Seclusion, Isolation and Restraint Policy

1. Seclusion, Isolation and Restraint Policy Kelli Hopkins, Assoc. Exec. Director, Board Services Dr. Kim Ratcliffe, Assoc.Exec.Director, Student Services Missouri School Boards’ Association

2. Why Policy? • A 230 lb teacher placed 120 lb 14 year old child on floor and lay on top of him, causing his death. • Death ruled homicide but no indictment by grand jury. Teacher moved to another state and is still teaching. • A 4 year old with CP and autism diagnosis suffered bruising and PTSD after being restrained in a wooden chair with leather straps for being uncooperative. • School Board found liable for negligent training and supervision. Teachers not liable, one still teaching in the district. GAO Report 09-719T (2009)

3. Why Policy? • A volunteer aide gagged and duct-taped 5 children, ages 6 and 7, for misbehaving. • Aide pled guilty to criminal charges. • Parents of 9 year old LD student gave permission to use time-out as last resort. Child was isolated alone in room for hours at a time for such behaviors as whistling, slouching and waving his hand. Child (apparently) wet himself and gave himself blisters trying to get out of the room. • Jury award of $1000 for each time child was put in room. GAO Report 09-719T (2009)

4. Why Policy? And now a short rant . . .

5. Why Policy? And now a moment of understanding, compassion and confession . . .

6. Federal Legislation S. 2860 and H.R. 4247 • House Bill passed in March 2010; no action in Senate. • Senate Bill referred to Committee December 2009. No champion in the Senate. House will likely have to start over. • Currently Senate has co-sponsors—Sen. Dodd (D-Conn.) and Sen. Burr (R-N.C.) • Possibly embed in ESEA. • Major differences that have been recently amended: • Writing planned use of seclusion or restraint into IEP. • P&A investigation/enforcement.

7. Why Policy? • Physical restraint and seclusion is not effective and is overused. • When misused can result in injury or death. • Various State Laws (33 states have laws) • Some both seclusion and restraint • Some only seclusion or restraint • Some special education only • Some nothing or generic corporal punishment language

8. Following passage of MO Law … MSBA convened a committee of stakeholders and experts to draft a policy Provided our policy to DESE as a recommendation Became the foundation of the DESE model policy

9. RSMo. 160.263 • Requires districts to include in discipline policy a prohibition on placing a student in an unattended and locked space except for emergencies while waiting for law enforcement. • Unattended, locked, emergencies and law enforcement are not defined in the statute • By July 1, 2011, the statute requires BOE in each school district to adopt a written policy that “comprehensively addresses the use of restrictive behavioral interventions as a form of discipline or behavior management.”

10. RSMo. 160.263 • Requires DESE to develop model policy by July 1, 2010. • Posted July 2010 on DESE School Law web page • http://www.dese.mo.gov/schoollaw/documents/seclusionpolicy.pdf • Schools must adopt a policy by July 1, 2011. • Define restraint, seclusion and time-out • Describe when each is allowed and prohibited and unique application requirements for specific groups of students • Describe implementation requirements • Time limitations • Training • Facility/space size • Supervision

11. Policy • Based on research, any policy needs these key components: • Purpose • Clear definitions • Detailed procedures for use of seclusion, isolation and restraint including post-incident debriefing and parent notification • Staff training • Implementation of a positive behavioral supports system

12. Policy • Statement of Purpose • Essentially that seclusion and restraint are not acceptable behavior modification techniques but are to be used in emergency situations only as a last resort to protect the student or others. • We also included property, but that is an area of contention and debate. • Safe Workplace

13. Policy • Clear Definitions • Mechanical Restraint – A device or physical object that the student cannot easily remove that restricts a student’s freedom of movement or normal access to a portion of his or her body. This includes, but is not limited to: straps, duct tape, cords, or garments. The term does not include assistive technology devices. • Chemical Restraint – Administration of a drug or medication to manage a student’s behavior that is not a standard treatment and dosage for the student’s medical condition. • Physical Restraint – The use of person-to-person physical contact to restrict the free movement of all or a portion of a student’s body. It does not include…

14. Policy • Clear Definitions • Physical Escort – temporary touching or holding of the hand, wrist, arm, shoulder or back for the purpose of inducing a student who is acting out or eloping to walk to a safe location. • Time Out – brief removal from sources of reinforcement within instructional contexts that does not meet the definition of seclusion or isolation. The purpose of time-out is to separate the student from the attention of staff and other students. • Seclusion – The confinement of a student alone in an enclosed space from which the student is physically prevented from leaving by locking hardware.

