Preventing Restraint & Seclusion

Best Practice in Preventing Restraint and Seclusion

In 2014 AZ passed a law that prohibits the use of seclusion and restraint on all pupils in all Arizona schools, except in the case of imminent danger of bodily harm. See

The Arizona Department of Education published a resource document “THE USE OF SECLUSION AND RESTRAINT: A GUIDANCE DOCUMENT ON BEST PRACTICES” outlining 7 best practices to prevent or reduce seclusion and restraint. Read below for additional resources not listed in the guidance document:

1. Seclusion and restraint should not be used for individual student discipline, but only as part of a school safety plan for when imminent danger is present

  1. When a pupil is known to display aggressive behavior, and does in fact have a behavior plan to prevent such behavior, the plan should not list the crisis procedures as part of the pupils’ individual plan. Instead the same crisis procedures taught to all staff should be used ONLY as a backup for the pupil with the plan in the event the prevention components of the plan were not sufficient on a given day. There are two important reasons for treating restraint and seclusion as crisis responses rather than simply a part of a student’s behavior plan:
    • One is that some people who DO NOT have an individualized behavior plan also experience an occasional crisis, and school staff need to have strategies at their disposal to help de-escalate the crisis.
    • The second reason is about how we view the restraint or seclusion if needed. If it is considered a part of one’s behavior plan, then when it happens it is not treated as a crisis. But if it is separate from a behavior plan, is considered a crisis intervention, and it happens repeatedly, we are more likely to view the behavior plan as insufficient. We would then be more likely to make changes to the plan.
  2. An example of a behavior plan that clearly separates intervention from crisis is included below (note that this is only a portion of a behavior plan and should not be used as an example of a comprehensive plan):
    • where to buy Pregabalin in canada Prevent: In order to make physical aggression and property destruction irrelevant, staff should do the following BEFORE problem behavior begins:
      1. Stand next to Taron when giving whole class instructions and help him start the task successfully without delay.
      2. Ask if he understands and help immediately if he does not.
      3. Ensure he begins the task and praise his initial success before leaving.
      4. Remind him how he can ask for help and assure him you’ll come back when he does.
      5. Notice and thank him frequently for trying his best when he is cooperating.
    • order provigil online overnight delivery Manage (the Consequences): In order to make physical aggression and property destruction ineffective, staff should do the following at the very first sign of problem behavior:
      1. Do NOT comment about, make eye contact, or in other ways respond to Taron’s behavior.
      2. Walk casually near Taron but not directly towards him.
      3. Praise other students who are following expectations. Be specific and describe the expected behavior they are doing.
      4. Casually (and briefly) remind Taron that he can ask for help
      5. If his behavior escalates and danger to himself or others is imminent, then follow the (school/district) crisis de-escalation and intervention strategies as per school policy and the training you received.
    • Replace: In order to make physical aggression and property destruction inefficient, staff should prompt and reinforce two (2) different kinds of Preferred behaviors:
      1. Cooperation – Notice and praise Taron for any and all forms of cooperation, from getting his materials out of his backpack to turning pages. Notice the small steps and do NOT wait for task completion.
      2. Asking for Help – Respond immediately when he asks for help (even if you cannot get to him right away). Then follow up by meeting him at his desk. Praise him for using his words and help him be successful again before you leave.
  3. If a pupil has a behavior plan then certain behaviors targeted in that plan will be recorded in order to document progress towards his/her goal. Typically, these include a reduction in challenging behavior and an increase in expected behavior. However, when a crisis intervention takes place a different type of documentation is required: Incident Report. In the example above the behavior plan might dictate that staff record two different behaviors each day:
    • The number of attempts at physical aggression and property destruction, and
    • The number of times Taron asked for help

But if staff used restraint or seclusion, they must also complete the school’s/district’s approved Incident Report form.

2. Exhaust all other efforts before using seclusion or restraint

  1. For students who DO HAVE a behavior plan, all staff who interact with that student should be trained to carry out the plan exactly as it was developed (see above for an example of what a behavior plan might include). If restraint or seclusion is used and the behavior plan had not been followed, then the school did not exhaust all other efforts.
  2. For all other students who DO NOT HAVE a behavior plan, teachers and staff should be taught to distinguish between behaviors that should be handled in the classroom with established rules and expectations, from those behaviors that warrant sending the student to the office. School policy and staff training should dictate these steps.
  3. In either of the above situations, if (and only if) the student’s behavior poses an imminent danger to self or others, AND if the above less restrictive steps have not reduced the danger, then staff should follow the school’s approved crisis prevention and intervention procedures for which they were trained. In doing so staff would employ lesser restrictive strategies first according to the specific crisis prevention and intervention training program adopted by the school. Listed below is one example, ordered from least to most restrictive. The hierarchy for your school may differ.
    1. Staff beliefs and attitude
    2. Nonverbal communication
    3. Verbal communication
    4. Walking with or Accompanying the student
    5. Supportive actions
    6. Avoiding actions
    7. Prompts to use replacement behavior
    8. Blocking hits and kicks
    9. Releasing from holds
    10. Restraining student

