Disabled students face dangerous discipline in Minnesota

A 10-year-old autistic boy was pinned to the floor and held facedown for 57 minutes by three staff members at his school after he threw a tantrum while working on a puzzle in his special education classroom.

Another boy with autism who caused disruptions in class was put in physical holds that left him struggling to breathe.

A 14-year-old girl with cerebral palsy who "acted out" in class severed her finger after an aide barricaded her alone in a room at her school.

It happens thousands of times a year in Minnesota's classrooms: Disabled students get punished for disruptive outbursts with severe forms of discipline — from forceful physical restraint to extended solitary confinement — that are either banned or more restricted in other states.

State reports examined by the Star Tribune show that such discipline occurred nearly 22,000 times on more than 2,500 special education students last year.

Records from recent years also show that school staff are using dangerous physical holds and lengthy isolation often in response to minor episodes by disabled students. One 9-year-old was physically restrained 189 times over the first half of a school year. Others have been refused water or kept alone in rooms until they wet their pants.

Some staff members are putting special education students in intense facedown holds that last 15 minutes or more, records also show — long enough to risk injury or even accidental death.

Valarie Jones was horrified by her teenage son's bruised, swollen face after he was restrained by school staff in response to a fight he had with another special education student.

"I thought the other boy had beaten him up, but it wasn't the other boy, it was the teacher who threw him down," said Jones, whose son has several disabilities. "To me, it was worse than you would treat an animal."

With rising numbers of special education students in Minnesota's schools, many of whom suffer from mental or behavioral disorders, classroom discipline has become the focus of urgent debate among educators — and a source of fear and outrage among parents of disabled children.

The most controversial form of discipline is a maneuver known as "prone restraint," in which students are forced to the floor and held facedown by two or three school workers for an unlimited amount of time in an attempt to subdue them. The technique, which federal officials have linked to abuse and accidental death, has been outlawed in 20 states.

Other physical restraints are also raising alarms. In Minnesota, schools can use a "supine hold," in which students are restrained lying on their backs, and a "basket hold," in which an adult grasps a student from behind and holds the student by the wrists with the child's arms crossed in front of the body.

Last year the U.S. Education Department declared that the prone hold and other restraints that restrict breathing "should never be used." The department also urged schools to avoid confining children in isolation rooms "as a means of coercion or retaliation, or as a convenience."

"There is no evidence," the department said, "that using restraint or seclusion is effective in reducing the occurrence of the problem behaviors."

But such practices continue in Minnesota schools.

In fact, while state lawmakers have tightened rules on the use of seclusion and restraints in recent years, records show the use of prone restraint increased in 2012.

Prone restraint is supposed to be phased out in August. But at the request of school officials, the Legislature is moving to let the practice continue for at least two more years.

Some say the discipline is needed because disabled students can be dangerously unpredictable and risk harming themselves and others.

In the past five years, teachers and aides have been punched, kicked and bitten by disabled students, sometimes so severely they were forced to retire.

"I think both students and staff members may incur additional injuries if we didn't, in certain circumstances, employ prone restraint," said Sandy Lewandowski, superintendent of Intermediate District 287, a suburban Twin Cities district that takes high-needs students from other local schools.

Lewandowski and other school superintendents said that prone restraint is used as a last resort, when all other methods of calming a child have failed. She said it is a better alternative than expelling them or calling police.

School superintendents have persuaded state officials, including Education Commissioner Brenda Cassellius, that they need more time to institute alternatives.

"The commissioner would like to see the use of prone restraint eliminated in schools," said Charlene Briner, chief of staff for the state Education Department. "It is not as simple as flipping a switch."

Lauren Powell was afraid to go to school.

Several times a week, the boy, then 10, would get upset and lash out. One day he slapped a teacher. Another time he tipped over a bookcase.

His punishment, Lauren said, was always the same, even if his offense was throwing a paper airplane at someone.

