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Technical Assistance & Guidelines Manual Use of Physical Restraint and Seclusion

November 2018

It is a policy of the State Board of Education and a priority of the Oregon Department of Education that there will be no  discrimination or harassment on the grounds of race, color, religion, sex, sexual orientation, national origin, age or  disability in any educational programs, activities or employment.  Persons having questions about equal opportunity and nondiscrimination should contact the Deputy Superintendent of  Public Instruction at the Oregon Department of Education, 255 Capitol Street NE, Salem, Oregon 97310; phone 503‐947‐ 5697; fax 503‐378‐5156; or TDD 503‐378 2892. 

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Table of Contents Use of Physical Restraint and Seclusion in Oregon ..................................................................................................... 3 Physical Restraint and Seclusion OARs ........................................................................................................................ 5 Use of Physical Restraint ................................................................................................................................................. 6 Physical Restraint Q&A ............................................................................................................................................. 7 Use of Seclusion ............................................................................................................................................................. 12 Seclusion Q&A.......................................................................................................................................................... 13 Use of Physical Restraint and Seclusion in Early Intervention and Early Childhood Special Education ........................................................................................................................ 19 Staff Training Requirements .......................................................................................................................................... 21 Staff Training Requirements Q&A .......................................................................................................................... 22 Documentation Requirements ....................................................................................................................................... 24 Documentation Requirements Q&A ....................................................................................................................... 25 Reporting Requirements ................................................................................................................................................ 29 Reporting Requirements Q&A ................................................................................................................................ 30 General Q&A.................................................................................................................................................................... 31 Sample Forms ................................................................................................................................................................. 33 Physical Restraint Incident Report – Option 1 ...................................................................................................... 34 Physical Restraint Incident Report – Option 2 ...................................................................................................... 39 Physical Restraint Debriefing Report ..................................................................................................................... 43 Seclusion Incident Report – Option 1 .................................................................................................................... 45 Seclusion Incident Report – Option 2 .................................................................................................................... 49 Seclusion Debriefing Report ................................................................................................................................... 52 Physical Restraint and/or Seclusion Incident Report........................................................................................... 54 Physical Restraint and/or Seclusion Debriefing Report – Condensed Version ................................................ 58 Student Incident Log ................................................................................................................................................ 59 Continuous Monitoring Form .................................................................................................................................. 60 Student Monitoring Form......................................................................................................................................... 62 Parent Notification Letter ........................................................................................................................................ 64 Administrative Approval Form ................................................................................................................................ 65 Quick Reference Guide .................................................................................................................................................. 66 Acronym Index ................................................................................................................................................................ 67

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Use of Physical Restraint and Seclusion in Oregon School districts, education service districts (ESDs) and school boards must have policies and procedures in place that comply with the laws and rules regarding physical restraint and/or seclusion. Oregon Administrative Rules 581-021-0550, 0553, 0556, 0559, 0563, and 0566 were created from HB 2939 in 2011. Physical restraint and/or seclusion can only be applied if student behavior imposes a threat to the safety of the student or the safety of others, and if other, less restrictive methods of controlling the behavior are ineffective. There are further specific rules under which physical restraint and/or seclusion may be used in public education programs. Rules include established time limits and parameters for seclusion and/or physical restraint such as access to bathrooms, water breaks, and the continuous monitoring of the situation by staff and administrators. The statute and subsequent rules also specify the following:  Parent(s)/Guardian(s) of students who are physically restrained and/or secluded are to be notified, verbally or electronically, by the end of the school day in which the incident occurred.  Parent(s)/Guardian(s) of students who are physically restrained and/or secluded must receive written documentation of the incident within twenty-four hours. • Written documentation to parent(s)/guardian(s) must include the following: • Date, time, and location of the physical restraint and/or seclusion; • Description of the student’s behavior that prompted the physical restraint and/or seclusion; • Efforts of de-escalation and the alternative methods attempted prior to the physical restraint and/or seclusion; • Name(s) of personnel which administered the physical restraint and/or seclusion; • Description of the training status of personnel involved; • Timely notification of a debriefing meeting and their right to attend. [OAR 581-021-0556(2)(b)(A-H)]

  

Within two school days after each incident of physical restraint and/or seclusion school personnel must convene a debriefing meeting to discuss and document the incident. Parent(s)/Guardian(s) must receive timely notification of a debriefing meeting to be held and of their right to attend the meeting. The notes from the meeting must be shared with the parent(s)/guardian(s). Physical restraint and/or seclusion training programs approved by the Oregon Department of Education (ODE) must meet the standards of the Department of Human Services (DHS). The training of school personnel in physical restraint and/or seclusion is required and must meet certain criteria, including being

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

grounded in evidence-based techniques and positive behavioral strategies, along with teaching de-escalation methods, prevention and crisis response. Public education programs are required to select a training program from an approved list compiled by ODE, and provide de-escalation, restraint and seclusion training to school staff working with students in public education programs. Public education programs are defined by the following: a. Are for students in early childhood education, elementary school or secondary school [OAR 581-021-0550(5)(a)]; b. Are under the jurisdiction of a school district, an ESD or another educational institution or program [OAR 581-021-0550(5)(b)]; and, c. Receive, or serve students who receive, support in any form from any program supported, directly or indirectly, with funds appropriated to ODE [OAR 581-0210550(5)(c)].



School districts and ESDs must prepare an annual report detailing the use of physical restraint and/or seclusion for the previous school year and make this report available to the public.

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USE OF PHYSICAL RESTRAINT & SECLUSION OARs OAR 581-081-0550 to 581-021-0570:

581-021-0550 Definitions - Click here

581-021-0553 Use of Physical Restraint and Seclusion in Public Education Programs - Click here

581-021-0556 Program’s Procedures Regarding Physical Restraint and Seclusion - Click here

581-021-0559 Reporting Requirements for the Use of Physical Restraint and Seclusion - Click here

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

581-021-0566 Required Use of Approved Restraint and Seclusion Programs - Click here

581-021-0568 Standards for Seclusion Rooms - Click here

581-021-0569 Use of Seclusion Cells Prohibited - Click here

581-021-0570 Complaint Procedures - Click here

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Use of Physical Restraint Physical Restraint Defined: Physical restraint is the restriction of a student’s movement by one or more persons holding the student or applying physical pressure upon the student. This does not include touching or holding a student without the use of force for the purpose of directing the student or assisting the student in completing a task or activity. Physical restraint may be used as a part of a behavior intervention plan (BIP) when other, less restrictive, interventions are deemed not effective and the student’s behavior imposes a threat of imminent, serious bodily injury to themselves or others; or In an emergency, a program administrator, teacher, program employee or volunteer may use physical restraint as necessary to prevent a student from harming themselves or others in accordance with [OAR 581-021-0553] and [OAR 581-021-0556]. Physical restraint can be used only for as long as the student’s behavior imposes a reasonable threat of imminent, serious bodily injury to themselves or others [OAR 581-021-0553(2)(A)]. Staff will continuously monitor the student’s status during physical restraint [OAR 581-021-0553(2)(C)]. Training programs or systems of physical restraints selected for use in a program must include the use of evidence-based techniques and skills training, positive behavior supports, conflict prevention, de-escalation and crisis response techniques. Only staff who are current with required training, in accordance with an approved training program, may implement physical restraint with a student, except in cases of emergency as described in [OAR 581-021-0553(B)(ii)].

