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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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