To The Editor:
I was invited to join the Waterbury Area Anti-Racism Coalition in April to discuss the impact of trauma associated with the use of restraint and seclusion. I have since followed the process of policy review by the Harwood Unified Union School District.
I am impressed by the depth and breadth of concerns presented by Brian Dalla Mura, special educator, as well as opinions shared by the anti-racism coalition, an opinion piece by the Alliance Against Seclusion and Restraint, and by community members. These contributions highlight the detrimental effects of prone restraint and seclusion on all children, with the most significant impact on children with disabilities, as well as children of color.
There seems to be no dispute that prone restraint and seclusion can have very tragic consequences, including death. What needs to be explored and understood is the continued use of interventions that have no scientific evidence in reducing problematic behaviors. In fact, some studies suggest that the use of restraint and seclusion actually increase problematic behaviors. The question is why do we continue to cling to ineffective strategies?
Attempts to rationalize illogical decision-making, including comments such as identifying a community as somehow “different,” or suggesting that community members aren’t interpreting legal statutes correctly, highlight the idea of irrationality. Momentum and leadership are needed to shift systems.
Letting go, or the de-implementation of interventions that are not working, is a current area of study. De-implementation is most often studied in health care when providers are reluctant to change their preventive practices not based on science, but on other factors such as fear of litigation, patient anxiety, financial disincentives, etc. Letting go is complex, and there are two criteria for letting go: the intervention is not effective, or the intervention is harmful. Prone restraint and seclusion clearly meet the criteria for letting go. Based on the overwhelming evidence, it seems reasonable to conclude that as decision-makers at a variety of levels, we need to promote letting go.
Two resource articles are:
Issue Brief #1: Promoting Alternatives to the Use of Seclusion and Restraint
Unpacking the complexities of de-implementing inappropriate health interventions
Mary Ann Donnelly-DeBay
Richmond
