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Deb Davis's group definition discussion

The definitions group reviewed the definitions that were developed at the last CBR meeting and also reviewed additional definitions from the handout provided by Deb Davis entitled Developing School Policies & Procedures for Physical Restraint and Seclusion in Nebraska Schools (emailed to participants prior to the meeting).  The definitions are found on pages 32, 33, and 79 – 82. 

Definitions developed at the last CBR meeting:

Physical restraint is defined as any physical intervention of one or more persons substantially restricting another person’s freedom of movement, physical activity, or normal access to his or her body for the purpose of maintaining the safety of the student or others.  It is a means for controlling that person’s movement, reestablishing behavioral self-control, and establishing and maintaining safety for the individual, other individuals, and school staff.

Definitions group questions/thoughts:

  • What does substantially mean?  Should it be removed? 
  • Should physical restraint include the use of the body to block a student’s movement?
  • The regulation should also include the following regarding physical restraint:
    • to be employed only when there is imminent risk of harm to the student or others.
    • not to be used when the student is only noncompliant, confrontational, verbally aggressive.
    • not to be used to prevent destruction of property except in those instances where there is imminent risk of harm to the student or others.

Seclusion is the involuntary isolation of a child that separates him or her from others.

Definitions group questions/thoughts:

  • Although the room is never locked, wouldn’t there be situations in which staff should prevent the student from leaving?
  • Add the following sentence from the physical restraint definition:  It is a means of controlling that person’s movement, reestablishing behavioral controls, and establishing and maintaining safety for the individual, other individuals, and school staff.

Timeout is a voluntary break as described in a written plan that is intended to be a therapeutic intervention and should not be confused with seclusion. 

Definitions group questions/thoughts:

  • The definition should distinguish between inclusion timeout (occurs within the classroom) and exclusion timeout (occurs outside the classroom, but should not be confused with seclusion). 
  • Should the term therapeutic be changed to positive? 

The definitions group recommends that the following definitions be considered if the final rule contains these terms:

Corporal punishment:  “Infliction of bodily pain as a penalty for disapproved behavior” (p. 80).

Chemical restraint:  “The use of medication, taken involuntarily, to control student behavior for the purpose of restraint” (p. 80, modified).

Mechanical restraint:  The MADSEC revision on p. 8 of the side-by-side contains the following that should be included:  “Prescribed assistive devices such as splints, standing tables and chairs with restraints used for positioning or prevention of contractures are not considered mechanical restraints….Vehicle restraints required by law or recommended as part of a behavior intervention plan are not considered mechanical restraints.”

Crisis intervention training:  This is a parking lot issue that will require close examination by the entire group.  The definition on p. 32 is helpful.  See also p. 10 of the CEC article, which lists the categories that should be included in training.  The term de-escalation should be included and defined. 

Functional behavioral assessment:  “Ongoing process of gathering information that can be used to hypothesize about the function of student behavior.  The analysis provides the information necessary to develop a [positive] behavioral intervention plan” (p. 32).

Aversives:  The current Chapter 33 regulations state that “Aversive therapy or treatment includes the application of unusual, noxious or potentially hazardous substances, stimuli or procedures to a student.  Such substances, stimuli, and procedures include but are not limited to:  water spray, hitting, pinching, slapping, noxious fumes, extreme physical exercise, costumes, or signs.”  The group may want to compare this with the list on page 79.

Behavior intervention plan:  If this term is defined in the regulation, it should include the parent as a member of the team that develops the plan. 

Physical prompt:  “A teaching technique that involves physical contact between the adult/supervisory person and the child.  This enables the child to learn or model the physical movement necessary for the development of the desired competency” (p. 80, Instructional Physical Prompt).

Physical escort:  “Touching or holding a student with [delete or without] the use of force for the purpose of directing the student to a new location” (p. 81).  The group believes this type of escort should be considered a restraint.

Positive behavioral supports:  This will probably have to be defined as it relates to the BIP.  The definition on p. 81 may be helpful.

