Pressured to Handle Disabled Children, A School Tries Restraints, 'Isabel's Office'
Wall Street Journal logo
July 9, 2007
By ROBERT TOMSHO
WAUKEE, IOWA
- When Eva Loeffler walked into her daughter Isabel's classroom at Waukee Elementary
School on Dec. 15, 2004, she says a male guidance counselor was trying to contain
the shrieking 8-year-old by wrapping his arms around hers in a restraint hold.
Isabel, suffering from autism and other disabilities, had a history of aggressive
behavior, but Mrs. Loeffler had never seen her so agitated. Her eyes were glazed
and her face was red. "She was like a wild animal," says Mrs. Loeffler, who, at the
time, felt sorry for the counselor who had to deal with her daughter in such a state.
That sympathy waned as Mrs. Loeffler and her husband learned all the measures the
school district used on Isabel. These included restraint holds by three adults at
once and hours in a seclusion room that teachers called "Isabel's office." There
the girl sometimes wet herself and pulled out her hair, according to documents filed
in a 2006 administrative-law case the Loefflers brought against the school district.
In March, the presiding administrative-law judge ruled that the district had violated
federal law by educating Isabel in overly restrictive settings and failing to adequately
monitor its methods. The district has appealed. Its lawyer, Ronald Peeler, says it
used "established educational principles" in addressing Isabel's problems, and made
adjustments when its discipline wasn't working. "We are not dealing with an exact
science here," says Mr. Peeler.
As public schools come under pressure to teach more children with behavioral disabilities,
the use of restraint and seclusion has become a contentious issue. Faced with laws
that make it more difficult to expel or suspend misbehaving special-education students,
educators say they need to use harsh tactics sometimes to protect other children
and teachers.
The danger comes when schools turn methods designed for extraordinary circumstances
into routine disciplinary tools. The result can be a vicious cycle of punishment
and rebellion, hurting the very children who were supposed to benefit from attending
a mainstream school.
Some states are taking action. Last year, Michigan barred schools from restraining
students by holding them face-down on the floor. The move was sparked by the case
of Michael Renner-Lewis III, an autistic 15-year-old who died in 2003 after being
restrained in that manner at a Kalamazoo-area high school. This year, Kansas and
Connecticut have stepped up reporting requirements for school districts using restraint
or seclusion.
At psychiatric hospitals that receive federal funds, only licensed medical personnel
may order a troubled patient to be put into a restraint hold or locked in a room.
The subject must receive a face-to-face evaluation within an hour. Even with these
rules, restraint and seclusion result in as many as 150 deaths a year in health-care
settings, according to the U.S. Department of Health and Human Services, which is
campaigning to eliminate the practices.
By contrast, there is little regulation in public schools. The federal government
doesn't gather incident data. About half the states have no standards and most that
do have no reporting requirements, says Reece Peterson, a special-education professor
at the University of Nebraska-Lincoln who has studied the issue.
Earlier this year, Colorado's federally funded disability advocacy office accused
a Colorado Springs-area school district of abuses including allowing students to
beat themselves bloody while being held in seclusion rooms. A similar office in Oakland,
Calif., recently accused six California schools of routinely using restraint and
seclusion in place of proper behavior plans for special-education students.
"Why do we allow the place where children spend the most time to be the place where
they get the least protection from these deadly tactics?" says Rocky Nichols, executive
director of the Disability Rights Center of Kansas, a Topeka-based advocacy group.
Decades ago, schools often denied enrollment to students with serious behavioral
disorders or assigned them to segregated facilities. Conflicts over disciplinary
methods often played out far from public view. Then came the 1975 federal law now
known as the Individuals with Disabilities Education Act. It requires schools to
provide disabled students with individualized education plans and put them in the
least-restrictive appropriate setting -- which often means a regular public school.
The idea is that children with disabilities will mature and learn more if they have
contact with peers in regular schools.
In 2005, 472,000 children were receiving special-education services for emotional
disturbances. Of them, 35% were going to school in "fully inclusive" settings --
spending 80% or more of their day in regular classrooms -- up from 17% in 1990.
Isabel Loeffler's story -- drawn from interviews, school records and court testimony
-- reflects the struggle of schools to develop proper disciplinary techniques amid
the pressure to "mainstream" disabled children.
When Isabel was three, her parents took her to a specialist to determine why she
was not speaking as well as other children her age. Other problems slowly surfaced.
