P R E V E N T I N G T H E U S E O F E X C L U S I O N A N D R E S T R A I N T
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Transcript of P R E V E N T I N G T H E U S E O F E X C L U S I O N A N D R E S T R A I N T
What is Seclusion What is Seclusion and Restraint amp and Restraint amp
Why should I Why should I carecare
Supporting Student Behavior Standards for the Emergency
Use of Seclusion and Restraint
Awareness Training
Muskegon Area Intermediate
School DistrictPresented by Steven Vitto MA Behavioral Specialist MAISDCertified Crisis Prevention Trainer (CPI)
Certified Therapeutic Crisis Intervention Trainer (TCI)
Certified State of Michigan PBS Coach and Trainer
Certified Balanced amp Restorative Justice Trainer (BARJ)
AndrewAndrew
11 years old11 years old
Died from traumatic asphyxia and chest compression
Face-down restraint with arms crossed over chest
AngieAngie
7 years old7 years old
Stopped breathing after being placed in prone restraint position
Death being ruled a homicide
ChaseChase
17 years old17 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
ChrisChris
13 years old13 years old
Asphyxiation by prone restraint
He was restrained 4 times
hellipin his last 24 hours
EdithEdith 15 years old15 years old
Restraint Asphyxia ndash 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
GarethGareth
15 years old15 years old
Died of asphyxiation by a prone restraint
Restrained by three staff members on his 4th day at the facility
IsaiahIsaiah
17 years old17 years old
Four youths witnessed his death
Students say staff sat on him for three hours until he passed out and died
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Supporting Student Behavior Standards for the Emergency
Use of Seclusion and Restraint
Awareness Training
Muskegon Area Intermediate
School DistrictPresented by Steven Vitto MA Behavioral Specialist MAISDCertified Crisis Prevention Trainer (CPI)
Certified Therapeutic Crisis Intervention Trainer (TCI)
Certified State of Michigan PBS Coach and Trainer
Certified Balanced amp Restorative Justice Trainer (BARJ)
AndrewAndrew
11 years old11 years old
Died from traumatic asphyxia and chest compression
Face-down restraint with arms crossed over chest
AngieAngie
7 years old7 years old
Stopped breathing after being placed in prone restraint position
Death being ruled a homicide
ChaseChase
17 years old17 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
ChrisChris
13 years old13 years old
Asphyxiation by prone restraint
He was restrained 4 times
hellipin his last 24 hours
EdithEdith 15 years old15 years old
Restraint Asphyxia ndash 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
GarethGareth
15 years old15 years old
Died of asphyxiation by a prone restraint
Restrained by three staff members on his 4th day at the facility
IsaiahIsaiah
17 years old17 years old
Four youths witnessed his death
Students say staff sat on him for three hours until he passed out and died
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
AndrewAndrew
11 years old11 years old
Died from traumatic asphyxia and chest compression
Face-down restraint with arms crossed over chest
AngieAngie
7 years old7 years old
Stopped breathing after being placed in prone restraint position
Death being ruled a homicide
ChaseChase
17 years old17 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
ChrisChris
13 years old13 years old
Asphyxiation by prone restraint
He was restrained 4 times
hellipin his last 24 hours
EdithEdith 15 years old15 years old
Restraint Asphyxia ndash 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
GarethGareth
15 years old15 years old
Died of asphyxiation by a prone restraint
Restrained by three staff members on his 4th day at the facility
IsaiahIsaiah
17 years old17 years old
Four youths witnessed his death
Students say staff sat on him for three hours until he passed out and died
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
AngieAngie
7 years old7 years old
Stopped breathing after being placed in prone restraint position
Death being ruled a homicide
ChaseChase
17 years old17 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
ChrisChris
13 years old13 years old
Asphyxiation by prone restraint
He was restrained 4 times
hellipin his last 24 hours
EdithEdith 15 years old15 years old
Restraint Asphyxia ndash 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
GarethGareth
15 years old15 years old
Died of asphyxiation by a prone restraint
Restrained by three staff members on his 4th day at the facility
IsaiahIsaiah
17 years old17 years old
Four youths witnessed his death
Students say staff sat on him for three hours until he passed out and died
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
ChaseChase
17 years old17 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
ChrisChris
13 years old13 years old
Asphyxiation by prone restraint
He was restrained 4 times
hellipin his last 24 hours
EdithEdith 15 years old15 years old
Restraint Asphyxia ndash 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
GarethGareth
15 years old15 years old
Died of asphyxiation by a prone restraint
Restrained by three staff members on his 4th day at the facility
IsaiahIsaiah
17 years old17 years old
Four youths witnessed his death
Students say staff sat on him for three hours until he passed out and died
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
ChrisChris
13 years old13 years old
Asphyxiation by prone restraint
He was restrained 4 times
hellipin his last 24 hours
EdithEdith 15 years old15 years old