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Physical Restraint Q&A 1.

Q: What does physical restraint mean? A: Physical restraint means the restriction of a student's movement by one or more persons holding the student or applying physical pressure upon the student. It does not include the touching or holding of a student without the use of force for the purpose of directing, re-directing, or prompting/assisting the student in completing a task or activity [OAR 581-021- 0550(3)(a)&(b)]. The use of chemical, mechanical and prone restraints are prohibited [OAR 581-0210553(1)].

2.

Q: When can physical restraint be used? A: Only when the student’s behavior imposes a reasonable, imminent threat of serious bodily injury to themselves or others, and less restrictive interventions have proven not to be effective.

3.

Q: Is there a time limit for how long a student can be placed in physical restraint? A: The student is physically restrained only until the student’s behavior no longer poses a reasonable threat of imminent, serious bodily injury to the student or others. If the restraint continues for more than thirty minutes, the following must occur:  The student must be provided access to the bathroom and water. This means the student is offered water and a bathroom break. If the student is still in the throes of escalated behavior, going to the bathroom at that moment may not be prudent. Staff must exercise good judgement to avoid escalating the crisis or safety risk. At every thirty-minute interval, the student must be offered water and the opportunity to use the bathroom.  Every fifteen minutes after the initial thirty minutes an administrator must provide written authorization for the continuation of the restraint, including the justification as to why it must be continued.  School personnel must immediately attempt to notify the student’s parent(s)/guardian(s), verbally or electronically.

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4. Q: Must the student be continuously monitored while being physically restrained? A: Yes. At a minimum, the staff administering the physical restraint must monitor the student’s condition, making sure the student is not being unduly harmed and is able to breathe. Whenever additional staff members are present, it is best practice to have a staff member who is not involved in the physical restraint monitoring the student’s condition at all times, including checking to ensure that the student is able to breathe, is not being unduly harmed in any way and the joints are not being overly pressured in some manner. The district is expected to follow the guidelines provided by an approved training program on the number of needed staff. Best practice often suggests at least three staff members should be present. It is suggested that one to two staff members implement the restraint and a third staff member monitors the student’s condition and coordinates staff actions. Staff should be available to trade off on the restraint, if needed, due to fatigue or other conditions. 5. Q: Is it considered physical restraint when a staff member is escorting a student out of the classroom or down the hall and has physical contact with the student by placing their hand on the student’s person, e.g. arm? A: Physical restraint means the restriction of a student's movement by one or more persons holding the student or applying physical pressure upon the student. It does not include the touching or holding of a student without the use of force for the purpose of physically re-directing/prompting the student or assisting the student in completing a task or activity [OAR 581-021-0550(3)(a)]. 6. Q: If a student calms down right away after being placed in a physical restraint is the school required to notify the student’s parent(s)/guardian(s), complete a physical restraint incident report and hold a debriefing meeting? A: Yes. Every time a student is placed in a physical restraint, the school must give the parent(s)/guardian(s) verbal or written notification by the end of the day the incident occurred. Within two days of the incident, a documented debriefing meeting by appropriate staff must occur and include all staff involved in the incident. Parent(s)/Guardian(s) need to be invited to this debriefing in a timely manner and must be provided a copy of the meeting notes [OAR 581-021-0556(4)].

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7. Q: Educational programs that are located in facilities are subject to different rules regarding the use of physical restraint and seclusion and are not subject to the previously mentioned rules. What are these programs and what regulations apply?

A: 

Educational programs located in treatment programs, juvenile detention facilities as defined in ORS 419A.004, youth correctional facilities as defined in ORS 420.005, and youth substance abuse programs are subject to different regulations regarding the use of physical restraint and seclusion.



The rules for students in treatment programs can be referred to in Health Systems Division: Behavioral Health Services - Chapter 309, Division 112, Use of Restraint for Patients in State Institutions.



Students in juvenile detention facilities or youth correctional facilities are subject to Division 490, Use of Time-Out, Room-lock Other, Isolation, Safety Programs, Physical Intervention, and Restraint in OYA Facilities.



Students placed in substance abuse programs that provide educational programs are subject to OAR 309-022-0175 Restraint and Seclusion.

The law and administrative rules surrounding restraint and seclusion applies only to students enrolled in public education programs. Public education programs are defined by the following: a) Are for students in early childhood education, elementary school or secondary school [OAR 581-021-0550(5)(a)]; b) Are under the jurisdiction of a school district, an ESD or another educational institution or program [OAR 581-021-0550(5)(b)]; and, c) Receive, or serve students who receive, support in any form from any program supported, directly or indirectly, with funds appropriated to ODE [OAR 581-021-0550(5)(c)].

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8.

Q: When physical restraint is included in a student BIP, what guidelines are used when responding to student behavior(s)?

A: When a BIP includes physical restraint as a means of responding to student behavior(s), the use of physical restraint should be initiated only if “less restrictive interventions would not be effective and the student’s behavior imposes a reasonable threat of imminent, serious bodily injury to the student or others” [OAR 581-021-0553(2)(a)(A)&(B)]. Guidelines for writing a behavior plan include, but are not limited to, the following:  Function-based;  Specific about triggers of the behavior(s);  Describes what the behavior(s) manifests as or looks like;  Specifies how staff should intervene and respond to various behavior(s) and at various stages;  Specifies how to respond with continual, less restrictive intervention(s) at various stages of escalation if needed, and;  Specifies what behavior(s) would ultimately result in physical restraint and/or seclusion after less restrictive measures have been rendered ineffective. Again, physical restraint should be implemented only as specified in [OAR 581-021-0553 (2)(a)(A)&(B)], above, and implemented by staff trained in a deescalation/physical restraint program that is approved by ODE, except in an emergency situation [OAR 581-021-0553(2)(c)(B)(i)].

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9.

Q: What would constitute mechanical restraint versus the use of adaptive equipment to assist a student with a disability? A: Mechanical restraint is prohibited in the State of Oregon and can never be used to restrain a student who poses an imminent threat of serious bodily injury to themselves or others. Protective and stabilizing devices to assist students with disabilities (i.e. - for feeding, maintaining support/posture when sitting/standing, swings to address sensory needs, etc.) do not represent mechanical restraint [OAR 581-021-0550(2)(a)&(b)]. These devices are recommended by the IEP team for providing access to FAPE for the student, and are not to be used for behavior management, physical restraint, or for the convenience of staff [OAR 581-021-0553(2)(b)]. Examples of Physical Restraint:  Restriction of a student's movement by one or more persons holding the student or applying physical pressure upon the student because there is reasonable threat of imminent, serious bodily injury to themselves or others.  The student continues to resist after the implementation of less invasive or restrictive measures and becomes escalated to the point of presenting a reasonable threat of imminent, serious bodily injury to themselves or others. [OAR 581-021-0550(3)(a)&(b)]

Examples of Non-Physical Restraint:  “Hand over Hand” prompting for instructional purposes.  Re-directing the student from a potentially dangerous situation by taking their hand or arm and gently guiding them away.  The student willingly goes when physically escorted (i.e. - holding the hand, arm around the shoulder) by a staff member.  Providing deep pressure to a student who is in need of sensory input, as per the student’s IEP.

