What is Seclusion and Restraint & Why should I care??

Supporting Student Behavior: Standards for the Emergency Use of Seclusion and Restraint Awareness Training Muskegon Area Intermediate School District Presented by Steven Vitto, M.A., Behavioral Specialist, M.A.I.S.D. Certified Crisis Prevention Trainer (CPI) Certified Therapeutic Crisis Intervention Trainer (TCI) Certified State of Michigan PBS Coach and Trainer Certified Balanced & Restorative Justice Trainer (BARJ)

Andrew 11 years old Died from traumatic asphyxia and chest compression. Face-down restraint with arms crossed over chest.

11 years old

Angie 7 years old Stopped breathing after being placed in prone restraint position. Death being ruled a homicide

7 years old

Chase 17 years old Asphyxiation by a prone restraint He was restrained for refusing to stop talking and not following instructions . According to an autopsy he died after suffocating on his own vomit.

17 years old

Chris 13 years old Asphyxiation by prone restraint He was restrained 4 times … in his last 24 hours

13 years old

Edith 15 years old Restraint Asphyxia – She was looking at a family photograph when a male aide instructed her to hand over the "unauthorized" personal item. The dispute escalated into a face-down floor restraint

15 years old

Gareth 15 years old Died of asphyxiation by a prone restraint Restrained by three staff members on his 4th day at the facility

15 years old

Isaiah 17 years old Four youths witnessed his death. Students say staff sat on him for three hours until he passed out and died.

17 years old

Jonathan 13 years old Restrained in a van while staff were running errands. Though he was clearly having difficulties breathing they continued running their errands… for another 1½ hours .

13 years old

Mark 14 years old Asphyxiation while being forcibly restrained by 3 staff in a prone position

14 years old

Sakena 18 years old Suffocation during face down restraint with staff member laying across her back.

18 years old

Travis 13 years old The autopsy indicated he died because of the face-down on the ground restraint. Restrained 1½ hours. Denied request for asthma meds.

13 years old

Omega 17 years old He died after being restrained by staff in prone position with arms behind his back. June 3, 2007

17 years old

Robert 12 years old Asphyxiation while restrained after a dispute about his… missing teddy bear He was restrained for 10 minutes, face down on the floor. The staffer who restrained the boy left him lying, unresponsive, on the floor

12 years old

Reality 142 deaths in the US from 1988 – 1998 due to S/R, reported by the Hartford Courant (Weiss et al, 1998) 111 fatalities over 10 years in New York facilities due to restraints (Sundram, 1994 as cited by Zimbroff, 2003) At least 16 children (<18 y.o.) died in restraints in Texas programs from 1988 – 2002, reported by local media (American-Statesman, May 18, 2003 ) At least 14 people died and at least one has become permanently comatose while being subjected to S/R from July 1999 to March 2002 in California (Mildred, 2002 )

142 deaths in the US from 1988 – 1998 due to S/R, reported by the Hartford Courant (Weiss et al, 1998)

111 fatalities over 10 years in New York facilities due to restraints (Sundram, 1994 as cited by Zimbroff, 2003)

At least 16 children (<18 y.o.) died in restraints in Texas programs from 1988 – 2002, reported by local media (American-Statesman, May 18, 2003 )

At least 14 people died and at least one has become permanently comatose while being subjected to S/R from July 1999 to March 2002 in California (Mildred, 2002 )

Reality 50 to 150 deaths occur in the US each year due to S/R estimated by the Harvard Center for Risk Analysis (NAMI, 2003) Federal Office of the Inspector General identified 42 of 104 (42%) SR deaths from 08/99 – 12/04 were not reported. (OIG, 2006)

50 to 150 deaths occur in the US each year due to S/R estimated by the Harvard Center for Risk Analysis (NAMI, 2003)

Federal Office of the Inspector General identified 42 of 104 (42%) SR deaths from 08/99 – 12/04 were not reported. (OIG, 2006)

The Research Over 85% of restraints, management, seclusion, begin with students refusing to follow a staff direction. How staff deal with this noncompliance plays a big part in whether the student’s behavior diffuses or escalates. There is no research supporting the use of forced compliance as a behavioral change strategy. There is a significant increase in children with ODD, ADHD, ASD, Social Maladjustment, Down Syndrome in our schools. Staff need to be trained in how to deal with oppositional, defiant and aggressive behavior. Most staff have little training in this area.

Over 85% of restraints, management, seclusion, begin with students refusing to follow a staff direction.

How staff deal with this noncompliance plays a big part in whether the student’s behavior diffuses or escalates.

There is no research supporting the use of forced compliance as a behavioral change strategy.

There is a significant increase in children with ODD, ADHD, ASD, Social Maladjustment, Down Syndrome in our schools.

Staff need to be trained in how to deal with oppositional, defiant and aggressive behavior.

Most staff have little training in this area.

Part One Introduction

TERMS What is restraint? What is physical management? What is physical assistance? What is a physical escort? What is mechanical restraint? What is seclusion? What is time-out? What is an emergency? What is imminent danger?

What is restraint?

What is physical management?

What is physical assistance?

What is a physical escort?

What is mechanical restraint?

What is seclusion?

What is time-out?

What is an emergency?

What is imminent danger?

Physical Restraint Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a student’s freedom of movement. Physical restraint of a student may only be used for the purpose of providing safety and support. RESTRICTIONS IN STATE GUIDELINES

Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a student’s freedom of movement. Physical restraint of a student may only be used for the purpose of providing safety and support.

