This article by Fred Clasen-Kelly first appeared in KFF Health News, republished with permission.

Photos show blood splattered across a small bare-walled room in a North Carolina school where a second grader repeatedly punched himself in the face in the fall of 2019, according to the child’s mom.

His mother, Michelle Staten, said her son, who has autism and other conditions, reacted as many children with disabilities would when he was confined to the seclusion room at Buckhorn Creek Elementary.

“I still feel a lot of guilt about it as a parent,” said Staten, who sent the photos to the federal government in a 2022 complaint letter. “My child was traumatized.”

Documents show that restraint and seclusion were part of the special education plan the Wake County Public School System designed for Staten’s son. Starting when he was in kindergarten in 2017, Staten said, her son was repeatedly restrained or forced to stay alone in a seclusion room.

Federal law requires school districts like Wake County to tell the U.S. Department of Education every time they physically restrain or seclude a student.

But the district, one of the largest in the nation, with nearly 160,000 children and more than 190 schools, reported for nearly a decade, starting in 2011, that it had zero incidents of restraint or seclusion, according to federal data.

Staten said she was alarmed to learn about the district’s reporting practices, and in March 2022 she sent a complaint letter to the Department of Education’s Office for Civil Rights. When the district set up her son’s special education plan, she wrote, “they said things like ‘it’s for his safety and the safety of others.’”

Further, she wrote, in his district files, “nowhere in the record was there documentation of the restraints and seclusion.”

The practice is “used and is used at often very high rates in ways that are quite damaging to students,” said Catherine Lhamon, assistant secretary for the Office for Civil Rights.

The Department of Education says it is meeting with schools that underreport cases of restraint and seclusion, tactics used disproportionately on students with disabilities and children of color like Staten’s son.

Lhamon called the practices “a life-or-death topic” and noted the importance of collecting accurate federal data. Secretary of Education Miguel Cardona announced new guidance to schools in 2022, saying that, “too often, students with disabilities face harsh and exclusionary disciplinary action.”

‘Children With Bruises’

For more than a decade, school nurses, pediatricians, lawmakers, and others have warned that restraint and seclusion can cause long-lasting trauma and escalate negative behaviors. In the worst cases, children have reportedly died or suffered serious injury.

“In an ideal world, it should be banned,” said Stacey Gahagan, an attorney and civil rights expert who has successfully represented families in seclusion and restraint cases. The tactics are “being used in ways that are inappropriate. I’m seeing parents with pictures of children with bruises and children afraid to go to school.”

No federal law prohibits restraint and seclusion, leaving a patchwork of practices across states and school districts with little oversight and accountability, according to parents and advocates for people with disabilities.

Tens of thousands of restraint and seclusion cases are reported to the federal government in any given year. But those are likely undercounts, say parents and advocates for students, because the system relies on school staff and administrators to self-report. It’s a failing even the Department of Education acknowledges.

“Sometimes school communities are making a deliberate choice not to record,” Lhamon said.

The Wake County Public School System declined to answer questions about Staten’s case for this article, citing student privacy law.

A 2022 report to Congress found North Carolina schools handed lengthy suspensions or expulsions to students with disabilities at the highest rate in the nation.

The district in 2022 submitted revised restraint and seclusion data to the federal government dating to the 2015-16 school year, said Matt Dees, a spokesperson for the Wake County Public School System, where Staten’s son attended school. In a written statement, he said federal reporting rules had been confusing. “There are different guidelines for state and federal reporting, which has contributed to issues with the reporting data,” Dees said.

But parents and advocates for children with disabilities don’t buy that reasoning. “That explanation would be plausible if they reported any” cases, Gahagan said. “But they reported zero for years in the largest school district in our state.”

Hannah Russell, who is part of a network of parents and advocates in North Carolina that helps families navigate the system, said even when parents present pictures of their injured children, the school systems will say “it didn’t happen.”

In North Carolina, 91% of districts reported zero incidents of restraint and seclusion during the 2015-16 academic year, the second-highest percentage in the nation after Hawaii, a federal report found.

“This was a problem before covid,” said Russell, a former special education teacher who said one of her own children with special needs was restrained and secluded in school. “It is an astronomical problem now.”

North Carolina’s Department of Public Instruction, which oversees public schools statewide, did not make officials available for interviews and did not answer written questions.

In an email, spokesperson Jeanie McDowell said only that schools receive training on restraint and seclusion reporting requirements.

Educators are generally allowed to use restraint and seclusion to protect students and others from imminent threats to safety. But critics point to cases in which children have died or suffered post-traumatic stress disorder and other injuries for minor transgressions such as failing to stay seated or being “uncooperative.”

