State Laws (Statutes & Regulations) on Restraint/Seclusion
Updated Through November 2009
by Jessica Butler, Esquire
Substantial Restraint and Seclusion Laws (21) CA, CO , CT, IA, IL, MA, MD, ME, MN, MT, NC, NH, NV, NY, OH, OR, PA, RI, TN, TX, WA
Some Seclusion Law (3) AR, VA, MO (forbids locked unattended space only)
Weaker Restraint/Seclusion Laws (4) DC (bans unreasonable restraint, limits on aversives in private schools), DE (special rule for autism programs only, imposing limited restrictions), WV (special rule for preschool only), HI (forbidding physical punishment unless therapeutic technique in IEP/504 plan)
No Meaningful Restraint/Seclusion Laws (23) AK, AL, AZ, FL, GA, ID, IN, KS, KY, LA, MI, MS, ND, NE, NJ, NM, OK, SC, SD, UT, VT, WI, WY Eight of these have Policy Guidelines against Abusive Interventions but not Laws FL, KS, KY, MI, NM, UT, VT, WI. New Guidelines also pending in Alabama and Indiana.
Bans Mechanical Restraints (Law) (11) CO, IA, IL, MA, ME, TN, MT, NC, PA, VA, MD (MD excepts schools certified by Joint Cmmn for Accred. of Health Care Orgs.)
Bans Chemical Restraints (Law) (7) CT, CO, IL, MA, ME, TN, NH
Guideline Suggestions Against Mechanical/Chemical Restraints Both: MI, WI. Mechanical only: FL, KS, VT.
States that define body part to which Restraints apply (16 states) CO, CT, IL, MA, MD, MN, MT, NC, NH, NV, OR, PA, RI, TN, TX, WA (16 states)
States that define restraint in terms of entire body (15 states) CO , IL, MA, MD, MN, MT, NC, NH, NV, OR, PA, RI, TN, TX, WA
Of these, states the define restraints in terms of arms, legs, and head, but prohibit “restraint or hold” that impairs breathing (1) CT
Seclusion Includes Unlocked Spaces that Children Cannot Exit CO, IA, MN, MT, MA, MD, NC, OR, PA, TN, VA (and guideline suggestions in KS and MT)
(11 of 24 states with Seclusion Laws)
Locked Seclusion Banned (8 States by Law) AR, CA, ME, MT, NY, PA, TX, NV (and guideline suggestions in KY, NM, VT, WI)
Locked Seclusion Permitted but Lock Must Disengage Automatically in Emergency (3) IA, IL, CT
Bans Aversives by Law unless otherwise stated. (22 State Laws, 3 Guideline Suggestions) CA, IA, IL, ME, MN, MT, NC, NH, NY, NV, OR, PA, RI, TN, VA, WA, MA (generally banned, but exceptions), DC (nonpublic schools only), WV (preschool only), HI (intentional infliction of pain), ND (same), VT (same). Guideline Suggestions only in FL, MI, WI.
Prohibit Restraints that Interfere with Breathing by Law (11) CO, CT, IA, MA, MD, MN, OH, PA, RI, TN, WA
Guidelines Against Restraints
RHODE ISLAND
Standard or Definition Rhode Island Statute Chapter 42-72.9
Children's Right to Freedom from Restraint Act Section 42-72.9-4 and State of Rhode Island Department of Children, Youth and Families, "Child Care Regulations: Addendum A-Regulations Regarding the Use of Crisis
Intervention, Restraint and Seclusion Within Covered Residential Facilities."
As of June, 2003
Restraint Definition "Therapeutic physical restraint" (used interchangeably with the term "physical restraint") means the acceptable use of a staff member's body to immobilize or reduce the free movement of a child/youth's arms, legs, torso, or head, in order to ensure the physical safety of a child/youth or other individual in the facility.
Restraint Exclusions The term does not include: (i) briefly holding a person in order to calm or comfort the person; (ii) restraint involving the minimum contact necessary to safely escort the person from one area to another.
Chemical Restraint Definition "Chemical restraint" means a medication used to control behavior or restrict the patient's freedom of movement and is not a standard treatment for the child's medical or psychiatric condition.
Seclusion Definition "Seclusion" means the involuntary confinement of a child/youth in a room in a Covered Facility, whether alone or with staff supervision, in a manner that prevents the child/youth from leaving.
Seclusion Exclusions This definition does not pertain to the use of "time out" as an acceptable form of short-term behavioral management nor does it pertain to covered facilities where the terms of seclusion are defined pursuant to particular judicial decrees.
Criteria for Restraint and Seclusion -No service provider shall administer a physical, mechanical, or chemical restraint on a child, unless the following conditions are met:
• service provider in a covered facility may impose restraints only to prevent immediate or imminent risk of harm to the physical safety of the child, staff, or other individuals in the facility. Restraints shall be removed at the earliest possible time that the child can commit to safety and no longer poses a threat to himself or herself or others;
• The use of mechanical restraints on children and youth must be administered in strict accordance with policies developed by the service provider and is limited to those covered facilities granted specific authority to use mechanical restraint methods by their respective state licensing authorities after review and approval of their policies. The use of mechanical restraints at the Rhode Island training school for youth will be governed exclusively by rules and regulations promulgated by DCYF in accordance with 42-72.9-9 on or before January 1, 2001;
• A physical, mechanical, or chemical restraint may be used only when less restrictive interventions have not succeeded in de-escalating a situation in which the child's and/or other's safety is at risk;
• Except in the case of an emergency, any use of restraint on a child in the school program of a covered facility must be in accordance with the child's individual education program;
• Any use of restraint on a child must be in accordance with safe and appropriate restraining techniques and be administered only by service providers that have both initial and ongoing education and training in the proper and safe use of restraints as established by nationally recognized training programs;
The use of chemical restraints on children and youth must be administered in strict accordance with policies developed by the service provider and is limited to those covered facilities granted specific authority to use chemical restraints by their respective state licensing authorities after review and approval of their policies. All chemical restraints must be ordered in writing by a physician and administered in accordance with the standards adopted by the joint commission on accreditation of healthcare organizations (JCAHO).
Monitoring Requirements The condition of the child in a restraint must be continually assessed, monitored, and reevaluated and the restriction of patient child movement or activity by restraint must be ended at the earliest possible time, considering the physical safety of the child being restrained and other individuals in the facility. For the purposes of this section, "monitor" means (i) direct observation, or (ii) observation by way of video monitoring within physical proximity sufficient to provide aid as may be needed.
Ordering and Initiation Any use of restraint on a child must be administered only by service providers that have both initial and ongoing education and training in the proper and safe use of restraints as established by nationally recognized training programs.
Restraints may not be written as a standing order or on "as needed" (PRN) basis.
In-person Assessment See "Monitoring Requirements" above.
Debriefing The Covered Facility must ensure that all children/youth directly and indirectly involved in a restraint or seclusion are provided the opportunity to debrief the incident as soon as practicable but no longer than within twenty-four (24) hours of the incident.
Family & amp; Guardian Notification No information provided.
Notification of Rights and Restraint and Seclusion Policies and Procedures at admission No information provided.
Training Covered Facilities are required to use only nationally recognized crisis intervention and physical restraint training programs, which are approved by the Department.
Each Covered Facility muse ensure that every new Service Provider successfully completes the training prescribed below in regard to crisis intervention and restraint prior to that Service Provider being authorized to be solely responsible for any child or children in the care of the Covered Facility. Covered Facilities and/or Parent Agencies must also ensure that all new Service Providers are given the opportunity to complete such training within thirty (30) days from their date of hire.
The required new Service Provider training includes, but is not limited to :
• A minimum of sixteen (16) hours of training in the Covered Facility's approved crisis intervention and restraining model or the prescribed number of minimum hours identified within the model, whichever is greater.
1. Such training shall include role-playing in de-escalation, demonstration by the Service Provider of each hold and self-protection method taught, and written pre-training and post-training tests.
2. Successful completion of this training must be verified by a written sign-off from the trainer stating that the Service Provider has successfully completed the training program and that he/she can competently implement the components of the training program. A copy of this documentation shall be kept in the Service Provider's personal file.
• When not included as a part of the Covered Facility's approved crisis intervention and restrain training model, each Service Provider shall also successfully complete training in the following:
1. Avoidance of power struggles
2. Aggressive behavior related to a medical condition
3. Physiological impact of restraint
4. Monitoring physical signs of distress and obtaining medical assistance
5. Legal issues
6. Positional asphyxia
7. Self protection techniques
8. Process for obtaining approval for continued restraint
9. Documentation
10. Investigation of injuries and complaints.
• Each Covered Facility and/or Parent Agency shall ensure that all staff, on a minimum of an annual basis, receive a minimum of eight (8) hours of refresher training.
Documentation In accordance with RIGL 42-72.9-6, any use of physical, mechanical or chemical restraint or seclusion must be documented using an Incident Report and must be documented in a progress note in the child's medical, educational, treatment or case record maintained by the covered facility.
