Seclusion Rooms: What Every Parent and Professional Should Know

Sharon Paley is based in the UK at the British Institute of Learning Disability (BILD). She is currently undertaking a professional study tour of Australia and has received a Florence Nightingale Foundation travel scholarship.

Sharon is an eminent author and specialist in positive behaviours, as well as being a bit of a rock chick on the side. With years of experience and research behind her, she is one of the country’s leading experts in seclusion rooms, and is called upon by international courts to advise when their use goes tragically and horribly wrong.

I’m using my Friday column to bring you Sharon’s written summary of her findings for Special Needs Jungle, aimed at parents, carers and teachers, to ensure that illegal practices come to an end once and for all.

 

seclusion rooms

Sharon Paley:

I first presented a conference paper on the use of ‘time out rooms’ in 2004, raising my concern, that there appeared to be the use of rooms in UK schools and care services in response to managing behaviour. In the professional role I was undertaking at that time I had become aware of seclusion being used within school settings.

In 2007 I presented a conference paper to a shocked professional audience; the presentation included a short video clip of a child in an American school who had been locked into a ‘time out room’.

This video showed Isabel Loffler an eight year old girl with autism as she is videotaped for more than three hours confined in the room, she has also wet herself. It was widely reported in the media that she was put into the room for refusing to complete a reading exercise, the video shows that she bangs her forehead with her fist and tries to climb the walls. At several points in the film, Isabel drops to the floor and stares at the teachers watching her through the window.

The use of time out rooms within educational settings for children and young people has been in the headlines once more in the UK following  a recent report which was  published by Estyn (Her Majesty’s Inspectorate for Education and Training in Wales) that highlights continuing concerns with regard to safeguarding issues at Pembrokeshire Council, these concerns arose from the report published in August last year which discussed the inappropriate use of so called ‘time out rooms’. The rooms were in schools and pupil referral units.

In June 2011 another case which centered on the use of so called ‘time out rooms’ hit the headlines when the  Court of Protection ruled that an 18-year-old man with autism and severe learning disabilities who was regularly placed in a padded seclusion room more than six times a day was unlawfully deprived of his liberty.

In April 2012 Lord Justice Ryder took the unusual step of lifting certain reporting restrictions applied to cases before the court of protection by naming some of the parties involved in this case. The young man was at a residential school which was reported by the media to charge fees of up to 250,000 GBP per annum, the school was run by SCOPE, a national charity which has campaigned for the rights of people with disability over many years.

On reading the sensational reports about the use of time out rooms in the media most people, especially parents, have the immediate reaction of knowing that the practice of locking a child in a room is at the very least immoral. However when a parent is faced with a professional who is having difficulty in responding appropriately to the behaviour of their child that presents a challenge, it may be that they have agreed to their son or daughter being placed in “time out” as they feel powerless to do otherwise. It may be also possible that they do not fully appreciate what the professionals mean when they suggest ‘time out’ ‘ quiet time’ or ‘chill out time’.

It can be presented in a such a sanitized way which gives parents confidence that the professionals know what they are doing. It is also true that for many parents there is a feeling that if they do not agree to a strategy offered to then that perhaps their son or daughter may be excluded from school.

It is important to understand what time out actually is. It is a term used to describe a very specific behavioural technique; you may be familiar with Super Nannies version of this? To explain it simply time-out is

time spent away from reinforcement, usually for a specified period of time”.

Time-out can be implemented using two primary approaches, non-exclusion and exclusion.

In non-exclusionary time-out the individual is not physically removed from the setting but they do not receive positive reinforcement from other people for a period of time or at least until they desist from exhibiting the behaviour of concern to other people (which may be challenging). Positive reinforcement is something which the person finds to be pleasant; even being ‘told off’ may be a pleasant experience for some children.

In exclusionary time out the individual is at least partially removed from the (educational) environment. Time out does not have to take place in a certain room with special equipment and the child isn’t usually left alone. For time out to be effective as a behaviour change strategy the individual must have a level of understanding which enables them to make the link between their behaviour and the response of time out.

There should also be some way that the young person can reflect on their behaviour and communicate this to someone (in their own way, this may be with symbols or signing) so that they are able to return to the activity/ environment they have left as soon as possible. As a strategy time out has limited use especially with children and young people who have autism or intellectual disability as they often lack the ability to make the connection between time out and any behaviour they may have been exhibiting.

On a personal note I am also concerned that anyone might have an honest belief that a young child or child who has an intellectual or cognitive disability might reasonably be expected to gain control over their behaviour while effectively being isolated from other people and important social contacts.