Restraint Asphyxia ndash 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
GarethGareth
15 years old15 years old
Died of asphyxiation by a prone restraint
Restrained by three staff members on his 4th day at the facility
IsaiahIsaiah
17 years old17 years old
Four youths witnessed his death
Students say staff sat on him for three hours until he passed out and died
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
EdithEdith 15 years old15 years old
Restraint Asphyxia ndash 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
GarethGareth
15 years old15 years old
Died of asphyxiation by a prone restraint
Restrained by three staff members on his 4th day at the facility
IsaiahIsaiah
17 years old17 years old
Four youths witnessed his death
Students say staff sat on him for three hours until he passed out and died
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
GarethGareth
15 years old15 years old
Died of asphyxiation by a prone restraint
Restrained by three staff members on his 4th day at the facility
IsaiahIsaiah
17 years old17 years old
Four youths witnessed his death
Students say staff sat on him for three hours until he passed out and died
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
IsaiahIsaiah
17 years old17 years old
Four youths witnessed his death
Students say staff sat on him for three hours until he passed out and died
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
JonathanJonathan
13 years old13 years oldRestrained in a van while staff were running errands
Though he was clearly having difficulties breathing they continued running their errandshellip
for another 1frac12 hours
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
MarkMark
14 years old14 years old
Asphyxiation while being forcibly
restrained by 3 staffin a prone position
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
SakenaSakena
18 years old18 years old
Suffocation during face down restraint with staff member laying across her back
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
TravisTravis
13 years old13 years old
The autopsy indicated he died because of the face-down on the ground restraint
Restrained 1frac12 hours
Denied request for asthma meds
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
OmegaOmega
17 years old17 years old
He died after being restrained by staff in prone position with arms behind his back
June 3 2007
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
RobertRobert
12 years old12 years old
Asphyxiation while restrained after a dispute about hishellip
missing teddy bearmissing 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
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
RealityReality 142 deaths in the US from 1988 ndash 1998 due to SR 142 deaths in the US from 1988 ndash 1998 due to SR
reported by the Hartford Courant reported by the Hartford Courant (Weiss et al 1998)(Weiss et al 1998)
111 fatalities over 10 years in New York facilities due 111 fatalities over 10 years in New York facilities due to restraints to restraints (Sundram 1994 as cited by Zimbroff 2003)(Sundram 1994 as cited by Zimbroff 2003)
At least 16 children At least 16 children (lt18 yo)(lt18 yo) died in restraints in Texas died in restraints in Texas programs from 1988 ndash 2002 reported by local mediaprograms from 1988 ndash 2002 reported by local media
(American-Statesman (American-Statesman May 18 May 18 20032003))
At least 14 people died and at least one has become At least 14 people died and at least one has become permanently comatose while being subjected to SR permanently comatose while being subjected to SR from July 1999 to March 2002 in California from July 1999 to March 2002 in California (Mildred (Mildred 20022002))
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
RealityReality
50 to 150 deaths occur in the US each year due 50 to 150 deaths occur in the US each year due to SR estimated by the Harvard Center for Risk to SR estimated by the Harvard Center for Risk AnalysisAnalysis (NAMI 2003)(NAMI 2003)
Federal Office of the Inspector General Federal Office of the Inspector General identified 42 of 104 (42) SR deaths from identified 42 of 104 (42) SR deaths from 0899 ndash 1204 were not reported0899 ndash 1204 were not reported (OIG 2006)(OIG 2006)
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
The ResearchThe Research Over 85 of restraints management seclusion Over 85 of restraints management seclusion
begin with students refusing to follow a staff begin with students refusing to follow a staff directiondirection
How staff deal with this noncompliance plays a big How staff deal with this noncompliance plays a big part in whether the studentrsquos behavior diffuses or part in whether the studentrsquos behavior diffuses or escalatesescalates
There is There is nono research supporting the use of forced research supporting the use of forced compliance as a behavioral change strategycompliance as a behavioral change strategy
There is a significant increase in children with There is a significant increase in children with ODD ADHD ASD Social Maladjustment Down ODD ADHD ASD Social Maladjustment Down Syndrome in our schoolsSyndrome in our schools
Staff need to be trained in how to deal with Staff need to be trained in how to deal with oppositional defiant and aggressive behavioroppositional defiant and aggressive behavior
Most staff have little training in this areaMost 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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Physical Restraint
Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a studentrsquos freedom of movement Physical restraint of a student may only be used for the purpose of providing safety and support
RESTRICTIONS IN STATE GUIDELINES
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
What is Physical Assistance
Physically assisting someone who is accepting of your help) eg putting on your coat)
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
What is physical management
Physically forcing someone to do something against their will (eg forcibly taking something away from someone physically making someone do a task)
RESTRICTIONS IN STATE GUIDELINES
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
What is mechanical restraint
Mechanical Restraint is the use of any device article garment or material attached or adjacent to the students 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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 studentrsquos movement is not physically restricted
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
What is an emergency
Emergency is a situation in which a studentrsquos 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
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
What is Prone Restraint
Prone Restraint is the restraint of a person face down
PROHIBITED IN STATE GUIDELINES
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
What is supine restraint
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 ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
State Board of Education Policy on Seclusion and Restraint
On December 12 2006 the State Board of Education adopted ldquoSupporting Student Behavior Standard for the Emergency Use of Seclusion and Restraintrdquo
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Context for the Policy
Referent group created by Superintendent of Public Instruction ndash May 2004
Group included parents advocates educators policy makers amp 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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 ldquoseclusionrdquo and ldquorestraintrdquo 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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Legal Context of the Policy
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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)
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 skillsrulesexpectations 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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 (eg 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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
TRAINING
Training Framework A comprehensive training framework includes
1048696 awareness training for the broader educational
community including pre-service training for all
teachers 1048696 awareness training for substitute teachers and 1048696 comprehensive training for key identified personnel
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Training Components
All training must include 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 related safety considerations including information regarding the increased risk of injury to students and staff when seclusion or restraint is used 1048696 instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency safety situations and 1048696 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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 1048696 proactive practices and strategies that ensure the dignity of students 1048696 conflict resolution 1048696 mediation 1048696 social skills training 1048696 de-escalation techniques 1048696 positive behavior support strategies 1048696 techniques to identify student behaviors that may trigger emergency safety situations 1048696 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 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
TRAINING CONTINUED
instruction in the use of seclusion and restraint 1048696 identification of events and environmental factors that may trigger emergency
safety situations 1048696 instruction on the State Board of Education policy on Supporting Student
Behavior The Emergency Use of Seclusion and Restraint 1048696 description and identification of dangerous behaviors 1048696 methods for evaluating the risk of harm to determine whether the use of seclusion
or restraint is warranted 1048696 types of seclusion 1048696 types of restraint 1048696 the risk of using seclusion and restraint in consideration of a studentrsquos known and
unknown medical or psychological limitations 1048696 instruction in the use of seclusion and restraint 1048696 the effects of seclusion and restraint on ALL students 1048696 how to monitor the physical signs of distress and 1048696 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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Definitions
Seclusion Last resort emergency
safety intervention Gives opportunity to
regain control Student is confined in
room or other space amp prevented from leaving
Continuous adult observation required
Restraint Emergency intervention Gives opportunity to
regain control Direct physical contact
that prevents or significantly restricts the studentrsquos 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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Seclusion Proportionate and sensitive
to studentrsquos 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 studentrsquos 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)