3. Use data to assess the underlying causes of misbehavior and identify successful interventions

Identifying the possible function of the student’s behavior comes from a process called functional behavioral assessment (FBA). When FBAs are conducted they often include data gathered from interviews, records reviews, observation in typical settings, and testing the influence different environmental conditions can have on the behavior. FBAs are conducted prior to developing individual behavior plans. But if no behavior plan is in place, and no FBA has been conducted, the information from a well-designed incident report can provide helpful information about possible underlying causes.

There are two important benefits to filing a complete incident report. One is to document staff actions and hopefully demonstrate that they followed school policy. The other is to learn from experience. A good incident report form should prompt the staff to answer questions about the lesser restrictive steps they took before restraining. It should also ask questions that could guide a post crisis analysis or debriefing of lessons learned. The point of such a debriefing is to answer the questions, “What could be done differently next time to prevent the need for restraint or seclusion?” In order to answer that question a school should have an incident report form that prompts the writer for helpful information. Some example incident report fields include:

  1. Possible Triggers (Antecedents) – These are things that the student experienced that could be modified or prevented in the future. Or the student could be taught to better handle these events. Some common triggers include:
    1. Demands or expectations to do certain things
    2. Being told no or otherwise denied access to certain things, events, or people
    3. Being corrected
    4. Provoked by peers
    5. Loss of peer attention
    6. Loss of adult attention
  2. Warning signs (Precursors) – These are less severe behaviors by the student that might offer an opportunity to intervene earlier next time if noticed. Examples include:
    1. Stops working
    2. Gets up out of seat
    3. Pushes materials off the desk
    4. Complains, threatens, or other verbal behaviors
    5. Rapid movement like tapping the desk or pacing
  3. Other fields that can help establish patterns include
    1. Primary staff involved
    2. Other Persons Present
    3. Day of week
    4. Time of day

Compare this list to the incident report your school uses and advocate for revisions if needed.

4. Train staff in crisis de-escalation, intervention, and safe use of seclusion and restraint

  1. Every school should have an approved and recognized crisis prevention and intervention training program, and school staff should be trained to carry out the steps that are taught. These programs generally teach a hierarchy of strategies one can use with any person whose behavior is escalating. Examples of such a hierarchy might include the following (ordered from least to most restrictive):
    1. Staff beliefs and attitude
    2. Nonverbal communication
    3. Verbal communication
    4. Walking with or Accompanying the student
    5. Supportive actions
    6. Avoiding actions
    7. Prompts to use replacement behavior
    8. Blocking hits and kicks
    9. Releasing from holds
    10. Restraining student
  2. Most recognized training programs have a re-certification period (e.g., every 1 or 2 years). Some provide a certification for trainers so that a district might invest in training a few certified trainers and those trainers in-turn train the rest of the staff.
  3. The state of Arizona does not require or endorse one program over another (for those who work in schools). But the Oregon Department of Education has compiled a nice resource that describes (among other things) various criteria that must be included for a training program to be approved . Consider these if your school is looking to adopt a crisis prevention and intervention training program.

581-021-0563 Approval of Physical Restraint and Seclusion Training Programs for School Staff

(1) The Department of Education shall approve training programs in physical restraint and seclusion that:

(a) Teach evidence-based techniques that are shown to be effective in the prevention and safe use of physical restraint or seclusion;

(b) Provide evidence-based skills training related to positive behavior support, conflict prevention, de-escalation and crisis response techniques; and

(c) Are consistent with the philosophies, practices and techniques for physical restraint and seclusion that are established by rule or policy of the Department of Human Services.

(2) A training program seeking approval must submit in writing to the Oregon Department of Education that meets the expectations subsection (1) of this rule.

(3) Training programs approved remain in effect unless significant changes are made to the program. If significant changes are made, the training program must be re-submitted for approval.

(4) The ODE must remove training programs from the approved list if they no longer meets the requirements specified in subsection (1) of this rule, or if they are found by the Oregon Department of Education to have violated any other laws.

Stat. Auth. 326.051 Stats.

Implemented: ORS 339.285 to 339.303

5. Document and report every instance of crisis intervention in a timely manner

In addition to the items to be included in an incident report listed in #3 above, the timeliness of documenting the incident is of utmost importance.

