Council for Exceptional Children’s ConferenceLouisville, Kentucky

November 22, 2010Toyah RobeySherri Clusky

Kentucky Department of EducationToyah.Robey@education.ky.gov

Sherri.Cluskey@education.ky.gov

Current Issues Surrounding Seclusion and Restraint in Schools:

Update on Federal and State Guidelines

Historical Context and Timeline: Federal

H.R.4247 - Keeping All Students Safe Act Passed March 3, 2009 Directs the Secretary of Education to establish minimum standards that:

prohibit school staff from using mechanical, chemical, physical restraint / escort that restricts breathing, or aversive behavioral intervention that compromises student health and safety

prohibit such school staff using physical restraint or seclusion, unless such measures are required to eliminate an imminent danger of physical injury to the student or others and certain precautions are taken

require states to ensure that a sufficient number of school personnel receive state-approved crisis intervention training and certification in first aid and certain safe and effective student management techniques;

prohibit physical restraint or seclusion from being written into a student’s individual education program as a planned intervention

require schools to establish procedures to notify parents in a timely manner if physical restraint or seclusion is imposed on their child. Requires that when the physical restraint or seclusion of a student is required to eliminate an imminent danger of physical injury to such student or others, school personnel continuously monitor such student face-to-face or, if their safety is significantly compromised by such monitoring, remain in direct visual contact with the student. Directs the Secretary of the Interior to ensure that schools operated or funded by the Department of the Interior comply with such minimum standards.

Historical Context and Timeline: FederalCommittee on Education and Labor, House ofRepresentatives requests Government Accountability office (GAO) to prepare report.

Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers- May 19, 2009

no federal laws restricting the use of seclusion and restraints in public and private schools

Varies from state to state100’s of cases of abuse and death over past two decadeshttp://www.gao.gov/new.items/d09719t.pdf

Historical Context and Timeline: Federal

U.S. Education Secretary Arne Duncan sends a letter to Chief State SchoolOfficers advising them to review their state polices on seclusion and restraint, July31, 2009: Develop, review or revise State policies and guidelines to ensure that every

student is safe and protected from being unnecessarily or inappropriately restrained or secluded

Publicize policies and guidelines so that administrators, teachers, and parents understand and consent to the limited circumstances under which these techniques may be used; ensure that parents are notified when these interventions do occur (24 hours)

Provide resources needed to successfully implement the policies and hold school districts accountable for adhering to the guidelines.

Utilize ARRA dollars to implement school-wide positive behavior supports (PBS)

http://www.pbis.org/seclusion/restraint/arne_duncans_letter.aspx

Historical Context and Timeline: KentuckyKDE does not currently have any statues or

regulations pertaining to seclusion and restraintKDE policy letter on the use of time-out in schoolsKDE guidance on procedures and best practices for

time-out roomsBehavior Home Page

http://www.state.ky.us/agencies/behave/homepage.htmlKentucky Center for Instructional Discipline (KCID)Academic and Behavior Response to Intervention

(ABRI)

Historical Context and Timeline: KentuckyKDE Restraint and Seclusion Advisory

CommitteeMet September 2009Membership- multi agency/local districts

teachers and administratorsMade recommendations focused on

Seclusion definition and acceptable and unacceptable practices

Restraint and acceptable and unacceptable practices

Guidance districts to ensure successful implementation

Historical Context and Timeline: KentuckyOn the forefrontIn holding pattern… S.2860:Preventing

Harmful and Restraint and Seclusion in Schools Act

Presentations/feedback Behavior Institute, June 2010CEC , November, 2010

Q&A DocumentPolicy Letters

The Use of Restraint in The Use of Restraint in SchoolsSchools

Types of RestraintMechanical

use of objects or device to restrict student’s movements in order to manage out-of-control behavior

Examples: tape, ropes, weighted blankets, belts, straps, handcuffs

Proper UseUsed only for orthopedic purposes in order to

participate in the school settingWith written order by physician, OT or PTShould be included in IEP

Types of RestraintChemical

Use of medication to control behavior or restrict movement (e.g. ADHD, ODD)

Proper UseAdminister all medications as prescribed by

physicianSchools may not require a student to be on

medication in order to attend schoolSchools should provide on-going data

regarding behavior or side effects of medication during titration

Types of RestraintPhysical

Physical restraint is a procedure with which a person(s) uses his or her body to effectively and immediately control or immobilize another” (Physical Restraint, 2001)

An emergency procedure to prevent injury to student or others in a crisis situation

Physical restraint is sometimes referred to as ambulatory restraint, manual restraint, physical intervention, or therapeutic holding

Physical RestraintUsed as last resort optionUsed only when student poses a danger to

seriously hurting themselves or othersConduct assessment of situation and student’s

historyNOTNOT appropriate

Only to protect propertyWhen student is non-compliant, confrontational,

or verbally aggressive without substantial risk of immediate injury to self or others

Used as a consequence for inappropriate behavior

Restraint and Seclusion in Schools: 21 Questions and Answers, CASE

Physical RestraintStaff training on effective classroom behavior

management strategies and conflict de-escalation techniques

Training/certification for staff responsible for employing physical restraint

Employ proactive intervention planning (positive behavior supports)Understand the function/purpose of challenging behavior

(Functional Behavior Assessments)Multiple methods for collection/monitoring of student

behavior with on-going team analysisDevelop a continuum of reinforcements and consequencesUse a team approach for problem-solving

Physical RestraintDistrict/School procedures/protocol when to employ physical

restraintStaff training and review throughout school yearMaintain record of staff trainedEmploy “safety plans” for students whose history of aggression or self-

injurious behavior would cause safety concernsMaintain incident reports of all restraints

Select key individuals to receive training/certificationEstablish Review Team

Staff debriefing/Incidence Report within 24 hours of incident Student actions/outcomes/student interview Student actions/outcomes/student interview Staff actions/outcomes/staff interview Next steps, plan modifications Contact parents

Physical RestraintAvoid prone restraints prone restraints (student is face down

on stomach) and supine restraints supine restraints (student is face up on back)

Avoid any restraints or places pressure/weight on chest, lungs, sternum, diaphragm, back, neck, or throat.

