All right, everyone. Go for it, Tracy and Tom.
Thanks again for being here for this webinar.
Okay, so I guess I'll start
and just greet everybody as well.
I'm Tom Faris with the Agency of Education.
I'm going into my seventh year with the agency, now.
Prior to that, I worked in schools as a special educator
and then as a school administrator for a number of years.
I've also worked in a variety
of residential
and other types of program settings.
So my experience with restraint seclusion
is pretty extensive in terms of experience
as a practitioner.
My involvement with the technical sides
of Rule 4500 really began
largely last February when I helped
to take some responsibility for supervising reports
that come into the agency regarding Rule 4500.
And I'm Tracy Harris.
Like Tom, I have also worked in public schools
and approved independent schools
in Vermont for many, many, many years.
And I've been with the Agency of Ed for coming on,
well, I guess it has been 12 years now,
and I've been, up until a couple years ago,
I was the lead at the agency
for all things related to restraints and seclusions.
But Tom is very capable,
and now I am just pulled in as a content expert
when there are tricky situations or when there're,
I'm on the special ed team at the Agency of Education.
So if there may be issues involving restraint and seclusion
of students on IEPs
where it may impact their IEP services,
I can get called into that too.
Okay, so first to just start
with the general purposes of Rule 4500.
So you can see on your screen,,
the purpose is for positive and safe environments.
We're looking to ensure that students are not subjected
to inappropriate use of restraint and seclusion,
and that we do emphasize the use
of positive behavioral interventions and supports.
Rule 4500 is for emergency situations.
It is not intended to be for behavior modification
or other educational purposes.
So we'll start with some definitions.
And this, I'm finding is really a critical definition
of seclusion because I found that there is a fair amount
of confusion in some places
about the definition of seclusion.
The most significant piece to me is that first part,
that it's the confinement of a student alone
in a room or area.
I've had opportunities to speak
with a number of people in the field.
End of the hall.
A number of people in the field
who have not necessarily been aware
of that requirement that the student has to be alone
and that they've been counting seclusion situations
where another staff member has been in the room
with the student, maybe processing with them
or assisting them in some way.
Those situations would not be seclusion.
It also requires that the student is prevented from leaving
or reasonably believes that they're prevented from leaving.
And that sometimes could come up
with a degree of subjectivity
because we don't know necessarily
exactly what a student believes.
But I think we can make reasonable inferences based
on the cues that we've given them
and the circumstances that they're in.
And it doesn't include timeout or private processing
where a student isn't left alone
or is interacting with an adult.
All right, we're gonna be making extensive use
of these polls during this presentation,
and these will be opportunities
for you to respond to a variety of scenarios.
The way that we're going to try to make these work is
to use a cascading method to get your responses.
These are gonna be a yes or no question at the end.
So when we're finished looking at the scenario question
will be whether the following scenario involves
a use of seclusion,
and you have an opportunity to put in the chat
whether you think this is an incident of seclusion
and perhaps some information about why or why not.
But we're gonna ask
that you not put your answer in until we cue you.
We'll get kind of a cascade of responses at that point.
You can type it in,
but don't push send right until the cue to do so.
Right. Right.
That allows everybody to have their own private think time
and not feel pressured when you're seeing other responses.
So we'll give what feels like an appropriate amount of time.
Well, I'm just, because some people may be better able
to process this if they hear it,
I don't typically read whole slides,
but I'll read the scenario for people.
This is about a student named Zuri who began kicking a peer
who was in line in front of her and wouldn't stop
when her BI attempted to intervene and deescalate.
The BI walked her to a quiet room and the door was closed.
Zuri was not permitted to leave
until she discussed the incident with her BI.
Together, Zuri and her BI processed the situation
and made a plan for what to do next time
she became upset with the peer.
So your question to answer is whether or not
this is a use of seclusion.
And if you wish to put in some further information
about why or why not you believe that.
We'll give you a moment to think about it.
All right, if you press enter for your answers,
we'll see what people have responded.
All right.
It's looking like the nos have it
with a few yeses sprinkled in.
So let's discuss this.
Okay, so the answer, the correct answer is no,
this does not describe an incident of seclusion.
Zuri and her BI were together in the enclosed space,
and she wasn't alone in the room,
and she was able to to interact with the BI.
Are there any other thoughts or questions about this
before we move on?
You can either raise your hand or put something in the chat.
[Participant] I don't have any of those features.
So it's not an either or.
Both conditions are met
in order to be considered a seclusion.
In fact, it's best practice
in many cases to have an adult
in a private space
in which they can co-regulate
and then process once the student is deescalated.
All right, moving on.
The next scenario, given the same situation,
but instead of going with her BI to the quiet room,
Zuri chose to go there herself and to cool down
before processing with the BI.
She was allowed to do so.
She closed the door,
she was told to open the door
whenever she felt ready to talk.
Is this seclusion?
So put your answers in chat,
but wait for the cue to submit them.
All right, go ahead.
Okay, it looks again as though the majority,
if not everybody said that, no, this was not seclusion.
Can we go to the next slide?
No, this is not seclusion either.
As many of you noted,
Zuri entered the room on her own accord
and she was able to exit when she felt ready to exit.
So she did not,
there was no reason for her to believe
that she could not leave
and it was her decision to go there in the first place.
Any other thoughts or questions about this scenario?
All right, next situation, (laughs)
and we're still with Zuri and her BI.
This time Zuri became highly aggressive toward her BI
once they entered the quiet room together
and didn't respond to deescalation strategies.
Given the level of aggression
and the failure of other less restrictive techniques,
the BI exited the room and gave Zuri the directive
that she was to remain there
until she was told she could leave.
Is this seclusion?
Again, wait for the cue before submitting your answers.
We'll give you about 15 seconds.
Okay. Submit your answers.
Okay, as the majority of you,
if not all of you answered,
yes, this does represent a seclusion.
She was confined alone in the quiet room
and had to remain until given permission to leave.
So this very clearly was an incident of seclusion.
And Evan had a question.
Yep. I see another question here as well.
So why don't we take those questions.
So, Evan was saying
that it sounds like the criterion
of confinement alone supersedes the student's feeling
of not being able to leave.
If an adult is in the room with a student and can't leave,
that is not a seclusion because they're not alone.
Both conditions have to be met
in order to be considered a seclusion.
Mm-hm.
Was there another question?
There was another question
but I don't have the chat in front of me,
but it flashes by me.
I saw there was a question somewhere in the chat about this.
I think that was the, oh, no.
I think that was another participant sharing
this similar question that Evan had.
So that's an excellent question.
Thanks for answering that Tracy as well.
That's really helpful to understand.
Yeah.
-Okay. -One more time with Zuri.
One more time With Zuri, poor Zuri is having a rough day.
In this case, again,
became highly aggressive toward her BI
once they entered the quiet room together
and was not responding to deescalation strategies.
Given that level of aggression,
the failure of other less restrictive interventions,
the BI exited the room, but left the door open.
Zuri was directed to remain in the room
until she was told she could leave.
Is this seclusion?
And again, take time to put this in chat,
but don't hit the response until you get the cue.
Okay. Now you can respond.
Okay, we're getting some mixed responses to this,
this scenario 'cause this is a little bit more complex.
We've moved to this slide and...
Yeah, this is a seclusion.
Again, Zuri was confined alone in the quiet room,
and she had to remain there until given permission.
Some people who said that this was not a seclusion
were noting that the door was open
and that Zuri was visible to the BI.