For a child to learn and understand how to manage their emotions and any behaviour which might be seen as ‘challenging’ by other people they are likely to need support guidance and explanation. If a child is isolated from others whenever they exhibit a behaviour which is perceived as ‘challenging’ by others it’s unlikely they will be able to reflect on why they have been left alone, or experience any guidance relating to their behaviour, its actually more likely this is a frightening experience and for any child, for a child with a disability it would possibly be more frightening.

When we consider this carefully it is easy to understand though why some people may almost drift into using a practice when  you are faced with a child whose behaviour appears to be out of control and risky, you notice that when the child is allowed to spend time alone they calm quickly.

A potential solution may appear to be a room which the child can use in order to ‘self sooth’, at first being accompanied by staff when in the room. Over time this practice becomes embedded, and it becomes the normal response to the child’s behaviour.

Arguably it is easier to mange the child and the behaviour  by putting them in a room rather than try to figure out what is making them behave this way which would be a more proactive and positive response.It might also be that it feels less risky than managing the behaviour in a more direct manner.

In order to free up a member of staff from guarding a door a catch is put on the exterior of the door to the room. The child is now placed in the room alone with the catch down; in most circumstances if this is a planned response it is likely to be unlawful. It is probable that this would constitute unlawful imprisonment and it might also be considered a breach of that child’s human rights.

Questions to ask…

  • Does the child access the room or space voluntarily?
  • Is the child  accompanied by a support worker/ teacher or other person in the room?
  • Can the child leave the room independently? Do they know how to get out of the room or area?
  • Is the ‘time out’ part of an assessed and agreed behaviour support plan that includes short term and long term goals?
  • Can the’ time out’  strategy  be easily implemented in a number of environments?

If the answer is yes to most of the above it is likely that you are using a time out strategy.

  • Do support staff or teachers or others take the child to the room or space?
  • Is the child left in the room or space alone?
  • Is the child is unable to leave the room independently or not understand how to leave the room when they choose to?
  • Do people watch/monitor the child  from outside the room without entering the room?
  • Is the practice dependent on a room or space which is available at the place the child  is being educated or cared for?

If the answer is yes to the above questions  the practice is more likely to be seclusion, and may be illegal except in specific circumstances described in legislation such as The Mental Health Act (1983)

It is important to understand what is actually meant when professionals suggest options such as ‘time out’, quiet space or safe space. The questions above may act as a quick guide.

If a child is put into any room or area from which their free exit is prevented this is a breach of their human rights, it may constitute unlawful imprisonment and in any event it is unacceptable practice.

There is limited evidence that time out strategies, implemented as part of an overall behaviour  response strategy will have any positive impact on children or their behaviour in the long term, especially when such strategies are applied without any positive behaviour support plan. Indeed it is likely that any such isolation may cause distress and even traumatise the child.

In November 2004 a 13 year old child, called Jonathan King hanged himself while in a time out room at his school in Georgia, USA. While this is an extreme and incredibly sad example of what can happen when time out is implemented it is too simplistic to argue that such an event could never occur in the UK.

The two examples cited in the opening of this  article are evidence that the practice is occurring in schools in the UK. It is difficult to say how widespread the practice is but it is probable that the two cases discussed at the outset of this piece are not isolated examples.

In my professional experience when I have come across ‘time out’ strategies in schools and other environments they have often been adopted by well-meaning staff who have worked with the parents and carers to agree a way forward.

The intent is often well meaning however it is my professional opinion that the use of rooms to isolate children is misguided, ill-informed, not based in any evidenced-based practice and unlikely to yield any positive outcomes. It is also potentially dangerous.

  • Wales Audit Office (2012) Special Inspection – Implementation of Safeguarding Arrangements- Pembrokeshire County Council. Cardiff Estyn.
  • Care and Social Services Inspectorate Wales (2011) Joint investigation into the handling and management of allegations of professional abuse and the arrangements for safeguarding and protecting children in education services in Pembrokeshire County Council. Crown Copyright.  Wales.