Zero Incidents Reported

In 2019, the Government Accountability Office, which conducts research for Congress, said some school systems almost never tell the federal government about the use of restraint and seclusion. About 70% of U.S. school districts report zero incidents.

The Department of Education’s “quality control processes for data it collects from public school districts on incidents of restraint and seclusion are largely ineffective or do not exist,” a 2020 GAO report said.

Lhamon said her office is conducting investigations across the country and asking districts to correct inaccurate data. The Department of Education wants school districts to voluntarily comply with federal civil rights law protecting students with disabilities. If they don’t, officials can terminate federal financial assistance to districts or refer cases to the Department of Justice.

The Wake County Public School System settled a lawsuit last year after the district did not report any use of restraint or seclusion in the 2017-18 school year, even though a student was secluded or restrained and witnessed the practices used with other children, according to Gahagan, who represented the student’s family.

As part of the settlement, the district agreed to notify parents by the end of each school day if their child had been restrained or secluded that day.

Gahagan said transparency would increase in Wake County but that problems persist across the country. Schools sometimes keep seclusion incidents hidden from parents by calling them “timeouts” or other euphemisms, Gahagan said.

“For most parents a ‘timeout’ doesn’t mean being put in a closet,” Gahagan said. “What is the recourse for a parent? There are not a lot of checks and balances. There is not enough accountability.”

Still, Gahagan, a former teacher, expressed sympathy for educators. Schools lack money for counselors and training that would help teachers, principals, and other staff learn de-escalation techniques, which could reduce reliance on physical interventions, she said.

Jessica Ryan said that in New York City, her son, who has autism, received counseling, occupational therapy, and a classroom with a standard education teacher and a special education teacher.

But when Ryan’s family moved last year to Wake County, home to more than 1 million people and part of the famed Research Triangle region, she was told he didn’t qualify for any of those services in the district, she said. Soon, her son started getting in trouble at school. He skipped classes or was written up for disruptive behavior.

Then in March, she said, her husband got a phone call from their son, who whispered, “Come get me. I’m not safe here.”

After the 9-year-old allegedly kicked a foam soccer ball and hit a school employee, he was physically restrained by two male school staffers, according to Ryan. The incident left the boy with a bloody nose and bruises on his leg, spine, and thigh, the medical records say.

The Wake County school district did not respond to questions about the events described in the documents.

After the incident, Ryan said, her son refused to go to school. He missed the remainder of fourth grade.

“It is disgusting,” said Ryan, 39, who said she was a special education teacher in Wake County schools until she resigned in June. “Our kids are being abused.”

The district did not record the incident in PowerSchool, a software system that alerts parents to grades, test scores, attendance, and discipline, Ryan said.

In August, Ryan’s son began classes at another Wake County school. By late October, school and medical records say, he was restrained or secluded twice in less than two months.

Guy Stephens, founder and executive director of the Alliance Against Seclusion and Restraint, a nonprofit advocacy group based in Maryland, said he founded the group more than four years ago after he learned his own son was afraid to go to school because he had been repeatedly restrained and secluded.

Stephens said some children subjected to the practice may start to act out violently at home, harm themselves, or fall into severe depression — impacts so adverse, he said, that they are a common part of the “school-to-prison pipeline.”

“When you go hands-on, you are putting more people in danger,” Stephens said. “These lives are being set on a path to ruin.”

In May, federal lawmakers proposed the Keeping All Students Safe Act, a bill that would make it illegal for schools receiving federal taxpayer money to seclude children or use restraint techniques that restrict breathing. Sen. Chris Murphy, a Connecticut Democrat, and other supporters have said a federal law is needed, in part, because some districts have intentionally misreported numbers of restraints and seclusions.

Advocates acknowledge Congress is unlikely to pass the bill anytime soon.

School administrators, including AASA, a national association of school superintendents, have historically opposed similar legislation, saying that restraint and seclusion are sometimes needed to protect students and staff in dangerous situations.

AASA spokesperson James Minichello declined comment for this article.

Staten said she begged officials at Buckhorn Creek Elementary and the district to remove restraint and seclusion from her child’s special education plan, documents show. Officials denied the request.

“I feel like they were gaslighting me into accepting restraint and seclusion,” Staten said. “It was manipulative.”

Staten and her husband now home-school their son. She said he no longer has emotional outbursts like he did when he was in public school, because he feels safe.

“It’s like a whole new kid,” Staten said. “It sometimes feels like that was all a bad dream.”KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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