The student should be able to speak and breath at all times

Never to be used as a punishment, force compliance, or an educational support

Manage student behavior

Physical RestraintEmergency SituationEmergency Situation Student poses a clear, present, and imminent physical danger to

self or others Employed by trained staff (2 staff) Use of established protocol- less restrictive measures have been

employed and exhausted (where not effective) Restraint should last only as long as necessary to resolve risk of

injury to self or others Degree of force should be commiserate with child’s size and age Degree of force may not exceed what is necessary to protect the

child or others from harm 2nd or 3rd Trained staff person should be observing and

documenting all actions of staff and student- for incident report Contact building administrator as soon as possible

Physical RestraintParent Contact

Contact parents as soon as possible (within 24 hours both verbally and through written communication)

Provide copy of all documentationEmploy multiple tools as proactive measures to

prevent or avoid physical restraint of studentsSchool-wide safety planningEffective classroom management strategiesThreat assessmentsIndividual Safety plans/check and connectWrap around services and consultation with community

agencies, special education cooperatives, and KDE

The Use of Seclusion in The Use of Seclusion in SchoolsSchools

SeclusionWhen a student is placed in a room or location

where they are alone (isolation) or prevented from leaving

Should be considered as a last resort optionStudents who are out of controlPosing threat to themselves or others

Not to be used as a punishment/consequenceOnly to protect propertyWhen student is non-compliant, confrontational, or

verbally aggressive without substantial risk of immediate injury to self or others

Used as a consequence for inappropriate behavior

Types of Time-outInclusionary- student remains in classroom

setting

Exclusionary- student moves away from classroom setting but still has access to other staff/students (principals office, detention, hallway)

Seclusionary- student moves to setting where the student is alone with no access to reinforcement

SeclusionTime-out Rooms

Safe and humane Inspect for potential hazards

Free of electrical outlets, equipment or breakable glassensure proper ventilation, lighting, and temperature

No locksPresence of trained staff- be able to see and hear student

at all timesBe of reasonable size for student movementAccess to restroom and water

Cool-down room/safe seatsSame rules applyStudent has ability to enter and exit at free-will

SeclusionSensory Rooms

No sustained evidence or research to support positive, education impact or benefits

Conflicts with best practice

Removes or impedes access to general curriculum

Without understanding function of behavior, may reinforce negative behaviors

No research supporting use

SeclusionStaff training on effective classroom behavior

management strategies and conflict de-escalation techniques

Certification for staff responsible for employing seclusion

Employ proactive intervention planning (positive behavior supports)Understand the function/purpose of challenging behavior

(Functional Behavior Assessments)Multiple methods for collection/monitoring of student

behavior with on-going team analysisDevelop a continuum of reinforcements and consequencesUse a team approach for problem-solving

SeclusionEmergency SituationEmergency Situation Student poses a clear, present, and imminent physical

danger to self or others Employed by trained staff (2 staff) Use of established protocol- less restrictive measures

have been employed and exhausted (where not effective) The seclusion should last only as long as necessary to

resolve risk of danger/harm Student is permitted to use restroom Student is permitted to drink water Any medical signs of distress must be reported and acted

upon

Restraint and SeclusionRestraint and SeclusionDistrict/School procedures/protocol when to employ

seclusionStaff training and review throughout school yearMaintain record of staff trainedEmploy “safety plans” for students whose history of aggression or self-

injurious behavior would cause safety concernsMaintain incident reports of all restraints

Select key individuals to receive training/certificationEstablish Review Team

Staff debriefing/Incidence Report within 24 hours of incident Student actions/outcomes/student interview Staff actions/outcomes/staff interview Next steps, plan modifications Contact parents

Resources Autism: Sensory Rooms, Maybe Not?, June 04,

http://autism.change.org/blog/view/sensory_rooms_maybe_not Debunking the Myths of Restraint and Seclusion, http://aprais.tash.org Evaluating the Educational Experiences of Students with Profound and Multiple Disabilities in Inclusive and

Segregated Classroom Settings: An Austrailian Perspective, Athur-Kelly, Pascoe, & Smyth-King, 2004 Handle With Care Letter to Congress, February 2, 2010 National Disability Rights Press Release on Follow-up Report on Restraint and Seclusion in Public Schools,

February 2, 2010 National Education Association Policy Letter, November 10, 2009 Policy Letter Concerning the Use of Time-Out, Kentucky Department of Education, 2000 with review in 2006 Restraint and Seclusion in California Schools: A Failing Grade, Protection and Advocacy, June 2007 Restraint and Seclusion in Schools: 21 Questions and Answers, Council of Administrators of Special

Education, 2009 Socio-communicative Perspectives on Research and Evidence-based Practices in the Education of Students

with Profound and Multiple Disabilities, Athur-Kelly, Bochner, Center, & Mok, April 2007 The Use of Physical Restraint Procedures in School Settings, CCBD Position Paper, Council for Children with

Behavior Disorders July, 2009 Unsafe in the Schoolhouse: Abuse of Children with Disabilities, Jessica Butler, Council of Parent Attorneys

and Advocates, Inc, (COPAA), May 2009 The Use of Seclusion in School Settings, CCBD Position Paper, Council for Children with Behavior Disorders

July, 2009 The Use of Seclusion and Restraint in Public Schools: The Legal Issues, Congressional Research Service,

April 14, 2009