What is Physical Assistance Physically assisting someone who is accepting of your help) e.g., putting on your coat)

Physically assisting someone who is accepting of your help) e.g., putting on your coat)

What is physical management? Physically forcing someone to do something against their will (e.g., forcibly taking something away from someone, physically making someone do a task) RESTRICTIONS IN STATE GUIDELINES

Physically forcing someone to do something against their will (e.g., forcibly taking something away from someone, physically making someone do a task)

What is a physical escort? Physical Escort is the touching or holding a student with a minimum use of contact for the purpose of directing movement from one place to another. RESTRICTIONS IN STATE GUIDELINES

Physical Escort is the touching or holding a student with a minimum use of contact for the purpose of directing movement from one place to another.

What is mechanical restraint? Mechanical Restraint is the use of any device, article, garment, or material attached or adjacent to the student's body, which the student cannot easily remove, and that restricts freedom of movement PROHIBITED IN STATE GUIDELINES

What is seclusion? Seclusion means the confinement of a student alone in a secured room or other space from which the student is physically prevented from leaving. RESTRICTIONS IN STATE GUIDELINES

Seclusion means the confinement of a student alone in a secured room or other space from which the student is physically prevented from leaving.

What is time-out? Timeout means a behavior management technique in which a student, for a limited and specified time, is placed in an environment where access to positive reinforcement is unavailable. Timeout should not be confused with seclusion because in a timeout setting a student’s movement is not physically restricted.

Timeout means a behavior management technique in which a student, for a limited and specified time, is placed in an environment where access to positive reinforcement is unavailable. Timeout should not be confused with seclusion because in a timeout setting a student’s movement is not physically restricted.

What is an emergency? Emergency is a situation in which a student’s behavior poses imminent risk to the safety of an individual student or to the safety of others. An emergency requires an immediate intervention. RESTRICTIONS IN STATE GUIDELINES

Emergency is a situation in which a student’s behavior poses imminent risk to the safety of an individual student or to the safety of others. An emergency requires an immediate intervention.

What is a Emergency Safety Intervention? Emergency Safety Intervention is the use of seclusion or restraint to de-escalate student behavior that poses an imminent risk to the safety of an individual student and others. RESTRICTIONS IN STATE GUIDELINES

Emergency Safety Intervention is the use of seclusion or restraint to de-escalate student behavior that poses an imminent risk to the safety of an individual student and others.

What is Prone Restraint? Prone Restraint is the restraint of a person face down. PROHIBITED IN STATE GUIDELINES

Prone Restraint is the restraint of a person face down.

What is supine restraint? Supine Restraint is the restraint of a person face up.

Supine Restraint is the restraint of a person face up.

State Board of Education Policy on Seclusion and Restraint On December 12, 2006 the State Board of Education adopted “Supporting Student Behavior: Standard for the Emergency Use of Seclusion and Restraint”.

On December 12, 2006 the State Board of Education adopted “Supporting Student Behavior: Standard for the Emergency Use of Seclusion and Restraint”.

Context for the Policy Referent group created by Superintendent of Public Instruction – May 2004. Group included parents, advocates, educators, policy makers & service providers. Group charge: Develop standards for the use of seclusion and restraint; Recommend substantive strategic directives; and Recommend implementation to State Board of Education

Referent group created by Superintendent of Public Instruction – May 2004.

Group included parents, advocates, educators, policy makers & service providers.

Group charge:

Develop standards for the use of seclusion and restraint;

Recommend substantive strategic directives; and

Recommend implementation to State Board of Education

The Supporting Student Behavior: Standards for the Emergency Use of Seclusion and Restraint (Supporting Student Behavior) document ▪ summarizes how a positive behavior support approach uses proactive strategies to reduce or eliminate the use of seclusion and restraint; ▪ defines the terms “seclusion” and “restraint”; ▪ outlines procedures for emergency use of seclusion and restraint; and ▪ provides a framework for training.

▪ summarizes how a positive behavior support approach uses proactive strategies to reduce or eliminate the use of seclusion and restraint;

▪ defines the terms “seclusion” and “restraint”;

▪ outlines procedures for emergency use of seclusion and restraint; and

▪ provides a framework for training.

The Supporting Student Behavior document is rooted in best practices and drafted in the belief that: the most effective strategies for supporting positive student behavior begin with meaningful instruction provided by highly trained professionals in a safe environment which promotes dignity for all students; school-wide systems of positive behavioral support to address challenging behavior will increase instructional time for all; and seclusion or restraint should be used only in an emergency and require diligent assessment, monitoring, documentation, and reporting by trained personnel.

the most effective strategies for supporting positive student behavior begin with meaningful instruction provided by highly trained professionals in a safe environment which promotes dignity for all students;

school-wide systems of positive behavioral support to address challenging behavior will increase instructional time for all; and

seclusion or restraint should be used only in an emergency and require

diligent assessment, monitoring, documentation, and reporting by trained personnel.

Legal Context of the Policy Policy is not meant to conflict with or limit corporal punishment statute. Policy is not law.

Policy is not meant to conflict with or limit corporal punishment statute.

Policy is not law.

State Board of Education Policy on Positive Behavior Support Each school district in Michigan will implement a system of school-wide positive behavior support (PBS) strategies. (Adopted September 12, 2006)

Each school district in Michigan will implement a system of school-wide positive behavior support (PBS) strategies. (Adopted September 12, 2006)

Impact of School-wide PBS on Seclusion and Restraint Implementation of a school-wide system will ensure that seclusion and restraint are used only as a last resort method. Encourages learning by building relationships; Teaches skills/rules/expectations; Identifies replacement behaviors that interfere with learning; Makes problem behavior less effective; Makes desired behavior more functional and adaptive.

