Fort Worth schools are restraining fewer students. Here’s what they’re doing instead.

Two years after a student died after being restrained at school, a growing number of teachers and staff members in the Fort Worth Independent School District are going through training on how to manage problematic behavior without the use of physical restraints, district records show.

Fort Worth ISD began using Ukeru, a restraint-free behavior management training program, last year following the death of a student at Boulevard Heights, a school for students with disabilities. Since then, dozens of teachers and staff members at the campus have gone through the training, records show.

Ukeru — a Japanese word meaning “to receive” — is a de-escalation technique developed in the early 2000s. It teaches school staff members to use reassuring, non-confrontational words and body language to help students who are in crisis calm down. If students become violent, the training program teaches educators to use blocking pads to deflect blows as they back away and continue to try to calm the student down.

Those techniques can be especially important for teachers who work with students with severe autism or other cognitive impairments, since many of those students can be prone to violent outbursts when they become overwhelmed.

“Our youth are in a crisis, especially post COVID,” said Nicole Stein, Fort Worth ISD’s director of psychological services. “The trauma and the things that our students are experiencing, we want to make sure our teachers are prepared for that.”

FWISD offers Ukeru, CPI training for behavior management

Fort Worth ISD offers Ukeru training alongside training from Crisis Prevention Institute, or CPI, a Milwaukee-based company that teaches techniques for restraining students safely, but only after de-escalation techniques have proven ineffective. The district has offered CPI training for years. Stein said the two training methods complement each other. Both include a strong focus on de-escalation, teaching school staff members how to head off problematic behavior before it arises.

But where the two protocols differ is in what happens if those de-escalation techniques fail. CPI training teaches staff members techniques for physically restraining students, although it emphasizes that those techniques are only to be used after all other options have been exhausted. Ukeru, meanwhile, teaches less invasive methods that don’t physically restrain or otherwise contain students.

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Stein said the district leaders hope the two training methods give teachers a wider range of tools. When a student begins exhibiting problematic behavior, district leaders want teachers to respond using Ukeru techniques first, she said. If the behavior escalates beyond the point where those techniques are effective, a physical restraint may still be necessary, she said — “only when (the behavior) is a danger to themselves or others, and as a last resort.”

Restraints decline drastically at Boulevard Heights, in FWISD

Both at Boulevard Heights and across Fort Worth ISD, the frequency of physical restraints has plummeted over the past five years, according to records released by the district in response to a records request by the Star-Telegram. During the 2017-18 school year, Fort Worth ISD reported 575 restraints at Boulevard Heights and 882 across the district, records show. Last year, that number dropped to just 43 at Boulevard Heights and 283 across the district.

Notably, even as the frequency of restraints declined, the number of students being restrained district-wide remained relatively flat during the same five-year period, indicating that teachers and staff restrained roughly the same number of students, but did so less often. During the 2017-18 school year, students who were restrained at school went through the experience 10 times, on average. Last year, that number dropped to three.

Though she acknowledged the district doesn’t have data to definitively establish a cause, Stein said she suspects the decline in restraints across the district is because of an increase in training in mental health and trauma-informed practices. If teachers and other staff members are better equipped to help students who are in crisis, those students’ behavior is less likely to escalate to a point where restraint is necessary, she said.

The district doesn’t keep records showing how often teachers and school staff members use techniques covered in Ukeru training. But district records show that a growing number of employees have gone through the training. Between February 2022, when the district began offering the training, and the end of the 2022-23 school year, 134 district employees received Ukeru training, records show, with about two-thirds of those employees coming from Boulevard Heights. Those numbers don’t include teachers and staff members who went through a training session held in Fort Worth this month.

Training follows Boulevard Heights restraint death

The district began using Ukeru as an alternative to restraint in February 2022, after a disabled student died after being restrained the previous year. Xavier Hernandez, 21, was a student at Boulevard Heights. Hernandez had been diagnosed with autism and schizophrenia.

On March 1, 2021, teachers and staff members at the school restrained Hernandez after he got up from his desk and tried to run out of the room. During the restraint, staff members noticed Hernandez had stopped breathing and his lips had turned blue. He was taken by ambulance to John Peter Smith Hospital, where he was pronounced dead later that day.