15. Policy • Clear definitions • Positive Behavioral Supports – A range of instructional and environmental supports to teach students pro-social alternatives to problem behavior and allow multiple opportunities to practice pro-social skills and receive high rates of positive feedback. • Definitions (except personnel)from • Dr. Tim Lewis • The Public Health Services Act 42 USC 290jj • HR 4247 • CCBD • Other states’ policies

16. MSBA Policy DESE Policy No preface, but explanation at end. Definitions up front Policy applicability as specified in written agreement between district and facility. Subheadings follow definitions of policy. Aversives restricted to SPED plans. Preface Definitions last Policy applicability—follow policy of outside facility. Subheadings use terminology of MO statute. Aversives more broadly addressed.

17. Isolation/Seclusion Model Policy Summary

18. Isolation/Seclusion/Time-out Three important distinctions: 1. Is the student in the room/space alone? If yes, restrictions/requirements could apply to use. 2. Is the room/space fully enclosed? If yes, restrictions/requirements could apply use. 3. Is the student prevented from leaving? If yes, restrictions/requirements will apply to use.

19. Restraint Model Policy Summary

20. Policy • Detailed procedures for use of seclusion and restraint including • Techniques prohibited/permitted • Some will require the exhaustion of certain remedies prior to use of seclusion or restraint. • Time limits for time-out and seclusion • Post-incident debriefing • Recordkeeping • Reporting or lack thereof is a big complaint of Protection and Advocacy (P & A) • Parent report • Lack of information to parents has many collateral consequences

21. Policy • Staff Training • Policy requirements • De-escalation techniques • Restraint techniques • Positive behavioral supports • System of Positive Behavioral Supports • Theory – all students can behave in an acceptable way • Not all come to school with the skills to do so • Must be taught and refreshed • Look at behavior like you do academics

22. Basic To Do List 1. Review and evaluate current use of seclusion/restraint as compared to policy under consideration. • What policies/procedures do you have in place? • Are they consistent with the model policy? • What practices currently exist throughout your district? • How effective are they? 2. Make decisions about adopting/adapting model policy. • Critical decision points (next slides) 3. Adopt policy and develop/implement procedures. • Make sure staff is trained and can implement consistently.

23. Definition Decisions • Emergency situation • Only threat of harm to self or others? • Consider adding destruction of school or personal property? • Seclusion • Does not distinguish between attended and unattended • Consider adding application of isolation monitoring and other provisions if “attended” seclusion will be used.

24. Use Decisions • Isolation • MSBA policy clarifies by adding “or” between situations for isolation use (not in DESE policy). • Consider maximum time limit for isolation – • Adopt 40 minutes of model policy? More? Less? Different by age/grade? • Seclusion • MSBA policy clarifies by adding “or” between situations for isolation use. • Isolation/Seclusion/Restraint • Allow inclusion in “plan” with parent agreement (per model)?

25. Application • School Personnel • All employees • Include Volunteers? Contractors on campus? • Other agency staff on campus? • Consider applying policy to external placements? • Include in contract language • If not included in contract, have rationale for different policies.

26. Training • Training for all personnel • Prevention techniques • Environmental management techniques • De-escalation techniques • Information about the policy • Training for those using seclusion/isolation/restraint • De-escalation and professionally accepted practices • Communication, documentation and notification procedures • A Review of Crisis Intervention Training Programs for Schools • Teaching Exceptional Children, Vol 42. No. 5, pp 6-17, 2010 • Consider which training program best meets district needs

27. Sample Forms Physical Restraint Incident Report Isolation/Seclusion Incident Report Isolation/Seclusion/Restraint Debriefing Notes Isolation/Seclusion/Restraint Student Incident Log

28. Resources • DESE Model Policy • http://www.dese.mo.gov/schoollaw/documents/seclusionpolicy.pdf • Council for Children With Behavior Disorders Position Papers • http://www.ccbd.net/documents/CCBD%20Position%20on%20Use%20of%20Restraint%207-8-09.pdf • http://www.ccbd.net/documents/CCBD%20Position%20on%20Use%20of%20Seclusion%207-8-09.pdf • http://www.ccbd.net/documents/CCBD%20Summary%20on%20Restraint%20and%20Seclusion%207-8-09.pdf • Federal Bills • http://www.govtrack.us/congress/bill.xpd?bill=h111-4247 • http://www.govtrack.us/congress/bill.xpd?bill=s111-2860

29. Contact Kelli Hopkins Kim Ratcliffe MSBA MSBA hopkins@msbanet.orgRatcliffe@msbanet.org 573-445-9920 Ext. 345 573-445-9920 EXT. 362 2100 I-70 Dr S.W. Columbia, mo 65203