Doug Loeffler, Isabel's father, left his job in 2002 managing a Denver-area mutual
fund to help sort out his daughter's problems.
A slender girl with straight brown hair, Isabel often avoided direct eye contact
and walked with an awkward, birdlike gait. Along with autism, her disabilities included
mild mental retardation, diminished motor skills and a serious speech impediment.
Isabel also touched and grabbed others at inappropriate times. She would pin her
younger sister, Victoria, to the floor and play rough with the family's golden retriever,
Sika.
In 2001, Isabel started school at the Buffalo Ridge Elementary School, in Castle
Rock, Colo. She was assigned to a regular classroom most of the day. Educators simplified
her curriculum and gave her individualized help from a special-education teacher.
By the end of the 2003-04 school year, she seemed to be making progress. With assistance,
she could identify numbers up to 100, and she had begun writing sentences.
Feeling confident in his daughter's progress, Mr. Loeffler took a new job that summer
overseeing mutual-fund managers at the Principal Financial Group in Des Moines. The
family bought a house near Waukee, about 15 miles west of the city.
The once-sleepy farm and mining town had become a fast-growing suburb, with housing
developments rising up beside old grain elevators and a school enrollment that tripled
during the 1990s. About 8% of Waukee's 5,000 students qualify for special-education
services. Only a handful of them are educated outside regular schools, which is a
point of pride for the district.
For advice on educating such students, the Waukee district and 54 others in Iowa
rely on the state-funded Heartland Area Education Agency, which has a "challenging
behavior team" to help local educators deal with their toughest cases.
Martin Ikeda, an Iowa Department of Education official who helped create the team
while at Heartland, says the agency believes it can reduce problem behavior and keep
children in regular schools with a slowly intensifying menu of responses ranging
from ignoring the behavior to dispatching the student to a closed "teaching room."
As Isabel entered the second grade in August 2004, Waukee initially assigned her
for most of the day to a special-education classroom that emphasized functional skills
such as identifying coins and going to the bathroom. After she performed better than
expected, she was moved a week later to another special-education class that was
more academically oriented.
The family communicated with Mirranda Krohn, Isabel's special-education teacher,
via a notebook that Isabel carried to and from school. "Isabel is off to a great
start," Ms. Krohn wrote on Sept. 1, 2004. "She seems to be making a lot of new friends.
She is so polite and fun to work with."
But problems soon surfaced. On Oct. 8, Isabel pulled one student's hair and hit another
in the mouth at recess, according to school records. On Oct. 27, she refused to do
what teachers asked and yelled "No," for an hour and a half.
A few weeks later, the school put together a formal education plan for Isabel. It
called for close adult supervision when she was in general education settings, such
as recess, and breaks to let her calm down by, among other things, listening to music.
When a break didn't end Isabel's misbehavior, the plan suggested punishing her by
making her complete a repetitive task, with a teacher holding her hand and making
her do so if necessary.
Such "hand-over-hand" procedures are most often used to teach new skills to those
who don't respond to verbal instruction. A child with severe disabilities, for example,
might be taught to eat properly by gently guiding his hand as he holds a spoon.
Many specialists say using hand-over-hand as punishment can backfire. "We many times
see behaviors escalate when we try to intervene physically," says Lee Kern, a special-education
professor at Lehigh University in Bethlehem, Pa.
At a Nov. 22 meeting, the Loefflers agreed to a behavior plan that included hand-over-hand,
school records indicate. Mr. Loeffler says if the tactic was discussed that day,
"it didn't jump out at us as a significant change."
For Isabel's hand-over-hand task, a teacher seated behind her would grip her hand,
in which she held a crayon, and move it across the page until the child indicated
she was ready to complete the coloring alone.
Isabel often reacted with rage. In one early incident that November, an adult aide
had to hold her in her chair while Ms. Krohn gripped her coloring hand. The next
afternoon, Isabel refused to work or play and "tore apart" the classroom, according
to school records.
In December, the school transferred her to a newly created special-education class
for students with serious behavioral problems. On her second day there, her conduct
began to unravel just before noon, according to a classroom log kept by teacher Patti
Brinkmeyer, who declined to be interviewed.
After hitting one classmate in the head, Isabel was forced to complete two pages
of hand-over-hand coloring. Minutes later, she hit a second student and began throwing
crayons and pulling things off walls.