A couple of points there,
going back to the condition that she reasonably believed
that she could not leave the room until she had permission.
That's a critical element of seclusion.
Something to keep in mind as well,
that in any seclusion,
the student has to be monitored continually.
So the simply the fact that the BI had eyes on Zuri
would be a condition we would expect regardless
of whether it was seclusion or not,
but especially if it were seclusion.
So being able to see the student or having the door open
does not remove this
as a situation of seclusion.
And just a point of clarification,
even with the door shut,
the door should have a window
because one of the requirements is that you do need
to have eyes on at all times.
But being in seclusion,
you don't even have to have a door to be in seclusion.
In some cases there may not be a seclusion room,
or you may be somewhere out in the community
and you just are confining the student to a space,
an alcove in the hallway, for an example.
So doors are not required
for something to be considered a seclusion.
Yeah.
And also the, again, emphasizing that element
that the student reasonably believes they cannot leave.
We've had scenarios brought to our attention where,
say in a planning room situation,
a single student is in a planning room,
there is a smaller space,
enclosed space off the planning room.
A second student comes in to access the planning room,
and the first student is directed into the smaller space
and told they need to remain in there
while the staff deals with the incoming student.
That is a seclusion as well.
So you really have to be careful
about how you use these spaces
and what sort of instructions students have.
If you are giving them instruction
that they are not to leave,
then in most cases you probably are imposing a seclusion
whether you intend to or not.
Before we move on to physical escort,
are there any further thoughts or concerns about seclusion
that people would like to raise right now?
There are some questions here,
and it gets into splitting hairs.
I'll be the first to acknowledge that.
So one person has asked,
what if you're sitting in the doorway,
the student is not trying to leave,
but you are asking the student not to leave.
So I would say that that is a matter of
are you considering yourself and does the student perceive
that you are in the room with them,
able to co-regulate or process?
And if that's the case, then, then no, it's not a seclusion.
However, if you are standing,
I think the other question is
if I'm standing right outside of the door,
standing on the other side of the threshold
with the door open,
but not physically over that threshold
or even standing in the doorway itself,
just giving more proximity.
So again, I think,
what you should be using as the criteria
is does the student believe that you are there with them
to process, to co-regulate, to answer questions?
I would, yeah,
sometimes kids need just a little bit more proximity
because those seclusion rooms can be small
and they may feel, you know, with two bodies in there,
they may feel crowded.
So if that's the case,
and if you're making it clear
that you're there to process with them,
that you're gonna try some deep breathing with them,
for example, that wouldn't be considered a seclusion.
However, if you are, you know,
standing there in the threshold, with your body,
not interacting, not co-regulating
and making it clear that your body is there
to prevent them from leaving,
then I would say that that would be a seclusion.
So it can be tricky.
A lot of times it's professional judgment.
Yeah.
Yeah, yeah.
It's not always as cut and dried
as we might like it to be given the rule.
A lot of it does come down to your intent and purpose.
So if you're there as essentially
as a way of blocking the student
and keeping them in a space,
then that is most likely seclusion.
If you are there to co-regulate, to help deescalate,
then perhaps not,
especially if you're in close proximity to the student.
I see there's some other questions.
It looks like there's a couple additional.
If a deescalated student has become calm
and asked to be alone in the room to help them calm down,
can the adult just step outside of the room.
If the student believes that they can leave? Sure.
-Yep. -Yeah.
-Yep. -In fact,
that's a great coping mechanism
that the student is using right then.
-Mm-hm. -And I imagine.
Yeah, as long as the student has control.
Yeah, so similar to the next question,
what if the student is asked to stay in a room
to protect them from another student?
So I guess if an adult is asking a student to stay in a room
to protect them from another student.
That's a good question that we haven't had.
Yeah, I think it,
that does touch on something
that I've had some personal experience with,
actually, that happened to a nephew of mine, sadly.
And I can just tell you, I can share what his feeling was
at that time was that he felt he was being secluded
in an office and he was told he could not leave
and it was unsafe for him to leave.
I think, you know,
hopefully this is an unusual circumstance,
but if it were to happen, I think to take a moment
to just process with the student and say,
if this feels unsafe for you,
there are other places you can be,
you don't have to remain here.
Give them some other options
because otherwise, I think, that potentially
would be considered seclusion
and a violation as well because the student is not there
because they are posing a risk of imminent harm.
Yeah.
Melissa asks a really good question and she asks,
at what age do these concepts of self-control come in
as this rule applies to three-year-old children?
That's absolutely correct.
And so it is
critical that you make it really blatant to the student
whether or not they're allowed to leave.
And unless,
how do I say this?
There are
early education centers
that are governed solely by DCF
and not public
early ed centers.
In those centers,
I believe DCF regulations say
that students are not allowed to be secluded.
I'm not the early ed expert here,
but I believe that that is the case.
Yeah, and I will also say I'm not the early ed expert,
but I'm aware that there is a whole other layer
of regulation involving Agency of Human Services
as well as Agency of Ed that that's at play here.
And I'd recommend that you talk
with in early ed with that expertise, questions about that.
(people chattering)
All right, we should probably go on
to the next definition.
Okay.
And I don't, I'll confess, Tracy,
I don't have the slide numbers in front of me here
as I'm not sure where we had divided our.
Oh, it's still you, unless you'd like me to take care of.
-Okay, that's fine. -Okay.
All right. So the next area is physical escort.
And this is another area
where we get frequent questions about this.
And, again, there may be some element of subjectivity here.
A physical escort involves momentary touching or holding
without use of force,
a student exhibits no or minimal resistance.
And it's strictly for the purpose of directing movement.
It's not considered a restraint
if those conditions are met.
So essentially the student still has the greatest degree
of control over their own movement.
And this escort may be more for the purpose
of providing direction to the student
of which way to move or, you know,
kind of queuing rather than forcing the student.
This is opposed to a moving restraint
where there is definite use of physical force.
It's more than a minimal touch or a cue.
It involves restriction of the students moving.
And in my mind, one of the most important pieces
is that the student is actively resisting,
that the student does not,
is not choosing to move in the way
or in the direction that staff are indicating.
And that this would be a restraint
that's governed by Rule 4500.
And if this is being used,
then it has to be used according to the protocols
of the restraint training program
that your school or district has adopted.
And here we have a side by side that illustrates some
of the differences between escort and moving restraint.
And I, you know, I will acknowledge that
there's room for some gray area between the two.
There's a certain amount of question
of intent or understanding on the part of the student.
You know, when we talk about momentary
or temporary physical contact,
we don't, I've had people ask me how many seconds?
And we don't have rules that specify that sort of thing.
To some extent you may need
to apply some interpretation here in terms
of what you're doing with this student.
I think in most cases,
generally the vast majority of cases, it's pretty clear.
But there certainly are going to be circumstances
where maybe it's not crystal clear
as to whether this is an escort or a moving restraint.
And it also is quite possible
that an escort could become a moving restraint.
And I wanted to add
that there are some semantics involved here.
There are some restraint training programs
that use the term escort
and what it means is it's a moving restraint.
So for example, if you are using a technique
where two staff members lock
each of the students' arms
and they walk with them,
that would be considered a moving restraint,
even though your program calls that an escort.
And the other thing I wanted to mention
is that some training programs do not allow moving escorts.
They are dangerous,
it is dangerous to be moving an actively resisting student.