Illegal Use of Seclusion room examples

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Hayley Goleniowska

Blogger, writer, advocate at at Downs Side Up
Hayley Goleniowska is the author of the popular blog, Downs Side Up, where she writes about life with her daughters, one of whom has Downs Syndrome, and other issues surrounding disability.
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About Hayley Goleniowska

Hayley Goleniowska is the author of the popular blog, Downs Side Up, where she writes about life with her daughters, one of whom has Downs Syndrome, and other issues surrounding disability.
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  • vaguest

    Hah, I went to visit 2 special schools when I was looking for somewhere for my son (Asperger’s) that had “sensory rooms”. I felt strongly that these were basically padded cells. They were sound-proof, had a lock on the outside, and a peephole that looked in to the room. A member of staff explained that these rooms could “also” be used as a safe place to put a child during a meltdown.

    A different school I went to had NO such rooms, and I witnessed staff dealing patiently, kindly and calmly with a meltdown. A school that locks children away or one that attempts to teach them to control themselves? Guess which I felt better suited my son (and in fact ANY child).

    Both of the schools I visited with these rooms were run by the same organisation, and one of them hit the national headlines a couple of years ago over their appalling management of a particular child. Shocking, yes, but not surprising to me. I was so glad I fought against my son going to one of these places. I do not believe there is any excuse for locking a child in a padded cell if the staff have the correct training.

    Just one question. Should these schools be reported to some authority, or would proof (ie witnessing it being misused) be needed first?

    • downssideup

      It’s frightening to think of what might have been isn’t it. Sharon has outlined what can be done if you have concerns about a school in a comment below. There are fortunately many groups working together on this.

  • http://aliisaacstoryteller.wordpress.com Ali Isaac

    I am shocked that such barbaric practices are taking place in this day and age. Its abuse, plain and simple, something that would never be done to a ‘normal’child. It breaks my heart to think that someone could do this to a child like my little girl if she has a tantrum…if she is already feeling disturbed and upset, imagine how traumatic an experience it must be to be locked up for hours like that as well. Fortunately she goes to a lovely school where the staff there know how to handle meltdowns with love and respect. Thank you for highlighting this horrible issue.

    • downssideup

      Like you my daughter is lucky to go to a fabulous school, but when I first read Sharon’s work around this issue I was shocked to the core. I want to help prevent such cases happening again.

  • Jo

    I think better training for staff to help them understand why children can behave the way they do is a huge missing piece. For many children with special needs the world can be just too bright, too noisy, too overwhelming, expectations too high. I have learnt much about sensory overload/meltdowns through my two sons. We forget that we are living in an ever changing, fast paced, overwhelming environment that becomes even more magnified for those needing a different approach.
    A room that is quiet, calm and with a person who understands can make the biggest difference. Not secluded, alone-that is hard for anyone.
    I for one am tired of “us” having to fit into everyone else’s world. Sometimes it would be nice if someone took the time to see the world look the eyes/experiences of these wonderful children.
    Those caring for these children have a duty to learn what they can to help not harm.
    I wonder what would happen to a parent if they took the approach described within the article.

    • downssideup

      Absolutely Jo, and there are many wonderful workshops and courses available teaching teachers about positive behaviour and alternative ways to deal with challenging behaviour.

  • audrey

    This rooms need to be taken out of irish schools. There is no regulation for their use, and nobody takes responsibility when they are misused. When a parent objects to them they are told ‘our school, our rules, remove your child’ My son was repeatedly locked in one, often for refusal to do work he couldn’t (or wouldn’t) do. It caused him immense distress, which made his behaviours worse. In December of 2012 it had gotten to the stage that he was locked in the room almost every day, sometimes for hours. HOW WAS THIS TEACHING HIM ANYTHING? When I pleaded with the school to give him back the resourse hours they had stopped, I was told no. When I begged them to take him for a walk if he got stressed, or bring him to the library, or into the sensory room, they said no ‘he likes going to the calm room’. It wasn’t a calm room, it was a scream room, an isolation room, a room of horror. In January of 2013 things had gotten even worse, he was locked in the room for 4 days in a row, for up to 5 hours at a time. Imagine that, 5 hours of being hysterical, screaming to be let out, screaming that it was child abuse that they couldn’t keep him there. HOW IS THIS RIGHT???? When we told them not to use the room again, they expelled him. Our kids have NO rights, NOBODY is standing up for them. They are being abused, neglected, treated badly, and we put up with it because we feel we have no choice (where else would our children go) but it has to stop. My sonn has suffered HORRIFICLY, the school have absolutely destroyed my little boy who will never be the same because of his experience and NOBODY CARES. The department of education have ignored our plea of action, for help, to stop this from happening to other children. The HSE have whitewashed it, ignored our complaints, and have said that the school did no wrong. 5 hours locked in for 4 days, hysterical, and that’s ok??? We need to make a stand, so much needs to change, but it wont because people are afraid. Its not their child, and they are just relieved its not them. It is only going to get worse with the savage cuts being made. My son is safe now, I don’t believe he will ever go to school again, but what about the other kids…who will protect them?

