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Understanding Seclusion, Withdrawal and Time Out

Seclusion 

Forced to spend time alone against their will

Requires Statutory powers other than in emergency

Time Out

Is a very specific clinical/behavioural intervention involving the removal of or from  reinforcing  stimuli as part  of a planned  behaviour programme

Requires a written agreed plan

Specifically-

“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 a 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.

Withdrawal

Removal from the situation but observed and supervised until ready to resume.

Legal Considerations

The 2010 Guidance, referring to the 2002 Guidance principles states;

The use of seclusion (where a person is forced to spend time on their own against their will) is a form of physical intervention and should only be considered in exceptional circumstances. The right to liberty is protected by criminal and civil law and seclusion outside the Mental Health Act should always be proportionate to the risk presented by the pupil.

The inappropriate use of seclusion may be unlawful, as will any unreasonable use of force where there is no legal justification.

Can only be used as an emergency measurenever as a planned response to behaviours of concern.

 

Recent Concerns

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 for 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 for many years.

Both of these cases indicate a heightened sensitivity to the inappropriate use of seclusion across education settings. The residential child care sector went through this in the 1980’s and 1990’s, see The Pindown Report: by Allan Levy and Barbara Kahan 1991. People sometimes mistakenly think that “pin down” referred to children being physically pinned down, literally. This wasn’t the case, it was fundamentally the miss-application of behaviourist strategies based on a poor understanding of their mechanics. The key strategy that was abused was seclusion (under the misnomer “timeout). The Real sad thing about pindown is that the staff thought they were acting in the best interests of the children, there was no malice intended. Twenty-odd years later the spotlight has turned on schools, if you are using seclusion (whether you call it that or something else) you are breaking the law (unless you have been granted the statutory powers by a court to do so).

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When we consider this kind of strategy (seclusion) 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 soothe, 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 manage the child and the behaviour by putting them in a room rather than trying to figure out what is making them behave this way which would be a more proactive and positive response. If the child is now placed in the room alone and prevented from leaving, either by locking the door or holding the handle on the outside; 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…

  1. Does the child access the room or space voluntarily?
  2. Is the child accompanied by a support worker/ teacher or another person in the room?
  3. Can the child leave the room independently? Do they know how to get out of the room or area?
  4. Is the ‘time out’ part of an assessed and agreed behaviour support plan that includes short-term and long-term goals?
  5. 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.

  1. Do support staff or teachers or others take the child to the room or space?
  2. Is the child left in the room or space alone?
  3. Is the child unable to leave the room independently or does not understand how to leave the room when they choose to?
  4. Do people watch/monitor the child from outside the room without entering the room?
  5. 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  then 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)

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