A staff member who participated in the restraint told Fort Worth Police Department detectives that he and a teacher held Hernandez face down on the floor, a dangerous maneuver known as a prone restraint. The same staff member later told the Star-Telegram that teachers at the school restrained Hernandez two to three times a week, typically on his stomach.

Fort Worth police investigated Hernandez’s death but didn’t make an arrest. A Texas Education Agency investigation is ongoing. Prone restraints are prohibited under the Texas Education Code, which is enforced by TEA.

Ukeru training can prevent restraints, research suggests

Research suggests Ukeru training can help institutions that serve people with disabilities reduce the frequency of physical restraints. In 2017, Woods Services, a nonprofit that runs a residential care facility for intellectually and developmentally disabled adults in southeastern Pennsylvania, began offering the training to its staff members. In 2021, researchers from the nonprofit’s research arm published a paper showing a decline in the use of restraints by staff in the residential facility after the training began.

Researchers looked not only at the raw number of restraints, but also at how that number compared to what they termed “restraint opportunities” — incidents of aggression or self-harm that might lead staff members to restrain a patient. In the first few months, when not all staff members had been trained, the number of restraints was only marginally lower than the number of opportunities, researchers found. But over the months that followed, staff members became less likely to physically restrain patients when they exhibited such behaviors.

Researchers also found that the number of “restraint opportunities” declined as more staff members went through the training, possibly indicating that employees were better equipped to head that behavior off before it escalated. Researchers noted that some patients responded to de-escalation techniques that were even less intrusive than the use of blocking pads, including hand-holding and counseling.

In the review, researchers found no significant difference in the number of injuries to staff members or patients before and after the training was implemented. They wrote that a clearer picture might emerge with an analysis that was limited to serious injuries to staff or patients, but data allowing for such a review wasn’t available.

Training program uses blocking pads instead of restraints

The Ukeru training program was launched in 2004 by Grafton Integrated Health Network, a Virginia-based behavioral healthcare provider that runs schools for students with disabilities. Ukeru President Kim Sanders said the nonprofit developed the techniques after years of seeing too many of their own employees get hurt while restraining students. Those injuries became frequent enough that the company was having a hard time keeping enough employees on the job, she said.

So several company officials, all of whom had backgrounds in working directly with patients, decided to come up with a different way of managing problematic behavior, Sanders said. Rather than turning to physical restraints, the company came up with a way to keep their employees from getting hurt while they continued to try to defuse volatile situations, she said. Employees use blocking pads to defend themselves from blows as they try to reassure the student, she said. They don’t use the pads to contain the student, but only to deflect kicks and punches as they back away. In most cases, the student calms down after a few moments, she said.

“I often have seen kids that just sort of melt,” she said. “It might end up with you and the kid… sitting on the ground, sitting on the blocking pads.”

One of the goals of the training is to make sure teachers feel safe while working with a student who’s lashing out, Sanders said. When people perceive a threat, it triggers the brain’s automatic fight-or-flight response. But when teachers are dealing with students in crisis, they don’t have the option of fighting or fleeing, Sanders said. So it’s crucial that they remain calm as they work to calm the student down, she said. The blocking pads not only keep teachers from getting hurt, but also help them feel as though they aren’t in any danger, which can keep their own stress levels from escalating, she said.

Sanders said the company is careful not to present Ukeru as a silver bullet solution to every behavior problem. When the company works with school districts, hospitals or other service providers, they start with the goal of reducing the frequency of physical restraints, not eliminating them entirely, she said.

In some cases, doing away with restraints altogether may not be a realistic goal, she said. But even if it is possible, she thinks insisting upon it at the outset could do more harm than good. The techniques represent a major shift away from how many teachers have managed their classrooms for years, she said, and a change of that magnitude can be difficult. So the company presents the training as an alternative that can help schools restrain fewer students. Still, districts that adopt the training could eventually discover that they’ve essentially eliminated restraint and seclusion on their campuses without setting out to do so, she said.

“We’d like to think that eventually, no one would be using restraints,” Sanders said. “But you’ve got to get there.”