c MODULE Behavior Management Positive Reinforcement PointLevel Systems

c MODULE: Behavior Management Positive Reinforcement, Point/Level Systems, Token Economies, Time -Out procedures, Suspensions and Terminations, Restraint Procedures (including de-escalation methods), Valley’s Bullying Prevention and Intervention Plan

Agenda ● Purpose and Definitions ● Tips on Avoiding the restraint ● Training and Proper Administration of Physical Restraint ● Reporting and Data Review

Caution � This presentation provides an overview of the regulatory requirements for the use of physical restraint, but does not iterate all of the detail in the regulations. � All school staff should read and be familiar with the regulations. � This presentation does not substitute for a careful reading of the full regulatory requirements.

Purpose of 603. CMR 46. 00 The Purpose of this restraint law is to ensure that students are free from unreasonable use of Physical Restraint.

Read the Regulations ● 603 CMR 46. 00 -- these regulations apply to all public education programs including school events and school sponsored activities. Lack of knowledge of the law will not protect you or your students from the consequences of inappropriate actions; ignorance is no excuse of the law!

PEP must have a plan… ● Each Public Educational Program (PEP) must develop a plan to respond to students that need immediate intervention. ● All staff must have a training regarding school PR policies. ● Each PEP must identify staff to participate in a 16 hour in-depth training (recommended).

Training is IMPORTANT Because… ● A safe school environment is better able to promote effective teaching and learning. ● Preparing appropriate responses to potentially dangerous circumstances helps to eliminate or minimize negative consequences. ● It is a requirement!

Key Aspect: Training & Awareness Regulation 46. 03(1&2) & 46. 04 (2) ● Annually, For ALL staff to Review: ● School restraint policy ● The school’s prevention and behavior support policy and procedures including individual crisis planning. ● Methods of prevention of need for physical restraint and alternatives to restraint. ● Types of restraint and related safety considerations ● Administering restraint in accordance with student’s needs/limitations ● Required reporting & documentation ● Identification of selected staff to serve as school wide resource in physical restraint.

Who should restrain? ❖Only staff who have received training may use approved restraint techniques, but… ❖All staff may use reasonable force to protect individuals from imminent, serious physical harm. ❖If you use PR have TWO goals in mind: 1. Only use when needed to protect a student/staff from physical harm. 2. Prevent/minimize any harm to the student as a result of the physical restraint. ❖ALWAYS, as a last resort!

Knowing the terminology: Regulation 46. 02(1&2) Physical restraint - “Direct physical contact that prevents or significantly restricts a student’s freedom of movement. ” ● Physical restraint does not include: brief physical contact to promote student safety, providing physical guidance or prompting when teaching a skill, redirecting attention, providing comfort, or a physical escort. ● Physical Escort● “ 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 who is agitated to walk to a safe location. ”

Other Terminology: Regulation 46. 02(3, 4 & 5) ● Medication Restraint - 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. ● Mechanical Restraint – the use of any device or equipment to restrict a student’s freedom of movement. The term does not include: a) Devices implemented by trained school personal, or utilized by a student. b) That have been prescribed by an appropriate medical or related services professional; and c) Are used for the specific and approved positioning or protective purposes for which such devices were designed. ● Seclusion Restraint – The involuntary confinement of a student alone in a room or area from which the student is physically prevented from leaving. Don’t do it.

Other Terminology: Regulation 46. 02(6) ● Consent: Consent shall mean agreement by a parent who has been fully informed of all information relevant to the activity for which agreement is sought, in his or her native language or other mode of communication, that the parent understands and agrees in writing to carrying out of the activity, and understands that the agreement is voluntary and may be revoked at any time. The agreement describes the activity and lists the records (if any) which will be released and to whom. In seeking parental consent, a public education program shall not condition admission or continued enrollment upon agreement to the proposed use of any restraint. ● Such consent will be required for: a) Prone restraint b) Medication restraint (“Authorized”) c) Release of records

Other Terminology: Regulation 46. 02(7) ● Time-Out shall mean a behavioral support strategy developed pursuant to 603 CMR 46. 04 (1) in which a student temporarily separates from the learning activity or the classroom, either by choice or by direction from staff, for the purpose of calming. During time-out a student must be continuously observed by a staff member. Staff shall 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. Time-out shall cease as soon as the student has calmed. a) Principal must give approval for time-out to continue longer than 30 minutes if the student is still agitated.

Other Terminology: Regulation 46. 02(7) ● Prone Restraint-shall mean 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. a) Only permissible as part of pre-established emergency plan, consented to by parents, and approved by Principal.

Use of Restraint Regulation 46. 03(1) ● Physical Restraint shall be considered an emergency procedure of last resort and shall be prohibited in public education programs except when: a) A student’s behavior poses a threat of assault, or imminent, serious, physical harm to self or others and b) The student is not responsive to verbal directives or other lawful and less intrusive behavior interventions, or c) Such interventions are deemed to be inappropriate under the circumstances.