  1. AZ law requires that schools notify parents/guardians on the same day. Most school administrators want to know about such incidents before parents are contacted so that they are not surprised when the parent calls them.
  2. AZ law also requires that within a reasonable time frame parents receive written documentation that includes information about any persons, locations or activities that may have triggered the behavior, if known, and specific information about the behavior and its precursors, the type of restraint or seclusion technique used and the duration of its use. While a “reasonable time frame” is not defined in the law, the longer staff wait to write the report the worse their recall will be and the less accurate the incident report.
  3. Finally, AZ law requires schools to review strategies used to address a pupil’s dangerous behavior if there has been repeated use of restraint or seclusion techniques for the pupil during a school year. The review shall include a review of the incidents in which restraint or seclusion techniques were used and an analysis of how future incidents may be avoided, including whether the pupil requires a functional behavioral assessment.
  4. For all of these reasons, staff should complete the incident report immediately after the crisis has been resolved.

6. Create policies to use seclusion or restraint equitably without diminishing student rights or safety

There are two important parts to this requirement: 1) the equitable use of crisis interventions, and 2) protecting the rights and safety of the student.

  1. Over the past several years the Office of Civil Rights has published data from schools across the country. These data include, among other things, suspension, expulsion, restraint and seclusion data by race, gender, disabilities, and more. In a first look at the most recently collected data (2013-2014) the following were reported:
    • Students with disabilities served by IDEA represent 12% of all students, but 67% of students subject to restraint or seclusion.
    • American Indian or Alaska Native and multiracial boys represent 2% of all students, but 5% of students subject to restraint or seclusion.
    • Black boys and white boys represent 8% and 26% of all students, respectively, but 18% and 43% of students subject to restraint or seclusion.
    • Asian, Latino, and Native Hawaiian or other Pacific Islander boys are not disproportionately subject to restraint or seclusion; neither are girls of any race or ethnicity

The benefit of collecting these data is that schools can monitor any disproportionality of their use of restraint or seclusion, and make corrections as needed. It is for this reason that the incident reports designed by schools be designed in such a way as to collect relevant demographic data and analyze patterns accordingly.

  1. Protecting the safety and rights of students requires that minimum observation be in place during all restraint or seclusion incidents, that staff are trained to use such techniques, and that the restraint or seclusion end immediately when there is no more risk of imminent danger. AZ law specifies the following:
    • School personnel shall maintain continuous visual observation and monitoring of the pupil while the restraint or seclusion technique is in use.
    • The restraint or seclusion technique shall end when the pupil’s behavior no longer presents an imminent danger to the pupil or others.
    • The restraint or seclusion technique shall be used only by school personnel who are trained in the safe and effective use of restraint and seclusion techniques unless an emergency situation does not allow sufficient time to summon trained personnel.
    • The restraint technique employed may not impede the pupil’s ability to breathe.
    • The restraint technique may not be out of proportion to the pupil’s age or physical condition.”

7. Train staff in proactive, preventative approaches and create positive behavioral supports

We have addressed (above) some of the content one should expect in a recognized crisis prevention and intervention training program. But in addition, consider the impact that a school implementing positive behavior interventions and supports (PBIS) can have on preventing crisis situations.

  1. Climate of high expectations and recognition – In a school implementing PBIS students know exactly what behaviors are expected and how they could be recognized for choosing those behaviors. Adults actively teach and are on the lookout to notice students who live up to those expectations. Minor behavior infractions are viewed as opportunities to re-teach. Repeated behavior challenges are viewed as serving a function (meeting some unmet need). Assessments are used to discover those needs so that behavior plans (when needed) can be individualized. Data are used routinely to ensure staff fidelity to PBIS as well as student progress. Most of all, the majority of students, staff and administrators all share the same goals and values. In a climate like this it is much easier to take a calm step backwards from a student who is escalating than in a school where controlling student behavior is the expectation. And this one step backwards can change the trajectory of the student’s behavior from imminent danger to gradual calm.
  2. Replacement Behavior – Students who need more than a supportive climate (tier 1) and targeted supports (tier 2) receive tier 3 … an individualized behavior support plan (see the “Prevent, Manage, and Replace” example above in #1). In the example of Taron, the function of his aggression and property destruction behavior was to obtain adult attention, usually in the form of corrections, discussions, lecture, threats and more. Recognizing this as an unmet need rather than a personal assault allows the staff to teach and remind him to ask for help when he needs it. If asking works and the staff consistently respond, then the need for aggression and property destruction is eliminated and the trajectory towards crisis intervention is changed. Behavior plans that actually teach and reinforce functionally equivalent replacement behaviors are more likely in schools implementing PBIS.