**JKAA-R - PHYSICAL RESTRAINT** **Last Updated Date:** 05/27/2014 **Adoption Date:** 01/10/2006 **Revision History:** 01/05/2016,03/05/2018 **School District General Policy** It is the policy of the district to use physical restraint only in emergency situations of last resort, after other lawful and less intrusive alternatives have failed or been deemed inappropriate, and with extreme caution.  In accordance with this policy, physical restraint shall only be used by employees who have received the necessary training under 603 CMR 46.04(2) or 603 CMR 46.04(3).  Employees shall use physical restraint with two goals in mind: 1. To administer a physical restraint only when needed to protect a student and/or a member of the school community from assault or imminent, serious, physical harm; and 2. To prevent or minimize any harm to the student as a result of the use of physical restraint. Program staff shall review and consider any known medical or psychological limitations, known or suspected trauma history, and/or behavioral intervention plans regarding the use of physical restraint on an individual student. **What Constitutes Physical Restraint?** Physical restraint is direct physical contact which prevents or significantly restricts a student’s freedom of movement.   Physical restraint does not include:  brief physical contact to promote safety, providing physical guidance or prompting when teaching a skill, redirecting attention, providing comfort, or a physical escort.  Physical Escort Not a Restraint- A physical escort, defined as a temporary touching or holding, without the use of force, of the hand, wrist, arm, shoulder, or back for the purpose of inducing a student that is agitated to walk to a safe location, is not considered to be a physical restraint.  Permitted physical escorts include guiding a student to time-out (if the student is not fighting the re-direction against his/her will), redirecting students by a busy road, or grabbing a student who is about to fall, or breaking up a fight between students. **Who May be Involved in Physical Restraint?** Only staff members who have received training in the use of physical restraint as a member of program staff, or staff members who have received in-depth training as a school-wide resource can administer physical restraint.  **When is the Use of Physical Restraint Appropriate?** The use physical restraint is appropriate only in emergency situations of last resort after other lawful and less intrusive alternatives have failed or been deemed inappropriate.  In all instances physical restraint must be conducted with extreme caution.  Whenever possible, physical restraint must be witnessed by at least one person who is not participating in the restraint.             Emergency Situations- The student represents an imminent danger to self or others. Last Resort- Other methods of de-escalation or behavior support have been unsuccessful, or would be inappropriate. **When is the Use of Physical Restraint Prohibited?** Physical restraint may not be used in any of the following circumstances: 1. Punishment- Physical restraint as a means of punishment is strictly prohibited. 2. Student Medical Safety Concerns- Physical restraint shall not be used where it cannot be safely implemented because of medical conditions (such as asthma, seizures, a cardiac condition, obesity, bronchitis, communication-related disabilities, or risk of vomiting). 3. Student Misbehavior Not Resulting in Assault or Imminent, Serious, Physical Harm- Physical restraint may not be used in response to a destruction of property, disruption of school order, refusal to comply with a public education program rule or staff directive, or verbal threats when those actions do not constitute a threat of assault, or imminent, serious physical harm. 4. Physical Restraint as a Standard Response - Physical restraint may not be used as a standard response.  Employees are required to engage in positive behavioral interventions.  No written behavioral or individualized educational program (IEP) may include the use of physical restraint as a standard response to any behavior.* ***Note**: Teams must be proactive at IEP meetings to remove references to the use of restraints                which were permitted prior to January 1, 2016.  **What Amount of Force May be Used When Physical Restraint is Appropriate?** When the use of physical restraint is appropriate, properly trained employee(s) shall only use the amount of force reasonably necessary to protect a student or another member of the school community from assault or from imminent, serious, physical harm. **What Safety Procedures are required in the Use of Physical Restraint?** The use of physical restraint shall be done in the safest method available and appropriate to the situation in a manner to prevent or minimize physical harm.  Physical restraint shall not be administered in a manner in which the student is prevented from breathing or speaking.  During the restraint a staff member must continuously monitor the physical status of the student, including skin temperature and color, and respiration.  If, at any time during a physical restraint, the student expresses or demonstrates significant physical distress including, but not limited to, difficulty breathing, the student shall be released from the restraint immediately, and school staff shall take steps to seek medical assistance. **What Types of Physical Restraint and Separation Techniques are prohibited?** The use of mechanical restraint, medication restraint, and seclusion are prohibited in all instances.  The use of prone restraint is generally prohibited. Mechanical restraint-Mechanical restraint is defined as the use of any device or equipment to restrict a student’s movement.  Medication restraint- Medication restraint is defined as the administration of medication for the purpose of temporarily controlling behavior.  Medication prescribed by a licensed physician and authorized by the parent for administration in the school setting is not medication restraint. Seclusion- Seclusion is defined as the involuntary confinement of a student alone in a room or area from which the student is physically prevented from leaving.  Prone Restraint**-** As indicated above, the use of prone restraint is generally prohibited.  Prone restraint is a physical restraint in which a student is placed face down on the floor or another surface, and physical pressure is applied to the student’s body to keep the student in the face down position. Prone restraint is prohibited, except when all of the following criteria are met: - the student has a documented history of repeatedly causing serious injury to self or others; - all other forms of restraint have been unsuccessful in ensuring safety; - there are no medical contraindications as documented by a licensed physician; - there is psychological or behavioral justification with no psychological or behavioral contraindications as documented by a licensed mental health professional; - the program has obtained consent from the parent to use prone restraint in an emergency, and the consent has been approved in writing by the principal; - the program has documented all of the above in advance of the use of prone restraint. **How Long May the Physical Restraint Continue?