Implementation of a school-wide system will ensure that seclusion and restraint are used only as a last resort method.

Encourages learning by building relationships;

Teaches skills/rules/expectations;

Identifies replacement behaviors that interfere with learning;

Makes problem behavior less effective;

Makes desired behavior more functional and adaptive.

Continuum of School-wide PBS

Are classroom response cost systems contributing to defiance and aggression? Response to Intervention Are we using evidenced based classroom behavior management systems at the universal level? Are classroom response cost systems evidenced based? Is there a balance, better yet, an overbalance of Positive Incentives and Feedback for Desired Behavior? When universal consequences (e.g., Classroom Response Cost System) are not effective, or when they trigger an escalation of behavior, do we differentiate our approach? Are we over-relying on classroom response cost systems to manage student behaviors?

Response to Intervention

Are we using evidenced based classroom behavior management systems at the universal level? Are classroom response cost systems evidenced based? Is there a balance, better yet, an overbalance of Positive Incentives and Feedback for Desired Behavior?

When universal consequences (e.g., Classroom Response Cost System) are not effective, or when they trigger an escalation of behavior, do we differentiate our approach?

Are we over-relying on classroom response cost systems to manage student behaviors?

Training on Policy Awareness Training- Needed for broad educational community including pre-service and substitute teachers. Comprehensive Training- Needed for key personnel identified by district to ensure trained personnel are available for emergency response.

Awareness Training- Needed for broad educational community including pre-service and substitute teachers.

Comprehensive Training- Needed for key personnel identified by district to ensure trained personnel are available for emergency response.

TRAINING Training Framework A comprehensive training framework includes: 􀁸 awareness training for the broader educational community, including pre-service training for all teachers; 􀁸 awareness training for substitute teachers; and 􀁸 comprehensive training for key identified personnel

Training Framework

A comprehensive training framework includes:

􀁸 awareness training for the broader educational

community, including pre-service training for all

teachers;

􀁸 awareness training for substitute teachers; and

􀁸 comprehensive training for key identified personnel

Training Components All training must include: 􀁸 proactive practices and strategies that ensure the dignity of students; 􀁸 conflict resolution; 􀁸 mediation; 􀁸 social skills training; 􀁸 de-escalation techniques; 􀁸 positive behavior support strategies; 􀁸 techniques to identify student behaviors that may trigger emergency safety situations; 􀁸 related safety considerations, including information regarding the increased risk of injury to students and staff when seclusion or restraint is used; 􀁸 instruction in the use of seclusion and restraint; 􀁸 identification of events and environmental factors that may trigger emergency safety situations; and 􀁸 instruction on the State Board of Education policy on Supporting Student Behavior: The Emergency Use of Seclusion and Restrain

All training must include:

􀁸 proactive practices and strategies that ensure the dignity of students;

􀁸 conflict resolution;

􀁸 mediation;

􀁸 social skills training;

􀁸 de-escalation techniques;

􀁸 positive behavior support strategies;

􀁸 techniques to identify student behaviors that may trigger emergency safety

situations;

􀁸 related safety considerations, including information regarding the increased

risk of injury to students and staff when seclusion or restraint is used;

􀁸 instruction in the use of seclusion and restraint;

􀁸 identification of events and environmental factors that may trigger

emergency safety situations; and

􀁸 instruction on the State Board of Education policy on Supporting Student Behavior: The Emergency Use of Seclusion and Restrain

Comprehensive Training for Key Identified Personnel C. Comprehensive Training for Key Identified Personnel A Local Educational Agency (LEA) will identify sufficient key personnel to ensure that trained personnel are available for an emergency situation. Before using seclusion or restraint with students, key identified personnel who may have to respond to an emergency safety situation must be trained in: 􀁸 proactive practices and strategies that ensure the dignity of students; 􀁸 conflict resolution; 􀁸 mediation; 􀁸 social skills training; 􀁸 de-escalation techniques; 􀁸 positive behavior support strategies; 􀁸 techniques to identify student behaviors that may trigger emergency safety situations; 􀁸 related safety considerations, including information regarding the increased risk of injury to students and staff when seclusion or restraint is used;

C. Comprehensive Training for Key Identified Personnel

A Local Educational Agency (LEA) will identify sufficient key personnel to ensure that trained personnel are available for an emergency situation. Before using seclusion or restraint with students, key identified personnel who may have to respond to an emergency safety situation must be trained in:

􀁸 proactive practices and strategies that ensure the dignity of students;

􀁸 conflict resolution;

􀁸 mediation;

􀁸 social skills training;

􀁸 de-escalation techniques;

􀁸 positive behavior support strategies;

􀁸 techniques to identify student behaviors that may trigger emergency safety

situations;

􀁸 related safety considerations, including information regarding the increased risk of injury to students and staff when seclusion or restraint is used;

TRAINING CONTINUED instruction in the use of seclusion and restraint; 􀁸 identification of events and environmental factors that may trigger emergency safety situations; 􀁸 instruction on the State Board of Education policy on Supporting Student Behavior: The Emergency Use of Seclusion and Restraint ; 􀁸 description and identification of dangerous behaviors; 􀁸 methods for evaluating the risk of harm to determine whether the use of seclusion or restraint is warranted; 􀁸 types of seclusion; 􀁸 types of restraint; 􀁸 the risk of using seclusion and restraint in consideration of a student’s known and unknown medical or psychological limitations; 􀁸 instruction in the use of seclusion and restraint; 􀁸 the effects of seclusion and restraint on ALL students; 􀁸 how to monitor the physical signs of distress; and 􀁸 how to obtain medical assistance.