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Use of Seclusion Seclusion Defined: The involuntary confinement of a student alone in a room from which the student is physically prevented from leaving. Seclusion does not include the removal of a student for a short period of time to provide the student with an opportunity to regain self-control if the student is in a setting from which the student is not physically prevented from leaving. Seclusion may be used as a part of a BIP when other, less restrictive interventions are not effective and the student’s behavior imposes a threat of imminent, serious bodily injury to themselves or others; or In an emergency, a program administrator, teacher, program employee or volunteer may use seclusion as necessary to prevent a student from harming themselves or others in accordance with [OAR 581-021-0553] and [OAR 581-021-0556]. Seclusion can be used only for as long as the student’s behavior imposes a reasonable threat of imminent, serious bodily injury to themselves or others [OAR 581-021-0553(2)(A)]. Staff will continuously monitor the student’s status during seclusion [OAR 581-021-0553(2)(C)]. Only staff who are current with required training, in accordance with an approved training program, may implement seclusion with a student, except in cases of emergency as described in [OAR 581021-0553(B)(ii)].

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Seclusion Q&A 1.

Q: What does seclusion mean? A: Seclusion means the involuntary confinement of a student alone in a room from which the student is physically prevented from leaving [OAR 581-021- 0550(6)].

2.

Q: What does not constitute seclusion? A: The removal of a student for a short time to provide the student with an opportunity to regain self-control, if the student is in a setting from which the student is not physically prevented from leaving. Seclusion may not be used for discipline, punishment or the convenience of personnel of the public education program.

3.

Q: Is in-school suspension (ISS) the same thing as seclusion? A: No. Seclusion means the involuntary confinement of a student alone in a room, from which the student is prevented from leaving. Students in ISS have access to staff and other students. Students in ISS are not involuntarily confined alone in a room from which they are physically prevented from leaving.

4.

Q: Is there a time limit for how long a student can be placed in seclusion? A: The student shall remain in seclusion only until the student’s behavior no longer poses a reasonable threat of imminent, serious bodily injury to the student or others. If the seclusion continues for more than thirty minutes, the following must occur: • The student must be provided access to the bathroom and water; • School personnel must immediately attempt to verbally or electronically notify parent(s)/guardian(s); and • Every fifteen minutes after the first thirty minutes, an administrator must provide written authorization for the continuation of the seclusion, including the justification as to why it must be continued.

 

 

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5.

Q: Must a student be continuously monitored while in seclusion and what does this mean? A: Yes. Continuous monitoring means that a staff member shall keep the student in full view at all times while the student remains in seclusion.

6.

Q: If a student calms down right away after being placed in seclusion is the school required to notify their parent(s)/guardian(s), complete a seclusion incident report and hold a debriefing meeting? A: Yes. Every time a student is placed in seclusion the school must give the parent(s)/guardian(s) verbal or electronic notification by the end of the school day, and written documentation within twenty-four hours [OAR 581-0210556(2)(a-b)]. Within two days of the incident, a documented debriefing meeting needs to occur, including staff involved in the seclusion. Parent(s)/Guardian(s) need to be notified of the debriefing in a timely manner and of their right to attend the meeting, and provided a copy of the debriefing documentation [OAR 581-021-0556(4)(a)].

7.

Q: What is the definition of a student being alone in a room? A: Being alone means that the student is physically separated from others, and, by the definition of seclusion, is ‘prevented from leaving’ the room. The student is alone in the room where the seclusion is occurring. There are no other students or staff in the room. The student, however, is continually visually monitored by staff.

8.

Q: Does staff need to be in the room with the student to keep them in full view or could there be a window or half door separating the student from the staff? A: The room used for seclusion must allow staff full view of the student in all areas of the room. The staff must be able to easily access and intervene with the student if needed for safety. Windows and half doors are permissible as long as the student is in full view

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8. cont.

9.

of the staff, and equally the student can see out of the room. The door must open outward and contain a port of shatterproof glass or plastic through which the entire room may be viewed from outside; half doors are acceptable options when direct visual monitoring can occur [OAR 581-021-0568(d)]. Q: What is an appropriate seclusion area/room? A: An appropriate seclusion area/room is free of potential harmful objects, such as unprotected light fixtures, electrical outlets and items that could be used as weapons. It must be an area/room that will ensure the safety of the student and all involved. The area/room must not be isolated from the school staff of the facility. The main feature defining seclusion is that the student is alone in an area/room and is physically prevented from leaving the area/room. See seclusion room standards and specifications [OAR 581-021-0568].

10.

Q: What are the standards for rooms used for seclusion? A: The standards for seclusion rooms are:  Any wall that is part of the room used for seclusion must be part of the structural integrity of the room (not free standing cells or portable units attached to the existing wall or floor), and must be no less than sixty-four square feet;  The room must not be isolated from school staff of the facility;  Doors must be unlocked or equipped with immediate-release locking mechanisms;  The door must open outward and contain a port of shatterproof glass or plastic through which the entire room may be viewed from outside; half doors are acceptable options when direct visual monitoring can occur;  The room must not contain protruding, exposed, or sharp objects;  The room must not contain free standing furniture;  Windows must be transparent for both staff and the student to see in/out, and made of unbreakable or shatterproof glass or plastic. Non-shatterproof glass must be protected by adequate climb-proof screening;

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10.  There must not be exposed pipes or electrical wiring in the room. Electrical cont. outlets must be permanently capped or covered with a metal shield secured by tamper-proof screws. The room must contain lights that must be recessed or covered with screening, safety glass or unbreakable plastic. Any cover, cap or shield must be secured by tamper-proof screws;  The room must meet State Fire Marshal safety, fire and health standards. If sprinklers are installed, they must be recessed or covered with a cage. If popdown type, sprinklers must have breakaway strength of less than eighty pounds. In lieu of sprinklers combined smoke and heat detectors must be used with similar protective design or installation;  The room must be ventilated. Heating and cooling vents must be secure and out of reach;  The room must be designed and equipped in a manner that would not allow a student to climb up a wall;  Walls, floors and ceiling must be solidly and smoothly constructed, to be cleaned easily and have no rough or jagged portions; and  Seclusion cells are prohibited [OAR 581-021-0569]. 11.

Q: What does “structural integrity” mean when determining whether a room used for seclusion is a seclusion cell? (Note: the law indicates ‘Seclusion Cell’ means a freestanding, self-contained unit, and any wall that is part of the room used for seclusion must be part of the structural integrity of the room). A: Structural Integrity (April, 2014) largely refers to those objects’ soundness of design and construction, including safety and workability. Structural integrity is an essential component of all structural engineering projects, …buildings, …and other structures that…apply to the safety of humans. Retrieved from: http://www.ehow.com/about_6510702_definestructural- integrity.html#ixzz32Bnv5wxC The intent of the seclusion room statutes was to ensure that any rooms built met certain standards. Stick built with their own existing walls or stick built to blend with existing walls versus being panels that are bolted to the floor and walls, or freestanding units [OAR 581-051-0568].

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12.

Q: What constitutes safe screening to ensure student safety from lights, electrical outlets, windows, etc., as noted in the seclusion standards [OAR 581-021-0568]? A: It would be prudent for safety screens to be designed in a manner keeping students’ fingers from becoming entangled in the screens.

13.

Q: When seclusion is included in a student’s BIP, what guidelines are used when responding to student behaviors? A: When a BIP includes seclusion as a means of responding to student behavior, the use of seclusion is initiated only when other, less restrictive interventions have been deemed ineffective and the student’s behavior imposes a reasonable threat of imminent, serious bodily injury to themselves or others [OAR 581-021-0553(2)(a)(A-B)]. Examples of seclusion: 

The student is alone and prevented from leaving the room after a “room clear” with the teacher/staff person on the outside of the room.



