous object, to maintain 
order or prevent or break up a fight, for self-defense, to ensure the 
safety of any person, to prevent imminent destruction of property, or 
if used as provided for in a student's IEP. Physical restraint is not 
permitted when used solely as a disciplinary consequence. 

* Mechanical restraint is prohibited, except under certain 
circumstances. 

* Seclusion is the confinement of a student alone in an enclosed space 
from which the student is physically prevented from leaving by locking 
hardware or other means. Seclusion is prohibited, except as reasonably 
needed to respond to a person in control of a weapon or other dangerous 
object, to maintain order or prevent or break up a fight, for self- 
defense, to respond to a student's behavior which poses a threat of 
imminent physical harm to self or others or imminent substantial 
destruction of property, or when used as specified in the student's 
IEP. 

* The student in seclusion must be monitored by an adult who is able to 
see and hear the student at all times, and the seclusion must be 
released upon cessation of the behaviors that led to the seclusion. The 
seclusion space must have been approved by the local education agency 
and have appropriate light, ventilation, and temperature, and be free 
of hazards. Seclusion is not permitted when used solely as a 
disciplinary consequence. 

* Isolation is a behavior management technique in which a student is 
placed alone in an enclosed space from which the student is not 
prevented from leaving. Isolation is permitted provided that the space 
used has appropriate light, ventilation, and temperature; the duration 
is reasonable in light of the purpose; the student is reasonable 
monitored; and, the space is free of hazards. 

North Dakota: 

None. 

Ohio: 

Ohio Rev. Code Ann. § 3319.41 (Education - Libraries; Schools - 
Superintendent, Teachers, Employees; School Reports): 

* Corporal punishment is prohibited, unless the board of education of a 
school district has taken certain steps to permit it. However, staff 
may use and apply such amount of force and restraint as is reasonable 
and necessary to quell a disturbance threatening physical injury to 
others, to obtain possession of weapons or other dangerous objects upon 
the person or within the control of the pupil, for the purpose of self- 
defense, or for the protection of persons or property. 

Oklahoma: 

None. 

Oregon: 

Or. Admin. R. 581-021-0060 to -0062 (Oregon Department of Education; 
School Governance and Student Conduct; Student Conduct and Discipline): 

* Corporal punishment is prohibited. However, corporal punishment does 
not include physical pain or discomfort resulting from physical 
restraint or seclusion that is part of a behavior support plan, that 
includes an individual limit on the number of incidents within a 
specified time period, and that is carried out under set policies and 
procedures. 

* The use of physical restraint or seclusion may only be used as part 
of a behavior support plan that was developed with the parents, when 
less restrictive interventions would not be effective and the student's 
behavior poses a threat of imminent, serious, physical harm to the 
student or others; or, in an emergency as necessary to maintain order 
or to prevent a student from harming him/herself, other students, and 
school staff or property. 

* Restraint or seclusion may only be used for as long as the behavior 
poses a threat of imminent, serious physical harm. Staff must 
continuously monitor a student's status during the restraint or 
seclusion. Staff must be trained to use restraint or seclusion, 
including training in prevention and de-escalation techniques. Parental 
notification by the end of the day is required, and each incident must 
be documented. 

* Seclusion rooms must allow for a full view of the student at all 
times, and be free of potentially hazardous conditions. 

Pennsylvania: 

22 Pa. Code § 14.133 (Education; State Board of Education; 
Miscellaneous Provisions; Special Education Services and Programs; 
IEP): 

* Restraints to control acute or episodic aggressive or self-injurious 
behavior may only be used when the student is a clear and present 
danger to himself, other students, or employees, and only when less 
restrictive techniques are less effective. Parental notification is 
required. The use of restraints may only be included in an IEP when: 
the restraint is utilized with specific component elements of positive 
behavior support; the restraint is used in conjunction with the 
teaching of alternate behavior; staff are authorized to use the 
procedure and have receiving required training; and there is a plan for 
eliminating the use of restraint through the application of positive 
behavior support. Parental consent must be obtained prior to the use of 
restraints. The use of prone restraints is prohibited. Data on the use 
of restraints must be maintained and reported. Restraint may not be 
used for the convenience of staff or as punishment. Mechanical 
restraints may only be used in certain circumstances. 

* Locked rooms, locked boxes or other structures or spaces from which 
the student cannot readily exit are prohibited. 