"I'd get dragged out of the room whenever I'd get upset," said Lauren, who has a mild form of autism. "Then they would put me in the calming room."

A typical day was recounted in an e-mail to his mother, Rachel Powell.

"It's been an up and down day," a teacher at St. Louis Park public schools wrote Powell on May 10, 2012. "He had a tough time near the end of art and came up here to my room. On the way he threw a shoe at [one of the aides] and in my room threw a pencil at my head. We moved to the calming room and spent about 30 minutes there with hitting, kicking spitting before [Lauren] laid down and began to work on calming."

The room was small, Lauren said, and a school worker would block the door, keeping him there for an hour or two with nothing to do.

"I'd try to escape," said Lauren, whose behavioral problems surfaced at the age of 4 when he was kicked out of day care. "I'm not good in small rooms."

When he resisted, Lauren said workers would restrain him in a hold he calls "the bear hug." He said they would squeeze him from behind so hard that Lauren, who suffers from asthma, would sometimes have trouble breathing. He'd come home with red marks on his arms and wrists.

"I knew that sometime I [might] get hurt really bad by one of those holds," he said.

For his mother, the breaking point came one day last spring, when Lauren came home and told her about his most terrifying restraint yet.

While he was trying to evade solitary confinement, he said, workers squished him so tightly that he began to suffocate. When he complained, he said, no one took him seriously.

"That's when I said you can't touch my son again because you are going to kill him," Powell said.

Holds that restrict or impair a child's ability to breathe are illegal in Minnesota.

Tami Reynolds, special education director in St. Louis Park, declined to address Lauren's discipline.

But she said no students or workers have been injured by physical restraints in the district, which does not allow prone restraint. Reynolds said other restraints are used only "to help students prevent themselves from being hurt or hurting others."

Powell said she knows school officials needed to protect others from Lauren's anger, but that's not an excuse for "manhandling" her son.

"These are special ed teachers," she said. "You'd expect them to have a little more patience and understanding. These children do not need to be humiliated and abused. There is a reason why they are acting this way."

Minnesota rules state that children should not be subjected to seclusion or restraint unless their actions create an "emergency" and no other type of discipline will be effective.

But state records show school workers have used the tactics to punish disabled children for throwing toys, yelling, disobeying teachers, hiding under tables and even sticking a tongue out.

In Willmar, Jackie Nelson's first-grade daughter was forced into a timeout room if she failed to sit perfectly still for 30 minutes or more at the "thinking desk." If the girl fidgeted or made any noise, her teacher would yell at her and sometimes put her into restraints, including a prone hold, state records show.

During one incident, the teacher forced the girl into the room even though she was on her way to the bathroom and was "dramatic about having to pee," state records show. A school worker said the girl was unable to hold it and had to sit in wet pants for 10 minutes.

State investigators cited the district in 2006 for multiple violations of the girl's care, including the use of seclusion 44 times in one school year despite objections from a district consultant who said such discipline could cause permanent psychological damage.

"Kids in a school setting look to their teacher to protect them, not threaten or harm them," Nelson said. "I doubt she will ever fully recover, because she always questions: 'Who do I turn to? Who is safe?' "

Willmar officials declined to discuss the case, but an attorney noted that a federal court dismissed the family's lawsuit against the district in 2010. The court said Nelson could not seek damages in part because she enrolled her daughter in another school district.

The court agreed the teacher was sometimes "overzealous," but concluded that the use of restraint and seclusion was "reasonable" because Nelson failed to formally object to the inclusion of the procedures in her daughter's personalized education plan.

To parents, the misuse of prone restraint is especially alarming. Disabled students have died from the hold because their chests were compressed while lying facedown on the floor, leading to asphyxiation, federal records show.