    • downssideup

      I am so very sorry to hear of the appalling treatment your son received. I wanted to highlight this issue to help prevent it from happeneing again. Do read Sharon Paley’s reply below, as it contains very practical advice about making a complaint and putting a stop to the suffering.

    • http://michelledaly.blogspot.com Michelle Daly

      Audrey, I am so sorry for the way your son was treated. We do not send our children to school to be segregated and isolated in secluded rooms by lazy, uncaring teachers who should know better.

      I have read so much about secluded rooms in Irish schools and admire you for speaking out though it’s incredibly sad that both you and your son were punished for doing so.

      To expel a child from school because you spoke out about the inhumane way he was treated shows the sheer arrogance and lack of accountability by the head teacher.

      I can see it would be futile to suggest you compalin to the school as you have moved on since your son was expelled and you have no desire for him to return.

      I think you should continue to write to the HSE (Health & Safety Executive). I have had dealings with them myself when I lived in Ireland and experience tells me if you keep on knocking on their door someone will eventually open it.

      I do so admire your courage for taking on the establishment and for continuing to talk about your experience.

      The bottom line is you complained about your son being locked in a secluded room and as a result he was expelled. What message are the school and indeed the Irish Education system that chooses to bury its head in the sand sending out?

      Put up or shut up! If you don’t like our practices then there’s the road.

      Shameful…

  • Sharon Paley

    It is sad to read your comments. I do think there are things you can do if you have proof that sensory rooms or other spaces are being utilised to isolate children. There is NO evidence that seclusion has any behavioural benefit. It is not a practice that ought be supported for managing a young child’s behaviour in my humble opinion. The following are a few ideas for raising concerns:

    1. Try to resolve concerns with the school. Name the practice and challenge what is happening. Ask for the legal basis for the practice,ask to see the policy and evidence of the training staff have revived related to supporting behaviour. You might also want to speak to the person who is responsible for safeguarding of children within the school and ask if the practice has been discussed through the safeguarding process.

    2. You could report the practice to OFSTED or the equivalent inspection authority. They have the power to request that such practices stop and to onward report. This is a useful approach as they may be able to help without the need for you to be identified, if you want to retain a relationship with the school.

    3. You could report the practice to the local safeguarding board. I have also advised the NSPCC when a parent took concerns to them.

    4. Ultimately the practice is illegal except in very specific circumstances and the burden of proof to prove such circumstances will be significant. If you knew that a neighbour was locking a adult person in a shed against their will what would you do? Who would you report that to?

    5. You could find a good huma rights lawyer and take some legal action. See the article below. This case didn’t get the publicity it deserved at all.

    http://www.independent.co.uk/news/uk/home-news/locking-autistic-man-in-padded-room-ruled-illegal-2298553.html

    • downssideup

      Thank you so much Sharon for the article and for taking the time to set out very clear and practical advice for worried parents needing to report such practices.

  • Dick

    Every solution needs to be individualised to the circumstances. Time-out rooms are not appropriate in almost all cases. That said, I worked in non-European based setting once with a child where for the student’s own safety it was necessary for

    1. Staff to physically escort the student to a padded room.
    2. On occassion, leave the student on their own in the room
    3. Not allow the student to leave the room
    4. Monitor from outside the room

    This was necessary because:

    1. The student was actively seeking out objects and surfaces in the enviornment to hit his head or other parts of his body on. The padded room was the only location where she would not be able to do this.
    2, While 2 staff would normally stay within the room, she would sometimes charge into their knees or other body parts in an attempt to injure herself off them.
    3. Mid meltdown, she would try to leave the room. When she used to be allowed leave, she would immediately seek out a hard surface. A criteria was set of remaining calm for 5 minutes before she left.

    I would also note that solely positive approaches were used prior to the introduction of the time-out procedures. It was part of a full positive behaviour support plan. A full multi-disciplinary team including experts in challenging behaviour and positive behaviour support were involved. The meltdowns happened across a variety of settings and the triggers could include something as simple as being offered a preferred toy or activity, low attention conditions, toileting accidents, a friend being absent etc. The alternative was to expel the student – which would not have helped her but would been less risky for the school.

    The girl’s behaviour improved. I hear she is now moving on to a mainstream setting.

