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Prioritizing student safety: It’s time to ban prone (face-down) restraint

Schools should be safe places for both students and staff. Six of North Carolina’s public school systems will be safer this year, thanks to policies that ban the use of prone restraint. 

Disability Rights NC applauds those six districts – Asheville City, Chapel Hill-Carrboro, Cumberland, Johnston, Transylvania and Tyrrell. However, North Carolina needs a statewide ban on the use of this potentially lethal technique so that all students in all of North Carolina’s public schools are safe.

Restraint in NC schools

State law permits school personnel to restrain students in certain circumstances. The law applies to any student, not just those who receive special education services. Restraint can be physical, meaning staff use their bodies to limit the student’s movement. Or restraint can be mechanical, with staff using a device to limit the student’s movement. 

Restraint is never completely safe; any time one person puts their hands on another, there is a risk of injury. But some types of restraint are particularly dangerous. Prone restraint, in which a person is held face-down, is one such technique. 

When implementing a prone restraint, staff hold down parts of the body in order to keep the student from moving or getting up. In many situations, the student being restrained suffers physical injuries, such as bruising, muscle strain and petechiae (broken blood vessels in and around the eyes typically seen in strangulation). For many people, the use of prone restraint leads to psychological trauma as well. In the worst cases, the person being restrained is killed.

Deaths from prone restraint

While there is little data about the number of deaths caused by prone restraint, there are dozens of stories illustrating how dangerous this technique can be. In Wisconsin, several adult staff at a day treatment facility held a seven-year-old girl in prone restraint for blowing bubbles in her milk; the girl died of suffocation. A 15-year-old Michigan student died while four school employees held him face-down for more than an hour. 

In 2012, a man held in prone restraint died in a facility operated by the NC Department of Health and Human Services (DHHS). The DHHS Secretary immediately banned the use of prone restraint in any mental health, developmental disability, or substance use service setting in the state. The NC Department of Public Instruction (DPI) and the State Board of Education have yet to follow the example set by DHHS; prone restraint remains permissible in the majority of our public schools.

Better, safer alternatives

Ideally, schools focus on proactive measures, such as positive behavioral interventions and supports (PBIS). PBIS is a system for implementing evidence-based behavioral interventions that can be used school-wide or tailored to an individual student. Implementing PBIS can reduce the occurrence of situations where restraint may be considered. Schools that implement PBIS have demonstrated decreased disciplinary referrals and increased academic achievement.  

If restraint is used, it is critical that staff are trained to use techniques that minimize the risk of harm to the student and to never use prone restraint. Some restraint training programs claim to teach “safe” prone restraint. These programs caution staff against putting any pressure on the person being restrained, especially on the back, as that can limit lung expansion and cause breathing difficulties. In the heat of the moment, however, staff attempting to restrain a struggling student are almost certain to use their own body weight to hold him or her down. School systems should not select a training program that includes prone restraint positions. 

The need for state action

A few school systems took matters into their own hands and adopted policies banning the use of prone restraint. Two of these systems adopted their bans while Disability Rights NC was investigating their use of the technique. The other four systems adopted similar policies on their own. This is cause for celebration, and Disability Rights NC applauds these school systems for their proactive efforts to protect students. 

But six school systems is not enough. Their policies do not protect students in the other 109 city- and county-based systems or in the more than 160 charter schools in North Carolina. We call on the State Board of Education and DPI to ban prone restraint in all public schools. It is time for North Carolina to join the 27 other states (including, in the Southeast, Alabama, Georgia, and Mississippi) that prohibit the use of prone restraint on any student.

Kristine Sullivan

Kristine Sullivan joined Disability Rights NC as an attorney on the day the agency opened its doors in July 2007. She is the author of a legal practitioner’s manual for advocating against the use of seclusion and restraint in public schools.