So I would suggest that if you need to do that,
you do it really momentarily,
just enough time to get the student to a safer place
or to a more private space to preserve their dignity.
And then you make it a stationary restraint.
(audio stuttering)
Oh, that's weird.
Yeah, I think somebody may have unmuted for a moment.
Yeah, I'm just gonna reiterate what Tracy said
because I think this is important,
that moving restraints are
one of the more risky or dangerous,
potentially dangerous activities that could take place.
And if there are alternatives
to implementing a moving restraint,
you certainly should consider those.
Also, knowing just Vermont schools
and the age of many of our buildings,
a moving restraint may involve encountering stairways
and moving restraint with stairways
is an especially dangerous maneuver.
Very dangerous, yes.
And there's a question
about what if the student lifts their legs up
while you're escorting them.
This person has been advised to release them
or to put a hold on the student, and that is correct.
There are no approved restraint training programs
that allow a child to be carried.
So you have to be using a hold or an escort
that you have been trained to use.
Oh, someone, I'm sorry.
When it says just an initial and then a last name,
I don't know what to call you.
So Ms. Foster or Mister, Megan says that Handle with Care
does allow you to lift the student.
I was not aware of that.
So that's something for me to check in on.
Thanks for raising that, Megan.
Yeah, there may be some elements
of Handle with Care that are not part
of the Vermont approval.
I'm not speaking out of great knowledge right now,
but I think there have been some questions
about the entire Handle with Care process
as opposed to elements of Handle with Care
that are approved for Vermont.
I could be mistaken about that,
but I believe that has been an issue.
So that's something
that we're gonna have to do some research on
and we will get back to you, Megan,
and anyone else that wants guidance on that.
-Yeah. -We can do that.
Meanwhile, we have another poll.
So the question is whether the following incident involves
an escort or a moving restraint
and an opportunity to state why or why you think not.
So Ben was asked to step into the hallway
to discuss a matter with the classroom assistant.
He refused and crawled under his desk.
The assistant was able to coax Ben out
from beneath the desk,
but Ben refused to leave the classroom,
told the assistant he was going to stay where he was.
The assistant placed an arm across Ben's shoulders
and engaged him in conversation
while slowly moving toward the door.
Ben grumbled, but, the check gets in the way, complained,
but slowly moved along with the assistant.
So again, don't submit your answer
until you're given the cue,
but the question is whether this was an escort
or moving restraint.
Okay, you can enter your answers.
Looks like we have 100% agreement on this one.
Yeah.
And as everyone or virtually everybody has responded,
yeah, this was an escort, not a moving restraint.
There was minimal force, the student resisted verbally,
but not physically.
And so as such, it was not something
that needs to be re reported as a restraint.
Okay.
We have some more definitions here
about some of the types of physical restraint.
So first of all, in general,
physical restraint is the use of physical force
to prevent an imminent and substantial risk
of bodily harm to the student or others.
So this obviously does not define
how you implement a physical restraint.
This talks about the purpose for physical restraint.
And it's important, I'll read that again,
that it's to prevent an imminent and substantial risk
of bodily harm to the student or others.
There are two types of physical restraint
that we are hoping to,
that would rarely be implemented.
Those are the prone restraint and the supine restraint.
Prone is where student is face down on their stomach.
Supine is where the student is held on their back.
These are prohibited except when the student's size
or the severity of the behavior require it
because the less restrictive restraint has failed
or would be ineffective.
The reason for that is not only are they more restrictive,
they're more dangerous.
These are restraints where there's some risk of interfering
with the students' breathing,
where other types of injury become more possible.
There are a number of states in the US
that have outright restricted these altogether,
that do not permit these.
Vermont does permit them.
But the rule is very clear that these are only to be used
in what we would hopefully feel
are extraordinary circumstances
where there are no other options.
So another poll.
Question of whether this incident represents restraint
or why or why not.
So we're back to Ben.
This time, Ben pulled the assistant's hair
and used his knee to strike the assistant's jaw.
As the assistant was able
to unclench Ben's fist from his hair,
and with her hands beneath the forearms,
she guided into a standing position.
She spoke quietly
and used verbal deescalation techniques to calm Ben.
Ben continued to reach toward the assistant's hair,
kicked at her shins.
And at this point the assistant used an approved maneuver
that involved wrapping Ben's upper arm with hers
and attempted to guide him toward the door.
Ben attempted to dig his heels in,
but due to his small size,
the assistant was able to move him toward the doorway
in spite of Ben's opposition.
So we're gonna take about 15 seconds
for you to respond and chat
as to whether or not you think this represents a restraint.
And then we'll review the answers.
All right, enter your answers.
Great.
And as it seems from the answers I've seen,
people correctly were responding
this was in fact a moving restraint.
It required more than minimal force,
Ben was actively resisting.
And as such it had to be reported as a restraint
and as governed by the 4500 rules.
A question in my own mind when I was reading the scenario is
I wondered was it necessary for the assistant
to apply a moving restraint.
And not having been there not knowing what the scenario is,
it wouldn't be for me to judge,
but it would be a question I'd have
if this were reported to me
about was it necessary to remove Ben from the classroom
and implement a somewhat more risky moving restraint?
Or could could there have been a restraint that took place
there in the classroom and pose somewhat less risk for Ben?
Just a personal question.
Are there other thoughts or questions
that people had about this?
There is a somewhat unrelated question here
that asks if a medical professional prescribes a restraint
that it doesn't fall under 4,500
and doesn't need to be reported.
So the answer to that question is a little tricky.
It depends on what type of restraint is being prescribed
and for what reason.
If a medical professional is prescribing,
I'll just use a very exaggerated sort of thing,
like if a medical professional says
that a student in a wheelchair needs to be harnessed in
using more than just the seatbelt on the wheelchair,
and that is for positional,
bodily mechanics, having the students sit straight up
and not slump over.
If that's the case, and if that particular harness
is designed to be used for that reason,
then that would not be considered a restraint.
It is a mechanical restraint,
but because it was prescribed by the physician
and it was and the particular harness
was meant to be used for that reason
and the school nurse has trained everyone
in how to make sure that that harness is in place,
then that does not count as a seclusion
and doesn't need to be reported.
However, there are some doctors who may prescribe that,
for example, I think we had an instance
where a physician prescribed some sort of device
where it would lock the student's arm
so that the student couldn't bend their arm
because the student had self-injurious behaviors
that involved biting their arm.
That would be something that should be involved,
should be included in a student's health plan,
and the school nurse should be the one
that is in charge of that.
It just feels to me like that is,
there's room for interpretation,
but to me it feels like
if you are only putting that device on
when the student is acting up,
that would require a high level of training
on how to get that brace on.
And it seems like it could be dangerous doing that
to a child that's actively resisting.
So the nurse would need to really guide that.
I would not recommend it.
I'm sure there are lots of other examples
and they probably would be worth
just calling Tom or I and discussing it.
And I'm sorry that you didn't get an answer
when you asked that previously.
Just make sure you direct that to...
Oh, go ahead.
Yeah, this sort of situation actually has come up
a few times recently, people contacting me.
And again, it typically involves
what would be considered mechanical restraints.
And the question has a couple of times lately been about,
I think five point restraints on a school bus for a student
and whether that would be considered a restraint.
And my answer to that is it depends.
If this is something that has to be used
because a student is physically incapable
of supporting themselves in the seat
and needs that in order to be able to remain seated,
but because they have a physical condition
that prevents them from safely sitting in the seat,
then that's probably a medical appliance
and wouldn't be considered a mechanical restraint.
