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Memo from APRAIS organizations to US Dept of Ed re: Restraint/Seclusion prevention guidelines

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  • Alpy2@aol.com
    APRAIS is a group of organizations dedicated to preventing the use of restraint and seclusion in schools. Following is a memo directed to the U.S. Department
    Message 1 of 1 , Sep 1, 2011
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      APRAIS is a group of organizations dedicated to preventing the use of restraint and seclusion in schools.  Following is a memo directed to the U.S. Department of Education (OSERS and OSEP) in anticipation of the issuance of guidelines in this area.
       
      Memorandum
       
      TO:         Alexa Posny, Assistant Secretary, Office of Special Education and Rehabilitative Services
      Melody Musgrove, Director, Office of Special Education Programs
       
      From:    APRAIS Member Organizations
       
      RE:          Anticipated Restraint and Seclusion Prevention Guidelines
       
      We understand that the Department of Education plans to release guidance to the field soon on restraint and seclusion use in schools.   The release of such guidance responds to an urgent need expressed by school personnel and parents to provide meaningful direction regarding these practices.  Reducing the use of restraint and seclusion is squarely aligned with other important school reform efforts, such as the prevention of bullying and the focus on safe and effective school climates.  APRAIS member organizations applaud these efforts and offer the collective expertise of the organizations we represent as the Administration continues to move forward on this issue.  
       
      Ultimately, the course of action the Department of Education and all school districts take must be toward improvement in the overall safety of everyone involved and towards the reduction of use of these techniques.  When positive school climate, safety of all, and reduction of the use of restraint and seclusion are the overarching principles, evidence-based practices are implemented with greater success. 
       
      To that end, we strongly encourage the Administration and the Department of Education to use the available evidence base as a guidepost for reducing and preventing use of restraint and seclusion in schools.  Important elements reflected in this ample body of work from other disciplines form the basis for the items in the checklist provided below.
       
      We encourage these checklist items to be used to evaluate pending recommendations or policy guidance from the Department. 
       
      ” Clearly establishes the goal as constant and deliberate reduction in the use and duration of restraint and seclusion in educational settings, programs, and schools.

      ” Encourages a proactive and positive framework for all students; not specifically focused on any subgroup of students, such as students with disabilities.
       