Rhode Island: 

08-010-013 R.I. Code R. §§ 1.0 - 10.0 (Department of Elementary and 
Secondary Education; Board of Regents for Elementary and Secondary 
Education; Physical Restraint): 

* Public education programs must develop procedures regarding the use 
of physical restraint and crisis intervention. These must be reviewed 
annually and made available to parents. Staff must receive annual 
training on the restraint policy, de-escalation techniques, types of 
restraints and related safety considerations, and how to administer 
restraint in accordance with known medical or psychological limitations 
applicable to an individual student. Some staff must receive advanced 
training, which must include the simulated experience of administering 
and receiving physical restraint, instruction regarding the effects on 
the person restrained and on monitoring physical signs of distress, and 
more. 

* Prone containment, which simultaneously immobilizes all four 
extremities, is prohibited except when used by trained personnel as a 
limited emergency intervention that is a documented part of a 
previously agreed upon written behavioral intervention plan. These 
rules do not limit school staff from using reasonable force to protect 
students, other persons or themselves from imminent, serious physical 
harm. 

* Physical restraint may only be used when non-physical interventions 
would not be effective, the student's behavior poses a threat of 
imminent, serious, physical harm to self or others, and any applicable 
positive techniques from the student's behavioral intervention plan 
have been attempted. It is limited to the use of reasonable, necessary 
force. Physical restraint may not be used as a means of punishment or 
as an intervention designed or likely to cause physical pain. Only 
trained personnel may administer restraints, and when possible it must 
be witnessed by at least one other adult who does not participate in 
the restraint. No restraint may prevent a student from breathing or 
speaking, and the student must be continuously monitored. The restraint 
must be released as soon as the student is no longer at risk of causing 
imminent physical harm to self or others. Each incident must be 
documented, there must be follow-up, and parents must be notified as 
soon as possible but no later than two school days later. 

* Seclusion, placing a child alone in a locked room without 
supervision, is strictly prohibited. Seclusion is permitted when the 
student is under constant surveillance and observation and when 
documented as part of a previously agreed upon written behavioral 
intervention plan. Any intervention which denies adequate sleep, food, 
water, shelter, bedding or access to bathroom facilities is also 
prohibited. 

South Carolina: 

None. 

South Dakota: 

None. 

Tennessee: 

Tenn. Code Ann. §§ 49-10-1301 to -1306 (Education; Special Education; 
Special Education Isolation and Restraint Modernization and Positive 
Behavioral Supports Act): 

* A special education student may only be restrained or isolated if the 
restraint or isolation is provided for in the student's IEP, or if 
there is an emergency and it is necessary to assure the physical safety 
of the student or others nearby. If an emergency situation, school 
personnel must immediately contact those school personnel designated to 
authorize the isolation or restraint, and they must evaluate the 
student's condition within a reasonable time. Parents must be notified 
the same day. Each incident must be documented. School personnel must 
remain in the physical presence of any restrained student and must 
continuously observe a student who is in isolation or being restrained 
to monitor the health and well-being of the student. 

* As applied to special education students, chemical restraints are 
prohibited against unless under the direction of a physician and with 
parental consent; mechanical restraints are prohibited; and any form of 
life-threatening restraint, including restraint that restricts the flow 
of air into a person's lungs, is prohibited. Additionally, the use of 
isolation or physical restraint as a means of coercion, punishment, 
convenience, or retaliation is prohibited. 

* Actions undertaken by school personnel to break up a fight or to take 
a weapon from a student are not prohibited. 

* As applied to special education students, the use of a locked door or 
other structure that accomplishes the intent of locking a student in a 
room or structure, to isolate or seclude a student, is prohibited. 

Texas: 

Tex. Educ. Code Ann. § 37.0021 (Education Code; Public Education; Safe 
Schools; Discipline, Law and Order; Alternative Settings for Behavior 
Management): 

* Rules must be promulgated for the use of restraint and time-out by 
school personnel. 

* Seclusion is a behavior management technique in which a student is 
confined in a locked space that is designed solely to seclude a person 
and contains less than 50 square feet of space. School personnel may 
not place a student in seclusion. 

* This section does not prevent a student's locked, unattended 
confinement in an emergency situation while awaiting the arrival of law 
enforcement if the student possesses a weapon and the confinement is 
necessary to prevent bodily harm to the student or another person. 