Reporting All restraints must be recorded by the individuals administering the restraints and reviewed by supervisory personnel as soon as practicable but no later than forty-eight (48) hours after the restraint was administered.
Quality Improvement Each Covered Facility shall develop methods by which the use of restraint and seclusion is monitored and internally reviewed to identify patterns and practices of service providers as a group or as individuals. Such methods shall include mechanisms by which data acquired by these reviews will be used to positively affect practices within the Covered Facility and within individual service providers.
§ 42-72.9-2 -Fundamental purpose.
This chapter is enacted to protect and promote the right of each child who is a resident or patient in a covered facility to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints (as defined in this chapter) imposed for purposes of discipline or convenience. Every child who obtains services from a covered facility has a right to be free from both physical and chemical restraints that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by service providers.
§ 42-72.9-3 -Definitions.
For the purposes of this chapter:
(1) "Service provider" means any person employed or contracted by a covered facility to provide direct care, residential treatment, education, or direct supervision of children.
(2) "Covered facility" means any agency, organization, or public or private entity that provides any of the following for children, regardless of the state agency under whose authority its license is established: residential treatment, including in-house educational programming; in-patient or residential psychiatric treatment for mental illness; and group or shelter home care pursuant to a licensed granted by the department of children, youth, and families. The term "covered facility" does not include the public school system or psychiatric hospitals, or the Rhode Island training school for youth. The department of children, youth, and families will promulgate policies and regulations in accordance with § 42-72.9-9 relative to the use of seclusion and restraint at the Rhode Island training school for youth on or before January 1, 2001.
(3) "Therapeutic physical restraint" means the acceptable use of a staff member's body to immobilize or reduce the free movement of a child/youth's arms, legs, torso, or head, in order to ensure the physical safety of a child/youth or other individual in the facility. The term does not include: (i) briefly holding a person in order to calm or comfort the person; (ii) restraint involving the minimum contact necessary to safely escort the person from one area to another.
(4) "Mechanical restraint" means any approved mechanical restriction that immobilizes or reduces the free movement of a child/youth's arms, legs, torso, or head in order to hold a child/youth safely including: (i) medical devices, including, but not limited to, supports prescribed by a health care provider to achieve proper body position or balance; (ii) helmets or other protective gear used to protect a person from injuries due to a fall; or (iii) helmets, mitts and similar devices used to prevent self-injury when the device is part of a documented treatment plan and is the least restrictive means available to prevent the self-injury.
(5) "Life threatening physical restraint" means any physical restraint or hold on a child that restricts the flow of air into a person's lungs, whether by chest compression or any other means.
(6) "Chemical restraint" means a medication used to control behavior or restrict the patient's freedom of movement and is not a standard treatment for the child's medical or psychiatric condition.
(7) "Seclusion" means the involuntary confinement of a child/youth in a room in a covered facility, whether alone or with staff supervision, in a manner that prevents the child/youth from leaving. This definition does not pertain to the use of "time out" as an acceptable form of short-term behavioral management nor does it pertain to covered facilities where the terms of seclusion are defined pursuant to particular judicial decrees.
(8) "Time out" means the brief separation of a child/youth from the group not to exceed twenty (20) minutes, designed to de-escalate the child/youth. During the "Time out," a child/youth's freedom of movement is not restricted and the child/youth need not be directly supervised, but must be visually monitored.
§ 42-72.9-4 -Use of restraints.
(a) No service provider may use a life threatening physical restraint on any child at any time. This section shall not be construed as limiting any defense to a criminal prosecution for the use of deadly physical force that may be available in the general laws.
(b) After January 1, 2001, no service provider shall administer a restraint on a child unless trained in accordance with the provisions of this chapter.
(c) No service provider shall administer a physical, mechanical, or chemical restraint on a child, unless the following conditions are met:
(1) A service provider in a covered facility may impose restraints only to prevent immediate or imminent risk of harm to the physical safety of the child, staff, or other individuals in the facility. Restraints shall be removed at the earliest possible time that the child can commit to safety and no longer poses a threat to himself or herself or others;
(2) The use of mechanical restraints on children and youth must be administered in strict accordance with policies developed by the service provider and is limited to those covered facilities granted specific authority to use mechanical restraint methods by their respective state licensing authorities after review and approval of their policies. The use of mechanical restraints at the Rhode Island training school for youth will be governed exclusively by rules and regulations promulgated by DCYF in accordance with § 42-72.9-9 on or before January 1, 2001;
(3) A physical, mechanical, or chemical restraint may be used only when less restrictive interventions have not succeeded in de-escalating a situation in which the child's and/or other's safety is at risk;
(4) Except in the case of an emergency, any use of restraint on a child in the school program of a covered facility must be in accordance with the child's individual education program;
(5) Any use of restraint on a child must be in accordance with safe and appropriate restraining techniques and be administered only by service providers that have both initial and ongoing education and training in the proper and safe use of restraints as established by nationally recognized training programs;
(6) The use of chemical restraints on children and youth must be administered in strict accordance with policies developed by the service provider and is limited to those covered facilities granted specific authority to use chemical restraints by their respective state licensing authorities after review and approval of their policies. All chemical restraints must be ordered in writing by a physician and administered in accordance with the standards adopted by the joint commission on accreditation of healthcare organizations (JCAHO);
(7) The condition of the child in a restraint must be continually assessed, monitored, and reevaluated and the restriction of patient child movement or activity by restraint must be ended at the earliest possible time, considering the physical safety of the child being restrained and other individuals in the facility. For the purposes of this section, "monitor" means (i) direct observation, or (ii) observation by way of video monitoring within physical proximity sufficient to provide aid as may be needed;
(8) Restraints may not be written as a standing order or on "as needed" (PRN) basis; and
(9) All restraints must be recorded by the individuals administering the restraints and reviewed by supervisory personnel as soon as practicable but no later than forty-eight (48) hours after the restraint was administered.
§ 42-72.9-5 -Seclusion.
(a) No service provider may cause the involuntary placement of a child in seclusion except as an emergency intervention to prevent immediate or imminent risk of injury to the physical safety of the child, staff, or other individuals in the facility and may not be used for discipline, convenience or as a substitute for a less restrictive alternative. The following requirements must be observed for any child placed in seclusion:
(1) The condition of the child in seclusion must be continually assessed, monitored, and reevaluated and the seclusion must be ended at the earliest possible time, considering the physical safety of the child being secluded and other individuals in the facility. For the purposes of this section, "monitor" means (i) direct observation, or (ii) observation by way of video monitoring within physical proximity sufficient to provide aid as may be needed; and
(2) The simultaneous use of seclusion and mechanical or chemical restraint is prohibited.
(b) Nothing in this section shall be construed to limit the use of "time out" as a method of managing behavior within a covered facility.
§ 42-72.9-6 -Recording.
(a) Any use of physical, mechanical, or chemical restraint or seclusion on a child must be documented in the child's medical, educational, treatment or case record maintained by the covered facility. The documentation shall include:
(1) In the case of emergency use, the nature of the emergency and what other steps, including attempts at verbal de-escalation, were taken to prevent the emergency from arising if there were indications that such an emergency was likely to arise; and
(2) A detailed description of the nature of the restraint, its duration and its effect on the child's established medical, educational or treatment plan.
(b) Each covered facility shall: (1) maintain a weekly log of the use of physical, mechanical, or chemical restraint or seclusion on children in their care and the nature of the emergency that necessitated its use, and
(2) include that information in an annual compilation on its use of restraint and seclusion. The director of the state agency that has jurisdiction or supervisory control over the covered facility shall issue regulations regarding the specific content of the annual compilation and review the annual compilation prior to renewing a license for or a contract with the covered facility. The annual compilation of use of restraints and seclusion by each covered facility is a public record.
(c) If the use of restraint or seclusion results in serious physical injury or death to the child, the covered facility shall report the incident immediately to the department of children, youth, and families as defined by law and to the director of the state agency that has jurisdiction or supervisory control over the covered facility. The director shall report any incidence of serious injury or death to the child advocate. The term "serious injury" shall be defined by DCYF in the rules and regulations promulgated pursuant to § 42-72.9-9.
§ 42-72.9-7 -Training and policies.
(a) Each covered facility shall:
(1) Develop policies and procedures that establish monitoring, documentation, reporting, and internal review of the use of restraint and seclusion on children;
(2) Require training of all service providers in the use of restraint and seclusion on children. The training shall include but not be limited to verbal defusing and de-escalation; prevention strategies; types of physical restraint; the differences between life threatening physical restraint and other varying levels of physical restraint; monitoring to prevent harm to a child physically restrained or in seclusion; and recording and reporting procedures on the use of restraints and seclusion; and
(3) Make the policies and procedures required under subsection (a)(1) available to the director of the state agency that has jurisdiction or supervisory control over the covered facility.