Prone restraint:  “The student is being held face down, lying on their stomach on a horizontal surface such as the floor” (p. 32)

Supine restraint:  “The student is being held face up on their back o a horizontal surface such as the floor” (p. 32). 

Imminent:  “Likely to happen right away; within a matter of minutes” (p. 32).

CH 33 Definitions Collected from different sources and reviewed on March 24, 2011 by subgroup

 

2.1 Physical Escort

Physical escort is an emergency behavioral intervention by trained staff that uses physical force for the purpose of moving a student involuntarily to a designated seclusion time-out room or area. This emergency behavioral intervention is used as a last resort when the student’s actions pose an imminent danger of substantial risk of injury or harm to that student or others, significant property damage and/or severe educational disruption. The purpose of a physical escort in the context of an emergency behavioral intervention plan is a means for establishing and maintaining safety.

Refer to physical escort limitations, permitted uses, training standards and prohibitions specified in these rules.

2.2 Physical Restraint

Physical restraint is an emergency behavioral intervention by trained staff and as defined by a recognized training program that uses various holds that involuntarily immobilizes or reduces a student’s freedom of movement of their arms, legs, body or head. This emergency behavioral intervention is used as a last resort when positive behavioral supports have not been successful and the student’s actions pose an imminent danger of substantial risk of injury or harm to that student or others, significant property damage and/or severe educational disruption. The purpose of a physical restraint in the context of an emergency behavioral intervention plan is a means for establishing and maintaining safety, to prevent injury or harm to that student or others, to assist the student to regain their composure and to support the student’s re-entry into the learning environment.

Refer to physical restraint permitted uses, time limits, exclusions, training standards and prohibitions specified in these regulations.

2.3 Seclusion Time-out

Seclusion time-out is an emergency behavioral intervention by trained staff that involuntarily removes a student by physical escort to a time-out room or area which is used specifically to isolate that student from others. This emergency behavioral intervention is used as a last resort when positive behavioral supports have not been successful and the student’s actions pose an imminent danger of substantial risk of injury or harm to that student or others, significant property damage and/or severe educational disruption. The purpose of a seclusion time-out in the context of an emergency behavioral support plan is a means for establishing and maintaining safety, to assist the student to regain their composure and to support the student’s re-entry into the learning environment. This does not include inclusion time-out and exclusion time-out which are a part of a school wide and/or an individual student’s positive behavioral support plan.
Refer to seclusion time-out limitations, permitted uses, time limitations, adult supervision requirements, training standards and prohibitions specified in these regulations.

2.4 Seclusion Time-out Room or Area

A seclusion time-out room or area is a designated room or space which is used specifically in behavioral emergencies to involuntarily isolate a student from others as a means for establishing and maintaining safety. This does not include Inclusion time-out and exclusion time-out which are a part of a school wide and/or an individual student’s positive behavioral support plan.

Refer to seclusion time-out room or area limitations, time limitations, adult supervision requirements, physical characteristics, training standards and prohibitions specified in these regulations.

2.5 Additional Definitions

Aversive interventions are the use of aversive therapy or treatment that includes the application of unusual, noxious or potentially hazardous substances, stimuli or procedures to a student. Such substances, stimuli, and procedures include but are not limited to: water spray, hitting, pinching, slapping, noxious fumes, extreme physical exercise, costumes, or signs.

Behavioral emergency is when a student is engaging in dangerous behaviors that presents substantial risk of injury or harm to that student or to others, significant property damage and/or severe educational disruption.

Chemical restraint is the use of medication, given involuntarily, to control student behavior for the purpose of physical restraint.

Prevention and conflict de-escalation training is training which is provided broadly to school staff on how to prevent, defuse, and de-escalate potential behavioral emergencies which meet state standards.

Corporal punishment is the infliction of bodily pain as a penalty for disapproved behavior.

Crisis intervention training is training provided to selected school staff which address how to deal with aggressive, violent or out of control behavioral emergencies. It includes specific techniques for physical escort, physical restraint and seclusion time-out. The curriculum would meet state standards and would result in certification of school staff.

Dangerous Behavior is when a student’s behavior presents a substantial risk of injury or harm to that student or others.