The student is physically separated from others in the classroom and is prevented from leaving the designated area with the teacher/staff person outside of the designated area.

Examples that are not seclusion: 

The room is “cleared” and a teacher/staff person remains in the room with the student to assist with behavior management.



The student is physically separated from others in the classroom in a designated area and there is a teacher/staff person present with that student in the designated area.

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Use of Physical Restraint and Seclusion in Early Intervention and Early Childhood Special Education This section applies to the use of physical restraint and seclusion in Early Intervention (EI) and Early Childhood Special Education (ECSE). Physical Restraint Defined: Physical restraint is the restriction of a child’s movement by one or more persons holding the child or applying physical pressure upon the child. This does not include touching or holding a child without the use of force for the purpose of directing the child or assisting the child in completing a task or activity. Seclusion Defined: The involuntary confinement of a child alone in a room from which the child is physically prevented from leaving. Seclusion does not include the removal of a child for a short period of time to provide the child with an opportunity to regain self-control if the child is in a setting from which the child is not physically prevented from leaving. EI/ECSE is considered a public education program, which must meet the following criteria: a) Serves students in early childhood education, elementary or secondary school; b) Is under the jurisdiction of a school district, ESD or other educational institution or program; and c) Receives, or serves students who receive, support in any form from any program supported, directly or indirectly, with funds appropriated to ODE. In providing care and educational instruction to young children there will always be some physical contact for guiding, directing, prompting or preventing harm. It is normal and natural for an adult to guide or direct a child by gently laying a hand on the child’s shoulder, back, arm, or clasping the child’s hand. It is also normal and natural to briefly hold a child in an effort to calm or comfort the child. It may be necessary for an adult to hold a child on their lap to maintain the child’s attention or to provide structure or security for some activities. An adult may use their body to block a child from exiting an area of safety or entering a dangerous area. These normal, typical activities that adults use to guide, direct and protect children are not considered physical restraint. Seclusion is NOT an acceptable option for use with young children. A young child should NEVER be left alone in a room. If a child is not in need of physical restraint to prevent threat of imminent, serious bodily injury to themselves or others, the child could be removed or separated from other children ‘for a short time to provide the child with an opportunity to regain self-control in a setting from which the child is not OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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physically prevented from leaving’ [OAR 581-021-0550(6)(a)]. The child being removed or separated from other children is to always be accompanied by an adult. Physical restraint does not include placing children in tray chairs, high chairs and/or other adapted equipment for physical support or instructional purposes. Mechanical restraint is prohibited by law, although mechanical restraint does not include placing a child in a protective or stabilizing device ordered by a licensed physician. Discretion must be used to ensure that placement in such chairs or adapted equipment meets the instructional or physical support needs of the child and is not used to restrict the child’s mobility. The use of a safety harness during bus transportation is not considered restraint when it is used as an appropriate safety precaution when the child is in a moving vehicle. EI/ECSE programs must select and be trained in the use of one of ODE’s approved physical restraint programs [OAR 581-021-0566]. Physical restraint shall not be used as a form of discipline, punishment or for the convenience of personnel in the public education program [OAR 581-021-0553(2)(b)]. Physical restraint may be used only for as long as the child’s behavior poses a reasonable threat of imminent, serious bodily injury to themselves or others and only when less restrictive interventions would not be effective [OAR 581-021-0553(2)(a)(A)(B)]. Staff must continuously monitor a child’s status during physical restraint. For those children suspected or determined that physical restraint may be necessary, the use of physical restraint shall be included in a behavioral intervention plan (BIP) that is referenced in the child’s Individualized Family Service Plan (IFSP) or Individualized Education Plan (IEP). The behavior plan is to be signed by the parent(s)/guardian(s) to indicate their agreement with the plan. Each program shall have a documented process for annual review of the use of physical restraint that is available to the local public education program who has jurisdiction of the EI/ECSE program. The annual report also needs to be submitted to the Deputy Superintendent of Public Instruction. Physical restraint shall be used with extreme caution, and only when needed, to ensure the safety of the child and/or others, or in accordance with the child’s IFSP/IEP and BIP, and Oregon statutes and administrative rules regarding restraint and seclusion [OARs 581-021-0550, -0553, -0556, -0559, 0563, -0566, -0568, -0569, and -0570].

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Staff Training Requirements Oregon rules allow the use of physical restraint and/or seclusion in a public education program only under the following conditions:  

When other, less restrictive interventions would not be effective and the student’s behavior imposes a threat of imminent, serious bodily injury to themselves or others; and For only as long as the student imposes a threat of imminent, serious bodily injury to themselves or others.

After exhausting all less restrictive interventions that have been deemed ineffective, give the student a warning, whenever possible, that if the student harms or attempts to harm themselves or others, physical restraint may occur for their protection. This may help the student regain control of their behavior. Staff members using physical restraint and/or seclusion must be trained in an ODE approved deescalation/physical restraint and seclusion program. The district or program may select from an ODE approved training program list. If physical restraint and/or seclusion is part of a BIP, the plan must address a variety of interventions to prevent and de-escalate a crisis situation, and staff should use those interventions unless there is the threat of imminent, serious bodily injury to the student or others. When physical restraint and/or seclusion are included in a BIP, the team must include proactive preventions to attempt to de-escalate the student first. Continuous monitoring of a student during physical restraint and/or seclusion is mandatory. A student must always be able to breathe and speak during physical restraint and/or seclusion. Never restrain a student longer than absolutely necessary. The training will increase awareness of the physiological and emotional signs associated with a student starting to calm or de-escalate. When appropriate, let the student know as that soon as they become calm the process of releasing the physical hold can begin. School personnel and staff should avoid power struggles with students. Whenever possible, physical restraint should not be used in front of other students. It is more respectful of the student in crisis and minimizes the impact of the event on others. It would be

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preferable to clear the room of other students when a student is in crisis in order to protect the students and provide privacy for the student being restrained. Verbal threats or refusal to comply with staff directives or school rules do not warrant physical restraint and/or seclusion. Physical restraint and/or seclusion may not be used for discipline, punishment or the convenience of personnel of the public education program. Physical restraint must be applied in such a way that is safe and only reasonable force is used. Ideally, the staff member(s) monitoring the student during the physical restraint and/or seclusion would have rapport with the student to assist with recovering from the crisis.

Staff Training Requirements Q&A 1.

Q: What does [OAR 581-021-0553(2)(c)(B)(i)] mean when it states that only staff who are current in the required training in accordance with an ODE approved training program may impose physical restraint and/or seclusion with a student except when an emergency exists? A: Staff must be trained in a program approved by ODE, and selected by the district/school program, to implement physical restraint and/or seclusion on a student, except in an emergency situation that may require an untrained staff member to implement physical restraint and/or seclusion upon a student, in accordance with the law and rules regarding physical restraint and seclusion [OAR 581-021- 0553(2)(c)(B)(i)].

2.

Q: Must staff be trained in the use of physical restraint and/or seclusion before restraining a student in an emergency situation? A: No. In an emergency situation a school administrator, teacher, or other school employee who is not trained may use physical restraint and/or seclusion if a student’s behavior poses a reasonable threat of imminent, serious bodily injury to themselves or others [OAR 581-021-0553(2)(c)(B)(ii)].

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3.

