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