If it's being used to control the student's behavior though,
if this is a student who may be interacting with others
or may be engaging in self-injurious behavior
and the belts are used to prevent that,
then that would be a mechanical restraint.
So purpose sometimes is also a factor.
All right, and this perhaps the question was anticipating
this next slide,
which does reference that physical restraints
do not include the bottom techniques prescribed
by qualified medical professional.
Momentary periods of physical restriction accomplished
with limited force, minimum contact,
and hand-over-hand assistance with a task.
And there's a variety of things that are included here.
I can tell you from my experience
in responding to questions about this,
the first one probably is the most frequent question
that comes my way is that there's a situation
where a student maybe initiates a movement
to strike someone else
and a staff member puts up a hand and blocks that
and was that a restraint?
And the answer to that most likely would be no.
Again, you want to hear the details,
you can't give a blanket answer to any situation,
but that momentary physical restriction with limited force
is usually not gonna be considered a restraint.
Hand-over-hand assistance with a task.
To me, that that in my mind,
that goes back to work I did many years ago with students
who had to learn some basic living skills
such as toothbrushing or feeding themselves
that required hand-over-hand support
in order to learn the mechanics of some of the tasks.
That's not considered a restraint,
that that can be a teaching method.
And then obviously we've just talked
about some of the mechanical restraints
that are prescribed by medical professional,
techniques might also be more
in the lines of physical therapy, for instance.
There might be some situations where, you know,
a student may not be particularly happy
about engaging in some physical therapy,
but it is necessary for their physical wellbeing.
And it is prescribed by a professional
and typically implemented by somebody
with very specific training in implementing that.
All right, another poll.
Does this incident represent an acceptable use of restraint?
Why or why not?
So in this case,
Kara is a fourth grade student with disabilities,
has previously used a wheelchair for mobility reasons.
Over the past year,
she's made significant progress in physical therapy
and is able to move without the use of the chair
most of the time.
Her chair is still available in case of emergencies,
such as a building evacuation
so that she could be assisted to exit quickly if need be.
Recently, Kara's BI has been using the wheelchair
to keep Kara contained when she became dysregulated.
Sometimes Kara will yell loudly,
throw herself onto the floor,
or throw books in the BI's face.
So the BI will strap her in the wheelchair.
Often just the suggestion
that Kara will need to go to the chair
helps her BI deescalate her behavior.
So 15 seconds again, is this an acceptable use of restraint?
Okay, respond please.
All right.
It appears that the majority of responses are that no,
this is not acceptable.
This is not permissible.
I'll go to the answer.
Yeah, this is not acceptable.
It's clearly a mechanical restraint and it's not permitted.
Kara doesn't need the wheelchair.
So it's not a prescribed or authorized device.
The straps are being used as a mechanical restraint.
Even if she's presenting a risk of imminent physical harm,
this is not a restraint that would be permitted and
that the BI should be looking at other types of intervention
instead of strapping Kara into the chair.
Okay, I'm gonna take over for a period of time now,
and we are going to
really dissect these terms of substantial risk
and imminent harm and significant bodily harm.
Just so we're really clear,
the only reasons that you can use a seclusion or restraint
are when a student is posing
an imminent risk of substantial harm
or significant bodily harm.
These are emergency interventions only.
They're not to be used in any sort of planned way.
They're only a last resort
when there is a substantial risk of harm.
So let's dissect these terms.
Imminent means that the child's behavior is
or will be immediate or it could occur at any time.
So it's right there in your face,
it is happening or it's about to happen.
The students gotta chair above their head
and they're getting ready to throw it.
It means the child has the ability
or the means to enact a physical injury
or bodily harm through their behavior.
So if I am threatening to throw a chair
or if I don't have a chair,
but instead I'm going like this,
well, I don't really have the means to do that right now.
And even after adults have provided lessons,
less restrictive interventions to deescalate the behavior,
the child's behavior persists.
So that all those things combined equal imminent,
it's right there, it is about to happen.
The student has the means and the intent to enact that harm.
The next definition
that we're gonna talk about is significant bodily harm.
Here the bar is set really high.
The standard is high for what you,
what type of harm the student's behavior must pose
in order to allow
a restraint or seclusion.
So significant bodily harm means that it's severe enough
to cause a cut, an abrasion,
a bruise, burn or disfigurement.
It's severe enough to cause physical pain or illness
or significant enough
to impair the function
of a bodily member organ or mental faculty.
So we're gonna do some polls around this
and I'm going to describe Chloe,
who is a high school junior rugby player,
and she is angry with the score
that she received on a quiz and lashed out at her teacher.
She loudly provided very specific threats to the teacher,
such as, I'm gonna slash your throat with a 10-inch blade
and I'm gonna run your baby over with my boyfriend's car.
(sneezes) Excuse me.
At first, the teacher praised the other students
who are sitting quietly and planfully ignored Chloe.
When Chloe continued,
the teacher positioned herself at a safe distance,
but closer to Chloe's desk,
speaking softly and quietly prompting her
to use one of her anger management skills
and giving her the choice to take a break
and process her feelings with another staff member.
Chloe stubbornly remained in her seat,
arms crossed over her chest
and continued with the verbal,
very graphic, very loud threats.
So does Chloe's behavior
pose a substantial risk
and an imminent risk?
Okay, go ahead and hit Enter.
I'm seeing almost all no's.
And so the answer is that,
no, Chloe's behavior is not posing
a substantial risk of harm yet.
She is remained seated in her desk,
even with her arms crossed across her chest,
and she doesn't have a 10-inch blade
on her person right now.
She's not wielding that blade.
And chances are her boyfriend's car is not
inside the school building ready to be called
to run over the teacher.
Let's go to the next slide, which still involves Chloe.
This time Chloe begins angrily tearing pieces of paper
from her spiral notebook.
She's wadding them up into balls.
And I should mention that once again,
Chloe's a high school student, very large and strong,
she's on the rugby team.
She's wadding them up into balls
and throwing them directly at her teacher.
She has good aim.
And several of the paper balls strike
the teacher's head and torso.
Is Chloe's behavior now posing
a substantial risk of imminent harm.
Once again, type in your answer,
but don't press Send until I give you the cue.
Okay, go ahead and press Send.
I'm seeing some mixed responses, but mostly no's.
And the answer is no.
This doesn't represent a substantial risk of harm.
It is imminent. She is in the act of doing it.
But paper balls don't pose the risk of a serious injury.
You know, I suppose a case could be made
that it could strike the teacher's open eyeball
and cause a tear to her cornea.
But I think that would be
a very rare possibility
of that happening.
And, generally, paper balls don't
really cause any serious injuries.
So no, that wouldn't be,
that wouldn't rise to the standard
of allowing a physical restraint or a seclusion.
Let's go to the next poll that is still with Chloe.
This time, when the teacher moved closer to Chloe's desk,
Chloe stood up and hurled her desk at the teacher,
then began grabbing random objects
like chairs, the classroom globe, staplers,
and she threw those at the teacher as well.
Does Chloe's behavior now pose a substantial risk,
an imminent risk of substantial harm.
Go ahead and press Send now.
I'm seeing a big cascade here.
Okay.
Yes.
The answer is that yes,
this is a substantial and imminent threat.
Chloe has access to all of these objects.
They are heavy objects
that could cause significant physical injuries.
And she's carrying through with these threats now,
it's no longer just a verbal threat.
She is actually doing so.