Q: Can a school employee who has not been trained in an approved training program by ODE use physical restraint and/or seclusion on a student when the use of physical restraint and/or seclusion is included in the student’s BIP? A: Yes, but only if it is an emergency situation. When physical restraint and/or seclusion are used as part of a BIP in the student’s IEP or Section 504 plan, best practice and compliance with the law requires staff to be trained. Staff working with a student who has physical restraint and/or seclusion as a possible intervention in a BIP need to be trained in an approved training program addressing de-escalation procedures and the proper use of physical restraint and/or seclusion.

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Documentation Requirements Oregon rules allow the use of physical restraint and/or seclusion in a public education program only under the following conditions:  

When other, less restrictive interventions were deemed ineffective and the student’s behavior imposes a threat of imminent, serious bodily injury to themselves or others; and For only as long as the student imposes a threat of imminent, serious bodily injury to themselves or others.

Staff using physical restraint and/or seclusion must be trained in an ODE approved deescalation/physical restraint and seclusion program. The district or program may select from an ODE approved training program list. In an emergency, staff not trained may perform the physical restraint and/or seclusion, and that must be documented. If physical restraint and/or seclusion is part of a BIP, the plan must address a variety of interventions to prevent and de-escalate a crisis situation, and staff should use those interventions unless there is the threat of imminent, serious bodily injury to the student or others. When physical restraint and/or seclusion are included in a BIP, the team must include proactive preventions to attempt to de-escalate the student first. Continuous monitoring of a student during physical restraint and/or seclusion is mandatory. A student must always be able to breathe and speak during physical restraint and/or seclusion. Physical restraint and/or seclusion may not be used for discipline, punishment, or the convenience of personnel of the public education program. Physical restraint must be applied in such a way that is safe and only reasonable force is used. Ideally, the staff member(s) monitoring the student during the physical restraint and/or seclusion would have rapport with the student to assist with recovering from the crisis. Document the incident report as soon as possible after the incident. Each staff member or person involved should document their own version of the incident.

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Documentation Requirements Q&A 1. Q: What are the requirements for parent(s)/guardian(s) notification after the use of seclusion and/or physical restraint? A: Parent(s)/Guardian(s) must be notified following an incident involving the use of physical restraint and/or seclusion. Notification must include the following:  



Parent(s)/Guardian(s) notified verbally or electronically of the incident by the end of the school day when the incident occurred; Parent(s)/Guardian(s) receive written documentation of the incident within twenty-four hours of the incident that provides a description of the physical restraint and/or seclusion which includes the date, times when the physical restraint and/or seclusion began and ended, the location, a description of the student's activity that prompted the use of physical restraint and/or seclusion, efforts used to de-escalate the situation, the names and training status of the personnel of the public education program who administered the physical restraint and/or seclusion; and Parent(s)/Guardian(s) provided with a timely notification of a debriefing meeting to be held within two days and of the parent(s)/guardian(s) right to attend the meeting [OAR 581-021-0556(1)&(2)(a)&(b)(A-H); and (4)(a)].

2. Q: What is meant by a documented debriefing by appropriate staff? Who should be included and when must the debriefing occur?

A: A debriefing meeting is held regarding the use of physical restraint and/or seclusion within two school days of the incident and must include all personnel of the public education program who were involved in the incident and any other appropriate personnel [OAR 581-021-0556(4)(a)], and must be documented. Parent(s)/Guardian(s) have the right to attend this debriefing meeting and must be notified in a timely matter of this meeting after the physical restraint and/or seclusion. Written notes must be taken of the debriefing meeting, and a copy of the written notes must be provided to parent(s)/guardian(s) of the student.

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3.

Q: What is the purpose of the debriefing meeting and what issues should be reviewed by the debriefing team?

A: The primary purpose of the debriefing is to review the incident and take any actions necessary to reduce the chances that such an incident will reoccur. The debriefing session provides an opportunity to discuss the circumstances resulting in the use of physical restraint and/or seclusion. After reviewing the incident report and checking for accuracy, the debriefing team conducts a review of the factor(s) that precipitated the event, the de-escalation technique(s) used, the physical restraint technique(s) utilized, outcome(s) of the intervention(s), including any injuries to student(s) or staff that may have resulted from the incident, prior incidents of physical restraint and/or seclusion utilized with the student, and any other relevant factors that the debriefing team deems appropriate. The team may decide to initiate a functional behavior assessment and set up a BIP to address the behavior if deemed appropriate. If a BIP is already in place, the team might want to consider modifying the plan and/or conducting further function-based assessments to assist with modifying or enhancing the effectiveness of the BIP. Best practice would suggest a function-based BIP is developed after the second incidence of physical restraint and/or seclusion is implemented with a student. If a student is involved in five incidents in a school year involving physical restraint or seclusion, a team consisting of personnel of the public education program and a parent or guardian of the student must be formed for the purposes of reviewing and revising the student's behavior plan and ensuring the provision of any necessary behavioral supports. The law indicates that a BIP must be adjusted after five incidents leading to physical restraint.

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4.

Q: Districts and public education programs are required to report annually, at both local and/or district and state levels, the use of physical restraint and seclusion. What is the purpose of this annual review and what is needed to fulfill the document process requirement?

A: The primary purpose of the annual reporting is to ensure that all district policies are being implemented regarding the use of physical restraint and seclusion and to determine if current district practices have been effective in improving student behavior(s) and minimizing the use of physical restraint and seclusion.  The annual report requires each entity that has jurisdiction over a public education program to prepare a local report available to the districts’ stakeholders at the local level, as well as prepare and submit to the Superintendent of Public Instruction an annual report detailing the use of physical restraint and seclusion for the preceding school year, minimally including the following:  The total number of incidents involving physical restraint;  The total number of incidents involving seclusion;  The total number of seclusions in a locked room;  The total number of students placed in physical restraint;  The total number of students placed in seclusion;  The total number of seclusion rooms available, with a description that includes the location of those rooms and their designation (solely used for seclusion);  The total number of incidents that resulted in injuries or death to students or personnel as a result of the use of physical restraint and/or seclusion;  The number of students placed in physical restraint and seclusion more than ten times in the course of a school year, including an explanation of the steps taken by the public education program to decrease the use of physical restraint and seclusion for each student;  The number of incidents in which the personnel of the public education program administering physical restraint and seclusion were not trained; and  The demographic characteristics of all students upon whom physical restraint and seclusion was imposed, including race, ethnicity, gender, disability status, migrant status, English proficiency, and status as economically disadvantaged, unless the demographic information would reveal personally identifiable information about an individual student. [OAR 581-021-0559(1)(a-j)]

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5.

Q: Is a separate incident log required for each student? A: Best practice suggests that an incident log be maintained for each student involved in a physical restraint and/or seclusion incident to facilitate “tracking” of behavior. Depending on the specifics, the situation or circumstances associated with the student (i.e. special education or general education), the log might be filled in different ways and retained accordingly in compliance with the law and district policies and procedures.

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Reporting Requirements When physical restraint and/or seclusion is necessary as an emergency procedure to prevent harm to the student or others, parent(s)/guardian(s) must:    

Be notified of the physical restraint and/or seclusion either verbally or electronically by the end of the school day of the incident; Receive written documentation of the incident within twenty-four hours that provides a description of the physical restraint and/or seclusion; Be informed in a timely manner of a debriefing meeting to be held within two days and of their right to attend the meeting; and Written notes must be taken of the debriefing meeting, and a copy of the written notes must be provided to parent(s)/guardian(s).