    I’m writing this because while I share the concerns of others about the mis-use of so called time-out rooms and agree that people should be very skeptical and concerned about their use in most situations, I hear some people call for “bans” on their use. It would be more useful to properly regulate their use – demand that schools are able to demonstrate that they conducted a proper behaviour assessment and that less restrictive approaches were exhausted before they tried using time-out. It would also be important that limits be set on their use. They should not be used to manage challenging behaviour, but as part of a process of treating the behaviour.

    • andrea

      Unfortunately, my asd son has had to deal with a isolation room first hand. The incident in question happened 2 years ago and my son still to this day carries the mental scares.

      To be perfectly honest I had my reservations from the onset. The first visit to the school didn’t sit right with me, (the school had not been my first choice) while I had been waiting to be shown around the school, I noticed a small child with down syndrome being told off, the poor little boy was physically shaking, he was then told what a bad boy he was and told to sit on the floor and wait to see the head.

      The guided tour briefly touched upon an isolation room. This room just looked like an empty room with an old fashioned radiator on one wall and high up windows. I had never heard of such a room prior to the visit. I do recall asking how long a child would spend in such a room and the answer I was given was that it was up to the child and they would be free to leave at any given time? Then the guide stated that the room was rarely used.

      At that time I had immense pressure from the LA to agree to a school, I was assured that this school was equipped to deal with asd children. I stupidly agreed as I wasn’t fully aware of the options available to my son at that time.

      My son went on to have a two week taster prior to the six week summer break and he enjoyed every minute of his time.

      Fast forward six weeks…

      The first day back my son returned home looking pale and exhausted. I contacted the school and asked if there had been any problems? I was told that this was just an adjustment period for my son and things would settle down soon?

      “Things” didn’t settle down, my son on many occasions had unexplained bruising on his body (fingertip marks to arms and legs) and he was regressing fast. He would insist on taking his doll to school as at that point he was isolated from every other child.

      On the day I withdrew my son from that school, he had returned home (via taxi) looking grey, his speech was incoherent. It took me hours to calm him and when he was finally able to articulate his words, all he kept saying was “locked in room, sick, sick, they made me clean up sick!”

      I was beyond horrified at what I was hearing, my 9 year old child had been locked in a room in such a heightened and distressed state that he had physically vomited. Rather than being offered comfort or reassurance, he was forced to clean off the floor his own vomit!

      When I contacted the school the following morning and asked for an explanation, I asked if it was acceptable for a child in her care to be treated in such a cruel and undignified way? The reply I got knocked me completely off kilter, I was told “Do you think that it is acceptable for YOUR child to vomit on MY carpets?” the conversation didn’t last much longer…

      I informed the LA regarding the “calm room” incident and also requested some work for my child.

      Never in my wildest dreams did I expect the following…

      Someone from the school knocked on my door with a heap of text book, all balanced on a tupperware pot. I actually thanked the woman for the delivery, and closed the door to find my son cowering in the corner. I placed the items on the table and asked him what was wrong. He said that’s her! I then reassured him that she was gone and proceeded to look at the books. I had assumed the tupperware pot was for some project? It wasn’t until I opened it and sniffed the contents to find it was actually hand delivered vomit from the school! (nice)

      The police were contacted and the school given an anti social behaviour notice?

      • http://www.downssideup.com Hayley Goleniowska

        Andrea, I read your account and was actually so shocked I had to take a couple of days before answering. This abuse makes my blood run cold and strikes fear into my heart. I cannot in my wildest dreams imagine the kind of person that could act this way towards any child, letalone one who needs extra support and is more vulnerable.
        Was further action taken against the school and staff?

        I can only hope you are all recovering from your experiences and that you have found a safe alternative for your son.

        I am so very sorry this happened to you.

        Hayley

  • andrea

    Hi Hayley,

    I would love to say that those responsible for abusing my child were held accountable, however, this was not the case.

    There was an LADO (local designated officer) investigation, this came to nothing. The only concern they had was that my son had spit wiped on him, they did not seem to find any fault with a child being subjected to prolonged seclusion or the fact that he was restrained repeatedly throughout the day? I did start the complaints procedure with the initial help from Parent Partnership, unfortunately the time scales
    were not met. (nothing is made easy)

    Then came the manic three way ping-pong match with social services, the SEN department and CAMHS. Each department basically passed the buck onto the other.

    My son was out of school for over a year, which had a detrimental knock on effect with my younger asd child, he didn’t want to attend school either.

    On a brighter note, he is now in a specialist provision and making steady progress.