De-escalation is causing a situation to become more controlled, calm and less dangerous, thus reducing the risk for injury to someone.

Emergency behavioral interventions are the use of physical escort, physical restraint and seclusion time-out, as defined by recognized training programs in times of behavioral emergencies and as part of an emergency behavioral intervention plan.

Emergency behavioral intervention plan is a plan developed by a team that is part of a school wide plan and/or an individual student’s plan that has well defined strategies in a behavioral emergency. An individual student’s emergency behavioral intervention plan is for when an individual student presents with dangerous behaviors and for the purpose of maintaining safety of that student and others, trained staff would follow a plan to manage that student in times of behavioral emergencies. Written with the input and support of the parents or guardian and within the required guidelines set in place by these regulations. A school wide emergency behavioral intervention plan is for when a student presents with dangerous behaviors that the school did not anticipate, and for the purpose of maintaining safety of the student and others, trained staff would follow the school's emergency behavior intervention plan. This plan applies school wide to all students and would be made aware to students, staff and parents via code of conduct, school website, crisis or emergency procedures document, training opportunities and/or the student handbook.

Exclusion time-out is when a student is excluded from the reinforcing activity, is not allowed to participate or observe the activity and is not allowed to stay in the classroom. This is part of a school wide positive behavioral support plan and/or an individual student’s positive behavioral support plan.

Functional behavioral assessment is the ongoing process of gathering information that can be used to hypothesize about the function of student behavior. The analysis provides the information necessary to develop a positive behavioral intervention plan.

Imminent means likely to happen right away; within a matter of minutes.

Inclusion time-out is when a student is removed from the reinforcing activity, but is still allowed to observe the activity and stay in the classroom. This is part of a school wide positive behavioral plan and/or an individual student’s positive behavioral support plan.

Mechanical restraint is prescribed assistive devices such as splints, standing tables and chairs with restraints used for positioning or prevention of contractures are not considered mechanical restraints….Vehicle restraints required by law or recommended as part of a behavior intervention plan are not considered mechanical restraints.

Physical prompt is a teaching technique that involves physical contact between the adult/supervisory person and the child. This enables the child to learn or model the physical movement necessary for the development of the desired competency.
Positive behavioral support plan is a school wide and/or an individual student’s plan developed by a team that has well defined strategies, procedures, routines, and goals with high rates of positive feedback to prevent and modify inappropriate behavior.

Positive behavioral supports are a set of instructional and environmental supports to teach students pro-social alternatives to problem behaviors with high rates of positive feedback.

Prone restraint is when a student is being held involuntarily face down, lying on their stomach on a horizontal surface such as the floor.

Risk of injury or harm is dangerous behavior that has the intent and the means to cause substantial physical harm to self or others.

Severe Educational disruption is when a student’s actions severely disrupt other students and staff within an educational setting.

Significant property damage is substantial destruction to school property.

Substantial risk is a situation where there is imminent danger of substantial risk of injury or harm and there is an immediate ability to enact such harm.

Supine restraint is when a student is being held involuntarily face up on their back on a horizontal surface such as the floor

CH 33 Definitions by Group Consensus Feb 17, 2011 Meeting

 

Definition of consensus:  Consensus is collaboratively reaching a compromise, the components of which all participants can live with and publicly support.

Definition of physical restraint:  Physical restraint is defined as any physical intervention of one or more persons substantially restricting another person’s freedom of movement, physical activity, or normal access to his or her body for the purpose of maintaining the safety of the student or others.  It is a means for controlling that person’s movement, reestablishing behavioral self-control, and establishing and maintaining safety for the individual, other individuals, and school staff.

Additional language under consideration:  Physical restraint does not include:

  • Physical prompts, physical guidance, or physical cues used in the context of educational and functional programming and skill development with a person’s compliance.
  • Mechanical and chemical restraint
  • Punishment or use for staff convenience or shortage

Definition of seclusion:  Seclusion is the involuntary isolation of a child that separates him or her from others. 

Definition of timeout:  Timeout is a voluntary break as described in a written plan that is intended to be a therapeutic intervention and should not be confused with seclusion.