Unrestrained - Episode 46, Reece Peterson and Elisabeth Kane

Hosted By Terry Vittone | Recorded on 11.15.2017 | Length 33:10 | Download this Episode | Transcript
Unrestrained - Episode 46, Reece Peterson and Elisabeth Kane
Although journal articles have been written about the effectiveness of crisis prevention training in the health care environment—notably a quantitative quality improvement study by Dr. Sally Gillam about the incidence of violence in a large hospital emergency department—there has been no comparable study produced for education. However, a comparative review of crisis intervention training programs for schools was published in 2010 by podcast guest Reece L. Peterson, an Emeritus Professor of Special Education at the University of Nebraska–Lincoln.

Reece was working with a doctoral student who had written a paper on the topic of crisis intervention and physical restraint and seclusion, and upon searching for published material on the topic, discovered there were very few people who had done any examination or research about the use of crisis intervention in school settings. In fact, according to Reece, “Almost all of the works that have been done would have been done in residential treatment centers or hospitals.” Reece believed that a similar study for education would fit into his work on the broader issue of violence in schools and the disciplinary responses in place for dealing with disruptive behavior.
 
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Peterson’s subsequent article, A Review of Crisis Intervention Training Programs for Schools (Couvillon, Peterson, Ryan, Scheuremann, Stegall, 20101) examines the content of 13 programs provided by commercial vendors who offer training programs intended to provide information and skills to de-escalate crisis situations in a safe and effective manner. The article examines the content emphases of the programs and differences in training delivery methods, and it works from two important premises: that the ability to safely manage a behavioral crisis has become critical for school staff, and that the ability to assess the need for physical intervention and safely use appropriate procedural methods in emergency situations requires staff training. (An updated 2016 version of the article, broadened to include 17 main vendors of crisis intervention training and including input from doctoral candidate Elisabeth Kane, can be found here [PDF].)
 
Our podcast interview examines issues relating to crisis intervention training in the school setting including legal initiatives, standardization of training, or lack thereof, and the vital importance of fidelity of training across all layers of a school’s organizational structure.
 

Federal Guidelines Rather Than Legislation

Although several federal bills on the use of restraint and seclusion and the implementation of crisis intervention training have been proposed over the years, none have passed. This lack of a federal mandate on the practice, policies, and procedures on the use of restraint and seclusion in schools was the impetus for a 2012 US Department of Education guidance document [PDF], Restraint and Seclusion: Resource Document, issued under Arne Duncan, then the Secretary of Education. The document is notable for the inclusion of 15 principles that states, localities, and districts should follow to provide protection from restraint and seclusion. “At that time, Secretary Duncan recommended that schools develop their own policies in accord with these 15 principles,” explains Reece, adding further, “That guidance, even though it has been quite a while since it was published, remains the only real federal guidance on this topic at that level.”


According to Reece, this document has been responsible for the promotion and development of states’ policies. He cites a study by Marx and Baker, which reports that 38 states now have existing legislation and 45 have policy on restraint and seclusion. (Analysis of Restraint and Seclusion Legislation and Policy Across States: Adherence to Recommended Principles – Teri A. Marx, PhD, Joshua N. Baker, PhD, Journal of Disability Policy Studies, March 27, 2017 – an Education Week article about the study, including a link to the abstract, can be found here.) “I would suspect that most all of these states that now have policies were stimulated in part by the federal initiative and Arne Duncan's guidance document,” says Reece.


State Policy Is Not the Solution

While state policies on restraint, seclusion, and crisis intervention training may have beneficial effects, Reece notes that the level of discussion on these topics has diminished because states that have them in place feel they have addressed the problem. “On the other hand,” says Reece, “there continues to be these incidents occurring and often reported in the media where these procedures are used either abusively or without adequate supervision and the like, resulting in injuries to kids and others. And those situations that are reported in the media often don’t seem to be in compliance with what we would expect policies to cover. So, it's kind of a mixed bag there. Certainly, it's a good thing, I think, that these states have policies. But it is also not the solution.”