** Any use of physical restraint shall end as soon as the student is no longer an immediate danger to him/herself and/or others. Principal Approval Required for Restraints In Excess of Twenty (20) Minutes- If a student is restrained for a period longer than twenty (20) minutes, program staff shall obtain the approval of the principal.  The approval shall be based upon the student’s continued agitation during the restraint justifying the need for continued restraint.  **What is the Difference between Seclusion and Time-Out?** Seclusion occurs when a student who is left alone with no staff present or immediately available in an area where the student is prevented from leaving.  Seclusion is not permitted under any circumstances. Time-outs are a permitted behavioral support strategy.  Time-outs involve a temporary separation of a student from learning activities or from the classroom, either by choice or by direction of staff for the purpose of calming.  Time-outs must end as soon as the student has calmed.  If time-outs are used as a behavioral support strategy, there must be a procedure in place for the use of time-outs that includes a process for obtaining principal approval for time-outs of more than thirty (30) minutes.  During a time-out the student must be continually observed by staff member(s).  Staff member(s) must be with the student or immediately available to the student at all times. The space used for time-out must be clean, safe, sanitary, and appropriate for the purpose of calming. **What Notification is Required Following the Use of Physical Restraint?** Employee Notification to Principal- Employees who administered restraint are required to verbally inform the principal as soon as possible, and submit a written report no later than the next school day.  Parent Notification- The principal or director of pupil services, or his/her designee, will make reasonable efforts to verbally notify the student’s parents of the physical restraint within twenty-four (24) hours of the event.  A written report will be sent to the parents/guardians within three (3) school days by an email provided to the school by the parent/guardian or postmarked within three (3) school days by regular mail. If the parent/guardian receives school-related information in a language other than English, the written report shall be provided in such non-English language.  The student and parents/guardians shall have the right to respond to the use of physical restraint as well as the content of the report verbally or in writing. **What Must be Included in the Written Report to Parents/Guardians Following a Restraint?** The written report to parents within three (3) school days must include the following: 1) The name of the student; the names and job titles of the staff who administered the restraint, and observers, if any; the date of the restraint; the time the restraint began and ended; and the name of the principal or designee who was verbally informed following the restraint; and, as applicable, the name of the principal or designee who approved continuation of the restraint beyond 20 minutes pursuant to 603 CMR 46.05(5) (c). 2) A description of the activity in which the restrained student and other students and staff in the same room or vicinity were engaged immediately preceding the use of physical restraint; the behavior that prompted the restraint; the efforts made to prevent escalation of behavior, including the specific de-escalation strategies used; alternatives to restraint that were attempted; and the justification for initiating physical restraint. 3) A description of the administration of the restraint including the holds used and reasons such holds were necessary; the student's behavior and reactions during the restraint; how the restraint ended; and documentation of injury to the student and/or staff, if any, during the restraint and any medical care provided. 4) Information regarding any further action(s) that the school has taken or may take, including any consequences that may be imposed on the student. 5) Information regarding opportunities for the student's parents to discuss with school officials the administration of the restraint, any consequences that may be imposed on the student, and any other related matter. **What Action Other than the Written Report is Required Following a Restraint?** The district is required to take certain follow up procedures in addition to the report.  The follow-up procedures required are dependent upon whether the student was restrained once over the course of a week, or was restrained multiple times over the course of the week. Single Restraint of Student in the Course of a Week- After the release of a student from a restraint, the district shall review the incident with the student to address the behavior that precipitated the restraint, review the incident with the staff person(s) who administered the restraint to discuss whether proper restraint procedures were followed, and consideration of whether any follow-up is appropriate for students who witnessed the incident. Multiple Restraints of Student in the Week- The principal is required to conduct weekly reviews of restraint data.  If the principal identifies a student or student(s) who have been identified as being restrained multiple times during the course of the week, the principal shall convene a team to assess the restrained student’s progress and needs.  This assessment shall include at least the following: 1)   review and discussion of the written reports and any comments provided by the student and parent about such reports and the use of the restraints; 2)   analysis of the circumstances leading up to each restraint, including factors such as time of day, day of the week, antecedent events, and individuals involved; 3)   consideration of factors that may have contributed to escalation of behaviors,  consideration of alternatives to restraint, including de-escalation techniques and possible interventions, and such other strategies and decisions as appropriate, with the goal of reducing or eliminating the use of restraint in the future;  4)   agree on a written plan of action by the program. *Note- If the principal directly participated in the restraint, a duly qualified individual designated by the superintendent or board of trustees shall lead the review team’s discussion.  