Each entity that has jurisdiction over a public education program must prepare and submit to the Superintendent of Public Instruction an annual report detailing the use of physical restraint and seclusion for the preceding school year.

This annual report must be made available to the following:     

The public at the entity’s main office and the website of the entity; The school board or governing body overseeing the entity; If the entity is an ESD, the component school districts of the ESD; If the entity is a public charter school, the sponsor of the public charter school; and Parent(s)/Guardian(s) of students in a public education program, who shall be advised at least once each school year about how to access the report.

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Reporting Requirements Q&A 1.

Q: What are the annual reporting requirements?

A: The annual reporting requirements regarding physical restraint and seclusion include that all incidents occurring the preceding school year must be collected and made available by the local school district, entity, consortium or cadre that has jurisdiction over the school district, ESD, EI/ECSE or component school districts. The report must also be submitted to the Superintendent of Public Instruction. [OAR 581-021-0559]. 2.

Q: When making the annual report available to the public, what are the responsibilities of the entities that have jurisdiction over a public education program? A: The annual report must be made public to the following:  The Superintendent of Public Instruction via the state restraint and seclusion collection;  The entity’s main office and website;  The school board or governing body overseeing the entity;  If the entity is an ESD, the component school districts of the ESD;  If the entity is a public charter school, the sponsor of the public charter school; The parent(s)/guardian(s) of students in a public education program shall be advised, at least once each school year about accessing the annual report.  

3.

Q: Is an incident report required for each student? A: Yes. An incident report will be maintained for each student involved in a physical restraint and/or seclusion incident to facilitate “tracking” of behavior. Sample student incident reports are provided at the end of this document.

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General Questions Regarding Students with Accommodation Plans and/or Special Needs General Q&A 1. Q: When should seclusion and/or physical restraint be included in a BIP? A: If a student is on an IEP or Section 504 plan and the team could reasonably foresee that the student may require seclusion and/or physical restraint, either due to the nature and severity of the student’s behavior and/or a history of the use of seclusion and/or physical restraint, then steps are taken to include the use of seclusion and/or physical restraint in the BIP. Prior to the implementation of any BIP that includes physical restraint and/or seclusion, a functional behavior assessment must be completed. 2. Q: Should a BIP be developed for students currently on an IEP or 504 plan if the student’s behavior results in the use of seclusion and/or physical restraint? A: If the student with an IEP or 504 plan has been secluded and/or physically restrained and does not have a BIP including seclusion and/or physical restraint, then the appropriate individuals (IEP team, 504 plan team) need to promptly meet and consider the need for a BIP. When the plan is developed following the completion of a functional behavior assessment, the team needs to determine whether or not to include seclusion and/or physical restraint as a possible safety intervention. The BIP needs to specify the behaviors and interventions to be implemented by staff at various levels and stages to de-escalate behavior utilizing less invasive interventions. Physical restraint and/or seclusion are last resort interventions after less restrictive measures have been deemed ineffective.

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3.

Q: What actions should a district take when a student who has not been identified as eligible for special education or a 504 plan is subjected to frequent seclusions and/or physical restraints? A: If there is a suspected disability, the student must be promptly referred for consideration of eligibility for special education or a Section 504 plan. In addition, the team needs to consider the development of a BIP that may include seclusion and/or restraint, even if the student is not found eligible under IDEA or Section 504. Best practice would suggest conducting a functional behavior assessment and implementing a behavior intervention plan after two incidents of physical restraint and/or seclusion. However, the law requires reviewing and revising the student’s behavior plan and ensuring the provision of any necessary behavior supports after five incidences involving restraint and/or seclusion.

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Sample Forms Physical Restraint Incident Report – Option 1 Physical Restraint Incident Report – Option 2 Physical Restraint Debriefing Report Seclusion Incident Report – Option 1 Seclusion Incident Report – Option 2 Seclusion Debriefing Report Physical Restraint and/or Seclusion Incident Report Physical Restraint and/or Seclusion Debriefing Report – Condensed Version Student Incident Log Continuous Monitoring Form Student Monitoring Form Parent Notification Letter Administrator Approval Form

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PHYSICAL RESTRAINT INCIDENT REPORT (OPTION 1) ‘Physical restraint’ means the restriction of a student's movement by one or more persons holding the student or applying physical pressure upon the student [OAR 581-021- 0550(3)(a&b)]. Physical restraint may also be used in the case of an emergency circumstance when trained personnel are not immediately available due to the unforeseeable nature of the emergency circumstance [OAR 581-021-0553(2)(B)(ii)]. A. Student Information Student Name:

SSID Number:

Date of Birth:

Grade:

□ IEP □ 504 Plan □ BIP

B. School Information School:

Address:

District:

Time Restraint Began:

Time Restraint Ended:

C. Incident Description Date Incident Occurred:

□ a.m. □ p.m. Location of incident:

□ a.m. □ p.m.

Behavior(s) that lead to restraint:

□ Classroom □ Hall □ Cafeteria □ Playground □ Other: ______________________

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Behavior(s) directed at:

□ Staff □ Peers □ Self

Description of activity in which the restrained student or other students were engaged in immediately preceding the use of physical restraint:

□ Other:

___________________

Thorough description of efforts made to de-escalate and alternatives to physical restraint that were attempted:

Restraint methodology used:

Physical restraint hold(s) used:

Why was the use of physical restraint necessary?

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How restraint ended (check all that apply):

□

Determination by staff member(s) that student was no longer a risk to themselves or others

□

Intervention by administrator(s) to facilitate de-escalation

□

Law enforcement personnel arrived

□

Staff sought medical assistance

□

Other (describe): _______________________________________________________________________ _______________________________________________________________________

Student behavior during restraint:

Student behavior after restraint:

Staff member(s) responsible for continuous monitoring of student status during the physical restraint:

Description of any injury to student(s) and/or staff and any medical/first aid care provided (as per district policy, if injury occurred, complete ‘injury/accident report’ in addition to this form):

D. Staff Administering Restraint

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Name:

Position:

Certified to Name of approved administer restraint restraints: methodology:

□ □ □ □ □ □ □ □ □ □

Yes No Yes No Yes No Yes No Yes No

*Received prior restraint training:

□ □ □ □ □ □ □ □ □ □

Yes No Yes No Yes No Yes No Yes No

*If the staff member(s) involved with the restraint is not trained in an approved restraint methodology, explain why not below:

E. Observers Staff member(s)/other adult witness(es) Include name and position:

Student(s):

F. Parent(s)/Guardian(s) Notification1

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1

Verbal or electronic notification of parent(s)/guardian(s) following the use of physical restraint is required by the end of the school day the incident occurred; written notification is required within twenty-four hours [OAR 581-0210556(2)(a&b)].

Name of parent(s)/guardian(s) contacted: ________________________ ________________________

Documented attempt(s) to contact parent(s)/guardian(s) if unable to contact verbally Describe:

Contacted by the following staff member(s) Include name and position:

Phone number: ________________________ Date and time of contact: ________________________

□

a.m.

□

p.m.