instruction in the use of seclusion and restraint;

􀁸 identification of events and environmental factors that may trigger emergency safety situations;

􀁸 instruction on the State Board of Education policy on Supporting Student Behavior: The Emergency Use of Seclusion and Restraint ;

􀁸 description and identification of dangerous behaviors;

􀁸 methods for evaluating the risk of harm to determine whether the use of seclusion or restraint is warranted;

􀁸 types of seclusion;

􀁸 types of restraint;

􀁸 the risk of using seclusion and restraint in consideration of a student’s known and unknown medical or psychological limitations;

􀁸 instruction in the use of seclusion and restraint;

􀁸 the effects of seclusion and restraint on ALL students;

􀁸 how to monitor the physical signs of distress; and

􀁸 how to obtain medical assistance.

Part Two Standards for Seclusion and Restraint

Definitions Seclusion Last resort emergency safety intervention Gives opportunity to regain control Student is confined in room or other space & prevented from leaving Continuous adult observation required Restraint Emergency intervention Gives opportunity to regain control Direct physical contact that prevents or significantly restricts the student’s movement

Seclusion

Last resort emergency safety intervention

Gives opportunity to regain control

Student is confined in room or other space & prevented from leaving

Continuous adult observation required

Restraint

Emergency intervention

Gives opportunity to regain control

Direct physical contact that prevents or significantly restricts the student’s movement

Justification for Use Seclusion: Must be used only under emergency situations and if essential Emergency situations include behavior that: Poses imminent risk to the safety of the individual student Poses imminent risk to the safety of others Restraint: Must be used only under emergency situations and if essential Emergency situations include behavior that: Poses imminent risk to the safety of the individual student Poses imminent risk to the safety of others Fits the corporal punishment statute

Seclusion:

Must be used only under emergency situations and if essential

Emergency situations include behavior that:

Poses imminent risk to the safety of the individual student

Poses imminent risk to the safety of others

Restraint:

Must be used only under emergency situations and if essential

Emergency situations include behavior that:

Poses imminent risk to the safety of the individual student

Poses imminent risk to the safety of others

Fits the corporal punishment statute

Corporal Punishment Deliberate infliction of physical pain by hitting, paddling, spanking, slapping, or any other physical force as a means of discipline. Person employed by, engaged as a volunteer or contractor may use reasonable physical force as necessary to maintain order and control in a school or school related setting for the purpose of providing an environment that is conducive to safety and learning.

Deliberate infliction of physical pain by hitting, paddling, spanking, slapping, or any other physical force as a means of discipline.

Person employed by, engaged as a volunteer or contractor may use reasonable physical force as necessary to maintain order and control in a school or school related setting for the purpose of providing an environment that is conducive to safety and learning.

Limitations Seclusion not to be used for: Staff convenience Discipline or punishment As a substitute for less restrictive interventions As a substitute for training in CPI and PBS Restraint not to be used for: Staff convenience Discipline or punishment As a substitute for less restrictive interventions As a substitute for training in CPI and PBS

Seclusion not to be used for:

Staff convenience

Discipline or punishment

As a substitute for less restrictive interventions

As a substitute for training in CPI and PBS

Restraint not to be used for:

Staff convenience

Discipline or punishment

As a substitute for less restrictive interventions

As a substitute for training in CPI and PBS

Prohibited Practices Seclusion: Corporal punishment Depriving basic needs Child abuse Seclusion of preschool children Intentional application of a noxious substance or physical stimuli resulting in physical pain or extreme discomfort Restraint: Corporal punishment Depriving basic needs Child abuse Mechanical and chemical restraint Intentional application of a noxious substance or physical stimuli resulting in physical pain or extreme discomfort Prone restraint

Seclusion:

Corporal punishment

Depriving basic needs

Child abuse

Seclusion of preschool children

Intentional application of a noxious substance or physical stimuli resulting in physical pain or extreme discomfort

Restraint:

Corporal punishment

Depriving basic needs

Child abuse

Mechanical and chemical restraint

Intentional application of a noxious substance or physical stimuli resulting in physical pain or extreme discomfort

Prone restraint

Use of Physical Force under the Corporal Punishment Statute In maintaining order and control, a person may use physical force upon a student: To restrain or remove a pupil whose behavior is interfering with the orderly exercise and performance of school functions if the pupil has refused to comply For self-defense or defense of another To prevent a student from inflicting harm on self To quell a disturbance that threatens physical injury To obtain possession of a weapon or other dangerous object To protect property

In maintaining order and control, a person may use physical force upon a student:

To restrain or remove a pupil whose behavior is interfering with the orderly exercise and performance of school functions if the pupil has refused to comply

For self-defense or defense of another

To prevent a student from inflicting harm on self

To quell a disturbance that threatens physical injury

To obtain possession of a weapon or other dangerous object

To protect property

Procedures for Use Seclusion and Safety: Use trained key personnel Watch for physical distress Medical assistance if needed Continuously observe Document observations Restraint and Safety: Use trained key personnel Watch for physical distress Seek medical assistance if needed Continuously observe Document observations

Seclusion and Safety:

Use trained key personnel

Watch for physical distress

Medical assistance if needed

Continuously observe

Document observations

Restraint and Safety:

Use trained key personnel

Watch for physical distress

Seek medical assistance if needed

Continuously observe

Document observations

Seclusion: Proportionate and sensitive to student’s: Severity of behavior Developmental and chronological ages Size Physical, medical and psychiatric condition Gender Personal history, including history of physical or sexual abuse Restraint: Proportionate and sensitive to student’s: Severity of behavior Developmental and chronological ages Size Physical, medical and psychiatric condition Gender Personal history, including history of physical or sexual abuse Procedures for Use (continued)

Seclusion:

Proportionate and sensitive to student’s:

Severity of behavior

Developmental and chronological ages

Size

Physical, medical and psychiatric condition

Gender

Personal history, including history of physical or sexual abuse

Restraint:

Proportionate and sensitive to student’s:

Severity of behavior

Developmental and chronological ages

Size

Physical, medical and psychiatric condition

Gender

Personal history, including history of physical or sexual abuse

Duration Seclusion: No longer than needed to allow student to regain control Elementary = no more than 15 minutes Middle / High School= no more than 20 minutes If more time is needed, add support staff and document to explain time extension Restraint: No longer than needed to allow student to regain control, but generally no longer than 10 minutes If more time is needed, add support staff and document to explain time extension

Seclusion:

No longer than needed to allow student to regain control

Elementary = no more than 15 minutes

Middle / High School= no more than 20 minutes

If more time is needed, add support staff and document to explain time extension

Restraint:

No longer than needed to allow student to regain control, but generally no longer than 10 minutes

If more time is needed, add support staff and document to explain time extension

Debriefing Seclusion: Followed by debriefing with the parent and student to explore Triggers Whether behavior will occur again What, if any, follow-up is needed Restraint: Followed by debriefing with the parent and student to explore Triggers Whether behavior will occur again What, if any, follow-up is needed

Seclusion:

Followed by debriefing with the parent and student to explore

Triggers

Whether behavior will occur again

What, if any, follow-up is needed

Restraint:

Followed by debriefing with the parent and student to explore

Triggers

Whether behavior will occur again

What, if any, follow-up is needed

Emergency Intervention Plan (EIP) for Seclusion Trigger = a pattern of behavior requiring the use of seclusion occurs or is reasonably anticipated Documented steps for EIP: Detail the emergency plan Ask if a known medical condition contraindicates seclusion List possible alternative, pros and cons of each Periodic review Trained personnel

Trigger = a pattern of behavior requiring the use of seclusion occurs or is reasonably anticipated

Documented steps for EIP:

Detail the emergency plan

Ask if a known medical condition contraindicates seclusion

List possible alternative, pros and cons of each

Periodic review

Trained personnel

Trigger = a pattern of behavior requiring the use of restraint Documented steps for EIP: Detail the emergency plan Ask if a known medical condition contraindicates restraint Conduct peer review by knowledgeable staff Emergency Intervention Plan (EIP) for Restraint

Trigger = a pattern of behavior requiring the use of restraint

Documented steps for EIP:

Detail the emergency plan

Ask if a known medical condition contraindicates restraint

Conduct peer review by knowledgeable staff

EIP for Restraint (continued) Gain informed consent based upon an explanation of: Emergency restraint Possible discomforts and risks Possible alternative strategies, pros and cons of each Answers to questions Freedom to withdraw consent Periodic review Trained personnel Tell / show student circumstances when restraint would occur

Gain informed consent based upon an explanation of:

Emergency restraint

Possible discomforts and risks

Possible alternative strategies, pros and cons of each

Answers to questions

Freedom to withdraw consent

Periodic review

Trained personnel

Tell / show student circumstances when restraint would occur

Documentation and Reporting Seclusion: Document each use of seclusion and reason for use Document in writing and report immediately to building administrator Verbally report to parent/guardian immediately or ASAP Provide written report to parent within 24 hours Restraint: Document each use of seclusion and reason for use Document in writing and report immediately to building administrator Verbally report to parent/guardian immediately or ASAP Provide written report to parent within 24 hours

Seclusion:

Document each use of seclusion and reason for use

Document in writing and report immediately to building administrator

Verbally report to parent/guardian immediately or ASAP

Provide written report to parent within 24 hours

Restraint:

Document each use of seclusion and reason for use

Document in writing and report immediately to building administrator

Verbally report to parent/guardian immediately or ASAP

Provide written report to parent within 24 hours

Data Collection System Seclusion data must include: Frequency Relationship to suspension, expulsion and drop-out rates ID of appropriately trained key personnel and levels of education, training and knowledge A schedule for reporting and analyzing data by MDE (to be determined) Restraint data must include: Frequency Relationship to suspension, expulsion and drop-out rates ID of appropriately trained key personnel and levels of education, training and knowledge A schedule for reporting and analyzing data by MDE (to be determined)

Seclusion data must include:

Frequency

Relationship to suspension, expulsion and drop-out rates

ID of appropriately trained key personnel and levels of education, training and knowledge

A schedule for reporting and analyzing data by MDE (to be determined)

Restraint data must include:

Frequency

Relationship to suspension, expulsion and drop-out rates

ID of appropriately trained key personnel and levels of education, training and knowledge

A schedule for reporting and analyzing data by MDE (to be determined)

SCENARIO #1 Johnnie brings a restricted item to school- e.g., Pokie Man cards. Johnnie’s teacher asks for the cards. Johnny curtly say’s “No way” The teacher reiterates, “Give me the cards” John refuses. The teacher physically takes the cards away. Physical Management

Johnnie brings a restricted item to school- e.g., Pokie Man cards. Johnnie’s teacher asks for the cards. Johnny curtly say’s “No way” The teacher reiterates, “Give me the cards” John refuses. The teacher physically takes the cards away.