(b) DCYF is responsible for ensuring compliance with initial and refresher restraint training and for funding the training in accordance with its contract or rate provisions with residential providers.
§ 42-72.9-8 -Penalties.
(a) Any covered facility that does not comply with the provisions of this chapter is subject to licensing action, including, but not limited to, license revocation, by the agency or department of state government that has jurisdiction or supervisory control over the covered facility.
(b) Any service provider who willfully and intentionally violates the provisions of this chapter, and by reason of that violation inflicts physical injury upon a child, shall upon conviction of the violation be fined a sum not exceeding five hundred dollars ($500) and/or imprisoned for a term not exceeding six (6) months. However, if the service provider is exonerated, all costs incurred in defense of these charges shall be paid by the covered facility.
(c) Nothing contained in this chapter shall be construed to limit or restrict any criminal or civil action available to an appropriate party under applicable state law.
Click here to review Rhode Island Board of Regents for Elementary and Secondary Education Physical Restraint Regulations http://www.ride.ri.gov/Regents/Docs/RegentsRegulations/PHYS%20REST%20REGS%20FINAL.pdf
Click here to review the Requirements that must be met for districts to be in compliance with the Rhode Island Physical Restraint Regulations-Education Commisioner Deborah A. Gist, January 8, 2010http://www.ride.ri.gov/Special_Populations/Documents/Restraint%20Request.pdf
MASSACHUSETTS
MASSACHUSETTS Education Laws and Regulations
603 CMR 46.00:
Physical Restraint
Section:
46.01:
Authority, Scope, Purpose and Construction
46.02:
Definitions
46.03:
Procedures and Training
46.04:
Determining When Physical Restraint May Be Used
46.05:
Proper Administration of Physical Restraint
46.06:
Reporting Requirements
46.07:
Special Circumstances
View All Sections
In effect April 2, 2001
46.01: Authority, Scope, Purpose and Construction
(1) Authority. 603 CMR 46.00 is promulgated by the Board of Education pursuant to M.G.L. c. 69, § 1B, and c. 71, § 37G.
(2) Scope. 603 CMR 46.00 governs the use of physical restraint on students in publicly funded elementary and secondary education programs, including all Massachusetts public school districts, charter schools, collaborative education programs and special education schools approved under 603 CMR 28.09, except as provided in 603 CMR 18.05(5)(h). Educational programs in facilities operated by the Department of Youth Services shall comply with the restraint requirements of 102 CMR 3.00.
(3) Purpose. The purpose of 603 CMR 46.00 is to ensure that every student participating in a Massachusetts public education program is free from the unreasonable use of physical restraint. Physical restraint shall be used only in emergency situations, after other less intrusive alternatives have failed or been deemed inappropriate, and with extreme caution. School personnel shall use physical restraint with two goals in mind:
(a) To administer a physical restraint only when needed to protect a student and/or a member of the school community from imminent, serious, physical harm; and
(b) To prevent or minimize any harm to the student as a result of the use of physical restraint.
(4) Construction. Nothing in 603 CMR 46.00 shall be construed to limit the protection afforded publicly funded students under other state or federal laws, including those laws that provide for the rights of students who have been found eligible to receive special education services. Nothing in 603 CMR 46.00 precludes any teacher, employee or agent of a public education program from using reasonable force to protect students, other persons or themselves from assault or imminent, serious, physical harm.
46.02: Definitions
As used in 603 CMR 46.00, the following terms shall have the following meanings:
(1) Extended restraint: A physical restraint the duration of which is more than twenty (20) minutes. Extended restraints increase the risk of injury and, therefore, require additional written documentation as described in 603 CMR 46.06.
(2) Physical escort: Touching or holding a student without the use of force for the purpose of directing the student.
(3) Physical restraint: The use of bodily force to limit a student's freedom of movement.
(4) Public education programs: Public schools, including charter schools, collaborative education programs, special education schools approved under 603 CMR 28.09, except as provided in 603 CMR 18.05(5)(h), and school events and activities sponsored by such programs.
(5) Restraint - Other: Limiting the physical freedom of an individual student by mechanical means or seclusion in a limited space or location, or temporarily controlling the behavior of a student by chemical means. The use of chemical or mechanical restraint is prohibited unless explicitly authorized by a physician and approved in writing by the parent or guardian. The use of seclusion restraint is prohibited in public education programs.
(a) Mechanical Restraint: The use of a physical device to restrict the movement of a student or the movement or normal function of a portion of his or her body. A protective or stabilizing device ordered by a physician shall not be considered mechanical restraint.
(b) Seclusion Restraint: Physically confining a student alone in a room or limited space without access to school staff. The use of "time out" procedures during which a staff member remains accessible to the student shall not be considered "seclusion restraint."
(c) Chemical restraint: The administration of medication for the purpose of restraint.
(6) School Working Day: Any day or partial day that students are in attendance at the public education program for instructional purposes.
46.03: Procedures and Training
(1) Procedures. Public education programs shall develop written procedures regarding appropriate responses to student behavior that may require immediate intervention. Such procedures shall be annually reviewed and provided to school staff and made available to parents of enrolled students. Such procedures shall include, but not be limited to:
(a) Methods for preventing student violence, self-injurious behavior, and suicide, including de-escalation of potentially dangerous behavior occurring among groups of students or with an individual student;
(b) A school policy regarding restraint that provides a description and explanation of the school's or program's method of physical restraint, a description of the school's or program's training requirements, reporting requirements and follow-up procedures, and a procedure for receiving and investigating complaints regarding restraint practices.
(2) Required training for all staff. Each principal or director shall determine a time and method to provide all program staff with training regarding the school's restraint policy. Such training shall occur within the first month of each school year and, for employees hired after the school year begins, within a month of their employment. Training shall include information on the following:
(a) The program's restraint policy;
(b) Interventions that may preclude the need for restraint, including de-escalation of problematic behaviors;
(c) Types of restraints and related safety considerations, including information regarding the increased risk of injury to a student when an extended restraint is used;
(d) Administering physical restraint in accordance with known medical or psychological limitations and/or behavioral intervention plans applicable to an individual student; and
(e) Identification of program staff who have received in-depth training pursuant to 603 CMR 46.03(3) in the use of physical restraint.
(3) In-depth staff training in the use of physical restraint. At the beginning of each school year, the principal or director of each public education program or his or her designee shall identify program staff that are authorized to serve as a school-wide resource to assist in ensuring proper administration of physical restraint. Such staff shall participate in in-depth training in the use of physical restraint. The Department of Elementary and Secondary Education recommends that such training be at least sixteen (16) hours in length.
(4) Content of in-depth training. In depth training in the proper administration of physical restraint shall include, but not be limited to:
(a) Appropriate procedures for preventing the need for physical restraint, including the de-escalation of problematic behavior, relationship building and the use of alternatives to restraint;
(b) A description and identification of dangerous behaviors on the part of students that may indicate the need for physical restraint and methods for evaluating the risk of harm in individual situations in order to determine whether the use of restraint is warranted;
(c) The simulated experience of administering and receiving physical restraint, instruction regarding the effect(s) on the person restrained, including instruction on monitoring physical signs of distress and obtaining medical assistance;
(d) Instruction regarding documentation and reporting requirements and investigation of injuries and complaints; and
(e) Demonstration by participants of proficiency in administering physical restraint.
46.04: Determining When Physical Restraint May Be Used
(1) Use of restraint. Physical restraint may be used only in the following circumstances:
(a) Non-physical interventions would not be effective; and
(b) The student's behavior poses a threat of imminent, serious, physical harm to self and/or others.
(2) Limitations on use of restraint. Physical restraint in a public education program shall be limited to the use of such reasonable force as is necessary to protect a student or another member of the school community from assault or imminent, serious, physical harm.
(3) Prohibitions. Physical restraint is prohibited in the following circumstances:
(a) As a means of punishment; or
(b) As a response to property destruction, disruption of school order, a student's refusal to comply with a school rule or staff directive, or verbal threats that do not constitute a threat of imminent, serious, physical harm.
(4) Referral to law enforcement or other state agencies. Nothing in these regulations prohibits:
(a) The right of any individual to report to appropriate authorities a crime committed by a student or other individual;
(b) Law enforcement, judicial authorities or school security personnel from exercising their responsibilities, including the physical detainment of a student or other person alleged to have committed a crime or posing a security risk; or
(c) The exercise of an individual's responsibilities as a mandated reporter pursuant to MGL c. 119, § 51A. These regulations shall not be used to deter any individual from reporting neglect or abuse to the appropriate state agency.
46.05: Proper Administration of Physical Restraint
(1) Trained personnel. Only school personnel who have received training pursuant to 603 CMR 46.03
(2) or 603 CMR 46.03(3) shall administer physical restraint on students. Whenever possible, the administration of a restraint shall be witnessed by at least one adult who does not participate in the restraint. The training requirements contained in 603 CMR 46.00 shall not preclude a teacher, employee or agent of a public education program from using reasonable force to protect students, other persons or themselves from assault or imminent, serious, physical harm.