Use of Restraint Regulation 46. 03(2) ● Physical Restraint may not be used under the following circumstances: a) As a means of discipline or punishment; b) As a response to property destruction, disruption of school order, a student’s 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 c) If the student cannot be safely restrained because it is medically contraindicated (asthma, seizures, a cardiac condition, obesity, bronchitis, communication-related disabilities, or risk of vomiting”) d) Physical Restraint may not be included in a written BIP or IEP as a standard response to any behavior.

Use of Restraint Regulation 46. 03 (3) ● Prone Restraints may only be used on an individual student basis under the following, limited circumstances: a) The student has a documented history of repeatedly causing serious self-injuries and/or injuries to other students or staff; b) All other forms of physical restraints have been unsuccessful; c) There are no medical contraindications as documented by a licensed physician; d) There are no psychological or behavioral contraindications, as documented by a licensed mental health professional; e) Written, parental consent has been obtained to use prone restraint in an emergency f) Principal’s approval of such emergency use in writing, and g) All of the above has been documented in advance by the program.

For Selected Staff: In-Depth Training - Contents Regulation 46. 03 & 46. 04 (4) ● Prevention techniques ● Identifying Specific dangerous behaviors ● Experience in restraining and being restrained ● Demonstration of learned skills ● Recommended 16 hours ● Instruction on the impact physical restraint has on the student and family

What is the definition of physical restraint? A Brief physical contact to promote student safety B A bear hug to hold a student who is aggressive C Direct physical contact that prevents or significantly restricts a student’s freedom of movement D A physical escort

What is the definition of physical restraint? A Brief physical contact to promote student safety B A bear hug to hold a student who is aggressive C Direct physical contact that prevents or significantly restricts a student’s freedom of movement D A physical escort INCORRECT – Please try again

What is the definition of physical restraint? A Brief physical contact to promote student safety B A bear hug to hold a student who is aggressive C Direct physical contact that prevents or significantly restricts a student’s freedom of movement D A physical escort CORRECT

True or False: When a student becomes a threat to self or others you can use a seclusion restraint? True False

True or False: When a student becomes a threat to self or others you can use a seclusion restraint? True False INCORRECT – Please try again

True or False: When a student becomes a threat to self or others you can use a seclusion restraint? True False CORRECT

Agenda ✓Purpose and Definitions ➢Tips on Avoiding the restraint ➢Training and Proper Administration of physical restraint ➢Reporting and data Review

Verbal Escalation ➢ Questioning ➢ Refusal ➢ Release ➢ Intimidation ➢ Tension Reduction

Managing Behavior Anxiety ◦ Remove the trigger. ◦ Use a behavior management techniques ● Aggression ◦ See above 1. Identify Emotions 2. Set a limit 3. Give a reason 4. “Act Calm” ●

Positive Reinforcement, Point/Level Systems and Token Economies Positive Reinforcement - Is anything that increases the likelihood of a behavior occurring again. ● Delivered immediately after behavior ● Is individualized ● If not working team needs to reassess what is motivating for individual. ● Needs to be behavior targeted specific Example: “Good Job” WRONG Approach “Good job completing your classwork quietly”

Avoiding the Restraint ● Managing the Environment ● Prompting ● Proximity (Leg Length Away) ● Caring Gesture ● Hurdle Help ● Redirection ● Planned Ignoring-Positive Attention ● Directive Statements ● Time Away/Time Out

Avoiding the Restraint ♦ Very clear expectations ♦ Be consistent, but be flexible ♦ Lots of prompting ♦ Relationships matter ♦ Avoid Power Struggles ♦ If the class is having problems, look at your structure ♦ If a child is having problems, alter programming for the child ♦ Be self-reflective

Help Students Manage Their Emotions Do’s & Don’ts ❖ Don’t : tell them to “Calm down” when starting the discussion. ❖ Instead: try “I can see that you are upset. Let’s talk about it. ” ❖ This way is more respectful, and more likely to help the student “calm down”.

Help Students Manage Their Emotions Do’s & Don’ts ❖ Don’t belittle or minimize the problem: -Argue/blame/give orders lecture/defend another Don’t touch without permission! ❖ Instead: Present a non-threatening appearance -Sitting -Actively listening -Asking questions -Make eye contact

Help Students Manage Their Emotions Do’s & Don’ts ❖ Do let the student “VENT” -Listen sympathetically: leaning forward, giving eye contact, nodding in recognition of what’s said. (showing we’re listening, not necessarily agreeing). -Ask the student to explain vague/confusing complaints. -Write down or repeat what was said.