19 Tex. Admin. Code § 89.1053 (Education; Texas Education Agency; 
Adaptations for Special Populations; Commissioner's Rules Concerning 
Special Education Services; Clarification of Provisions in Federal 
Regulations and State Law): 

* School personnel may only use restraint in an emergency in which a 
student's behavior poses a threat of imminent, serious physical harm to 
the student or others or imminent, serious property destruction. 
Restraint shall be limited to reasonable force as is necessary to 
address the emergency, shall be discontinued when the emergency no 
longer exists, shall be implemented as to protect the health and safety 
of the student, and shall not deprive the student of basic human 
necessities. 

* A core team of school personnel must be trained in the use of 
restraint and must include special education personnel likely to use 
restraint. Personnel who use restraint but who have not received 
training must receive training within 30 days following the use of 
restraint. Training must include prevention and de-escalation 
techniques. Each incident must be documented, and parents must be 
notified the same day. 

* Time-out is a behavior management technique in which the student is 
separated from other students in a setting that is not locked and from 
which the exit is not blocked. Physical force or threats may not be 
used to place a student in time-out. Time-out must be included in the 
student's IEP if it is utilized on a recurrent basis. School personnel 
must be trained in the use of time-out. Each instance must be 
documented. 

Utah: 

Utah Code Ann. §§ 53A-11-801 to -806 (State System of Public Education; 
Students in Public Schools; Physical Restraint Guidelines): 

* Corporal punishment is prohibited, unless the parents have provided 
written permission. However, corporal punishment does not include the 
use of reasonable and necessary physical restraint or force in self- 
defense, to obtain possession of a weapon or dangerous object, to 
protect the child or another person from physical injury, to remove 
from a situation a child who is violent or disruptive, or to protect 
property from damage. 

* Behavior reduction intervention for students with disabilities is 
excepted from this part under certain circumstances. 

Vermont: 

None. 

Virginia: 

8 Va. Admin. Code § 20-670-130 (Education; State Board of Education; 
Regulation Governing the Operation of Private Day School for Students 
with Disabilities; Program Requirements): 

* This section only applies to private day schools whose primary 
purpose is to provide educational services to persons with autism, 
developmental disabilities, deafness, mental retardation, emotional 
disturbance, learning disability or other certain disabilities. It does 
not apply to public schools or private day schools whose primary 
purpose is to provide educational services to students without 
disabilities, even though it may also serve children with disabilities. 

* Parents must be informed of the policies of the school's behavior 
management or modification program, and informed consent must be 
obtained before implementation of any behavior management program. 

* The use of physical restraints must follow written policies and 
procedures. Physical restraint is limited to that which is minimally 
necessary to protect the student or others and may only be used by 
trained staff after less intrusive interventions have failed and when 
failure to restrain would result in harm to students or others. Staff 
must review the training at least annually. Each incident must be 
documented and reported to the parents. 

* Corporal punishment and the use of restraint as punishment, reprisal, 
or convenience is prohibited. The use of mechanical and chemical 
restraints is also prohibited. 

* Washington: 

Wash. Admin. Code 392-172A-03120 to -03135 (Superintendent of Public 
Instruction; Rules for the Provision of Special Education; Aversive 
Interventions): 

* No school district may authorize or allow the use of aversive 
interventions on a special education student if the intervention would 
violate the conditions of this part. 

* The use of force or restraint which is either unreasonable under the 
circumstances or deemed to be an unreasonable form of corporal 
punishment is prohibited. This includes interfering with a student's 
breathing, or physically restraining a student by binding or otherwise 
attaching the student's limbs together or by binding or otherwise 
attaching any part of the student's body to an object. However, this 
type is restraint is permissible if it is used when and to the extent 
reasonably necessary to protect the student, other persons, or property 
from serious harm. The restraint, including the duration of its use, 
must be provided for by the terms of the student's IEP. An adult must 
remain in visual or auditory range, and the student must either be 
capable of releasing himself or herself from the restraint, or must 
continuously remain within view of an adult. 

* Aversive intervention does not include the use of reasonable force, 
restraint, or other treatment to control unpredicted spontaneous 
behavior which is a clear and present danger of serious harm to the 
student or another person, a clear and present danger of serious harm 
to property, or a clear and present danger of seriously disputing the 
educational process. 