According to Reece, the awareness and effectiveness of state policies is scattershot at best, and policy could be better facilitated by federal legislation, even though we routinely bump into a conundrum where our federal legislative process is stagnant or reactive at best, and so we tend to leave this type of legislation up to the states. “I think a lot of this probably does boil down to what happens at the local level, and whether alert administrators are aware of these issues and provide adequate training and supervision,” he says. “In fact, it seems to be a mixed bag even with policies; there are districts that are having trouble. And on the other hand, in the states that don’t have policies, there are districts that seem to be doing a really good job.”
 
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This scattershot effectiveness dramatically underscores why it’s crucial for staff to have internal dialog in their schools about their training and their plan of approach for critical issues like least restrictive environments. In fact, here in CPI’s Yammer Instructor Community, Certified Instructors have written about how they aren’t waiting for further legal mandates, but instead have chosen to work hard within their organizations to create good documentation and training processes to protect both students and staff more immediately. Given the current political climate, it may be a considerable time before legislation provides clear, meaningful policy, and implementing CPI’s Nonviolent Crisis Intervention® training has never been more imperative. Now is the time to act!
 

Why Broader Organizational Training and Training Fidelity Are So Important

One important trend in crisis prevention training that Reece remarks on is the broadening of training to larger audiences within schools and districts. Prevention and de-escalation components usually reserved for smaller or specialized teams or departments are now offered to a broader audience. According to Reece, this is “an extremely valuable and important outcome.” This theme has appeared in previous CPI podcasts, including interviews with Becky Eckhardt and Michele Brand of Nebraska’s South Sioux City Community Schools and nurse educator Sara Holland of Virginia Mason Memorial Hospital. As Becky Eckhardt explains in her interview, “We not only train all our student services staff, we've also trained all our school counselors. Every administrator in South Sioux City is trained as well as many, many general education staff and support staff. Our long-term goal is to have 100% of our staff trained. We believe it has changed our climate and how adults respond to students in crisis.”

 

An important trend in crisis prevention #training is broadening it to larger audiences in #schools.

Lack of legislative or other oversight bodies that accredit training is also a significant concern, especially considering the plethora of organizations—at least 17 main vendors, according to the updated study, as well as many individuals—that offer instruction in crisis prevention. According to Elisabeth Kane, a doctoral candidate working on the study under Reece’s tutelage, with so many providers, and the freedom to choose training programs that lack accreditation, schools risk losing focus on viewing restraint and seclusion as last resort measures. One theme common to both CPI Certified Instructors in the field as well as analysts in academia is that the effectiveness of training depends on staff being consistently and identically trained, not on some staff having more or different training than others.
 

Looking Forward

At the conclusion of the interview I asked Reece and Elisabeth if they felt optimistic that public awareness of the danger of restraint and seclusion in schools might soon translate into meaningful policy and legislation. Both were hopeful, but with reservations: Elisabeth noted that policy and legislative initiatives to date have been reactive rather than proactive, and Reece said he is optimistic, but that his optimism is tempered with frustration due to numerous instances where there is awareness, but not progress, and abusive and injurious conditions continue to occur in schools. “Certainly things are moving forward,” concludes Reece, “but there’s also a recognition that there’s really serious problems still out there in schools to be worked on.”
 

Guest Biographies

Reece L. Peterson is an Emeritus Professor of Special Education at the University of Nebraska–Lincoln, specializing in the education of students with emotional or behavioral disorders. His interests include intervention for students with behavioral needs, student discipline in school, school violence prevention, as well as special education policy. He has authored a book and several articles on the use of physical restraint and seclusion procedures in schools.

Elisabeth J. Kane is a doctoral candidate in School Psychology at the University of Nebraska–Lincoln. She has received training in two different models of crisis intervention and has authored several articles on the use of physical restraint and seclusion procedures in schools. She has helped to design a study of crisis intervention training and has served as an expert witness on the topic of safe use of physical restraint.

1. A Review of Crisis Intervention Training Programs for Schools (Couvillon, Peterson, Ryan, Scheuremann, Stegal, 2010, TEACHING Exceptional Children, Vol. 42, No 5, pp. 6 – 17. Copyright 2010 CEC.)
 
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