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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 parentguardian 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 parentguardian 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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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)
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
SCENARIO 1SCENARIO 1
Johnnie brings a restricted item to school- Johnnie brings a restricted item to school- eg Pokie Man cards Johnniersquos teacher eg Pokie Man cards Johnniersquos teacher asks for the cards Johnny curtly sayrsquos ldquoNo asks for the cards Johnny curtly sayrsquos ldquoNo wayrdquo The teacher reiterates ldquoGive me the wayrdquo The teacher reiterates ldquoGive me the cardsrdquo John refuses The teacher cardsrdquo John refuses The teacher physically takes the cards awayphysically takes the cards away
Physical Physical ManagementManagement
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
SCENARIO 2SCENARIO 2
You ask a Johnny to leave the You ask a Johnny to leave the room and go to the time-out room and go to the time-out area John tells you to go to h-ll area John tells you to go to h-ll Irsquom not going anywhere The staff Irsquom not going anywhere The staff physically manage John to the physically manage John to the ldquotime-outrdquo room and then hold ldquotime-outrdquo room and then hold the doorthe door
Physical Escort
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Scenario 3Scenario 3
Johnny hates to go to gym Johnny hates to go to gym Halfway down the hall he flops on Halfway down the hall he flops on the floor and refuses to move the floor and refuses to move The staff pull him by his feet and The staff pull him by his feet and pick him up and carry him to the pick him up and carry him to the GymGym
Physical Physical EscortEscort
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Scenario 4Scenario 4
You have told Johnny he canrsquot go You have told Johnny he canrsquot go out for recess until his work his out for recess until his work his done The bell for recess rings done The bell for recess rings and Johnny gets up and starts to and Johnny gets up and starts to go outside even though his work go outside even though his work is incomplete The teacher is incomplete The teacher blocks the door and physically blocks the door and physically keeps Johnny from going outkeeps Johnny from going out
Physical Restraint
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Scenario 5Scenario 5
Staff are working with Johnny Staff are working with Johnny and he throws his materials on and he throws his materials on the floor Staff tell him to pick it the floor Staff tell him to pick it up Johnny refuses Staff use up Johnny refuses Staff use hand over hand and force Johnny hand over hand and force Johnny to pick up the materialsto pick up the materials
PHYSICAL MANAGEMENT
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Scenario 6Scenario 6
Johnnyrsquos teacher uses a red light Johnnyrsquos teacher uses a red light classroom management system John classroom management system John violates a class rule and the teacher violates a class rule and the teacher tells him to move his clip from green tells him to move his clip from green to yellow Johnny says ldquonordquo The to yellow Johnny says ldquonordquo The teacher moves the clip Johnny gets teacher moves the clip Johnny gets mad and moves the clip back The mad and moves the clip back The teacher tells Johnny to return to his teacher tells Johnny to return to his seat He refuses The teacher seat He refuses The teacher physically moves Johnny to his seatphysically moves Johnny to his seat
PHYSICAL MANAGEMENT
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Scenario 7Scenario 7
In the pre-school class Johnny is In the pre-school class Johnny is having problems sitting at circle having problems sitting at circle Consequently the teacher uses a Consequently the teacher uses a seatbelt to keep Johnny in his seatbelt to keep Johnny in his seatseat
MECHANICAL RESTRAINT
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Scenario 8Scenario 8
Johnny keeps leaving music class Johnny keeps leaving music class so the teacher assistant holds so the teacher assistant holds him and keeps him from leaving him and keeps him from leaving the activitythe activity
PHYSICAL RESTRAINT
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Scenario 9Scenario 9
Johnny hits another student in Johnny hits another student in class He continues to hit the class He continues to hit the student The teacher holds Johnny student The teacher holds Johnny with a basket wrap Johnny resists with a basket wrap Johnny resists and she physically moves him to and she physically moves him to the office conference room the office conference room Johnny is screaming and yelling Johnny is screaming and yelling and the teacher closes the door to and the teacher closes the door to keep Johnny from leavingkeep Johnny from leaving
Physical Physical RestraintRestraint
Physical EscortPhysical Escort
SeclusionSeclusion
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Other Potential Other Potential Scenarios Scenarios
Coming in from recessComing in from recess Removing a hatRemoving a hat Denying Access to ComputeDenying Access to Compute Refusing to go to an activitryRefusing to go to an activitry
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Is It RestraintIs It Restraint
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Acceptable Use of Acceptable Use of Restraint in SchoolsRestraint in Schools