This report has been prepared by: Signature:

Position:

Address:

Phone Number:

G. Continuous Physical Restraint Needed after Thirty (30) Minutes Time (Every fifteen minutes):

Administrator Signature and Justification:

Parent(s)/Guardian(s) Contacted:

Time:

Immediately - Time/Date:

Time:

Staff member(s) making contact:

Time:

*Attempt(s) to contact Time/Date: Electronic Telephone Direct

Time:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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PHYSICAL RESTRAINT INCIDENT REPORT (OPTION 2) ‘Physical restraint’ means the restriction of a student's movement by one or more persons holding the student or applying physical pressure upon the student [OAR 581-021- 0550(3)(a&b)]. Physical restraint may also be used in the case of an emergency circumstance when trained personnel are not immediately available due to the unforeseeable nature of the emergency circumstance [OAR 581-021-0553(2)(B)(ii)]. Student Name:

□ IEP

□ 504 Plan

□ BIP

SSID Number:

Date of Birth:

Grade:

School:

Incident description: Date Incident Occurred:

Time Restraint Began:

□ Location of incident:

a.m.

Time Restraint Ended:

□ p.m.

□

a.m.

□ p.m.

Behavior(s) that lead to physical restraint:

□ Classroom □ Hall □ Cafeteria □ Playground □ Other:

________________

Behavior(s) directed at: □ Staff □ Peers

Description of activity in which the restrained student or other students were engaged in immediately preceding the use of physical restraint:

□ Self □ Other:

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Thorough description of efforts made to de-escalate the situation and alternatives to physical restraint that were attempted:

Restraint methodology used:

Physical restraint hold(s) used:

Student behavior during restraint:

Student behavior after restraint:

Why was the use of physical restraint necessary?

How restraint ended (check all that apply):

□ Determination by staff member(s) that student was no longer a risk to themselves or others

□ Intervention by administrator(s) to facilitate de-escalation

□ Law enforcement personnel arrived □ Staff sought

medical assistance

□ Other (describe): ___________________________________ ___________________________________

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Staff member(s) responsible for continuous monitoring of student status during the physical restraint:

Description of any injury to student(s) and/or staff and any medical/first aid care provided (as per district policy, if injury occurred complete ‘injury/accident report’ in addition to this form):

Staff Administering Restraint Name:

Position:

Certified to administer restraints: □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No

Name of approved restraint methodology:

Received prior restraint training: □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No

Observers Staff member(s)/other adult witness(es) Include name and position:

Student(s):

Parent(s)/Guardian(s) Notification2: 2

Verbal or electronic notification of parent(s)/guardian(s) following the use of physical restraint is required by the end of the school day the incident occurred; written notification is required within twenty-four hours [OAR 581-0210556(2)(a&b)].

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Name of parent(s)/guardian(s) contacted: ________________________ ________________________

Documented attempt(s) to contact parent(s)/guardian(s) if unable to contact verbally Describe:

Contacted by the following staff member(s) Include name and position:

Phone number: ________________________ Date and time of contact: ________________________

□ a.m.

□

p.m.

This report has been prepared by Name:

Position:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Date:

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PHYSICAL RESTRAINT DEBRIEFING REPORT Within two school days of using physical restraint a documented debriefing meeting by appropriate staff, including staff involved in the restraint, must occur. Parent(s)/Guardian(s) must be informed of the debriefing in a timely manner, with an invitation to join the debriefing meeting [OAR 581-0210556(4)(a)]. The purpose of the debriefing is to review the incident and the specifics surrounding it, preferably from a function-based perspective, and take any necessary actions to reduce the chances that such an incident will reoccur. A. Student Information Student Name:

SSID Number:

Date of Birth:

□ IEP

Grade:

□ 504 Plan □ BIP B. School Information School:

Address:

District:

Date of Debriefing:

Time of Debriefing:

Location of Debriefing:

C. Debriefing Notes

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D. Further Action(s) to be Taken

E. Signatures of Meeting Attendants Name:

Position:

Signature:

Name:

Position:

Signature:

Name:

Position:

Signature:

Name:

Position:

Signature:

Name:

Position:

Signature:

Name:

Position:

Signature:

F. This report has been prepared by Name:

Position:

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Address:

Phone Number:

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SECLUSION INCIDENT REPORT (OPTION 1) ‘Seclusion’ means the involuntary confinement of a student alone in a room from which the student is physically prevented from leaving [OAR 581-021-0550(6)]. A. Student Information Student Name:

SSID Number:

Date of Birth:

□ IEP

Grade:

□ 504 Plan □ BIP B. School Information School:

Address:

District:

Time Seclusion Began:

Time Seclusion Ended:

C. Incident Description Date Incident Occurred:

□ a.m. □ p.m. Location of incident:

□ a.m. □ p.m.

Behavior(s) that lead to seclusion:

□ Classroom □ Hall □ Cafeteria □ Playground □ Other: _______________ Behavior(s) directed at: □ Staff

Description of activity student(s) engaged in immediately preceding the use of seclusion:

□ Peers □ Other: _______________

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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Thorough description of efforts made to de-escalate and alternatives to seclusion attempted:

Why was the use of seclusion necessary?

How seclusion ended (Check all that apply):

□ Determination by staff member(s) that student no longer required seclusion

□ Intervention by administrator(s) to facilitate de-escalation

□ Other (Describe): _______________________________ _______________________________ Student behavior during seclusion:

Student behavior after seclusion:

Staff member(s) responsible for continuous monitoring of student status during seclusion:

Location of seclusion room: _____________________________________ Seclusion room meets the following criteria:

□ Allows staff full view of the student in all areas of the room

□ Free of potentially hazardous conditions, such as: unprotected light fixtures and electrical outlets

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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D. Observers Staff member(s)/other adult witness(es) Include name and position:

Student(s):

E. Parent/Guardian Notification3 3

Verbal or electronic notification of parent(s)/guardian(s) following the use of seclusion is required by the end of the school day the incident occurred; written notification is required within twenty-four hours [OAR 581-0210556(2)(a&b)].

Name of parent(s)/guardian(s) contacted: Phone number:

Documented attempt(s) to contact parent(s)/guardian(s) if unable to contact Describe:

Contacted by the following staff member(s) Include name and position:

Date and time of contact:

□ a.m. □ p.m. F. Documentation of Continuous Seclusion Needed After Thirty (30) Minutes Time (To be documented every fifteen minutes)

Administrator signature and justification

Time: Time: Time: Time: Time:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Parent(s)/Guardian(s) contacted Immediately - Time/Date: Staff member(s) that made contact: Attempt(s) to contact Time/Date: Electronic Telephone Direct (Circle One)

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*Continue attempting to contact – even if message left

Time: G. This report has been prepared by Name:

Position:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Address:

Phone:

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SECLUSION INCIDENT REPORT (OPTION 2) ‘Seclusion’ means the involuntary confinement of a student alone in a room from which the student is physically prevented from leaving [OAR 581-021-0550(6)]. Student Name:

□ IEP □ 504 Plan

□ BIP

SSID Number:

Date of Birth:

Grade:

School:

Time Seclusion Began:

Time Seclusion Ended:

Incident Description Date Incident Occurred:

□ a.m. □ p.m. Location of incident:

□ a.m. □ p.m.