(2) Use of force. A person administering a physical restraint shall use only the amount of force necessary to protect the student or others from physical injury or harm.
(3) Safest method. A person administering physical restraint shall use the safest method available and appropriate to the situation subject to the safety requirements set forth in 603 CMR 46.05(5). Floor or prone restraints shall be prohibited unless the staff member administering the restraint has received in-depth training according to the requirements of 603 CMR 46.03(3) and, in the judgment of the trained staff member, such method is required to provide safety for the student or others present.
(4) Duration of restraint. A person administering physical restraint shall discontinue such restraint as soon as possible. If, due to unusual circumstances, a restraint continues for more than twenty (20) minutes, it shall be considered an "extended restraint" for purposes of the reporting requirements in 603 CMR 46.06.
(5) Safety requirements. Additional requirements for the use of physical restraint:
(a) No restraint shall be administered in such a way that the student is prevented from breathing or speaking. During the administration of a restraint, a staff member shall continuously monitor the physical status of the student, including skin color and respiration. A restraint shall be released immediately upon a determination by the staff member administering the restraint that the student is no longer at risk of causing imminent physical harm to him or herself or others.
(b) Restraint shall be administered in such a way so as to prevent or minimize physical harm. If, at any time during a physical restraint, the student demonstrates significant physical distress, the student shall be released from the restraint immediately, and school staff shall take steps to seek medical assistance.
(c) Program staff shall review and consider any known medical or psychological limitations and/or behavioral intervention plans regarding the use of physical restraint on an individual student.
(d) Following the release of a student from a restraint, the program shall implement follow-up procedures. These procedures shall include reviewing the incident with the student to address the behavior that precipitated the restraint, reviewing the incident with the staff person(s) who administered the restraint to discuss whether proper restraint procedures were followed, and consideration of whether any follow-up is appropriate for students who witnessed the incident.
46.06: Reporting Requirements
(1) Circumstances under which a physical restraint must be reported. Program staff shall report the use of physical restraint as specified in 603 CMR 46.06(2) after administration of a physical restraint that results in any injury to a student or staff member, or any physical restraint of a duration longer than five minutes
(2) Informing school administration. The program staff member who administered the restraint shall verbally inform the program administration of the restraint as soon as possible, and by written report no later than the next school working day. The written report shall be provided to the principal or director of the program or his/her designee, except that the principal or director shall prepare the report if the principal or director has administered the restraint. The principal or director or his/her designee shall maintain an on-going record of all reported instances of physical restraint, which shall be made available for review by the Department of Elementary and Secondary Education, upon request.
(3) Informing parents. The principal or director of the program or his/her designee shall verbally inform the student's parents or guardians of the restraint as soon as possible, and by written report postmarked no later than three school working days following the use of restraint. If the school or program customarily provides a parent or guardian of a student with report cards and other necessary school-related information in a language other than English, the written restraint report shall be provided to the parent or guardian in that language.
(4) Contents of report. The written report required by 603 CMR 46.06(2) and (3) shall include:
(a) The names and job titles of the staff who administered the restraint, and observers, if any; the date of the restraint; the time the restraint began and ended; and the name of the administrator who was verbally informed following the restraint.
(b) A description of the activity in which the restrained student and other students and staff in the same room or vicinity were engaged immediately preceding the use of physical restraint; the behavior that prompted the restraint; the efforts made to de-escalate the situation; alternatives to restraint that were attempted; and the justification for initiating physical restraint.
(c) A description of the administration of the restraint including the holds used and reasons such holds were necessary; the student's behavior and reactions during the restraint; how the restraint ended; and documentation of injury to the student and/or staff, if any, during the restraint and any medical care provided.
(d) For extended restraints, the written report shall describe the alternatives to extended restraint that were attempted, the outcome of those efforts and the justification for administering the extended restraint.
(e) Information regarding any further action(s) that the school has taken or may take, including any disciplinary sanctions that may be imposed on the student.
(f) Information regarding opportunities for the student's parents or guardians to discuss with school officials the administration of the restraint, any disciplinary sanctions that may be imposed on the student and/or any other related matter.
(5) Report to the Department of Elementary and Secondary Education. When a restraint has resulted in a serious injury to a student or program staff member or when an extended restraint has been administered, the program shall provide a copy of the written report required by 603 CMR 46.06(4) to the Department of Elementary and Secondary Education within five school working days of the administration of the restraint. The program shall also provide the Department with a copy of the record of physical restraints maintained by the program administrator pursuant to 603 CMR 46.06(2) for the thirty day period prior to the date of the reported restraint. The Department shall determine if additional action on the part of the public education program is warranted and, if so, shall notify the public education program of any required actions within thirty calendar days of receipt of the required written report(s).
46.07: Special Circumstances
(1) Special Circumstances - Students with Disabilities. Restraint administered to a student with a disability pursuant to an Individualized Education Plan ("IEP") or other written plan developed in accordance with state and federal law to which the public education program and the student's parent or guardian have agreed shall be deemed to meet the requirements of 603 CMR 46.00, except that the limitations on chemical, mechanical, and seclusion restraint set forth in 603 CMR 46.02(5), the training requirements set forth in 603 CMR 46.03, and the reporting requirements set forth in 603 CMR 46.06 shall apply.
(2) Special Circumstances - Individual Waiver of Reporting Requirements. Public education programs may seek a parent's or guardian's consent to waive the reporting requirements of 603 CMR 46.06 for restraints administered to an individual student that do not result in serious injury to the student or a program staff member and do not constitute extended restraint. Extended restraints and restraints that result in serious injury to a student or program staff member must be reported in accordance with the requirements of 603 CMR 46.06, regardless of any individual waiver to which the parent or guardian may have consented. Individual waivers should be sought only for students who present a high risk of frequent, dangerous behavior that may require the frequent use of restraint.
(3) Limitations on individual waivers.
(a) A public education program may not require a parent's consent to such a waiver as a condition of admission or provision of services.
(b) A parent may withdraw consent to such waiver at any time without penalty.
(4) Individual Waiver - documentation required. The program shall maintain the following documentation on site in the student's file and shall make such documentation available for inspection by the Department of Elementary and Secondary Education at its request at any time:
(a) The informed written consent of the parent or guardian to the waiver, which shall specify those reporting requirements(s) in 603 CMR 46.06(1)-(4) that the parent or guardian agrees to waive; and
(b) Specific information regarding when and how the parent or guardian will be informed regarding the administration of all restraints to the individual student.
(5) Prohibition on Program or Classroom Waivers: Nothing herein shall be construed to allow a program or classroom to receive an exemption or waiver from any of the requirements of 603 CMR 46.00 on behalf of all of the students enrolled in a particular program or classroom.
RIGHTS REGARDING THE USE OF RESTRAINT IN MASSACHUSETTS PUBLIC SCHOOLS
The Massachusetts Department of Elementary and Secondary Education (DESE) regulates public schools in their use of physical restraint on students.1 This pamphlet describes these requirements. This pamphlet does not include the program and safety standards for Approved Public or Private Day and Residential Special Education School Programs§.2
WHAT IS RESTRAINT?
Restraint is physically limiting an individual student’s freedom of movement or controlling behavior by chemical means.3 It is used in emergency situations in order to protect a student or staff member when other, less intrusive methods have failed. The different types of restraint include:
Physical restraint: Using bodily force to limit a student’s freedom of movement.4
Physical escort: Touching or holding a student without the use of force in order to direct his or her movement.5
Mechanical restraint: The use of a physical device to restrict a student’s movement, or the movement or normal function of part of his or her body.6
Seclusion restraint: Physically confining a student alone in a room or limited space without access to school staff.7
Chemical restraint: The use of medication for the purpose of restraint.8
WHAT ARE THE RISKS INVOLVED IN THE USE OF RESTRAINT?
When misused, restraint and seclusion can be dangerous and even deadly. In particular, a number of students have died as a result of the improper use of prone restraint. Prone restraint involves holding a child facedown against the floor. When a person administering prone restraint applies too much pressure to a student’s torso, he or she can inadvertently suffocate the student or cause the student to have fatal heart problems. If the staff member ignores verbal or other signs of physical distress, does not release the student from the restraint upon noticing them and/or does not seek medical attention quickly enough, these problems can be fatal. Other physical restraints can also be harmful, mentally as well as physically, if used improperly.9
HOW AND WHEN MAY RESTRAINT BE USED IN A PUBLIC SCHOOL CLASSROOM?