Restraint of a student most often refers to a set of Restraint of a student most often refers to a set of proven techniques used by school personnel during proven techniques used by school personnel during extraordinary circumstances in order to secure the extraordinary circumstances in order to secure the safety of the child andor those persons who cannot safety of the child andor those persons who cannot otherwise escape harmotherwise escape harm
Unacceptable Use of Restraint in SchoolsThe 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 Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Functional Behavior Functional Behavior Assessment amp Behavior Assessment amp Behavior Intervention PlanningIntervention Planning
Getting a real grasp Getting a real grasp PositivePositive Pro-activePro-active Skill-based - not Skill-based - not punitivepunitive
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Functional Behavioral Functional Behavioral AssessmentAssessment
What purpose does the behavior What purpose does the behavior serve for the studentserve for the student
How can you determine the answerHow can you determine the answer Watch the student ask people look at Watch the student ask people look at
records and patternsrecords and patterns When does the behavior happenWhen does the behavior happen Where does the behavior happenWhere does the behavior happen Who is thereWho is there What happens after the behaviorWhat happens after the behavior
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
In Other WordsIn Other Words
ldquoldquoWhy is this person Why is this person engaging in this engaging in this behavior in this behavior in this setting at this timerdquosetting at this timerdquo
Gordon Paul 1967Gordon Paul 1967
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Is it a Behavior Is it a Behavior Intervention Intervention Plan (BIP)Plan (BIP)
If the BIP focuses on what If the BIP focuses on what happens happens afterafter a behavior a behavior occurs it is a Behavior occurs it is a Behavior Management PlanManagement Plan
If the BIP focuses on what If the BIP focuses on what happens happens beforebefore a behavior a behavior occurs it is a Behavior occurs it is a Behavior Intervention PlanIntervention Plan
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Positive Support Positive Support
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Comprehensive Comprehensive Training In Restraint Is Training In Restraint Is Important for SchoolsImportant for Schools De-escalation techniques De-escalation techniques
emphasizedemphasized Risk of injury to students is reducedRisk of injury to students is reduced Risk of injury to staff is reducedRisk of injury to staff is reduced Restraint should be respectful and Restraint should be respectful and
enable student to regain self-controlenable student to regain self-control
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
THE REVISED SCHOOL CODE (EXCERPT)
Act 451 of 1976
3801312 ldquoCorporal punishmentrdquo 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 ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
THE REVISED SCHOOL CODE
Sec 1312 (1) As used in this section ldquocorporal punishmentrdquo
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
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
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
RisksRisks
Restraints can be a dangerous method Restraints can be a dangerous method of intervention of intervention
The Child Welfare League of American The Child Welfare League of American (CWLA) estimates that between 8 to 10 (CWLA) estimates that between 8 to 10 children die each year due to restraints children die each year due to restraints with numerous others suffering various with numerous others suffering various injuries from bumps and bruises to injuries from bumps and bruises to broken bones (not just in schools)broken bones (not just in schools)
Also emotional injuries to the studentsAlso emotional injuries to the students
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
RisksRisks One of the leading causes of deaths during One of the leading causes of deaths during
restraint is ldquoasphyxiardquo which is a restriction restraint is ldquoasphyxiardquo which is a restriction of the personrsquos ability to breathe of the personrsquos ability to breathe
It is referred to as restraint associated or It is referred to as restraint associated or positional asphyxia and sometimes called positional asphyxia and sometimes called ldquoSudden Death Syndromerdquo ldquoSudden Death Syndromerdquo
Restraint associated occurs during the Restraint associated occurs during the process of restraining a person in a manner process of restraining a person in a manner that causes difficulty with breathing in and that causes difficulty with breathing in and out This leads to insufficient oxygen in the out This leads to insufficient oxygen in the blood which leads to a disturbed heart blood which leads to a disturbed heart rhythm which leads to deathrhythm which leads to death
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
RisksRisks Any restraint that restricts the free Any restraint that restricts the free
movement of the chest or diaphragm may movement of the chest or diaphragm may restrict breathing and contribute to restrict breathing and contribute to positional or restraint associated positional or restraint associated asphyxia asphyxia