Help Students Manage Their Emotions Do’s & Don’ts ❖ DO help the student devise possible solutions: -Writing down or repeating suggestions. -Provide a dignified way out of situation. (I have to check the hallway or parking lot. Would you like to walk along with me? )

Follow-Up Procedure: Prevention/Learning from the Experience Regulation 46. 05 (5) (e) ● Following every restraint action taken, the circumstances should be discussed with the student, and with others, as appropriate. ● Ask: “How can we avoid this from happening again? ”

COPING • Control (back in physical & Emotional Control) • Orient (To the facts or Kids POV) • Patterns (help the kid see trends) • Investigate (alternatives to the behavior) • Negotiate (a contract) • Give (them power back or de-brief)

What if… ● You have used EVERY possible means to deescalate the situation but…. ● You continue to move down the verbal escalation scale towards tension reduction and… ● You have to restrain to protect yourself, others or the child then… ● Make certain to follow the regulations.

Questioning, refusal, release, intimidation are the first five steps of the Verbal Escalation Continuum. What is the fifth step? A Pacing B Tension Reduction C Exercise D Agitation

Questioning, refusal, release, intimidation are the first five steps of the Verbal Escalation Continuum. What is the fifth step? A Pacing B Tension Reduction C Exercise D Agitation INCORRECT – Please try again

Questioning, refusal, release, intimidation are the first five steps of the Verbal Escalation Continuum. What is the fifth step? A Pacing B Tension Reduction C Exercise D Agitation CORRECT

What does the “N” stand for in the acronym COPING (C-control, O-orient, P-patterns, I-investigate, N-? , G-give) A Nightmare B Nantucket C Negotiate D Nightingale

What does the “N” stand for in the acronym COPING (C-control, O-orient, P-patterns, I-investigate, N-? , G-give) A Nightmare B Nantucket C Negotiate D Nightingale INCORRECT – Please try again

What does the “N” stand for in the acronym COPING (C-control, O-orient, P-patterns, I-investigate, N-? , G-give) A Nightmare B Nantucket C Negotiate D Nightingale CORRECT

True of False: You don’t need your principal’s approval to perform an Extended Restraint? True False

True of False: You don’t need your principal’s approval to perform an Extended Restraint? True False INCORRECT – Please try again

True of False: You don’t need your principal’s approval to perform an Extended Restraint? True False CORRECT

Agenda ✓ Purpose and Definitions ✓ Tips on Avoiding the restraint ➢ Training and Proper Administration of Physical Report ➢ Reporting and Data Review

Policy and Procedures; Training Regulation 46. 04(1, 2&3) Every PEP must have these procedures in place: 1) Methods for preventing student violence, self-injurious behavior, and suicide, including individual crisis planning and de-escalation of potentially dangerous behavior occurring among groups of students or with an individual student; 2) Methods for engaging parents in discussions about restraint prevention and the use of restraint solely as an emergency procedure; 3) A description and explanation of the program’s alternatives to physical restraint and method for physical restraint emergency situations;

Policy and Procedures; Training Regulation 46. 04(4, 5, 6&7) 4) A statement prohibiting: medication restraint, mechanical restraint, prone restraint unless permitted pursuant to 603 CMR 46. 03 (1) (b), seclusion and the use of physical restraint in a manner inconsistent with 603 CMR 46. 00; 5) A description of the program’s training requirements, reporting requirements, and follow-up procedures; 6) A procedure for receiving and investigating complaints regarding restraint practices; 7) A procedure for conducting periodic review of data and documentation on the use of physical restraints on the individual students and school-wide.

Policy and Procedures; Training Regulation 46. 04(8, 9&10) 8) A procedure for implementing the reporting requirements; 9) A procedure for making reasonable efforts to orally notify a parent of the use of restraint on a student within 24 hours of the restraint, and for sending written notification to the parent within three school working days following the use of restraint; 10) A procedure for the use of time-out that includes a process for obtaining Principal’s approval of time-out for more than 30 minutes based on the individual’s student's continuing agitation.

Proper Administration of Physical Restraint Regulation Section 46. 05 ● ● Remember training considerations. Have an adult witness if possible. Use only the amount of force necessary to protect the student or others. Use the safest method. Do not use floor or prone restraints unless you have received indepth training –for prone, all required steps must be completed beforehand. ● Discontinue restraint ASAP or if the student indicates that s/he cannot breathe.

Proper Administration of Physical Restraint Regulation Section 46. 05 ● Physical restraints must be terminated as soon as the student is no longer an immediate danger to himself or others, or the student indicates that he or she cannot breathe, or if the student is observed to be in severe distress (i. e. , difficulty breathing, sustained or prolonged crying or coughing) ➢ If the student is restrained for longer than 20 minutes, staff must obtain approval of Principal, based on student’s continued agitation.

