Student Behavior Student Behavior Interventions:Interventions:

Restraint, Seclusion, Restraint, Seclusion, ExclusionExclusion

Sue GriebnerSue Griebner

Counselor LeadershipCounselor Leadership

April 6, 2011April 6, 2011

Considerations:

How severe is the behavior- is the student a danger to himself/herself or others

Does the student have a behavior intervention plan (BIP)

What options are there for intervention

Behavioral Intervention Options Exclusion- removal of student to supervised area for limited

period of time with no instruction during that time Mechanical restraint is device or material attached or adjacent to

student’s body to restrict movement- Not Allowed Physical restraint is use of physical force without use of device to

limit movement Seclusion is confinement of student alone in a room who is

prevented from leaving- Not Allowed (Administrative Procedure 5062)

Positive interventions Functional Behavior Assessment/ Behavior Intervention Plan

Issues/Implications of Physical Restraintand Seclusion (Legal Requirements, Professional Standards, and Health and Safety ) Restraint was first introduced in France’s psychiatric

hospitals in the late 18th century to prevent injury. It was not until the Children’s Health Act of 2000 that national standards were established. (Ryan and Peterson, 2002)

It was seen as acceptable and a valuable tool to maintain control of “unruly” children in residential group homes. (Wrightslaw)

Physical restraint was becoming more prevalent in public schools. (Wrightslaw)

When Physical Restraint and Seclusion Is Used

In three months in 2009 the Council of Parent Attorneys and Advocates (COPAA) conducted a survey that identified 185 cases using prone restraint, tape, trapped in chairs, locked in seclusion rooms (Wrightslaw)

The Child Welfare League of America estimated there were 8-10 deaths a year from improper restraint (Ryan, Robbins, Peterson, Rozalski, 2009)

The Office of Governmental Accountability (GAO) released a report with hundreds of allegations of abusive restraint. Some were fatal. Students were pinned to the floor, handcuffed, locked in closets. A 7 year old was held down for hours. Children as young as 3 were restrained or put in seclusion. Texas reported 100 restraints/day. (Dan Lawton) A 13 year old hung himself in a seclusion room. (Dawn Koplos)

A school district in Wisconsin wanted to use $121,000 of federal stimulus funds to build soundproof seclusion rooms for special needs students (Disaboom)

Problems With the Use Of Restraint Person is unable to breathe when placed in a face-

down position on the floor or if a staff member puts his or her weight on a student’s back or chest

Aspiration from restraint in a face-up position Blunt trauma to the chest in positioning the student,

can cause cardiac arrhythmia and inhibition of body’s cooling system

Use of antipsychotic medications increases the risk of sudden death by over 2 times and antidepressants can increase the heart’s electrical cycling rate, also associated with sudden death (Wrightslaw)

Ethical and Practical Concerns With the Use of Restraint and Seclusion Restraint and/or exclusion could be a positive

reinforcer because it provides attention Restraint and/or exclusion without any attempt to

determine the function of the behavior limits options No use of positive interventions before or during

restraint and/or exclusion Continued use of restraint and/or exclusion with no

benefit to reducing behavior of concern (Sturmey, et. al, 2005)

It may cause psychological harm or loss of dignity Loss of trust with staff members Students with special education services more likely to

be restrained and/or excluded

Guidelines for Restraint and Exclusion Only 31 states have guidelines for crisis intervention procedures (Ryan,

Robbins, Peterson, Rozalski, 2009). Maryland is one of them. Federal legislation proposed for guidelines for every state- the Keeping

All Students Safe Act in the House and Senate was introduced (December 9, 2009). The Preventing Harmful Restraint and Seclusion in Schools Act passed out of the House on February 4, 2010 to the floor for a full vote. Unfortunately, there are still no formal federal guidelines.

Prince George’s County Public Schools’ Administrative Procedure #5062 , February 1, 2010 Restraint used only if preventing imminent, serious physical harm. The FBA or IEP must describe behaviors or circumstances where appropriate. It can only be used by staff trained through Dept of Special Education. Restraint only with with reasonable force and not to exceed 30 minutes or when student calm. No face down, impairing ability to breathe, obstructing view of face, limiting student’s ability to communicate distress, placing pressure on student’s head, neck or torso, straddling torso

Guidelines for Restraint and Exclusion, contd. Exclusion: Student must be seen at all times, have adequate

lighting, and door must be unlocked and free of barriers. Period of exclusion appropriate to developmental level of student and severity of behavior and no more than 30 minutes

Of course, no mechanical restraint, only protective or stabilizing devices

When using restraint: document less intrusive methods tried preceding behavior, resulting behavior, staff who observed the restraint, names and signatures of staff implementing restraint, and monitoring restraint Also included- description of type of restraint, length of time, student’s behavior and reaction during restraint, name and signature of administrator informed of use

If restraint not included in IEP or BIP an, IEP meeting must be held within 10 business days to discuss with parents

What We Do At Margaret Brent(Results of Survey) Of 17 rooms, all but 2 use time-out in the classroom for

aggression, disruption, or not following directions. Most use this intervention 3-5 times per week. The student is in time-out for about 5 minutes

In terms of restraint- two elementary classrooms use basket hold 2-3 times per month. Four classroom use holding hands down until the student calms about 3 times per month. One room has to hold a student’s arms down from behind about three times per month. This intervention is only for the most aggressive behavior for one student.

Exclusion to a quiet room with 1-2 staff members or Crisis Team members about 2 times per month. Always less than 30 minutes- usually 5-10 minutes.

What We Do At Margaret Brentcontd. Positive interventions include such things as: Verbal Praise Positive gestures (thumb’s up) Food Music Videos Playtime Computer time Basketball

References

Agency Release Free Resources on Restraint, Seclusion by Christina Samuels February 1, 2011

Disability Scoop: Education Department Staying Out Of Restraint, Seclusion Debate By Michelle Diament October 22, 2010

Disabilityscoop Tueday, March 22, 2011

Legislation Would Stop Restraint in Public Schools by Dan Lawton Disability Advocacy Against Physical Restraint- Disaboom

Letter from Nicole A. Joseph, Esq. Maryland Disability Law Center and Dr. Mark Zawislak Director of Spec. Ed. Cecil Cty Public Schools, February 1, 2010

On Special Education: Oregon Bill Seeks to Ban Most Use of Restraints, Seclusion by Nirvi Shah February 24, 2011

References contd.

Pathfinders for Autism: Federal Legislation Pending to End Restraint and Seclusion in Schools Author Dawn Koplos, Director Education Policy & Children’s Issue, The Arc of Maryland

Physical Restraints in Schools by Joseph B. Ryan, M.S. Ed. And Reece Peterson, Ph. D. University of Nebraska-Lincoln Hartford Courant

Prince George’s County Public Schools’ Administrative Procedure #5062 , February 1, 2010

TACT-2 Therapeutic Aggression Control Techniques v. 2: Effectively preventing and intervening in crisis with troubled children and youth Trainee Workbook

Wrightslaw.com, March 1, 2011