Certainly, the teacher would want to move away.
The teacher would probably ask
to have the classroom evacuated.
And if there were no other adults,
the teacher would need to remain nearby.
But she would probably want
to seclude Chloe
in that room.
But we will get more into the fine line
between whether or not seclusion is allowable
in just a minute.
And also just like to add that I saw several people noted
that some of the prior activities were not imminent harm,
but they were of concern.
And I think that's,
it's important to note that simply
because something does not represent imminent harm,
it does not rise to that bar.
It doesn't mean that it goes unaddressed.
Absolutely.
That we're talking about restraint and seclusion here,
but there are other levels
of intervention that could and should take place
when a situation like this arises.
And we're not saying
that this is something to simply ignore.
Another example that I see not infrequently is
when a student, particularly a very young student,
may make a threat in the classroom
that they're going to use a firearm.
Clearly they don't have a firearm with them.
And that that is not a threat
of imminent harm in that moment.
However, it's a concern
and one that definitely needs to be followed through
by the school officials just to ensure
does that student have access outside of school?
Is this something that we need to continue to monitor?
And sadly, we've seen recently
that there's little, if any, age limit
to when these circumstances could arise.
So just to say we're not advising
that you simply ignore something
because it doesn't rise to that bar.
Correct.
Let's go on to discuss the permissible use of seclusion.
And this is tricky.
This is an area in which we've gotten lots of questions,
a lot of debate,
and we have actually issued some written guidance
around that, around this.
And you'll find that in some of the materials
that Cassandra has posted on the web.
So seclusion may be used
only when, you're gonna hear me say
this over and over again,
the student's behavior poses imminent risk
of substantial physical injury,
only when less restrictive interventions have failed
or would be ineffective to prevent harm,
only to be used by staff who are trained
to use a restraint or seclusion.
Seclusions are only to be temporary interventions.
They're meant to be monitored at all times.
The student must be monitored at all times.
The seclusion space has to be large enough
to allow safe, sorry, I'm getting pinged
and it's distracted.
We have an an agency-wide meeting going on right now
and I keep getting notifications.
Anyway.
The seclusion space needs to be large enough
to permit safe movement.
It needs to be adequately lit, heated, ventilated,
free of dangerous objects,
and it needs to be in compliance
with all fire and safety codes.
Seclusion can be used
if there are no known contraindications.
For example, some students
may have a history of trauma
that involved severe neglect
where they had been left alone
in their rooms for long periods of time.
And a team may have gotten together
or a therapist
may have advised
that seclusion is really contraindicated for this student.
So you can't use seclusion in those instances.
And also seclusion
is permissible when physical intervention
is contraindicated.
So let's advance this slide
and let me review all of these .
Again, imminent risk,
less restrictive interventions have failed,
temporary interventions only when monitored,
space meets criteria.
There are no known contraindications to seclusions
and only when physical restraint
is contraindicated.
This is a point that is made very clearly in the rules.
And what it suggests,
and what it means is that physical restraint
is the preferable intervention.
Physical restraint, although it may seem counterintuitive
to a lot of people, physical restraint is considered
the less restrictive intervention
and therefore seclusion is not allowed
unless physical restraint is contraindicated.
Now, there may be many reasons
why restraint is contraindicated,
and I even mentioned with Chloe a minute ago
that that might be something to consider.
So I'll get into those things later.
But first let's do some polls.
So we're gonna talk about D'Andre.
When he was told that he would need to edit an essay
that he'd written the previous day,
D'Andre lost his temper
and climbed to the top of a tall shelf next to the windows
where he began pounding his fists
in an attempt to break the glass.
Then he began banging his own head forcefully
against the window.
The teacher evacuated the classroom,
fearing that the glass may shatter
and cause harm to D'Andre and others.
The classroom assistant who was CPI trained remained
in the classroom with D'Andre
and tried several deescalation techniques,
but the behaviors continued.
At that point, another CPI trained staff member arrived
and together they were able to persuade D'Andre
off the shelf.
And then they accompanied him to the quiet room,
placed him in seclusion.
They were outside of the room,
the door was closed,
and he needed to be there
until he was no longer showing aggressive behaviors.
So the question is,
is seclusion permissible in this example with D'Andre?
[Participant] Yes.
And why or why not?
Type in your answer, but don't press Send yet.
Let's give everyone think time about this.
I'm going to answer that question
after we've discussed this specific example.
Okay, go ahead and press Send, everyone.
I'm seeing a lot of no's, but some yeses.
[Participant] With an explanation why.
Yeah, this is confusing
and this is why we've written guidance around this,
but the answer is no.
Seclusion wouldn't be permissible in this instance
and let's talk about why.
[Participant] Yeah, please, do.
Somebody needs to mute, I think.
There were no other students in the room.
There were two staff members.
That provided the time and the space
to attempt additional deescalation techniques.
No other students were in the area and couldn't be harmed.
The staff may have been able to,
well, they did coax him down from the shelf
and they could have corralled him
to a safer part of the room.
And staff had the ability to restrain him
in that evacuated classroom.
So once again,
restraint is considered the less restrictive intervention.
And so, given the fact
that he was continuing the self-injurious
and the aggressive behavior towards others
and was not responding to any of the deescalation techniques
that were being used,
the two trained staff members
should have restrained D'Andre
rather than taking him to seclusion.
Let's talk about D'Andre some more in the next poll.
So same example, he's banging against the window.
The class has evacuated,
the assistant attempts a variety of strategies
to calm him to no avail.
So she restrains him properly using a CPI hold.
But D'Andre, who's very wiry and quick,
is able to escape that hold.
He now begins aggressing against the assistant,
biting, scratching and kicking.
Oops.
And no other staff members have arrived
to help contain the situation.
The assistant is able to persuade D'Andre
to walk with her to the quiet room.
And she walks in the quiet room with him
and they're both inside that room,
but then D'Andre punches and kicks the assistant some more
and she's not confident
that she'll be able to hold him safely.
So she steps out of the room, closes the door,
and secludes him, visually monitoring him,
but calling for additional support as well.
Take your time and think this over.
Type in your answer,
but don't press Send until I give you the cue.
Okay. Go ahead and press Send.
Great.
Yeah, I'm seeing mostly yeses and yes,
this is a permissible use of seclusion.
And let's talk about why that's so.
First, the staff member
tried several deescalation strategies.
She then did attempt the restraint,
which is the less restrictive intervention, more preferable.
But the student remained aggressive
and was able to escape the hold.
In my professional opinion,
the staff member made the sound decision
to accompany the student into the quiet room.
And I think that was a sound decision
because D'Andre had complied with her and had walked there,
which indicates to me that maybe he was,
maybe the act of walking alone had deescalated him.
So she went into the quiet room with him.
That wouldn't be considered a seclusion.
But then when D'Andre rescaled and became aggressive,
I think it was a sound judgment
for her to exit the room and seclude him.
She had no other assistance.
She'd already attempted restraint and failed.
She was likely fatigued, she was possibly injured.
She probably lacked confidence in her ability
to restrain D'Andre further.
So in this case,
I would say that seclusion is permissible.
I can't think of anything else
she might have done differently
to avoid the use of the seclusion.
Tracy, we have a question in the chat.
Oh, okay.
Can you explain this a little bit better?
My concern is that when you are
in a student's personal space and using force to restrain,
this seems to be more restrictive
than having a student in a safe place where they're safe
and being supported by an adult.
I totally get the question.