A Star Tribune review of 592 prone restraint reports from 2011 showed 97 incidents involved at least one worker who didn't know how to perform the hold. In 18 cases, none of the staffers had received training. Minnesota, which first began collecting prone restraint reports in August 2011, prohibits untrained workers from performing physical holds. Lack of proper training has been cited in deaths involving prone restraint. The state declined to provide 2012 incident reports.

In 65 percent of the Minnesota cases, schools failed to use less aggressive tactics first or acted when no emergency existed, according to Dan Stewart, an attorney with the Minnesota Disability Law Center who separately reviewed the 2011 reports on prone restraint. Many students were restrained repeatedly, sometimes on the same day, records show.

"It's like, 'We know prone works, so we are going to use that instead of anything else,' " Stewart said. "But if you have repeated use, it's not working. They're not addressing the underlying behavior."

Gary Riege is still haunted by his experiences in two Cottage Grove elementary schools, where he said he was restrained about once a week from kindergarten to fifth grade. The 16-year-old estimates half of the time he was put facedown on the floor, with some holds lasting 15 or 20 minutes.

Sometimes, Gary said, he deserved it — like the time he hit a student with his lunch tray in kindergarten, or when he threw chairs and desks. Other incidents puzzle him.

"I'd be put in holds just for saying 'no' when I didn't want to do something," said Gary, who struggles with short-term memory issues as a result of fetal alcohol spectrum disorder. "They'd put me in a hold just for yelling, or throwing a piece of paper, or running in the halls. … It was almost always something small that escalated into something larger."

His adoptive mother, Christine Riege, broke down in tears as she sorted through incident reports from those days.

"He always came home with bruises and red marks," Riege said, as Gary hugged her on the couch. "No matter how many times I complained, no matter how many times I was at the school, it never did anything … This is why we have so many angry kids."

Officials with South Washington County Schools declined to comment on Riege's discipline, but said the district stopped using prone restraint and locked timeout rooms in recent years.

At least 256 disabled students in Minnesota were subjected to prone restraint 1,756 times last year. Altogether, various physical holds were used on 2,318 students in 2012, records show.

Even those who defend the use of prone restraint acknowledge that the procedure is sometimes misused.

"I'm not denying that people have done incredibly stupid things — they have," said Merrill Winston, a director at Professional Crisis Management Association, which trains educators on restraint. "The question is whether this is as dangerous as people say it is."

Winston declined the Star Tribune's request to videotape a training session. So did superintendents of two districts that frequently use prone restraint.

"People could misinterpret it," said Connie Hayes, superintendent of Intermediate District 916 in the northeast metro, which specializes in educating children with severe behavioral issues. The procedure, she added, is "too scary."

Dakota County Deputy Sheriff Erika Morgan knows how often violence can erupt in a special ed class.

For the past two years, she has been stationed at Alliance Education Center in Rosemount. It provides special education services to about 100 disabled students whose behavior is too extreme for traditional classrooms. As the state has cut back or eliminated mental health programs, many of those students have ended up at such schools. Most Alliance students have been diagnosed with autism or emotional and behavioral disorders.

Morgan is called on daily to break up fights and chase disobedient kids through the halls. She sees a lot of black eyes and bruises, but does not pursue assault charges unless she believes a student was trying to hurt someone.

She makes about one arrest per week for actions ranging from disorderly conduct to assault. Students often spend a night in jail and then return to school. Two students were charged with felonies that led to six-month sentences.

But Morgan overlooks most of the crime she witnesses. "If I charged everyone for everything they did, we'd have no one left in school," she said.

Alliance is part of Intermediate District 917, where the number of staff members injured by students climbed from 30 in 2008 to 172 in 2012. About 70 percent of the district's students are disabled.

Over the past five years, at least 58 district employees were kicked or punched in the head by a student, including a staff member who missed two weeks of work with a concussion. Nearly 100 employees were bitten. Teachers and aides were hit with everything from chairs to computers.

The state doesn't collect data on injuries to special education workers, but employees at other districts said they've also seen a rise in aggressive behavior from students.