At 12:22 p.m., Ms. Brinkmeyer used a restraint hold on Isabel. The girl spit and
tried to bite the teacher, who sought help from Jason Sanders, a guidance counselor
and football coach. He and Ms. Brinkmeyer used restraint holds at least seven times
that day on Isabel.
Alternately talking gibberish and laughing hysterically, the 8-year-old scratched
and kicked the adults. When they tried to restrain her, she attempted to butt their
chins with her head.
Mrs. Loeffler arrived to pick up her daughter for a dentist's appointment around
1:30 p.m. She says Mr. Sanders was sitting in a chair with his feet on the floor.
Isabel was standing between his legs, facing away from him, and he had her torso
locked between his legs. His arms were wrapped around hers, says Mrs. Loeffler.
In a brief phone interview, Mr. Sanders said, "That wouldn't be the kind of restraint
I would use." He then excused himself and later declined to comment further.
According to testimony in the court case, Ms. Brinkmeyer and Mr. Sanders as well
as other school personnel were trained and certified to use restraint holds developed
by David Mandt & Associates, a Dallas-based company founded in 1975 whose method
is used by more than 500 school districts.
Bob Bowen, Mandt's chief executive, says his company's holds weren't used properly
in Isabel's case, which he has reviewed. He says Mandt teaches them as last-resort
safety measures only and doesn't condone their use for behavior management.
The Loefflers say that when they first realized restraint holds were being used,
they didn't know whether it was a good idea. Mr. Loeffler adds that they didn't realize
the full extent of the practice until much later, when they gained access to records
like a classroom log for Jan. 14, 2005.
It indicates that, during a coloring session that day, Isabel tried to bite a teacher's
aide three times, banged her own free hand against the desk and yelled "stupid" at
other children. The entry in the notebook that went home that night made no mention
of hand-over-hand, saying only that Isabel had a "rough" day and "had a hard time
keeping her hands to herself."
Because Isabel's behavior temporarily improved that spring, the Loefflers put off
pushing for any changes in her education plan until the following school year, when
Isabel and Ms. Brinkmeyer transferred to Walnut Hills Elementary School, a newly
built facility only blocks from the family's home.
At home that summer, Isabel urinated in closets and on beds, something her parents
had never seen. Thinking their daughter's outbursts were at least partly related
to her lack of time around nondisabled children, the Loefflers pressed at an Aug.
19 meeting with school officials for her to be in a regular-education classroom more
often.
Isabel was given a new locker outside a regular-education classroom and a promise
that she would be in regular classes as often as possible for so-called specials,
like music and art.
That fall, her behavior problems continued -- as did the hand-over-hand procedures
to punish her. It took as many as four educators to make Isabel complete her assignments.
Sometimes she broke free and trashed the classroom. On Sept. 20, 2005, she emptied
out drawers, threw a walkie-talkie and dumped soda on the floor.
By then, Waukee educators had documented 17 hand-over-hand interventions with Isabel.
Some lasted as long as two and a half hours.
Such punishments are unusual and extreme, says Garry L. Martin, a psychology professor
at the University of Manitoba. "If they are doing this for even five or 10 minutes
at a time, I would say that is way too long," says Dr. Martin. He and other academics
say that unless such measures change behavior they should be abandoned. Otherwise
they may induce children to mimic the aggression.
Teachers began experimenting with moving Isabel out of the classroom when she was
agitated, school records show. They tried timeouts in a small conference room next
to Ms. Brinkmeyer's classroom, but Isabel jumped on tables and grabbed at electrical
outlets.
Timeouts soon moved to "Isabel's Office," a former storage room at the end of a hallway.
It had a gray linoleum floor, beige concrete-block walls and a door with a small
window. Under a new plan that Heartland and the district presented to the Loefflers
in November, Isabel would receive one-on-one instruction in the room until she could
prove she could obey adults and be around other students without disruption. If she
became agitated in isolation, teachers would remove her desk, chair and all other
materials and the door would be closed.
To end such timeouts, the plan said, Isabel would first have to sit on the floor
perfectly still for five minutes in a yoga-style position the school called "body
basics." Then, she would have to complete a so-called "contingent task," which in
her case involved pulling apart a pair of folded socks.
The Loefflers protested, saying the plan would make it impossible for Isabel to get
an appropriate education. But they weren't happy with the status quo either. They
stayed up several nights weeping and talking about what to do. Eva Loeffler says
she began to fear Isabel would have to be placed in an institution.