Research shows that ldquoprone restraintsrdquo or Research shows that ldquoprone restraintsrdquo or ldquofloor restraintsrdquo are the most dangerous ldquofloor restraintsrdquo are the most dangerous and most likely to cause asphyxia because and most likely to cause asphyxia because they involve placing the child face down they involve placing the child face down on the floor which puts pressure on the on the floor which puts pressure on the childrsquos ribs chestchildrsquos ribs chest
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
RisksRisks Students may also have risk factors such Students may also have risk factors such
as medical conditions that exacerbate the as medical conditions that exacerbate the risks of restraints risks of restraints
Students with asthma epilepsy or heart Students with asthma epilepsy or heart conditions can be more prone to have conditions can be more prone to have adverse reactions including death with adverse reactions including death with certain types of restraints certain types of restraints
Obese students and students taking Obese students and students taking certain medications may also be more certain medications may also be more prone to adverse reactions with certain prone to adverse reactions with certain types of restraints types of restraints
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
RisksRisks The childrsquos treatment or The childrsquos treatment or
programming should focus on other programming should focus on other methods of addressing behavior methods of addressing behavior such as PBSsuch as PBS
If restraints are used it is very If restraints are used it is very important that safety measures to important that safety measures to protect the child and the person protect the child and the person restraining the child are restraining the child are implementedimplemented
Safety measures include training Safety measures include training monitoring and reportingmonitoring and reporting
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Signs of Physical Signs of Physical DistressDistress
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 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 physical distress and injury
A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional AsphyxiaA very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia
Positional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in deathPositional Asphyxia also termed ldquoRestraint Asphyxiardquo occurs when the position of a personrsquos body interferes with that personrsquos ability to breathe resulting in death
Improperly applied restraints techniques particularly in the prone position increase the risk of asphyxiaImproperly applied restraints techniques particularly in the prone position increase the risk of asphyxia
Staff must avoid force and pressure on the studentrsquos back chest and diaphragmStaff must avoid force and pressure on the studentrsquos back chest and diaphragm
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Signs of Physical Signs of Physical DistressDistress
CirculatoryCirculatory
Extremities are cold to the touchExtremities are cold to the touch
Blue tinge to nail beds andor area Blue tinge to nail beds andor area around moutharound mouth
BleedingBleeding
Flushed or ashen faceFlushed or ashen face
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Signs of Physical Signs of Physical DistressDistress
RespiratoryRespiratory
Rapid shallow breathingRapid shallow breathing Panting gruntingPanting grunting Blue tinge to nail beds andor area Blue tinge to nail beds andor area
around the moutharound the mouth Nasal flaringNasal flaring Absence of difficulty breathingAbsence of difficulty breathing
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Signs of Physical Signs of Physical DistressDistress
NeurologicalNeurological
Confusion disorientationConfusion disorientation SeizureSeizure VomitingVomiting Difficulty breathingDifficulty breathing UnconsciousnessUnconsciousness Unequal pupil sizeUnequal pupil size Complaint of heachesComplaint of heaches
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Signs of Physical Signs of Physical DistressDistress
GastrointestinalGastrointestinal
VomitingVomiting
Compliant of constipationCompliant of constipation
DiarrheaDiarrhea
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Signs of Physical Signs of Physical DistressDistress
Musculo-SkeletalMusculo-Skeletal
Joint swellingJoint swelling
Complaint of painComplaint of pain
Redness BruisingRedness Bruising
Deformity of limb or jointDeformity of limb or joint
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
ResourcesResources Personal Emergency Intervention TrainingPersonal Emergency Intervention Training
Devereux Institute of Clinical Training and Devereux Institute of Clinical Training and ResearchResearch
Nonviolent Crisis Intervention TrainingNonviolent Crisis Intervention Training Crisis Prevention InstituteCrisis Prevention Institute
CoalitionCoalition Against Institutionalized Child AbuseAgainst Institutionalized Child Abuse wwwcaicaorgwwwcaicaorg
ldquoldquoSame Old Sad Songrdquo ndash Smokie NorfulSame Old Sad Songrdquo ndash Smokie Norful
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
PBSPBS
Covers 4 areasCovers 4 areas11 Systems changeSystems change
22 Environmental alterationEnvironmental alteration
33 Skill instructionSkill instruction
44 Behavioral consequenceBehavioral consequence
Group process to evaluate and Group process to evaluate and address all four areasaddress all four areas
Resources on PBS on website and Resources on PBS on website and wwwedlawrccomwwwedlawrccom
Questions and Answers
Questions and Answers