SCENARIO # 2 You ask a Johnny to leave the room and go to the time-out area. John tells you to go to h-ll. I’m not going anywhere. The staff physically manage John to the “time-out” room and then hold the door Physical Escort

You ask a Johnny to leave the room and go to the time-out area. John tells you to go to h-ll. I’m not going anywhere. The staff physically manage John to the “time-out” room and then hold the door

Scenario # 3 Johnny hates to go to gym. Halfway down the hall he flops on the floor and refuses to move. The staff pull him by his feet, and pick him up and carry him to the Gym Physical Escort

Johnny hates to go to gym. Halfway down the hall he flops on the floor and refuses to move. The staff pull him by his feet, and pick him up and carry him to the Gym

Scenario # 4 You have told Johnny he can’t go out for recess until his work his done. The bell for recess rings and Johnny gets up and starts to go outside even though his work is incomplete? The teacher blocks the door and physically keeps Johnny from going out. Physical Restraint

You have told Johnny he can’t go out for recess until his work his done. The bell for recess rings and Johnny gets up and starts to go outside even though his work is incomplete? The teacher blocks the door and physically keeps Johnny from going out.

Scenario # 5 Staff are working with Johnny and he throws his materials on the floor. Staff tell him to pick it up. Johnny refuses. Staff use hand over hand and force Johnny to pick up the materials. PHYSICAL MANAGEMENT

Staff are working with Johnny and he throws his materials on the floor. Staff tell him to pick it up. Johnny refuses. Staff use hand over hand and force Johnny to pick up the materials.

Scenario # 6 Johnny’s teacher uses a red light classroom management system. John violates a class rule and the teacher tells him to move his clip from green to yellow. Johnny says “no.” The teacher moves the clip. Johnny gets mad and moves the clip back. The teacher tells Johnny to return to his seat. He refuses. The teacher physically moves Johnny to his seat. PHYSICAL MANAGEMENT

Johnny’s teacher uses a red light classroom management system. John violates a class rule and the teacher tells him to move his clip from green to yellow. Johnny says “no.” The teacher moves the clip. Johnny gets mad and moves the clip back. The teacher tells Johnny to return to his seat. He refuses. The teacher physically moves Johnny to his seat.

Scenario * 7 In the pre-school class, Johnny is having problems sitting at circle. Consequently, the teacher uses a seatbelt to keep Johnny in his seat. MECHANICAL RESTRAINT

In the pre-school class, Johnny is having problems sitting at circle. Consequently, the teacher uses a seatbelt to keep Johnny in his seat.

Scenario # 8 Johnny keeps leaving music class so the teacher assistant holds him and keeps him from leaving the activity. PHYSICAL RESTRAINT

Johnny keeps leaving music class so the teacher assistant holds him and keeps him from leaving the activity.

Scenario # 9 Johnny hits another student in class. He continues to hit the student. The teacher holds Johnny with a basket wrap. Johnny resists and she physically moves him to the office conference room. Johnny is screaming and yelling and the teacher closes the door to keep Johnny from leaving Physical Restraint Physical Escort Seclusion

Johnny hits another student in class. He continues to hit the student. The teacher holds Johnny with a basket wrap. Johnny resists and she physically moves him to the office conference room. Johnny is screaming and yelling and the teacher closes the door to keep Johnny from leaving

Other Potential Scenarios Coming in from recess Removing a hat Denying Access to Compute Refusing to go to an activitry

Coming in from recess

Removing a hat

Denying Access to Compute

Refusing to go to an activitry

Is It Restraint ?

Acceptable Use of Restraint in Schools Restraint of a student most often refers to a set of proven techniques used by school personnel during extraordinary circumstances in order to secure the safety of the child and/or those persons who cannot otherwise escape harm. Unacceptable Use of Restraint in Schools The holding of a student for any length of time with a purpose or intent other than providing safety, comfort or support should be considered as avoidable and a misapplication of restraint. Physically restraining a student as a means of discipline, to force compliance, or for the convenience of a caregiver is an unacceptable practice.

Restraint of a student most often refers to a set of proven techniques used by school personnel during extraordinary circumstances in order to secure the safety of the child and/or those persons who cannot otherwise escape harm.

The holding of a student for any length of time with a purpose or intent other than providing safety, comfort or support should be considered as avoidable and a misapplication of restraint. Physically restraining a student as a means of discipline, to force compliance, or for the convenience of a caregiver is an unacceptable practice.

Functional Behavior Assessment & Behavior Intervention Planning Getting a real grasp: Positive Pro-active Skill-based - not punitive

Getting a real grasp:

Positive

Pro-active

Skill-based - not punitive

Functional Behavioral Assessment What purpose does the behavior serve for the student? How can you determine the answer? Watch the student, ask people, look at records and patterns When does the behavior happen? Where does the behavior happen? Who is there? What happens after the behavior?

What purpose does the behavior serve for the student?

How can you determine the answer?

Watch the student, ask people, look at records and patterns

When does the behavior happen?

Where does the behavior happen?

Who is there?

What happens after the behavior?