On Dec. 2, the Loefflers agreed to the new behavior plan, provided that the school
shorten the number of days Isabel had to behave to get back into the special-education
classroom. The school acceded and also agreed to accept help from the University
of Iowa's Center for Disability and Development, which had been working with the
family.
To help the center get a clearer picture of Isabel's situation, Walnut Hill agreed
to make a video of her on Dec. 7, her first day of being isolated in the new room.
When Mrs. Loeffler arrived to pick up Isabel that afternoon, Isabel was sitting in
the isolation room and had wet her pants. Mrs. Loeffler collected her daughter, changed
her clothes and left.
Doug Loeffler dropped the video off at the Iowa center the next day without watching
it.
School records show that for the rest of the month, Isabel was sometimes in the isolation
room for up to five hours a day. At times, she screamed, spit and rolled on the floor
of the room. On Dec. 12, she also pulled out a chunk of her own hair, according to
an email Ms. Brinkmeyer sent to a Heartland psychologist.
Isabel attended classes at Walnut Hill for the last time on Dec. 21, 2005. The Loefflers
kept her home after the holiday vacation while pondering what to do. Late on the
evening of Jan. 11, 2006, they watched the video of Isabel for the first time to
prepare for a conference the next day with school officials.
Clad in a white top and black pants, Isabel moves across the screen for more than
three hours. Put into the isolation room for refusing to complete a reading exercise,
she doesn't appear particularly angry, although at times she bangs her forehead with
her fist and tries to climb the walls.
At several points in the film, Isabel drops into the "body basics" position and stares
at the teachers watching her through the window. But each time, before the mandatory
five minutes are up, Isabel fidgets, pulls at her fingers or rocks backwards onto
the floor.
Mrs. Loeffler says watching Isabel struggle to come into compliance left her heartbroken
and feeling like the school's tactics were fueling her daughter's misbehavior. "That's
when I knew we could not send her back," she says.
State-sponsored mediation efforts failed to produce a new education plan for Isabel,
although the school district did agree to provide support to Mrs. Loeffler as she
tried to educate Isabel at home.
On Aug. 21, 2006, the Loefflers filed an administrative-law case against the district,
seeking to force it to provide a less restrictive education for Isabel at a school
other than Walnut Hill. Federal law provides for such proceedings as an avenue for
special-education parents unhappy with their child's education plan.
On March 29, after 10 days of hearings, presiding administrative-law judge Susan
Etscheidt found that Waukee and Heartland had not tried hard enough to put Isabel
in a regular classroom and used "highly intrusive interventions" that were not acceptable
or beneficial to her.
The administrative-law judge ordered the educators to seek outside expertise, come
up with a new education plan for Isabel and provide her with compensatory summer
classes. In dealing with such students, the judge wrote, schools must "focus on positive
behavior supports and not punitive techniques such as restraint, extended isolation,
or time out."
The district and Heartland appealed the ruling last month to the U.S. district court
in Des Moines, saying it wasn't supported by the preponderance of the evidence. Mr.
Peeler, the district's lawyer, says missteps are inevitable when dealing with troubled
children, but the district made adjustments such as reducing the five-minute rule
to one minute after viewing the video.
Ms. Brinkmeyer, in her testimony, said she never did anything to intentionally hurt
Isabel. School officials say they tried hard to encourage good behavior in positive
ways, such as urging Isabel to take breaks when she appeared stressed.
Heartland fears that the ruling may restrict options in handling students with severe
behavior disorders. "We are trying to find ways to keep kids in schools and keep
them in classes with their regular-education peers," says Sue Seitz, Heartland's
lawyer.
Mr. Loeffler recently decided to accept a job with an investment firm in the Los
Angeles area. "We had so much baggage, I just think it was a good time for us to
have a clean start," he says.
While making plans for the move, Eva Loeffler has continued teaching her daughter
at home in a brightly painted basement room lined with posters and bookshelves. One
recent morning, Isabel scampered in toting a pink backpack, said the Pledge of Allegiance
to a tiny American flag and rang a cowbell to start the school day.
Early on, certain gestures or the mention of words like "timeout" sparked angry outbursts
from Isabel but more recently, with the help of a psychologist, such behavior has
faded, Mrs. Loeffler says. These days, the 10-year-old talks about wanting "to go
back to regular school," her mother says. "She wants to know the date when she can
start."