Cassandra, you're the one that wrote that.
No, I just shared it.
Excellent question. Oh, okay.
It's an excellent question
and it's a question that we get a lot of the time,
as I mentioned, it seems counterintuitive.
It seems counterintuitive to me
until I really begin to digest it.
What I can say is that the rule was written
before I came to the agency, and I wasn't involved
in the public comment period.
But there was a lot of public input
into the making of these and crafting of these rules.
Many different types of people had input
into the writing of the rules,
therapists, physicians, parents,
advocates, multidisciplinary people.
And it was written specifically
because all of those people felt
that restraint really is the less restrictive intervention.
The other thing I would add is that there is federal
as well as some state legislation
that is in the wings,
hasn't yet been enacted,
but is written as an act, I think,
and that actually forbids
the use of seclusion.
There are many states,
several states that have gone ahead
and banned seclusion altogether.
We have some districts in Vermont
that have banned the use of restraint,
or I mean, sorry, of seclusion.
And there is a bill waiting in our state legislature
that would propose
to ban the use of seclusion.
Of course, you know,
there are going to be exceptions
such as if it's determined to be contraindicated.
But that's what I can explain.
Yeah, I think it's also important
to think about what's going on
when these circumstances take place.
That a student who is in seclusion is not a student,
is who's in there sitting quietly
and showing well-regulated behavior.
If that were the case, then the seclusion needs to end.
One of the more challenging parts of my job recently,
since I've been looking at violation notices of 4500,
is reading the accounts of what is taking place
when students are in seclusion for extended periods of time.
And I won't go into details, but I will tell you
that it's oftentimes pretty shocking.
As difficult as it may be
for a student to be physically restrained,
I think on the whole,
a student who is experiencing that level
of crisis or dysregulation,
whatever term you might prefer to use,
they're probably much safer when they're in a restraint
with trained adults than they are
when they're left in a seclusion room.
The reports I get of seclusion rooms
literally being demolished are not infrequent.
The reports of students engaging
in significantly potentially self-injurious behaviors
are also fairly frequent.
It's when you take into account the overall circumstances
of what is happening when a student is in seclusion,
it becomes a lot more understandable as to why seclusion
is not the preferred approach.
Students can get very dysregulated very quickly
when they're secluded.
And Adam
just is asking
for additional clarification for his understanding
that seclusion is when the child is the only person
in the room and there's no staff member in there
to support or provide personal assistance.
That's correct.
Okay.
I am going to still get into this further
and can answer more questions,
but let's go to, I think it's one more poll.
I might be wrong. There may be another one with D'Andre.
But poll number 13,
D'Andre's team in this instance
had taken a look at his data.
They'd consulted with his therapist
and determined that physical restraint is contraindicated
for him because he has a history of sexual trauma.
And the data has shown that restraints
only escalated him further.
So in this instance,
physical restraint has been contraindicated.
So this time D'Andre's teacher directed him
to go to the quiet room
and with the classroom assistant accompanying him,
he complied.
Once they'd arrived at the seclusion space however,
D'Andre again punches and kicks the assistant.
The assistant tells Deandre that he is to remain
in the quiet room for the remainder of that class period
and until recess ends.
The assistant closes the door and visually monitors him
from the outside of the room throughout that period of time.
Is this unacceptable or permissible use of restraint?
Type in your answers, but don't press Send yet.
Permissible use of seclusion.
What's that?
Seclusion, correct?
Did I say restraint?
-Yeah. -Sorry.
Is this a permissible use of seclusion?
Okay, go ahead and press Send.
Okay.
Getting some mixed reviews.
And I have to confess, this is a trick question.
I pulled a quick one on you.
But the answer is no and let me explain why.
It was permissible to use seclusion rather than restraint
because there was a team decision
that would contraindicate restraint.
But the reason that this particular seclusion
is not permissible is that seclusion
is only meant as a temporary intervention.
And the assistant told D'Andre
that he would have to stay there
for the rest of the class period and through recess.
We are not allowed to put arbitrary time limits
on the amount of time a student is to spend in seclusion.
And in fact, seclusion should be terminated
as soon as the student no longer poses
an imminent risk of substantial harm,
or as soon as less restrictive interventions
might prove successful.
So if you answered yes
because the team had a contraindicated restraint,
you're right in that reasoning.
But you have to remember that seclusions are only temporary.
We can't put a time limit on them.
And let me just look at my notes. Yes.
So one more thing that I wanted to say
about how you might determine
whether a physical restraint is contraindicated.
There may be many reasons that a team may decide
that restraint is contraindicated.
One person mentioned a history of sexual abuse.
That, if the team has gathered,
if the therapist has weighed in,
if all team members really agree,
that would a really valid reason
to contraindicate the use of restraint,
and to use seclusion.
Other things
may be a medical condition.
Certainly if the student has a broken arm or broken leg,
that might be a reason not to risk harming
the already injured bodily part.
Asthma, severe asthma, could be a reason
to not use physical restraint,
certainly not to use prone or supine,
but even sometimes with severe asthmatics,
even a standing or sitting hold
could induce an asthma attack.
And then don't forget your data.
Use common sense as a team.
Take data.
If you have data that supports,
and I think I put this in the example with D'Andre,
if you have data that supports your claim
that the student's behavior only escalates further,
then you would have valid reason to say,
let's try seclusion and see if that's more effective.
I mentioned with Chloe that you might want
to consider seclusion in that situation.
You would only consider seclusion
if the team had already considered restraint
to be contraindicated.
And the reason I mentioned it with Chloe
is that she was large and big and old.
And at some point a team may determine
that a child who is approaching the age of 18
and about to go out there into the real world
where police intervention can occur
and will occur if they become violent,
a team may decide A, that their size and strength
doesn't make it a safe intervention
for either Chloe or the staff member,
or that it's time for her to learn more.
It's just time not to impose the physical restraints.
Any questions?
Can a parent dictate
that a team should contraindicate restraint
without additional input?
The answer's no, but,
so any one person
doesn't have the ability to contraindicate
or to trump State Board of Ed rules.
It needs to be a team decision
and it needs to be made with input from a physician,
if that's relevant,
a therapist, if that's relevant.
And with all the team members,
with people who know the child well.
And the team comes together
and there's agreement.
History of trauma being left.
Oh, sorry, that was, nevermind.
Were there other questions?
No, I don't see any other questions.
Okay.
So I think now is when Tom's gonna take over again?
Yep.
We'll start talking about permissible use of restraint.
Okay, so once again, as we've said before,
restraint may only be used if there's imminent
and substantial risk of physical injury,
less restrictive interventions have failed
or would be ineffective.
It's in accordance with a school-wide safety plan,
monitored face-to-face, used in a manner that is safe,
proportionate and sensitive
to a range of student characteristics
and used by trained and certified staff.
And that last piece,
the trained and certified staff is perhaps the place
that we find at the agency
where we're more frequently likely to get violations
that either staff have
imposed restraints who are not trained
and certified to do that,
or they have training,
but they've used a restraint technique
that isn't approved by their training.
And keeping in mind also that prone and supine restraints
are only to be used when a student's size
and the severity of the behavior require these.
That this is a last resort
and should only be used if other techniques have failed
or would not be effective.
So in this poll we're talking about Abigail,
who's a kindergarten student,
and she's had some difficulties adjusting
to her new school environment.
Her mother has alerted the teacher
that Abigail's had a rough morning
and instead of putting her on the bus,
she was driving her to school that day.