The principal shall ensure that a record of each individual student review is maintained and made available for review by the Department or the parent, upon request. **Principal Monthly Review** As mentioned above, the principal is required to conduct weekly reviews to determine if any students have been physically restrained multiple times.  Additionally, the principal shall conduct a monthly review of school-wide restraint data.  This review shall consider patterns of use of restraints by similarities in the time of day, day of the week, or individuals involved; the number and duration of physical restraints school-wide and for individual students; the duration of restraints; and the number and type of injuries, if any, resulting from the use of restraint.  The principal shall determine whether it is necessary or appropriate to modify the school’s restraint prevention and management policy, conduct additional staff training on restraint reduction/prevention strategies, such as training on positive behavioral interventions and supports, or take such other action as necessary or appropriate to reduce or eliminate restraints.  **What Information Is Reported to the State Regarding the Use of Physical Restraint?** Injury reports and annual data on the use of physical restraints must be reported to the Department of Elementary and Secondary Education (Department). Injury reports- All restraint-related injuries will be reported by the District to the Department. When a physical restraint has resulted in an injury to a student or program staff member, the program shall send a copy of the written report detailed above postmarked no later than three (3) school days of the administration of the restraint.   The District shall also send the Department a copy of the record of physical restraints written reports for the thirty (30) day period prior to the date of the reported restraint.  Within thirty (30) calendar days the Department will determine if any action is warranted. Annual report**-** The District will collect data concerning every use of physical restraint and report such data to the Department on an annual basis.   Such data shall be reported in a manner and form directed by the Department.  **Staff Training Requirements** Annually, the District will conduct general staff training covering information on the role of the student, family, and staff in preventing restraint.  The training will cover the District’s restraint prevention and behavior support policy and procedures, including the use of time-out as distinct from seclusion.   Staff will be instructed in interventions that could be used to preclude the need for restraint, as well as de-escalation techniques and other alternatives.  Staff will also receive information on the types of permitted physical restraints and related safety considerations, including medical or psychological limitations, known or suspected trauma history.  Staff who have received or will receive in-depth training and who can serve as resources to others should be identified to the school staff as a whole.   For those staff members who will receive in-depth training, the Department recommends that the training in the use of physical restraint be at least 16 hours and include an annual refresher training.  Such training must include at least the following: •     Appropriate procedures for preventing the use of physical restraint, including the de-escalation of problematic behavior, relationship building and the use of alternatives to restraint; •     A description and identification of specific dangerous behaviors on the part of students that may lead to the use of physical restraint and methods for evaluating the risk of harm in individual situations in order to determine whether the use of restraint is warranted; •     The simulated experience of administering and receiving physical restraint, instruction regarding the effect(s) on the person restrained, including instruction on monitoring physical signs of distress and obtaining medical assistance; •     Instruction regarding documentation and reporting requirements and investigation of injuries and complaints; •     Demonstration by participants of proficiency in administering physical restraint; and, •     Instruction regarding the impact of physical restraint on the student and family, recognizing the act of restraint has impact, including but not limited to psychological, physiological, and social-emotional effects. **Procedures for Receiving and Investigating Complaints** Before initiating a formal complaint procedure, a student or his/her parent/guardian who has concerns regarding a specific use of a physical restraint, may seek to resolve his/her concerns regarding specific use of a physical restraint by raising the issue with the principal. The student and/or his/her parent/guardian should direct their concerns regarding a specific use of a physical restraint to the principal within ten (10) days of the parent/guardian’s receipt of the written report from the school. The principal shall attempt, within his/her authority to work with the individual to resolve the complaint fairly and expeditiously.  If the student and/or his/her parent/guardian are not satisfied with the resolution, or if the student and/or his/her parent/guardian does not choose informal resolution, then the student and/or his/her parent/guardian may proceed with the formal complaint process. A student or his/her parent/guardian, who has concerns regarding specific use of a physical restraint, may seek to resolve concerns regarding a specific use of a physical restraint by submitting a written complaint to the Office of the Superintendent. The student and /or his/her parent/guardian should submit this letter to the Office of the Superintendent within twenty (20) days of the parent/guardian’s receipt of the written report from the school. The written complaint shall include (a) the name of student; (b) the name of the school where the physical restraint allegedly occurred; (c) the name of the individuals involved in the alleged physical restraint; (d) the basis of the complaint or concern; and (e) the corrective action to be sought. The Office of the Superintendent, through its designees, shall conduct an investigation into the complaint promptly after receiving the complaint. In the course of its investigation, the Office of the Superintendent and/or its designees shall contact those individuals that have been referred to as having pertinent information related to the complaint. Strict timelines cannot be set for conducting the investigation because each set of circumstances is different. The Office of the Superintendent and/or designees will make sure the complaint is handled as quickly as feasible. After completing the formal investigation, the Office of the Superintendent shall contact the individual who filed the complaint regarding the outcome of its investigation and its determination as to whether any corrective action is warranted.