In Other Words “ Why is this person engaging in this behavior in this setting at this time?” Gordon Paul, 1967

“ Why is this person engaging in this behavior in this setting at this time?”

Gordon Paul, 1967

Is it a Behavior Intervention Plan (BIP)? If the BIP focuses on what happens after a behavior occurs, it is a Behavior Management Plan. If the BIP focuses on what happens before a behavior occurs, it is a Behavior Intervention Plan.

If the BIP focuses on what happens after a behavior occurs, it is a Behavior Management Plan.

If the BIP focuses on what happens before a behavior occurs, it is a Behavior Intervention Plan.

Positive Support ?

Comprehensive Training In Restraint Is Important for Schools De-escalation techniques emphasized Risk of injury to students is reduced Risk of injury to staff is reduced Restraint should be respectful and enable student to regain self-control

De-escalation techniques emphasized

Risk of injury to students is reduced

Risk of injury to staff is reduced

Restraint should be respectful and enable student to regain self-control

THE REVISED SCHOOL CODE (EXCERPT) Act 451 of 1976 380.1312 “Corporal punishment” defined; infliction of corporal punishment by employee, volunteer, or contractor; exercise of necessary reasonable physical force; liability; violation; deference given to reasonable good-faith judgments; development, implementation, and enforcement of code of student conduct; model list of alternatives to use of corporal punishment; authority permitting corporal punishment void.

380.1312 “Corporal punishment” defined; infliction of corporal punishment by employee, volunteer, or contractor; exercise of necessary reasonable physical force; liability; violation; deference given to reasonable good-faith judgments; development, implementation, and enforcement of code of student conduct; model list of alternatives to use of corporal punishment; authority permitting corporal punishment void.

THE REVISED SCHOOL CODE Sec. 1312. (1) As used in this section, “corporal punishment” means the deliberate infliction of physical pain by hitting, paddling, spanking, slapping, or any other physical force used as a means of discipline. (2) Corporal punishment does not include physical pain caused by reasonable physical activities associated with athletic training. (3) A person employed by or engaged as a volunteer or contractor by a local or intermediate school board or public school academy shall not inflict or cause to be inflicted corporal punishment upon any pupil under any circumstances. (4) A person employed by or engaged as a volunteer or contractor by a local or intermediate school board or public school academy may use reasonable physical force upon a pupil as necessary to maintain order and control in a school or school-related setting for the purpose of providing an environment conducive to safety and learning. In maintaining that order and control, the person may use physical force upon a pupil as may be necessary for 1 or more of the following:

Sec. 1312.

(1) As used in this section, “corporal punishment” means the deliberate infliction of physical pain by hitting, paddling, spanking, slapping, or any other physical force used as a means of discipline.

(2) Corporal punishment does not include physical pain caused by reasonable physical activities associated with athletic training.

(3) A person employed by or engaged as a volunteer or contractor by a local or intermediate school board or public school academy shall not inflict or cause to be inflicted corporal punishment upon any pupil under any circumstances.

(4) A person employed by or engaged as a volunteer or contractor by a local or intermediate school board or public school academy may use reasonable physical force upon a pupil as necessary to maintain order and control in a school or school-related setting for the purpose of providing an environment conducive to safety and learning. In maintaining that order and control, the person may use physical force upon a pupil as may be necessary for 1 or more of the following:

THE REVISED SCHOOL CODE (a) To restrain or remove a pupil whose behavior is interfering with the orderly exercise and performance of school district or public school academy functions within a school or at a school-related activity, if that pupil has refused to comply with a request to refrain from further disruptive acts. (b) For self-defense or the defense of another. (c) To prevent a pupil from inflicting harm on himself or herself. (d) To quell a disturbance that threatens physical injury to any person. (e) To obtain possession of a weapon or other dangerous object upon or within the control of a pupil. (f) To protect property. (5) A person employed by or engaged as a volunteer or contractor by a local or intermediate school board or public school academy who exercises necessary reasonable physical force upon a pupil, or upon another person of Supporting Student Behavior: Standards for the Emergency Use of Seclusion and Restraint Michigan Department of Education 20

(a) To restrain or remove a pupil whose behavior is interfering with the orderly exercise and performance of school district or public school academy functions within a school or at a school-related activity, if that pupil has refused to comply with a request to refrain from further disruptive acts.

(b) For self-defense or the defense of another.

(c) To prevent a pupil from inflicting harm on himself or herself.

(d) To quell a disturbance that threatens physical injury to any person.

(e) To obtain possession of a weapon or other dangerous object upon or within the control of a pupil.

(f) To protect property.

(5) A person employed by or engaged as a volunteer or contractor by a local or intermediate school board or public school academy who exercises necessary reasonable physical force upon a pupil, or upon another person of Supporting Student Behavior: Standards for the Emergency Use of Seclusion and Restraint Michigan Department of Education 20

Risks Restraints can be a dangerous method of intervention. The Child Welfare League of American (CWLA) estimates that between 8 to 10 children die each year due to restraints with numerous others suffering various injuries from bumps and bruises to broken bones (not just in schools). Also emotional injuries to the students

Restraints can be a dangerous method of intervention.

The Child Welfare League of American (CWLA) estimates that between 8 to 10 children die each year due to restraints with numerous others suffering various injuries from bumps and bruises to broken bones (not just in schools).