Restraint may only be used when a student’s behavior poses a threat of imminent, serious physical harm to him or herself or to others, and when all non-physical interventions would be ineffective.10 Only school personnel who have been trained in the use of restraint may use it. Furthermore, only staff members who have received in-depth training may use floor or prone restraints, and they may only do so if it is necessary for the safety of the student or others. 115 Revised 11/17/09
The person administering the restraint must use the safest method available, use no more force than is necessary to protect the student or others from physical injury, and discontinue the use of restraint as soon as it is possible and safe to do so.12 If a restraint lasts more than 20 minutes, it is considered an extended restraint for the purposes of reporting.13 When possible, another adult should be present to witness the use of restraint.14 If at any time during the use of restraint the student shows signs of being in serious physical distress, he or she must be released immediately, and school staff must seek medical help.15 After the student has been released, the incident must be reviewed with the student in order to address the behavior that led to the use of restraint. The incident must also be reviewed with the staff member who administered the restraint to make sure that proper procedures were followed and whether any follow-up is necessary for the students who witnessed it. 16 Some types of restraint cannot be used in Massachusetts public schools at all. This includes seclusion and types of restraint that prevent a student from speaking or breathing.17 Chemical and mechanical restraint may only be used with approval from a physician and written consent from the student’s parents.18 Restraint may not be used as a means of punishment or as a response to property destruction, merely disruptive behavior, refusal to follow rules or verbal threats.19
WHO IS QUALIFIED TO ADMINISTER RESTRAINT?
Only school personnel who have been trained in the use of restraint may administer it to students.20 All school staff must receive basic training within the first month of the school year or within one month of being hired to work there.21 Basic training should include information on: The program’s restraint policy Alternatives to restraint in handling problematic behavior. Types of restraints and the safety concerns they raise The risk of injury involved in extended restraint How to use physical restraint on individual students who have known medical or psychological problems and behavioral intervention plans The names of staff members who have received in-depth training in the use of physical restraint.22 Some staff members have received in-depth training on the use of restraints so that they can serve as a school-wide resource to make sure that proper restraint procedure is being followed.23 In-depth training must include: Alternatives to restraint in de-escalating problematic behavior A description and identification of dangerous behaviors for which restraint may be necessary 5 Revised 11/17/09 guage. Methods of evaluating the level of risk in individual situations in deciding whether restraint is necessary Simulated experiences of using and receiving restraint Information on the effects of restraint on the person receiving it, including how to monitor physical distress and how to seek medical help if necessary Instruction on documentation, reporting requirements and investigation of injuries and complaints about the use of restraint Demonstration by participants of the proper use of physical restraint.24
HOW AND WHEN MUST THE USE OF RESTRAINT BE REPORTED?
Schools are required to report the use of physical restraint when it lasted for more than five minutes and/or resulted in any injury to a student or staff member.25 The person who administered the restraint must verbally tell the school administration about the incident as soon as possible, and submit a written report about it by the next school day.26
The written report must include information about:
The date and time of the restraint
The people involved: The names and titles of the person administering the restraint, any bystanders and the school official to whom the use of restraint was reported.
The events leading up to the restraint: What was happening before restraint became necessary, what the student did to prompt the use of restraint, what alternatives to restraint were used to de-escalate the situation, and why restraint was necessary.
The restraint itself: What holds were used and why, how the student reacted to the restraint, how the restraint ended, whether any injuries resulted, what kind of injuries resulted, and what sort of medical treatment was provided.
Whether extended restraints were used: What alternatives to extended restraint were tried, what the outcomes of those alternatives were, and why the extended restraint was necessary.
Further action by the school: Whether the school plans to take further disciplinary or other action against the student, and of what kind.
Any opportunities for the student’s parents or guardians to meet with school officials to discuss the restraint, any further action and related matters.27
The school principal or other administrator must keep all such reports on file so that they can be reviewed by DESE on request.28 He or she must verbally inform the parents of the student who was restrained about the incident as soon as possible, and send the written report within three school days after the restraint was used. If the school usually provides the family with information in a language that is not English, the written report must also be in that lan29
When a restraint results in a serious injury to a student or staff member, or when extended restraint is used, the school must provide DESE with a copy within five school 5 Revised 11/17/09 days of the incident. The school must also provide DESE with a copy of the record of physical restraint for the 30 days before the reported restraint. If DESE requires any other documents, it will notify the school within 30 days of receiving the report.30
HOW CAN YOU PROTECT YOUR CHILD AGAINST THE IMPROPER USE OF RESTRAINT?
If you believe that a school has improperly used restraint on your child and have not been able to resolve the issue with the school itself, you may file a complaint with Program Quality Assurance Services (PQA), a unit of DESE.
After contacting PQA, you will receive an intake information form that will provide PQA with information about the student, the incident and other relevant information. You must fill the intake information form out and send it within 30 days of receiving it, and forward it to the appropriate school administrator. Once PQA has received the intake information form, an Educational Specialist will contact you, the school and the school district in order to resolve the problem. In most cases, PQA will make a decision regarding a complaint within 60 days.
You can contact PQA at:
Program Quality Assurance Services
§ent of Elementary and Secondary Education
75 Pleasant Street
Malden, MA 02148
(781) 338-3700
You may also file a complaint with the U.S. Department of Education’s Office of Civil Rights (OCR) within 180 days of the use of restraint. If you have waited longer than 180 days, you must include information as to why you did not file the complaint within that time frame. Once your complaint has been received and reviewed, you will be contacted by an OCR employee within your state.
You can fill out a complaint with the OCR online at http://wdcrobcolp01.ed.gov/CFAPPS/OCR/complaintform.cfm, or contact the OCR’s Boston office at:
Boston Office
Office of Civil Rights
5 Post Office Square, 8th Floor, Suite 900
Boston, MA 02109
(617) 289-0111
If you want more information on how to protect your child from the use of restraint, seclusion and aversive treatments, you can refer to the following booklet published by the Alliance to Prevent Restraint, Aversive Interventions, and Seclusion. 5 Revised 11/17/09
http://www.tash.org/dev/tashcms/ewebeditpro5/upload/In_the_Name_of_Treatmentfinal.pdf.
If you have questions about the complaint process or the use of restraint in schools in general, contact the Mental Health Legal Advisors Committee.
Mental Health Legal Advisors Committee
399 Washington Street, 4th Floor
Boston, MA 02108
(617) 338-2345
(800) 342-9092
ENDNOTES
1 Mass. Gen. L. ch. 71, § 37G and 603 Code of Massachusetts Regulation (CMR) 46.
2 The Massachusetts regulations for these programs can be found at 603 CMR 18.
3 603 CMR 46.02 (5).
4 603 CMR 46.02 (3).
5 603 CMR 46.02 (2).
6 603 CMR 46.02 (5)(a).
7 603 CMR 46.02 (5)(b).
8 603 CMR 46.02 (5)(c).
9 United States Government Accountability Office, “Seclusions and Restraints: Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers.” 2009. Testimony before the Committee on Education and Labor in the House of Representatives. Statement of Gregory D. Kutz.
10 603 CMR 46.04 (1).
11 603 CMR 46.05 (1).
12 603 CMR 46.05 (2), (3), (4).
13 603 CMR 46.05 (4).
14 603 CMR 46.05 (1).
15 603 CMR 46.05 (5)(b).
16 603 CMR 46.05 (5)(d).
17 603 CMR 46.02 (5); 603 CMR 46.05 (5)(a).
18 603 CMR 46.02 (5).
19 603 CMR 46.04 (3).
20 603 CMR 46.05 (1).
21 603 CMR 46.03 (2).
22 603 CMR 46.03 (2).
23 603 CMR 46.03 (3).
24 603 CMR 46.03 (2).
25 603 CMR 46.06 (1).
26 603 CMR 46.06 (2).
27 603 CMR 46.06 (4).
28 603 CMR 46.06 (2).
29 603 CMR 46.06 (3).
30 603 CMR 46.06 (5).
CONNECTICUT
section 46a-150 of the Connecticut General Statutes
PHYSICAL RESTRAINT, MEDICATION AND SECLUSION
OF PERSONS RECEIVING CARE, EDUCATION OR SUPERVISION
IN A SCHOOL, INSTITUTION OR FACILITY
*See Sec. 17a-3a re Connecticut Juvenile Training School.
Table of Contents
Sec. 46a-150. Definitions.
Sec. 46a-151. Life-threatening physical restraint prohibited.
Sec. 46a-152. Physical restraint, seclusion and use of psychopharmacologic agents restricted. Notification of parent or guardian of physical restraint or seclusion of child required. Monitoring and documentation required.
Sec. 46a-153. Recording of use of restraint and seclusion required. Review of records by state agencies and State Board of Education. Reviewing state agency and State Board of Education to report serious injury or death to Office of Protection and Advocacy for Persons with Disabilities and to Office of Child Advocate.
Sec. 46a-154. Internal monitoring, training and development of policies and procedures required and subject to state agency inspection.
Secs. 46a-155 to 46a-169.
Sec. 46a-150. Definitions. For purposes of this section and sections 46a-151 to 46a-154, inclusive:
(1) "Provider of care, education or supervision of a person at risk" and "provider" mean a person who provides direct care, education or supervision of a person at risk.
