California teachers can pin students face down. Does the danger outweigh the benefit?

Dec. 23--It's a scenario that sounds more likely in jails than schools: Arms pulled behind their back, a person is forced into a "prone restraint," pinned face down on the floor with limbs held immobile by at least two people.

But prone restraints are regularly used in California schools, often on students with special needs such as those on the autism spectrum -- and at a higher rate on black students, an analysis of federal data by The Sacramento Bee found.

Next month, California state regulations on the use of prone restraints on students will change, limiting them to emergency situations. Current law allows them to be used too often as punishments or as a behavior modifier on hard-to-handle kids, critics said. Even with the new law, disability rights advocates and some parents worry that the intensely physical interventions will continue to be used often, and present the possibility of harm to kids. Some would like to see them banned in schools altogether.

The controversy over prone restraints drew attention last month when a thirteen-year-old boy with autism, Max Benson, died after being held in the position at Guiding Hands School in El Dorado Hills. Since then, more than 20 parents have pulled their children from the private school, which multiple school districts in the region contract with to provide services to special education students, according to officials.

The California Department of Education and the El Dorado County Sheriff's Office are both investigating Benson's death, the agencies said. In a preliminary report, the DOE found that Guiding Hands violated multiple state regulations regarding the use of restraints.

A letter sent to the school by the DOE and obtained by The Bee through a Public Records Act request found those violations included using an emergency intervention -- the prone restraint -- for "predictable behavior," using an emergency intervention as a substitute for the student's personally-designed behavior intervention plan and using the restraint for longer than necessary.

The state also found in applying the restraint, school staff used "an amount of force which is not reasonable and necessary under the circumstances."

Violations like those highlight the risky nature of prone restraints and the lack of training and tracking around their use, said some parents and advocates.

"I truly believe that if parents knew what a restraint looked like, no one would allow it," said Sadie Ferguson, who removed her son from Guiding Hands after learning of Benson's death. She was trained in behavior intervention techniques, including restraints, for a previous job.

"The reality is, you see it all the time now," she said.

Legal but controversial

Restraints are legal in both public and non-public schools in California, and federal laws rely on a complicated patchwork of state laws to ensure that students' rights and safety are protected during their use.

Current California law permits use of restraint in non-emergencies and only applies to students in special education.

California is one of 29 states that says restraint or seclusion cannot be used to discipline or punish children -- but the current law leaves leeway for other non-emergency situations, and statistics show restraints are used most often on black students who have special needs.

More than 122,000 students-- or one percent of the nation's student population -- were physically restrained or secluded at school in 2015-2016, according to the U.S. Department of Education. Many of those incidents were done in non-emergency situations, according to Disability Rights California, a nonprofit advocacy group based in Sacramento.

Only 28 states have laws providing strict protections against restraint and seclusion for all children; 38 states have broader regulations for children with disabilities, according to a report by attorney Jessica Butler, an autism advocate and parent of a child with autism.

About 76 percent of students physically or mechanically restrained at California schools in 2015-16 were served under the Individuals with Disabilities Education Act, according to data from the U.S. Department of Education'sOffice for Civil Rights. Students served under the act represented about 10 percent of California's student enrollment.

Black students were particularly likely to be restrained at school. They represented about 8 percent of California students served under the Individuals with Disabilities Education Act, but about 19 percent of students served under the act who were restrained at school.

Exact numbers of students who experienced restraints are hard to come by. The federal data may be incomplete. Unlike most schools, Guiding Hands and many other nonpublic schools do not individually appear in the data. The number of instances of restraint or seclusion logged statewide -- about 4,700 in 2015-16 -- is far lower than the number of behavioral emergency reports filed in 2011-12, the last year when the California Department of Education was required to collect such data statewide.

State data collection on holds will be restored next year.

New law, no ban

The new law, which goes into effect Jan. 1, takes protections further but does not forbid the use of prone restraints.

Outgoing Gov. Jerry Brown signed the bill, AB 2657, that will prohibit the use of restraint or seclusion on any student in California except when the student's behavior is identified as an imminent danger to him or herself or to others.