There was a para assigned to Abigail's classroom
who met Abigail and her mother when they arrived.
Abigail was quiet, sullen, said goodbye to her mother
and began walking in with the para.
Right before entering the school doors,
Abigail had a change of heart
and ran right to the back of the school building
onto the playground, onto a swing.
The para who was trained to administer restraints
attempted a wide variety of less restrictive interventions
in an effort to encourage Abigail
to stop swinging and walk to class.
Abigail ignored these strategies and kept swinging.
Yeah, I think I need the next slide.
Okay.
Well, all right.
I thought there was more to the scenario,
so instead I gave away the answer,
which I'm hoping most of you would have arrived at anyway,
that, no, this is not a permissible use of restraint.
Clearly there is no risk
of imminent physical harm posed
by Abigail continuing on the swing.
And there would need to be other attempts
to work with Abigail other than physically restraining her,
or in this case,
possibly imposing a moving restraint,
which would also be risky to the student.
So you got a freebie there.
And I see that there was a question
before we move to the next poll.
That was me just answering a previous question.
-Oh, okay. -About seclusion.
Okay. Thank you.
All right, so same example with Abigail arriving at school.
But instead of running to the playground,
Abigail impulsively ran after her mother
and straight into the flow of oncoming traffic
in the roadway adjacent to the school property.
This time, the para ran after Abigail,
caught up to her just before she stepped
in front of a moving car.
The para held Abigail in a standing hold.
Abigail wriggled, kicked and then went limp,
refusing to stand and walk.
The parent continued the stationary standing restraint
until Abigail agreed to walk into the school building.
Would this be a permissible use of restraint?
And I'll give you a cue
when to enter your answers into the chat.
Why don't you go ahead.
And as most, if not all of you are answering, yes,
this is a permissible restraint.
Clearly, Abigail was at imminent risk
of a serious injury from the traffic,
and there really wasn't any other opportunity
to implement a less restrictive intervention
because of the danger that was posed.
This does raise a question, though,
that comes up not infrequently in my experience right now,
about what if the scenario involves a student
leaving the building where there is a roadway nearby
that sometimes has heavy traffic,
rather than this pretty dramatic incident
where this is clear.
I don't think anybody would disagree
that Abigail needed to be restrained in that moment
for her personal safety.
It becomes less clear
if the danger is less imminent.
And those are gonna have to be
more case-by-case circumstances.
It's difficult for those of us at the agency
who may get the information about is that a remove?
And aren't looking at the situation.
It is so hard sometimes to know for certain
what the correct answer would be.
Why don't we move to the next poll?
Oh, prohibited interventions. Okay.
So as we've discussed earlier,
the Vermont rules prohibit mechanical restraint,
and we've talked about some of the circumstances
where there might be mechanical devices
that in effect impose a restraint,
but they may be permissible because that restraint is
for medical or therapeutic reasons
and is prescribed, monitored,
and presumably implemented by somebody
who is trained to do that.
Chemical restraint.
This is fortunately something I have not encountered
in recent years.
I will go way back into my past experience
when I first started the work that I do.
And there were incidents where chemical restraint was used,
and I found that horrific at the time
and would continue to do so.
I'm not aware of anybody using chemical restraints
at this point.
Any intervention that restricts or limits breathing
or communication, causes pain,
or is imposed without maintaining direct visual contact.
Okay.
Restraints that are imposed for the convenience of staff.
Restraints that are a substitute for an educational program
or if they're a substitute
for inadequate staffing or training.
This is especially important.
Restraint is not allowed to be used
as a form of discipline or punishment.
It's certainly not to be used as a response
to student's use of disrespect
and not in response to a verbal threat
that's not accompanied by the means or intent
to carry out that threat.
It's going back to the scenario that Tracy presented earlier
with the high school aged student
who was making wild threats,
clearly had no ability to carry those out.
So our next poll.
The question is whether the following intervention
would be permissible.
Frankie is frequently disruptive in class.
He's often defiant and given instructions,
uses racial slurs when he gets angry.
The school psychologist
has done functional behavior assessment.
The team used that
to develop a clearly defined behavior support plan.
A classmate reached for a toy,
Frankie used an offensive term related to his peer's race.
Because his plan stated he's to receive a 10 minute timeout
in response to the use of offensive racial language,
his BI brought Frankie to the seclusion room, shut the door,
set the timer for 10 minutes
and monitored him through the window
throughout the timeout.
So the question is, is this permissible?
And if you have any thoughts about why or why not,
we'll give you a few seconds to think about it
before you send your answer in the chat.
Okay, go ahead.
It looks as though the majority of the answers are no,
I haven't seen any yeses yet.
And that is correct.
He was secluded.
This clearly was a case of seclusion
and it was not permissible in this case.
Seclusion, as well as restraint,
are only emergency interventions,
not planned interventions.
So it's really important not to confuse a planned timeout
with a seclusion.
Frankie was alone, he was not permitted to leave.
There was no imminent risk of substantial injury.
And had there been any,
they still needed to be terminated
as soon as the harm was no longer present.
So the use of the timer to dictate
when Frankie could leave the seclusion,
even if seclusion had been permissible in this case,
dictating the end of seclusion
with a timer is also not permissible.
And there's another question in the chat.
Yeah, it was going back to the question
about mechanical restraints.
So let's hold that question and come back to it at the end
-so that we don't- -Oh, okay.
-Go ahead. -There's one from Evan.
-It says- -Oh, sorry.
It's okay.
If it's clearly outlined
within the student's behavior intervention plan
as a timeout procedure,
it wouldn't be considered a seclusion?
Question.
If the student is in the room alone, the door is shut,
the student reasonably believes that they cannot leave,
then that's a seclusion, not a timeout.
Thank you.
And again, restraints and seclusions
are emergency interventions.
They are not to be used in a planned manner.
And I always advise teams
not to mention the word restraint or seclusion
in a child's behavior intervention plan.
What I would advise is that you have a behavior plan
that does not mention seclusion or restraint,
but maybe would say in the event
that so-and-so's behavior is posing an imminent risk
of substantial physical injury,
then Rule 4500 would be used.
And then I would say,
you can consult so-and-so's safety plan
or ICMP, which is Individualized Crisis Management Plan.
And then you might draw up a separate safety plan
that has unique features to that student.
For example, you know,
with Johnny restraint has been contraindicated.
So use seclusion instead.
But don't use restraints or seclusions
in a planned manner.
Right, and I'd also add
that not only would this be a seclusion
rather than a timeout,
there are also instances
where similar conditions have been imposed
and called in-school suspension.
And that is also not acceptable or accurate.
It's still seclusion and has to be considered as such
and has to follow the Rule 4500 rules.
Okay, the next slide.
Termination of interventions.
And that's Frankie's instance.
That was part of the issue was that
as we saw, Frankie,
his intervention was terminated based on a timer
rather than on his behavior or his needs.
So let's move ahead.
So interventions have to be terminated
if there is any unnecessary pain or significant distress,
if breathing or communication are compromised,
if the student no longer poses an imminent
and substantial danger of physical injury
or if less restrictive interventions would be effective.
And this says, think about Frankie and his behavior plan.
Next slide.
So we have another scenario, another poll.
And the question is
whether the following intervention would be permissible.
Jayden is an eighth grader
who struggles with peer relationships
and managing his anger.
During a group activity in English class,
a friend accidentally steps on his new shoes
and Jayden starts threatening to fight him,
throws a punch,
which almost lands on his English teacher,
and she tries to intervene.