Also emotional injuries to the students

Risks One of the leading causes of deaths during restraint is “asphyxia” which is a restriction of the person’s ability to breathe. It is referred to as restraint associated or positional asphyxia and sometimes called “Sudden Death Syndrome.” Restraint associated occurs during the process of restraining a person in a manner that causes difficulty with breathing in and out. This leads to insufficient oxygen in the blood which leads to a disturbed heart rhythm which leads to death.

One of the leading causes of deaths during restraint is “asphyxia” which is a restriction of the person’s ability to breathe.

It is referred to as restraint associated or positional asphyxia and sometimes called “Sudden Death Syndrome.”

Restraint associated occurs during the process of restraining a person in a manner that causes difficulty with breathing in and out. This leads to insufficient oxygen in the blood which leads to a disturbed heart rhythm which leads to death.

Risks Any restraint that restricts the free movement of the chest or diaphragm may restrict breathing and contribute to positional or restraint associated asphyxia. Research shows that “prone restraints” or “floor restraints” are the most dangerous and most likely to cause asphyxia because they involve placing the child face down on the floor which puts pressure on the child’s ribs, chest.

Any restraint that restricts the free movement of the chest or diaphragm may restrict breathing and contribute to positional or restraint associated asphyxia.

Research shows that “prone restraints” or “floor restraints” are the most dangerous and most likely to cause asphyxia because they involve placing the child face down on the floor which puts pressure on the child’s ribs, chest.

Risks Students may also have risk factors such as medical conditions that exacerbate the risks of restraints. Students with asthma, epilepsy or heart conditions can be more prone to have adverse reactions, including death, with certain types of restraints. Obese students and students taking certain medications may also be more prone to adverse reactions with certain types of restraints.

Students may also have risk factors such as medical conditions that exacerbate the risks of restraints.

Students with asthma, epilepsy or heart conditions can be more prone to have adverse reactions, including death, with certain types of restraints.

Obese students and students taking certain medications may also be more prone to adverse reactions with certain types of restraints.

Risks The child’s treatment or programming should focus on other methods of addressing behavior, such as PBS. If restraints are used, it is very important that safety measures to protect the child and the person restraining the child are implemented. Safety measures include training, monitoring and reporting.

The child’s treatment or programming should focus on other methods of addressing behavior, such as PBS.

If restraints are used, it is very important that safety measures to protect the child and the person restraining the child are implemented.

Safety measures include training, monitoring and reporting.

Signs of Physical Distress A student who is highly agitated and is being restrained is under a great deal of physical stress. For this reason, staff must be thoroughly aware of the possible indications of physical distress and injury. A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia. Positional Asphyxia also termed “Restraint Asphyxia” occurs when the position of a person’s body interferes with that person’s ability to breathe, resulting in death. Improperly applied restraints techniques, particularly in the prone position, increase the risk of asphyxia. Staff must avoid force and pressure on the student’s back, chest, and diaphragm.

A student who is highly agitated and is being restrained is under a great deal of physical stress. For this reason, staff must be thoroughly aware of the possible indications of physical distress and injury.

A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia.

Positional Asphyxia also termed “Restraint Asphyxia” occurs when the position of a person’s body interferes with that person’s ability to breathe, resulting in death.

Improperly applied restraints techniques, particularly in the prone position, increase the risk of asphyxia.

Staff must avoid force and pressure on the student’s back, chest, and diaphragm.

Signs of Physical Distress Circulatory Extremities are cold to the touch Blue tinge to nail beds and/or area around mouth Bleeding Flushed or ashen face

Circulatory

Extremities are cold to the touch

Blue tinge to nail beds and/or area around mouth

Bleeding

Flushed or ashen face

Signs of Physical Distress Respiratory Rapid, shallow breathing Panting, grunting Blue tinge to nail beds and/or area around the mouth Nasal flaring Absence of / difficulty breathing

Respiratory

Rapid, shallow breathing

Panting, grunting

Blue tinge to nail beds and/or area around the mouth

Nasal flaring

Absence of / difficulty breathing

Signs of Physical Distress Neurological Confusion, disorientation Seizure Vomiting Difficulty breathing Unconsciousness Unequal pupil size Complaint of heaches

Neurological

Confusion, disorientation

Seizure

Vomiting

Difficulty breathing

Unconsciousness

Unequal pupil size

Complaint of heaches

Signs of Physical Distress Gastrointestinal Vomiting Compliant of constipation Diarrhea

Gastrointestinal

Vomiting

Compliant of constipation

Diarrhea

Signs of Physical Distress Musculo-Skeletal Joint swelling Complaint of pain Redness / Bruising Deformity of limb or joint

Musculo-Skeletal

Joint swelling

Complaint of pain

Redness / Bruising

Deformity of limb or joint

Resources Personal Emergency Intervention Training Devereux Institute of Clinical Training and Research Nonviolent Crisis Intervention Training Crisis Prevention Institute Coalition Against Institutionalized Child Abuse www.caica.org “ Same Old Sad Song” – Smokie Norful

Personal Emergency Intervention Training

Devereux Institute of Clinical Training and Research

Nonviolent Crisis Intervention Training

Crisis Prevention Institute

Coalition Against Institutionalized Child Abuse

www.caica.org

“ Same Old Sad Song” – Smokie Norful

PBS Covers 4 areas: Systems change Environmental alteration Skill instruction Behavioral consequence Group process to evaluate and address all four areas. Resources on PBS on website and www.edlawrc.com .

Covers 4 areas:

Systems change

Environmental alteration

Skill instruction

Behavioral consequence

Group process to evaluate and address all four areas.

Resources on PBS on website and www.edlawrc.com .

Questions and Answers