It also clearly prohibits restraining and secluding students as discipline, or for convenience or retaliation. It banned entirely the use of locked seclusion, and mandates that schools report all incidents of seclusion or restraint to the California Department of Education.

Under current policies, reporting restraints and seclusion have been inconsistent.

The new law, introduced by Assemblymember Shirley Weber, D-San Diego, also prohibits any restraints that restrict breathing.

While this means that educational providers should not place students face down in a prone position, the law has an exemption: if a prone restraint is used, the law states that a staff member not involved in the restraint should monitor the student's breathing.

Allowing the use of prone restraints to continue is necessary for critical situations where there are few alternatives, said Joe Kocurek, communications director for Weber.

"We want to provide a certain amount of latitude for very specific, extreme circumstances, but ban it under (most) circumstances," said Kocurek.

Prone restraints can reduce a person's oxygen supply in two ways: A person's ribs movement can be restricted, causing them difficulty in breathing. Abdominal organs can also be pushed up, which limits the lungs from expanding, according to a report by Disability Rights California.

Prone restraints should never be used on people at risk for positional asphyxiation, including those with obesity and those in an agitated, excited state, according to Disability Rights California, which sponsored AB 2657.

Suge Lee, attorney with Disability Rights California, said that they are happy with the new law, but more work needs to be done.

"In a lot of these restraint cases, I see that teachers and school staff are misinterpreting what an emergency is," she said. The new law is "only going to be as good as it's used."

Emergency behavioral interventions are meant to be used when there is spontaneous and unpredictable behavior that poses a risk of serious injury to the student or others. That could be relative, but it essentially means any behavior that has never seen before by the student, Lee said. If a student who has never had a history of running away spontaneously runs into traffic, a teacher can physically restrain him or her for safety, Lee said.

"We shouldn't appeal to this as the first thing we do," Kocurek said. "In fact it should be the last possible option under very extreme circumstances."

Disability Rights California recommends that restraint and containment be "viewed as the result of a treatment failure, not a treatment intervention."

Lee said that if a school is consistently using restraints as an intervention, as a substitute for a student's individualized plan, then that is a violation of a child's rights.

Lack of training

Lee and others also said teachers and staff need more training in how to properly do restraint holds. Current law does not mandate that school staff be certified in how to do the holds safely prior to using them, according to the DOE, and the new law makes no mention of training.

Many California schools use independent trainers to teach staff -- but will send only a few staff members to the classes. Those staff members in turn train others at the school, said Diana Berkheimer, a school safety instructor with Professional Assault Crisis Training, which conducts de-escalation and restraint courses.

Pro Act, Berkheimer's facility, conducts 36 hours of instruction before giving participants a one-year certification that allows them to train other teachers and staff in the techniques. Berkheimer said that in order to be more cost efficient, schools usually have one or two staff members trained by the agency, then rely on those staff members to train others at the school.

The haphazard nature of instruction can leave gaps, said Lee.

"Once the danger passes, you're supposed to let go," said Lee. "Time and time again, we don't see teachers doing that, and that is because of lack of information and lack of training."

Berkheimer said that proficiency in training is important, because interpreting how to restrain a student can vary.

"We want people to be treated with dignity and respect," she said. "When you apply it, it might not look the same way as I apply it."

Some Guiding Hands School staff members likely receive their restraint training from Handle With Care, a New York based agency that specializes in behavior management and crisis intervention training, according to parents and a school form obtained by The Bee. The agency has trained more than 100,000 people, according to its website.

It is not clear if all Guiding Hands School staff members received direct training from Handle With Care, or if one staff member trained the teachers.

An interview request with Handle With Care was not immediately returned. Guiding Hands declined to comment, but offered a statement shortly after Benson's death.

"It is with heavy hearts that we share the very difficult news that a beloved member of our school community has passed away. Out of respect for the family, and the ongoing investigation, we are unable to share full details at this time," it read in part.

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