Quickly calls for support,
clears the classroom of all other students.
Two behavioral interventionists who respond are now alone
in the classroom with Jayden,
who is still extremely agitated,
kicking at each of them as hard as he can.
They work to use verbal deescalation
and encourage him to use his breathing strategies,
but he's not hearing them.
He tries to bite one of the Bis
when they attempt to restrain him.
They determine that it's not gonna be effective
to use restraint, leave the classroom, close the door,
starting a seclusion.
As the adults observe through the window
of the classroom door,
Jayden slowly begins to enter a calmer state.
He takes some deep breaths and eventually,
and stops kicking the door.
He begins to walk around the classroom pacing.
He asks them to open the door
so he can have a drink of water.
The BIs state he needs to have a, quote, calm body, unquote,
and remains seated for at least 30 seconds
before they'll let him leave.
So the question to you,
is this permissible and why or why not?
Take a few seconds
and I'll cue you when to put your answers in.
Okay, go ahead.
It looks as though the majority of you answered no,
although there were some mixed answers.
So we'll move to the next slide.
Says, no, this use of seclusion was not permissible.
Jayden should have been allowed to leave the classroom
when he was no longer presenting a risk
of physical harm through his behaviors.
Remember that this is an emergency intervention.
It can only be used to prevent imminent physical harm.
It must end when the student
is no longer presenting this risk of harm
or if a less restrictive intervention would be effective.
In this particular case,
it appeared that while Jayden might have
still been somewhat agitated,
he wasn't presenting physical harm
and it seemed as though he was attempting
to use some of the techniques
that the staff had previously recommended for him.
So that would be an excellent opportunity
to use less restrictive interventions.
Simply because he is not continuing
to follow directions is not a reason to continue seclusion.
And requiring something such as a safe body for 30 seconds
is beyond what's allowable for seclusion.
So somebody here said,
you really have to know your student
and their patterns and behavior.
And I would fully agree with that.
I think this is something
that we haven't been exploring too much
with this whole discussion,
but that these situations
don't take place just in isolation
and they aren't simply done and over with
once it's happened.
Something we haven't talked about yet is
that each of these interventions also needs
to be an opportunity
to really examine the student situation more
and come to a better understanding
of what's happening with that student.
One of the saddest things that I can see is,
is if I'm seeing repeated reports of seclusions
or restraints of students coming in.
And there just doesn't seem to be significant change
in the behavior over time.
If you're having repeated episodes,
if this is just an ongoing set of issues,
you have to use that as an opportunity
to really look at a functional behavior assessment
and really try to determine
what are you going to do differently?
This shouldn't just be a regular occurrence.
This should be something that's part of a plan,
that if it is happening more than once,
what is the plan to decrease the frequency
or eliminate it all together?
All right, I'll move along.
There are a few questions in the chat as well.
Yeah, what I wanted to say is
that we're nearing the 10-minute mark
when this webinar is scheduled to end.
So I'm willing to stay on after 11:00
to answer and discuss additional questions.
But I think it would be best
to continue so that we can cover all of the content,
which we're almost done with.
Yep.
Okay, next, briefly, context of COVID.
This was originally part of the slide
when there were more formal
considerations in place
as a result of the COVID pandemic,
but it's important to note that COVID hasn't gone away.
That this is still an issue in schools.
This slide just gives a brief history
of some of the exceptions to the rule
that were permitted during the height of the pandemic.
Fall of 2020 there were exceptions allowing seclusion
instead of restraint in order to mitigate the risk
of infection spreading.
In 2021, some of those rules became modified
depending on the eligibility of students for the vaccine,
acknowledging that depending on a student's age,
they might be at greater risk due to the lack
of not being able to access the vaccine.
And then finally, as of fall 2022,
the formal COVID considerations have been removed.
So the rule is back in force
as previously stated.
So just in case anybody had been using
any of the exceptions that had previously been in place,
you need to know that those went away in the fall of 2022.
And I don't anticipate any changes
despite the fact that COVID is still an issue in schools
and something that schools need to be talking about.
So following the termination of an intervention.
The rule requires that a student be evaluated and monitored
for the remainder of the school day.
It's also important to note that this needs to be conducted
by someone who is not involved in the intervention.
That is also a not infrequent area of violation
where somebody who is involved in intervention
later assess the student.
That's largely to remove any potential conflict of interest.
The question of, you know, I think it'd be a risk
that somebody might minimize the impact
of an intervention on a student if they had been involved
in imposing that intervention.
And any injury that resulted
from the intervention must be documented.
That includes injury to staff.
And in our experience most frequently staff are the ones
who are most likely to experience injuries
in these processes.
I just wanted to interject
that the evaluation
following the restraint has to be done
by someone that wasn't involved.
But then the monitoring for the rest of the day,
that can happen by someone who was involved.
Right.
Typically there might be a BI involved who's,
it would just make sense for that person to be monitoring
the student for the end of the day.
So in terms of reporting,
the school administrator needs to be informed
no later than the end of the school day
in which a restraint or seclusion has occurred.
Parents, there has to be at least a documented attempt
to provide notice verbally or electronically
to parents as soon as possible,
no later than the school day
in which the intervention occurred.
And written notice within 24 hours of the intervention.
And the written notice has to include an invitation
for the parents to participate
in a debriefing of the incident.
The superintendent has to be notified
within three school days
if there has been any death, injury or hospitalization
as a result of the incident.
If an individual staff member
has used restraint or seclusion
three separate times on one or more students,
if the interventions, either restraint or seclusion,
have lasted more than 15 minutes,
if a student's been restrained or secluded
three or more times in the school year
or have been restrained or secluded more than once
in a school day or if there have been any violations
of the use of the rules.
And then finally, a report to the AOE.
And these are the reports that I see.
That if there's death or injury
that required outside medical intervention,
if the restraint or seclusion lasted
for more than 30 minutes
or if there have been violations of the rule.
There's a new reporting form that became available
at the beginning of last school year
and is still available for incidents
that meet criteria for reporting to the AOE.
There's an online link available
on the state webpage for use,
and superintendents have been notified about this.
And this allows us somewhat better data collection
and analysis so that we can offer better support
to folks in the field
and examine trends of incidents and restraints, seclusion.
I will point out though that, as previously stated,
the criteria for reporting to the AOE limit the number
of reports that we get
and therefore limits the usefulness
for this as a real source of data
about restraint and seclusion overall in the state.
To that end, we do have a form that's been or will be,
I'm not sure where it is right now,
in the pipeline going out to principles
just to give us a half school year report
on all incidents of restraint and seclusion,
just so that we can have just a quick understanding
of the how frequently these interventions are taking place.
'Cause our current system doesn't really give us
a good sense of that.
So now comments and questions.
-And, I also- -So this is.
I was just gonna say, Tracy, really quickly,
I know it's almost time,
so feel free to stay on if you have additional questions.
We have about five minutes in the formal part
of this presentation.
If you do have to leave,
thank you so much for joining us this morning.
A huge shout out to Tom and Tracy.
Really appreciate all the knowledge
that you've shared with us this morning
and your willingness to answer questions.
You will also, for attending today, receive a certificate
of attendance and a survey.
So please let us know how this went for you today
and certainly look forward to seeing you at a future event.
And now I will go ahead
and open it up for additional questions.
And there are a lot in the chat box.I,
I'm gonna have to scroll back because a lot have come up.