(2) "Assistant provider of care, education or supervision of a person at risk" and "assistant" mean a person assigned to provide, or who may be called upon in an emergency to provide, assistance or security to a provider of care, education or supervision of a person at risk.
(3) "Person at risk" means (A) a child requiring special education described in subparagraph (A) of subdivision (5) of section 10-76a, who is receiving special education by a local or regional board of education, or a child being evaluated for eligibility for special education pursuant to section 10-76d and awaiting a determination, or (B) a person receiving care, education or supervision in an institution or facility (i) operated by, licensed or authorized to operate by or operating pursuant to a contract with the Departments of Public Health, Developmental Services, Children and Families, Mental Health and Addiction Services or a regional education service center established under section 10-66a, or (ii) operating under contract with a local or regional board of education pursuant to subsection (d) of section 10-76d. The term does not include a person in the custody of the Commissioner of Correction, or a resident or patient of a nursing home subject to federal regulations concerning restraint of residents or patients.
(4) "Life-threatening physical restraint" means any physical restraint or hold of a person that restricts the flow of air into a person's lungs, whether by chest compression or any other means.
(5) "Physical restraint" means any mechanical or personal restriction that immobilizes or reduces the free movement of a person's arms, legs or head. The term does not include: (A) Briefly holding a person in order to calm or comfort the person; (B) restraint involving the minimum contact necessary to safely escort a person from one area to another; (C) medical devices, including, but not limited to, supports prescribed by a health care provider to achieve proper body position or balance; (D) helmets or other protective gear used to protect a person from injuries due to a fall; or (E) helmets, mitts and similar devices used to prevent self injury when the device is part of a documented treatment plan or individualized education program pursuant to section 10-76d and is the least restrictive means available to prevent such self-injury.
(6) "Psychopharmacologic agent" means any medication that affects the central nervous system, influencing thinking, emotion or behavior.
(7) "Seclusion" means the confinement of a person in a room, whether alone or with staff supervision, in a manner that prevents the person from leaving, except that in the case of seclusion at Long Lane School, the term does not include the placing of a single child or youth in a secure room for the purpose of sleeping.
(P.A. 99-210, S. 1, 6; P.A. 07-73, S. 2(a); 07-147, S. 1.)
Sec. 46a-151. Life-threatening physical restraint prohibited. No provider of care, education or supervision of a person at risk and no assistant provider may use a life-threatening physical restraint on a person at risk. This section shall not be construed as limiting any defense to criminal prosecution for the use of deadly physical force that may be available under sections 53a-18 to 53a-22, inclusive.
(P.A. 99-210, S. 2, 6.)
Sec. 46a-152. Physical restraint, seclusion and use of psychopharmacologic agents restricted.
Notification of parent or guardian of physical restraint or seclusion of child required. Monitoring and documentation required. (a) No provider or assistant may use involuntary physical restraint on a person at risk except (1) as an emergency intervention to prevent immediate or imminent injury to the person at risk or to others, provided the restraint is not used for discipline or convenience and is not used as a substitute for a less restrictive alternative, (2) as necessary and appropriate, as determined on an individual basis by the person's treatment team and consistent with sections 17a-540 to 17a-550, inclusive, for the transportation of a person under the jurisdiction of the Whiting Forensic Division of the Department of Mental Health and Addiction Services.
(b) No provider or assistant may involuntarily place a person at risk in seclusion except (1) as an emergency intervention to prevent immediate or imminent injury to the person or to others, provided the seclusion is not used for discipline or convenience and is not used as a substitute for a less restrictive alternative, or (2) as specifically provided for in an individualized education program developed pursuant to section 10-76d. Each local or regional board of education, institution or facility providing special education for a child shall notify the parent or guardian of each incident in which such child is placed in physical restraint or seclusion.
(c) No provider or assistant may use a psychopharmacologic agent on a person at risk without that person's consent except (1) as an emergency intervention to prevent immediate or imminent injury to the person or to others, or (2) as an integral part of the person's established medical or behavioral support or educational plan, as developed consistent with section 17a-543 or, if no such plan has been developed, as part of a licensed practitioner's initial orders. The use of psychopharmacologic agents, alone or in combination, may be used only in doses that are therapeutically appropriate and not as a substitute for other appropriate treatment.
(d) Any use of physical restraint or seclusion on a person at risk shall be documented in the person's medical or educational record. The documentation shall include (1) in the case of emergency use, the nature of the emergency and what other steps, including attempts at verbal deescalation, were taken to prevent the emergency from arising if there were indications that such an emergency was likely to arise, and (2) a detailed description of the nature of the restraint or seclusion, its duration and its effect on the person's established medical or behavioral support or educational plan.
(e) Any person at risk who is physically restrained shall be continually monitored by a provider or assistant. Any person at risk who is involuntarily placed in seclusion shall be frequently monitored by a provider or assistant. Each person so restrained or in seclusion shall be regularly evaluated by a provider or assistant for indications of physical distress. The provider or assistant conducting the evaluation shall enter each evaluation in the person's medical or educational record. For purposes of this subsection, "monitor" means (1) direct observation, or (2) observation by way of video monitoring within physical proximity sufficient to provide aid as may be needed.
(f) Nothing in this section shall be construed as limiting any rights a person may have under sections 17a-540 to 17a-550, inclusive, section 17a-566 or section 54-56d.
(g) Nothing in this section shall be construed as limiting the justified use of physical force by a local, state or federal law enforcement official or an employee of the Board of Pardons and Paroles or the Department of Correction responsible for the supervision of persons released on parole while in the performance of such official's or employee's duties.
(h) (1) Nothing in this section shall be construed as prohibiting the use of mechanical physical restraint in transporting any person (A) who is receiving services from the Department of Mental Health and Addiction Services pursuant to sections 17a-513 to 17a-517, inclusive, 17a-566 to 17a-567, inclusive, 17a-582 to 17a-603, inclusive, or 54-56d, or (B) who is committed to the department by a court of competent jurisdiction and has a pending criminal charge for which bail or a bond has not been posted, from a department facility to another location and, if applicable, back to such facility. Any such use of mechanical physical restraint shall be determined on an individualized basis by the head of the facility, or by a designee of the head of the facility, to be necessary and appropriate to protect the public safety.
(2) Any use of mechanical physical restraint under this subsection shall be documented in the medical record of the person who is transported. Such documentation shall include, but not be limited to, (A) the reason for the use of such restraint, including the risk of flight, the risk to public safety and the person's clinical condition, and (B) a detailed description of the nature of such restraint and its duration. If the use of any such restraint results in serious physical injury or death to such person, the head of the facility shall report such injury or death to the Commissioner of Mental Health and Addiction Services. The commissioner, upon receiving any such report, shall inform the director of the Office of Protection and Advocacy for Persons with Disabilities of such injury or death.
(P.A. 99-210, S. 3; P.A. 00-55; P.A. 04-257, S. 117; P.A. 05-108, S. 4; P.A. 07-147, S. 2.)
Sec. 46a-153. Recording of use of restraint and seclusion required. Review of records by state agencies and State Board of Education. Reviewing state agency and State Board of Education to report serious injury or death to Office of Protection and Advocacy for Persons with Disabilities and to Office of Child Advocate.
Each local or regional board of education, institution or facility that provides direct care, education or supervision of persons at risk shall (1) record each instance of the use of physical restraint or seclusion on a person at risk and the nature of the emergency that necessitated its use, and (2) include such information in an annual compilation on its use of such restraint and seclusion. The commissioner of the state agency that has jurisdiction or supervisory control over each institution or facility shall review the annual compilation prior to renewing a license for or a contract with such institution or facility. The State Board of Education may review the annual compilation of each local and regional board of education, institution and facility that provides special education for children and may produce an annual summary report identifying the frequency of use of physical restraint or seclusion on such children. If the use of such restraint or seclusion results in physical injury to the person, (A) the local or regional board of education, institution or facility that provides special education for a child may report the incident to the State Board of Education, and (B) the institution or facility shall report the incident to the commissioner of the state agency that has jurisdiction or supervisory control over the institution or facility. The State Board of Education and the commissioner receiving a report of such an incident shall report any incidence of serious injury or death to the director of the Office of Protection and Advocacy for Persons with Disabilities and, if appropriate, to the Child Advocate of the Office of Child Advocate.
(P.A. 99-210, S. 4; P.A. 07-147, S. 3.)
Sec. 46a-154. Internal monitoring, training and development of policies and procedures required and subject to state agency inspection.
(a) Each institution or facility that provides direct care, education or supervision of a person at risk shall develop policies and procedures that (1) establish monitoring and internal reporting of the use of physical restraint and seclusion on persons at risk, and (2) require training of all providers and assistant providers of care, education or supervision of persons at risk in the use of physical restraint and seclusion on persons at risk. Such training shall include, but not be limited to: Verbal defusing or deescalation; prevention strategies; types of physical restraint; the differences between life-threatening physical restraint and other varying levels of physical restraint; the differences between permissible physical restraint and pain compliance techniques; monitoring to prevent harm to a person physically restrained or in seclusion and recording and reporting procedures on the use of restraints and seclusion.