      ” Establishes a framework based on the SAMSHA Six Core Strategies to reduce the use of Restraint and Seclusion in schools and educational settings or programs.  Such a framework is demonstrated as effective and is essential to assure focus is on identifying risk factors for conflict and dangerous behaviors before they occur, along with putting in place early intervention strategies to immediately respond to conflict so that dangerous behaviors and the use of restraint and seclusion can be prevented. [1]  The Six Core Strategies, and important components under each, include:
      ·         Leadership toward Organizational Change.
      o   Develop a model district or building-wide policy statement that outlines the global prevention/reduction approach to the use of restraint and seclusion;
      o   Encourages:
      §   identification of data-driven goals to reduce use;
      §  Routine analysis of progress, targeted plans for areas needing improvement and celebration of successes;
      §  Identification of restraint and seclusion reduction champions at all horizontal and vertical organizational layers; and
      §  Assigns these staff to specific prevention roles within District, State or Department hierarchies.
      ·         The Use of Data to Inform Practice.
      o   Data is encouraged to be used in a way that allows administrators to identify and share successful restraint and seclusion prevention practices.
      o   Data collected and reported should be consistent with that already begun by the Department of Education Office of Civil Rights in 2010. 
      o   Transparency of the data is an essential component for successful reduction.   Data should be reported at the local, state, and federal levels, and available to the public on an accessible and easily accessed website as a matter of public record.
      o   Senior administrators should analyze trends within the school and among schools to ensure that restraints and seclusion are used only in the rarest of situations, when absolutely unavoidable and that positive behavioral intervention and de-escalation techniques are emphasized and implemented.
      ·         Workforce Development.
      o   Promotes use of training programs that, at a minimum, increase knowledge and skills in evidence-based practices shown to be effective in:
      §  the prevention of physical restraint;
      §  in keeping both school personnel and students safe in imposing physical restraint if necessary to remove an imminent danger of harm. 
      §  in the use of evidence-based positive behavior interventions and supports, safe physical escort, conflict prevention, behavioral antecedents, functional behavioral assessments, de-escalation of challenging behaviors, and conflict management;
      §  in first aid, including the signs of medical distress, and cardiopulmonary resuscitation; and
      §  certification for school personnel should be required to be renewed on a periodic basis.
      o  Staff training should also address:
      §  the growing evidence that many restraint and seclusion events occur because of win-lose conflicts set up by the numerous rules that govern building operations and the role of staff in enforcing these rules.
      §  the principle that imposition of restraint or seclusion is not educational or behavioral strategy, but the failure of educational or behavioral strategy.
      ·         Use of Prevention Tools.
      o   Promote the use of preventative methodologies such as school-wide positive behavior support, de-escalation strategies.
      o   Provide clear guidance for staff to assess if/when behavior presents an imminent danger of harm.
      o   Emphasize the need for positive approaches to be tried and documented prior to imposition of restraint upon students or use of seclusion for any length of time.
      o   Encourage the use of individual plans (consistent with existing requirements under State and Federal Law) for purposes of communicating and documenting proactive means of problem-solving, de-escalation and interruption that make the use of restraint or seclusion less likely or unnecessary.
      o   Emphasizes best practice and comprehensive approach to the issue; for example, as behavior is a form of communication, need to ensure students are provided with alternative and augmentative communication or other educational supports, accommodations or instructional strategies that are effective in reducing or eliminating need for exhibition of problem behaviors. 
      ·         Supporting Student, Family and Advocate Roles.
      o   Involving students, family members, and external advocates in a variety of roles in district and building planning can have a powerful impact, both as a primary prevention strategy to reduce the use of restraint and seclusion, and as an ongoing systems change strategy.  
      ·         Debriefing Tools.
      o   Successful efforts to reduce the use of restraint and seclusion use event debriefing procedures to inform policy, procedures, and practices and reduce future use of these interventions. A secondary goal of this strategy is to mitigate the adverse and potentially traumatizing effects of a restraint or seclusion event for involved staff and students, families, and for all witnesses to the event.
      o   Policies and procedures to be followed after each incident involving the imposition of physical restraint or seclusion upon a student, including procedures to provide to the parent of the student, with respect to each incident, verbal and written notification.
      o   Immediate and long term debriefing sessions focused on rigorous problem-solving methods to review and analyze the event, or sequence of events. The goal of such planning to prevent and reduce reoccurrence of the use of physical restraint or use of seclusion.  
      o   Debriefing should involve at minimum:
      §  Identification of antecedents to the physical restraint;  
      §  Consideration of relevant information in the student’s records, from teachers, other professionals, the parent and student;
      §  Consideration of the results of any Functional Behavioral Assessments, whether positive behavior plans were implemented with fidelity,
      §  Recommendations of appropriate positive behavioral interventions and supports to assist personnel responsible for the student’s educational plan, Individualized Education Program for a student eligible under the Individuals with Disabilities Education Act, and for plans providing for reasonable accommodations under Section 504 of the Rehabilitation Act;
      §  A plan to have a functional behavioral assessment conducted, reviewed, or revised by qualified professionals, the parent and the  student; and
      §  For any student not identified as eligible under Section 504 or the IDEA, evidence of such a referral or documentation of the basis for declining to refer the student.

       In addition to the core strategies defined above, we urge the Department to:

      ” Provide clear guidance on the use of restraint:
      ·         Limits use to situations in which there is imminent danger of harm.
      ·         Emphasizes the danger of any physical restraint technique that restricts breathing or uses extreme force.
      ·         Clarifies that the techniques may not be used for destruction of property, convenience of staff or discipline. 
      ·         Specifies that restraint must be limited to only such reasonable force as is necessary to achieve safety, and that it must end as soon as the threat of imminent danger of harm is over.
      ·         Emphasize the need for face-to-face monitoring to ensure student safety.  

      ” Provide clear guidance regarding seclusion:
      ·         Limits use to situations in which there is imminent danger of harm.
      ·         Specifies the extreme danger of placing students in a locked room or other space from which they cannot exit.
      ·         Provides technical assistance to clearly differentiate seclusion from time-out.
      ·         Encourages that techniques such as time-out are only used as part of evidence based, comprehensive, positive support plan developed in accordance with requirements under existing State and Federal law and regulation.
      ·         Emphasize the need for face-to-face monitoring to ensure student safety.
       
      Please let us know if you have specific questions or would like additional information regarding any of the points in this document.   We appreciate the opportunity for input on this important topic and encourage continued dialogue with diverse stakeholders prior to the release of any such recommendations or guidance.
       


      [1] Six Core Strategies© to Reduce the Use of Seclusion and Restraint in Inpatient Facilities, outlined below. See Huckshorn, K.A., Re-Designing State Mental Health Policy to Prevent the Use of Seclusion and Restraint, 33 Administration and Policy in Mental Health 4 (2006) at 482-491; and Huckshorn, K.A., Reducing the Use of Seclusion and Restraint in Mental Health Systems: A Public Health Prevention Approach with Interventions, 42 J. of Psychosocial Nursing and Mental Health Services 9 (Sept. 2004).


      Sandy, Illinois
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