"I've been here for three and a half years, and every year it has gotten more and more out of control," said Michael Woodwick, a special education teacher's assistant in St. Paul.

In Apple Valley, a seven-year veteran of special ed classrooms said she shrugged off more than 20 injuries until 2010, when a disabled student accidentally shoved a cart at her, knocking her head into a concrete wall. The concussion caused her to miss five months of work and ultimately led to balance problems that forced her to retire in 2011.

"It has completely ruined my life," said the worker, who recently underwent spinal surgery and spoke on the condition that she not be named. "I still have nightmares of kids kicking and hitting me."

Minnesota, like other states, has struggled to find the right balance between protecting school workers and subduing aggressive children.

State lawmakers have barred prone restraint on children under the age of 5 and taken other steps to address weaknesses cited by U.S. Secretary of Education Arne Duncan. He began urging states to overhaul their restraint and seclusion policies in 2009.

In a letter Duncan sent to education leaders that year, he said he was "deeply troubled" by reports showing thousands of disabled children had been harmed by the inappropriate use of restraint and seclusion.

In one case, a teenage boy with hyperactivity disorder hanged himself in seclusion.

Such tragedies prompted action in other states.

In Ohio, for instance, the governor banned the use of prone restraint by seven state agencies after the 2008 death of a 17-year-old girl, who suffocated while being held down at a treatment center. After further abuses were reported, Ohio's Education Department banned prone restraint in all schools starting next fall.

"One school had almost 900 incidents of restraint and seclusion," said Sue Tobin, legal counsel for Disability Rights Ohio. "How could anybody get an education in such a chaotic environment?"

Under Ohio's new rules, schools can use seclusion and other physical holds only if students pose an "immediate risk of physical harm" and there are no "safe and effective" options.

Similar restrictions have been imposed in 13 other states, according to a recent survey for the Autism National Committee, an advocacy group.

Minnesota is moving more slowly.

"When a child is out of control, what do you do?" asked Rep. John Ward, a former special education teacher from Baxter, Minn. "At this time, properly administered restraints — in my opinion — should be part of the available procedures."

Still, some lawmakers said they are troubled by the Star Tribune's findings and the growing use of prone restraint in some schools. They want information showing when the procedure is misused.

Schools are now required to document each use of prone restraint and submit those reports to the state. But the Minnesota Education Department is not checking for compliance, saying lawmakers did not mandate such analysis.

"That's a lousy answer," said Rep. Jim Davnie, DFL-Minneapolis, who said the department needs to step up its oversight.

Meanwhile, in response to parents' concerns, some school districts are altering their discipline policies. Some have banned prone restraint and seclusion because they have come to doubt the safety or effectiveness of either practice.

But changing the disciplinary culture can be difficult. When two districts in the southwest metro stopped using locked timeout rooms a few years ago, "I thought teachers were going to string me up," said Darren Kermes, executive director of the districts catering to disabled students in Carver and Scott counties. "They said, 'We won't be able to do our job' … But it has not resulted in an inability to serve these kids or an excessive increase in violence."

At Intermediate District 287, one of the state's heaviest users of prone holds, officials have been trying to find ways to help students avoid situations that lead to restraint. They are allowing disruptive children with special needs to spend more time by themselves, or asking teachers to speak more quietly to students who are sensitive to loud noises. The number of prone holds in the district dropped 40 percent this school year, Superintendent Lewandowski said, mostly because of those changes.

The district's new approach appears to be working for Lauren Powell, who transferred there last fall. He's having far fewer outbursts now that teachers reward him for doing the right thing in class, and he's finding other ways to deal with his anger.

"Whenever I get really mad, I ask for a piece of paper and I rip it up to keep myself calm," Lauren said. "They wouldn't give me a chance to even make a choice at my old school. If I started getting upset, I'd be in a hold."

Jeffrey Meitrodt • 612-673-4132