(b) Each institution or facility required to develop policies and procedures under subsection (a) of this section shall make such policies and procedures available upon request to the commissioner of the state agency that has jurisdiction or supervisory control over the institution or facility.
CONNECTICUT
STATE OF CONNECTICUT
REGULATION OF STATE BOARD OF EDUCATION
The Regulations of Connecticut State Agencies are amended by adding Sections 10-76b-5 to 10-76b-11, inclusive, as follows:
(New) Section 10-76b-5. Use of physical restraint and seclusion in public schools. Definitions.
For the purposes of sections 10-76b-6 to 10-76b-11, inclusive, of the Regulations of Connecticut State Agencies:
(1) “Assistant” means “assistant” as defined in section 46a-150 of the General Statutes;
(2) “Behavior intervention” means supports and other strategies developed by the planning and placement team to address the behavior of a person at risk which impedes the learning of the person at risk or the learning of others;
(3) “Business day” means “business day” as defined in subsection (a) of section 10-76h-1 of the Regulations of Connecticut State Agencies;
(4) “Individualized education plan” or “IEP” means “individualized education plan” as defined in section 10-76a-1 of the Regulations of Connecticut State Agencies;
(5) “Parent” or “parents,” means “parents” as defined in section 10-76a-1 of the Regulations of Connecticut State Agencies;
(6) “Person at risk” means “person at risk” as defined in subparagraph (A) of subdivision (3) of section 46a-150 of the Connecticut General Statutes;
(7) “Physical restraint” means “physical restraint” as defined in section 46a-150 of the Connecticut General Statutes;
(8) “Planning and placement team” or “PPT” means “planning and placement team” as defined in section 10-76a-1 of the Regulations of Connecticut State Agencies;
(9) “Provider” means “provider” as defined in section 46a-150 of the Connecticut General Statutes; and
(10) “Seclusion” means “seclusion” as defined in section 46a-150 of the Connecticut General Statutes, provided seclusion does not include any confinement of a person at risk in which the person is physically able to leave the area of confinement including, but not limited to, in-school suspension and time-out.
(New) Section 10-76b-6. Use of physical restraint and seclusion in public schools.
No provider or assistant shall (1) use involuntary physical restraint on a person at risk or (2) involuntarily place a person at risk in seclusion, unless such use conforms to the requirements of sections 46a-150 to 46a-154, inclusive, of the Connecticut General Statutes, and the requirements of sections 10-76b-5 to 10-76b-11, inclusive, of the Regulations of Connecticut State Agencies.
(New) Section 10-76b-7. Use of physical restraint and seclusion in public schools, exceptions.
Nothing in sections 46a-150 to 46a-154, inclusive, of the Connecticut General Statutes or sections 10-76b-5 to 10-76b-11, inclusive, of the Regulations of Connecticut State Agencies shall be construed to interfere with the responsibility of local or regional boards of education to maintain a safe school setting in accordance with section 10-220 of the Connecticut General Statutes or to supersede the provisions of subdivision (6) of section 53a-18 of the Connecticut General Statutes concerning the use of reasonable physical force.
(New) Section 10-76b-8. Use of seclusion in public schools, requirements.
(a) Except for an emergency intervention to prevent immediate or imminent injury to the person or to others conforming to the requirements of subsection (b) of section 46a-152 of the Connecticut General Statutes, seclusion may only be used if (1) this action is specified in the IEP of the person at risk and (2) if other less restrictive, positive behavior interventions appropriate to the behavior exhibited by the person at risk have been implemented but were ineffective.
(b) If the PPT of a person at risk determines, based upon the results of a functional assessment of behavior and other information determined relevant by the PPT, that use of seclusion is an appropriate behavior intervention, the PPT shall include the assessment data and other relevant information in the IEP of the person at risk as the basis upon which a decision was made to include the use of seclusion as a behavior intervention. In such a case, the IEP shall specify:
(1) the location of seclusion, which may be multiple locations within a school building,
(2) the maximum length of any period of seclusion, in accordance with subsection (d) of this section,
(3) the number of times during a single day that the person at risk may be placed in seclusion,
(4) the frequency of monitoring required for the person at risk while in seclusion, and
(5) any other relevant matter agreed to by the PPT taking into consideration the age, disability and behaviors of the child that might subject the child to the use of seclusion.
(c) In the event the parent disagrees with the use of seclusion in the IEP of the person at risk, the parent shall have a right to the hearing and appeal process provided for in section 10-76h of the Connecticut General Statutes.
(d) Any period of seclusion:
(1) shall be limited to that time necessary to allow the person at risk to compose him or herself and return to the educational environment and
(2) shall not exceed one hour. The use of seclusion may be continued with written authorization of the building principal or designee to prevent immediate or imminent injury to the person at risk or to others. In the case where transportation of the person at risk is necessary, the written authorization to continue the use of seclusion is not required if immediate or imminent injury to the person at risk or to others is a concern.
(e) The PPT shall, at least annually, review the continued use of seclusion as a behavior intervention for the person at risk. When the use of seclusion as a behavior intervention is repeated more than two times in any school quarter, the PPT
(1) shall convene to review the use of seclusion as a behavior intervention,
(2) may consider additional evaluations or assessments to address the child’s behaviors, and
(3) may revise the child’s IEP, as appropriate.
(f) The PPT shall inquire as to whether there are any known medical or psychological conditions that would be directly and adversely impacted by the use of seclusion as a behavior intervention. A person at risk shall not be placed in seclusion if such person is known to have any medical or psychological condition that a licensed health care provider has indicated will be directly and adversely impacted by the use of seclusion. For purposes of this subsection, a “licensed health care provider” means
(1) a legally qualified practitioner of medicine,
(2) an advanced practice registered nurse,
(3) a registered nurse licensed pursuant to chapter 378 of the Connecticut General Statutes, or
(4) a physician assistant licensed pursuant to chapter 370 of the Connecticut General Statutes. Such licensed health care provider may be the person at risk’s licensed health care provider or a licensed health care provider utilized by the public schools to provide an evaluation of the person at risk for purposes of determining the appropriate use of seclusion as a behavior intervention in the person at risk’s IEP. As part of the assessments described in subsection (b) of this section, the PPT may request a medical or psychological evaluation of the child for purposes of determining whether there is a medical or psychological condition that will be directly and adversely impacted by the use of seclusion as a behavior intervention. The parent may provide that information to the PPT. Any written statement provided by a licensed health care provider shall be included in the educational record of the person at risk.
(g) A person at risk in seclusion shall be monitored as described in the child’s IEP by a provider or assistant specifically trained in physical management, physical restraint and seclusion procedures including, but not limited to, training to recognize health and safety issues for children placed in seclusion to ensure the safe use of seclusion as a behavior intervention.
(h) Any room used for the seclusion of a person at risk shall:
(1) Be of a size that is appropriate to the chronological and developmental age, size and behavior of the person at risk;
(2) Have a ceiling height that is comparable to the ceiling height of the other rooms in the building in which it is located;
(3) Be equipped with heating, cooling, ventilation and lighting systems that are comparable to the systems that are in use in the other rooms of the building in which it is located;
(4) Be free of any object that poses a danger to the person at risk who is being placed in the room;
(5) Have a door with a lock only if that lock is equipped with a device that automatically disengages the lock in case of an emergency. Not later than January 1, 2014, the locking mechanism of any room in a public school specifically designated for use as a seclusion room shall be a pressure sensitive plate. Any latching or securing of the door, whether by mechanical means or by a provider or assistant holding the door in place to prevent the person at risk from leaving the room, shall be able to be removed in the case of any emergency. An “emergency” for purposes of this subdivision includes, but is not limited to,
(A) the need to provide direct and immediate medical attention to the person at risk,
(B) fire,
(C) the need to remove the person at risk to a safe location during a building lockdown, or
(D) other critical situations that may require immediate removal of the person at risk from seclusion to a safe location; and
(6) Have an unbreakable observation window located in a wall or door to permit frequent visual monitoring of the person at risk and any provider or assistant in such room. The requirement for an unbreakable observation window does not apply if it is necessary to clear and use a classroom or other room in the school building as a seclusion room for a person at risk.
(New) Section 10-76b-9. Parental notification of physical restraint, seclusion.
(a) If a person at risk is physically restrained or placed in seclusion, an attempt shall be made to notify the parent on the day of, or within twenty-four hours after, physical restraint or seclusion is used with the child as an emergency intervention to prevent immediate or imminent injury to the person or others, as permitted under sections 46a-150 to 46a-154, inclusive, of the Connecticut General Statutes. Such notification shall be made by phone, e-mail or other method which may include, but is not limited to, sending a note home with the child. The parent of such child, regardless of whether he or she received such notification, shall be sent a copy of the incident report no later than two business days after the emergency use of physical restraint or seclusion. The incident report shall contain, at a minimum, the information required under subsection (d) of section 46a-152 of the Connecticut General Statutes.