Do not use physical restraint Regulation 46. 03 (2) & 46. 03 (3) � When non-physical interventions could be used. � As a standard response for any student. � As a means of discipline or punishment. � When a student can not be safely restrained including medical contraindications. � As a response to property destruction, school disruption, refusal to comply, or verbal threats.

Safety Requirements Regulation 46. 05 (5) ● Make sure student is able to breathe and speak. If the student indicates that s/he cannot breathe restraint must be stopped. ● Monitor physical well-being, respiration, skin temperature, and color. ● If student experiences physical distress -- release restraint and seek medical assistance immediately. ● Know students’ medical and psychological limitations and behavior intervention plans, including known or suspected trauma history.

Extended Restraint Regulation 46. 02(1) & 46. 05 (5) (c) ➢ Longer than 20 minutes. ➢ Increases the risk of injury. ➢ Requires approval of the principal prior to the restraint exceeding 20 minutes. ➢ Requires additional written documentation and report to the Department of Elementary and Secondary Education.

Signs of stress during restraint ● Signs of physiological distress: ➢ Shock, seizure, vomiting, urinating/defecating, bleeding, marked change in complexion, saying “I can’t breath”. ➢ STOP IMMEDIATELY!!! ● Physiological distress as a direct result of restraint can include: ➢ Agitation, asphyxiation, pain, injury, and even death. ● Minimize physiological distress by avoiding pressure on: ➢ Chest, abdomen, below shoulders, joints, and neck.

When should you not use a physical restraint? A When non-physical interventions could be used B As a standard response for any student C As a means of discipline or punishment D When a student cannot be safely restrained including medical contraindications. E As a response to property destruction, school disruption, refusal to comply, or verbal threats F All of the above

When should you not use a physical restraint? A When non-physical interventions could be used B As a standard response for any student C As a means of discipline or punishment D When a student cannot be safely restrained including medical contraindications. E As a response to property destruction, school disruption, refusal to comply, or verbal threats F All of the above INCORRECT – Please try again

When should you not use a physical restraint? A When non-physical interventions could be used B As a standard response for any student C As a means of discipline or punishment D When a student cannot be safely restrained including medical contraindications. E As a response to property destruction, school disruption, refusal to comply, or verbal threats F All of the above CORRECT

Agenda ✓ Purpose and definitions ✓ Tips on Avoiding the restraint ✓ Training and Proper Administration of Physical Restraint ➢ Reporting and Data Review

Key Reporting Requirements Regulation Section 46. 06 ● When to Report: Report any restraints or in any case of an injury (to student or staff). ● Notify School Administration: Notify school administration as soon as possible, & provide A written report by the next school working day. ● Notify Parents: The principal or director of the program notifies the parent, verbally as soon as possible, and by written report within 3 school working days. ● Parents/Student: must have opportunity to comment orally and in writing on 1) the use of the restraint and 2) the information in the report.

Content of Written Report Regulation 46. 06 � Who was restrained? Who participated in the restraint? Observers? Who � � � was informed and when? If longer than 20 minutes the name of the principal or designee who approved the continuation. When did the restraint occur? (date/time) Describe the restraint, What was happening before, during, and after the restraint? Describe alternative efforts attempted and the outcomes of those efforts. What behavior prompted the restraint? Documentation of any injury to students or staff. Has the school taken, or will it take, any further actions, including disciplinary consequences?

Key Data Keeping Aspect: Ongoing Log Regulation 46. 06 ➢ School Principal/Designee maintains a 30 day log of all reported incidents of physical restraint in the school. a) Principal shall conduct a weekly review of restraint data to identify any students who have been restrained multiple times during the week. b) If such student(s) are identified, Principal shall convene a review team to assess the student(s)’s needs.

Key Data Keeping Aspect: Ongoing Log Regulation 46. 06 C) At minimum, the review teams’ assessment must include: 1) 2) 3) 4) 5) Written Reports of restraints Parent/student comments on such reports, if any Analysis of circumstances leading up to each restraint Factors that may contributed to escalation of behavior A written plan of action to reduce or eliminate future use of restraint. D) Administrative review Principal shall conduct a monthly review of school-wide restraint data to consider patterns and determine whether modifications to the school’s policies, additional staff training, or other action are appropriate to reduce restraints.

Reporting to the Department of Elementary and Secondary Education Regulation 46. 06 ● Any time there is an injury. ● Send report within 3 school working days of restraint. Include log for 30 day period prior to restraint. ● PEP will be required to collect and annually report data on the use of physical restraints across the program.

For further information please visit: http: //www. doe. mass. edu/lawsregs See 603 CMR 46. 00

True of False: We have to send a report to DESE any time there is an injury to a student during a restraint? True False

True of False: We have to send a report to DESE any time there is an injury to a student during a restraint? True False INCORRECT – Please try again

True of False: We have to send a report to DESE any time there is an injury to a student during a restraint? True False CORRECT

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