* Isolation, including the duration of its use, must be provided for by 
the terms of the student's IEP. The enclosure must be ventilated, 
lighted, temperature controlled, and permit continuous visual 
monitoring of the student from the outside. An adult must remain in 
visual or auditory range. The student must either be capable of 
releasing himself or herself from the enclosure, or must continuously 
remain within view of an adult. 

West Virginia: 

W. Va. Code R. § 126-28-8 (Procedural Rule; West Virginia Board of 
Education; West Virginia's Universal Access to a Quality Early 
Education System): 

* Staff members in a West Virginia pre-k classroom may not handle 
behavior problems by restraining a child by any means other than a firm 
grasp around a child's arms or legs and then for only as long as is 
necessary for the child to regain control. 

* Staff members in a West Virginia Pre-k classroom may not handle 
behavior problems by isolating a child without supervision or placing 
the child in a dark area. 

Wisconsin: 

None. 

Wyoming: 

None. 

[End of section] 

Footnotes: 

[1] These are excerpts from the definitions used by the Centers for 
Medicare and Medicaid Services (CMS) and they apply to all hospitals 
participating in the Medicare and Medicaid programs. 42 C.F.R § 
482.13(e)(1)(i)-(ii). We chose to use the CMS definitions because there 
are no federal statutes that apply to seclusion or restraint in the 
context of public or private schools. 

[2] GAO, Mental Health: Extent of Risk from Improper Restraint or 
Seclusion is Unknown, [hyperlink, 
http://www.gao.gov/products/GAO/T-HEHS-00-026] (Washington, D.C.: Oct. 
26, 1999). 

[3] GAO, Residential Treatment Programs: Concerns Regarding Abuse and 
Death in Certain Programs for Troubled Youth, [hyperlink, 
http://www.gao.gov/products/GAO-08-146T] (Washington, D.C.: Oct. 10, 
2007) and Residential Programs: Selected Cases of Death, Abuse, and 
Deceptive Marketing, [hyperlink, 
http://www.gao.gov/products/GAO-08-713T] (Washington, D.C.: Apr. 24, 
2008). 

[4] Arizona, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, 
Louisiana, Mississippi, Missouri, Nebraska, New Jersey, North Dakota, 
Oklahoma, South Carolina, South Dakota, Vermont, Wisconsin, and 
Wyoming. 

[5] Alaska, Colorado, Hawaii, Michigan, Ohio, Utah, and Virginia. 

[6] California, Colorado, Connecticut, Illinois, Iowa , Maine, 
Maryland, Massachusetts, Nevada, New Hampshire, New Mexico, New York, 
Oregon, Pennsylvania, Rhode Island, Texas, and Virginia. 

[7] Colorado, Delaware, Maryland, Massachusetts, Montana, New 
Hampshire, New York, North Carolina, Oregon, Pennsylvania, Tennessee, 
Virginia, and Washington. 

[8] California, Colorado, Connecticut, Illinois, Iowa, Maine, Maryland, 
Massachusetts, Minnesota, Nevada, New Mexico, New York, North Carolina, 
Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, and Virginia. 

[9] California and Connecticut. 

[10] Colorado, Connecticut, Iowa, Massachusetts, Pennsylvania, Rhode 
Island, Tennessee, and Washington. 

[11] There is likely a small percentage of overlapping allegations 
given our inability to reconcile information from the sources we used. 

[12] For the purposes of this report, our definition of students with 
disabilities does not indicate eligibility under IDEA. 

[13] Colorado, Delaware, Maryland, Massachusetts, Montana, New 
Hampshire, New York, North Carolina, Oregon, Pennsylvania, Tennessee, 
Virginia, and Washington. 

[14] Colorado, Connecticut, Iowa, Massachusetts, Pennsylvania, Rhode 
Island, Tennessee, and Washington. 

[15] California, Colorado, Connecticut, Illinois, Iowa , Maine, 
Maryland, Massachusetts, Nevada, New Hampshire, New Mexico, New York, 
Oregon, Pennsylvania, Rhode Island, Texas, and Virginia. 

[16] At the time, this department was called the Department of 
Protective and Regulatory Services. 

[17] The school implements a Behavior Support Plan in response to 
maladaptive and defiant behaviors by residents. The plan attempts to 
address and manage these behaviors; to foster more positive, 
appropriate, and pro-social behavior; and to ensure the safety of the 
residents and their peers. 

[End of section] 

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