(b) Where seclusion is included in the IEP of a person at risk, the PPT and the parents shall determine a timeframe and manner of notification of each incident of seclusion.
(c) The Department of Education shall develop a plain language notice for use in the public schools to advise parents of the laws and regulations concerning the emergency use of physical restraint or seclusion or the use of seclusion as a behavior intervention in a child’s IEP. On and after October 1, 2009, this notice shall be provided to the child’s parent at the first PPT meeting following the child’s referral for special education. For children who were eligible for special education prior to October 1, 2009, the notice shall be provided to the parent at the first PPT meeting convened after October 1, 2009. The notice shall also be provided to a child’s parent at the first PPT meeting at which the use of seclusion as a behavior intervention is included in the child’s IEP.
(New) Section 10-76b-10. Required training for providers or assistants on the use of physical restraint or seclusion.
A person at risk may be physically restrained or removed to seclusion only by a provider or assistant who has received training in physical management, physical restraint and seclusion procedures. Providers or assistants shall also be provided with training as described in subdivision (2) of subsection (a) of section 46a-154 of the Connecticut General Statutes.
(New) Section 10-76b-11. Reports of physical restraint, seclusion.
The recording and reporting of instances of physical restraint or seclusion and the compilation of this information shall be in accordance with section 46a-153 of the Connecticut General Statutes. The recording of such instances shall be done on a standardized incident report developed by the Department of Education. Such reports shall be completed no later than the school day following the incident.
EFFECTIVE DATE: Upon filing with the Secretary of the State.
STATEMENT OF PURPOSE:
(A) Purpose of regulation: To address the use of physical restraint or seclusion in the public schools for children who are or may be eligible for special education consistent with the requirements of Public Act 07-147.
(B) Summary of the main provisions of the regulation: This regulation adopts definitions contained in Public Act 07-147 concerning what is seclusion and restraint and who may perform such; requires that the use of physical restraint or seclusion conforms to the requirements of Public Act 07-147; provides exceptions to the restrictions on the use of physical restraint or seclusion as emergency interventions to allow districts to maintain a safe school setting and to use reasonable physical force consistent with the requirements of Section 53a-18 of the general statutes; details under what conditions seclusion may be used as a behavioral intervention strategy for a child eligible for special education; provides for parental notification in the event physical restraint or seclusion must be used as an emergency intervention, allows the PPT to determine the appropriate method of notification if seclusion is used as a behavior intervention and provides clarification on how school districts are to notify parents regarding the laws and regulations on the use of restraint and seclusion in the public schools; provides that providers or assistants be provided with training as required pursuant to subdivision (2) of subsection (a) of section 46a-154 of the general statutes; and requires that the Department of Education create a standardized incident report form for reporting incidents of physical restraint or seclusion.
(C) Legal effects of the regulation: The proposed regulation adds to the regulatory requirements for the provision of special education and related services to children who are eligible or whose eligibility for special education is being determined. The development of the IEP, including the conducting of any assessment or evaluation would follow the procedural requirements contained in the federal Individuals with Disabilities Education Act (IDEA) and the state special education regulations.
Content Last Modified on 10/15/2009 11:16:38 AM
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National Disability Rights Network Report- School Is Not Supposed to Hurt
EAST GOSHEN ELEMENTARY SCHOOL, WEST CHESTER, PENNSYLVANIA
Abbie was Restrained 14 times in one day for noncompliance issues
CCIU/EAST BRADFORD ELEMENTARY SCHOOL, WEST CHESTER, PA.
NAA: The Restraint and Prevention Symposium
Man Arrested For Abusing His Autistic Son
"This blog site and the work we are doing is dedicated to the many children who have lost their lives or been physically, mentally, and/or emotionally harmed by restraint, seclusion, and other abusive practices in public schools, and to the parents, family, and friends who love these children."
PADDED CELL?
National Disability Rights Network Report- School Is Not Supposed to Hurt
SECLUSION ROOM OR QUIET ROOM?
EAST GOSHEN ELEMENTARY SCHOOL, WEST CHESTER, PENNSYLVANIA
TO BE PRONE OR NOT TO BE PRONE? THAT IS THE QUESTION.
Abbie was Restrained 14 times in one day for noncompliance issues
POSITIVE BEHAVIORAL INTERVENTION COST TOO MUCH! RESTRAIN HIM IN THE RIFTON CHAIR INSTEAD.
CCIU/EAST BRADFORD ELEMENTARY SCHOOL, WEST CHESTER, PA.
QUIET ROOM OR CELL?
NAA: The Restraint and Prevention Symposium
ABUSE IS ABUSE, REGARDLESS OF WHO IT IS
Man Arrested For Abusing His Autistic Son
WELCOME TO RHODE ISLAND FAMILIES AGAINST RESTRAINT AND SECLUSION
The abuse of children at the hands of school personnel has risen over the last two decades and the nation is outraged. The children most likely to be abused are children with disabilities. Children who are poor and homeless are not excluded from the abuse.
The abuse presents itself in various forms -restraints, seclusion, suffocation, and sometimes even death. Last year, the Government Accountability Office (GAO) investigation found hundreds of allegations that children have been abused and some have died as a result of the misuses of restraints and seclusion in public and private schools, often by untrained staff. United States representatives George Miller and Cathy McMorris Rodgers introduced the "Preventing Harmful Restraint and Seclusion in School Act" (HR 4247) and senator Chris Dodd of Connecticut introduced it's sister bill, (S. 2860). This legislation is the first national effort to address the problem and ensure the safety of students and school staff.
The abuse of a child in school can easily escalate into retaliation against the parent(s), caretaker(s), or advocate. Retaliation can include the denial educational services, the denial of a child to attend school, an illegal eviction from your residence, neglect and abuse charges filed against you by the school, a loss of employment, removal of the child from the caretaker by child protective services, false charges against the parent, caregiver, or advocate that can lead to an arrest, etc.
We must stop asking, "What are they (everyone else) going to do about the abuse of our nation's children?" While the rest of America sits blind, not necessarily their fault, they are under the assumption that their tax dollars are paying for an education without abuse, restraints, seclusion, or retaliation. American citizens believe that when they send their children to school, they will be safe, not abused or killed by school personnel.
It is our belief that all children are entitled to a free, appropriate, and SAFE education in the public and private school system, as specified under IDEA. We need your support in effecting change within the system.
Thank you!
The abuse presents itself in various forms -restraints, seclusion, suffocation, and sometimes even death. Last year, the Government Accountability Office (GAO) investigation found hundreds of allegations that children have been abused and some have died as a result of the misuses of restraints and seclusion in public and private schools, often by untrained staff. United States representatives George Miller and Cathy McMorris Rodgers introduced the "Preventing Harmful Restraint and Seclusion in School Act" (HR 4247) and senator Chris Dodd of Connecticut introduced it's sister bill, (S. 2860). This legislation is the first national effort to address the problem and ensure the safety of students and school staff.
The abuse of a child in school can easily escalate into retaliation against the parent(s), caretaker(s), or advocate. Retaliation can include the denial educational services, the denial of a child to attend school, an illegal eviction from your residence, neglect and abuse charges filed against you by the school, a loss of employment, removal of the child from the caretaker by child protective services, false charges against the parent, caregiver, or advocate that can lead to an arrest, etc.
We must stop asking, "What are they (everyone else) going to do about the abuse of our nation's children?" While the rest of America sits blind, not necessarily their fault, they are under the assumption that their tax dollars are paying for an education without abuse, restraints, seclusion, or retaliation. American citizens believe that when they send their children to school, they will be safe, not abused or killed by school personnel.
It is our belief that all children are entitled to a free, appropriate, and SAFE education in the public and private school system, as specified under IDEA. We need your support in effecting change within the system.
Thank you!
LINKS TO OTHER SITES
- APRAIS
- Council of Parent Attorneys and Advocates
- Families Against Restraint and Seclusion
- National Disability Rights Network
- Parent to Parents
- TASH
- • FLORIDA Families Against Restraint and Seclusion
- • Georgia Families Against Restraint and Seclusion
- • MISSOURI Families Against Seclusion and Restraint
- • PENNSYLVANIA Families Against Restraint & Seclusion
OUR MISSION STATEMENT
To eliminate the over-use and unnecessary use of restraint and seclusion of children with disabilities in the public school system.
To promote the use of positive behavior support systems in all public schools.
To advocate for FBA's to be written by qualified certified behavior analysts.
To educate people about the dangers of restraint and seclusion.
To promote the use of positive behavior support systems in all public schools.
To advocate for FBA's to be written by qualified certified behavior analysts.
To educate people about the dangers of restraint and seclusion.
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