Behavior(s) that lead to seclusion:

□ Classroom □ Hall □ Cafeteria □ Playground □ Other:

_______________________

Behavior(s) directed at:

□ Staff

Description of activity in which the student(s) were engaged in immediately preceding the use of seclusion:

□ Peers □ Other: ______________________

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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Thorough description of efforts made to de-escalate and alternatives to seclusion that were attempted:

Student behavior during seclusion:

Student behavior after seclusion:

Location of seclusion room: ___________________________________

How seclusion ended (Check all that apply):

Seclusion room meets the following criteria:

□ Allows staff full view of the student in all areas of the room

□ Free of potentially hazardous conditions such as: unprotected light fixtures and

□ Determination by staff member(s) that student no longer required seclusion

□ Intervention by administrator(s) to facilitate de-escalation

□ Other (Describe):

electrical outlets Staff member(s) responsible for continuous monitoring of student status during seclusion Name and position: Observers Staff member(s)/other adult witness(es) Name and position:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Student(s)

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Parent(s)/Guardian(s) Notification4 4

Verbal or electronic notification of parent(s)/guardian(s) following the use of seclusion is required by the end of the school day the incident occurred; written notification is required within twenty-four hours [OAR 581-0210556(2)(a&b)].

Name of parent(s)/guardian(s) contacted:

Documented attempt(s) to contact parent(s)/guardian(s) if unable to contact Describe:

Contacted by the following staff member(s) Include name and position:

Phone number: Date and time of contact:

□ a.m. □ p.m. Documentation of Continuous Seclusion Needed After Thirty (30) Minutes Time (To be documented every fifteen minutes)

Administrator signature and justification

Parent(s)/Guardian(s) contacted Immediately - Time/Date:

Time:

Staff member(s) that made contact:

Time: Time:

Attempt(s) to contact Time/Date:

Time:

Electronic Telephone Direct (Circle one)

Time:

*Continue to attempt contact even if voicemail message left

Time: This incident report has been prepared by Name:

Position:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Date:

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SECLUSION DEBRIEFING REPORT Within two school days of the use of seclusion, a documented debriefing by appropriate staff must occur, including staff involved in the seclusion [OAR 581-021-0556(4)(a)]. The purpose of the debriefing is to review the incident and the specifics surrounding it, preferably from a function-based perspective, and take any necessary actions to reduce the chances that such an incident will reoccur. Those attending the debriefing meeting shall have the opportunity to review the Seclusion Report documenting the incident. A. Student Information Student Name:

SSID Number:

Date of Birth:

□ IEP

Grade:

□ 504 Plan □ BIP B. School Information School:

Address:

District:

Date of Debriefing:

Time of Debriefing:

Location of Debriefing:

C. Debriefing Notes

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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D. Follow-up Actions

Signatures of those attending the debriefing meeting:

Name:

Position:

Address:

Phone Number:

This report has been prepared by: Name:

Position:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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PHYSICAL RESTRAINT AND/OR SECLUSION INCIDENT REPORT Student Name: Incident Type: Date of Birth: SSID Number: Date of Incident: School Name:

□

IEP

□

504 Plan

□

BIP

Number of incidents this school year:

Including the current incident in this report, every five an IEP meeting, including the Approved training program used for incidents parent(s)/guardians(s), must be held for the purpose of physical restraint: reviewing and revising the student’s behavior plan, and ensuring the provision of any necessary behavioral supports. Time restraint started: Time restraint ended: Total time of restraint: □ a.m. □ a.m. □ p.m. □ p.m. Location of restraint (circle one): Classroom

Hall

Cafeteria

Time seclusion started:

Playground

Time seclusion ended:

□ □

a.m. p.m.

□ □

Other (describe):

Total time of seclusion: a.m. p.m.

Location of seclusion: □ Allows staff full view of the student in all areas of the room OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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□

Is free of potentially hazardous conditions (unprotected fixtures/outlets)

Staff involved in the incident

Name:

Position:

Administered restraint: □ Yes □ No

□ □ □ □ □ □ □ □

Yes No Yes No Yes No

Certified to administer restraints: □ Yes □ No

□ □ □ □ □ □ □ □

Yes No Yes No Yes No

Responsible for Observed continuous incident: monitoring: □ Yes □ Yes □ No □ No

□ □ □ □ □ □ □ □

Yes No Yes No Yes No

□ □ □ □ □ □ □ □

Yes Yes Yes No No No Description of student activity that prompted the use of physical restraint and/or seclusion:

Yes No Yes No Yes No Yes No

Description of efforts used to de-escalate the situation and the alternatives to physical restraint and/or seclusion that were attempted:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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Description of behavior(s) during physical restraint and/or seclusion (taken from continuous monitoring form):

Description of any injury to student(s) and/or staff and any medical or first aid care provided* (as per district policy, if injury occurred complete separate forms as needed in addition to this form):

*If serious bodily injury or death of a student occurs, written notification must be sent within twenty-four hours to the Department of Human Services, the superintendent, and if applicable, to the union representative for the affected party. A record of injuries and/or death must be maintained by the district. Contact the building administrator to report this information.

How physical restraint and/or seclusion ended:

□

Determination by staff member(s) that the student was no longer a risk to themselves or others

□

Intervention by administrator(s) to facilitate de-escalation

□

Law enforcement personnel arrived

□

Staff sought medical assistance

□

Other (describe): _______________________________________________________________________

Parent(s)/Guardian(s) Notification5 5

Verbal or electronic notification of parent(s)/guardian(s) following the use of physical restraint and/or seclusion is required by the end of the school day the incident occurred; written notification is required within twenty-four hours [OAR 581-021-0556(2)(a&b)].

Name of parent(s)/guardian(s) contacted:

Documented attempts to contact parent(s)/guardian(s) if unable to contact Describe:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Contacted by the following staff member(s) Include name and position:

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Phone number: Date and time of contact:

□ a.m. □ p.m. Method of Contact □ In Person

□

Phone

□

Written Notice

□

Other (Describe):

Date parent(s)/guardian(s) invited to debriefing meeting: Parental/Guardian attendance is not required, but inviting them to the debriefing meeting is required. Written notes must be taken of the debriefing meeting, and a copy of the written notes must be provided to the parent(s)/guardians(s) of the student [OAR 581-021-0556(4)(a)].

This report has been prepared by Name:

Position:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Address:

Phone Number:

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PHYSICAL RESTRAINT AND/OR SECLUSION DEBRIEFING REPORT (CONDENSED VERSION) Within two school days of the use of physical restraint and/or seclusion, a documented debriefing by appropriate staff must occur, including staff involved in the incident [OAR 581-021-0556(4)(a)]. The purpose of the debriefing is to review the incident and the specifics surrounding it, preferably from a function-based perspective, and take any necessary actions to reduce the chances that such an incident will reoccur. Those attending the debriefing meeting shall have the opportunity to review the Physical Restraint and/or Seclusion Incident Report. Debriefing Information Date, time and location of debriefing: Debriefing notes:

Further action(s) to be taken:

Signature of debriefing meeting attendees:

Name:

This report has been prepared by: Name: Position: Copy of Debriefing Report sent to parent(s)/guardian(s) OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Position:

Signature:

□

Yes; Date: 57

 

 

  

 

 

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STUDENT INCIDENT LOG Student Name: Date:

Type of Incident:

SSID Number: Duration of Incident:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Comments:

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CONTINUOUS MONITORING FORM State law requires continuous monitoring by personnel of the public education program for the duration of the physical restraint and/or seclusion. Student Name: SSID Number: Date of Birth: □ IEP

□ □

School Name:

Incident Type: □ R: Physical Restraint □ S: Seclusion

Date and Time of Incident:

504 Plan BIP Location of Incident:

Write the actual time under the five-minute increments listed in the left column. Attach completed form to the Incident Report. Time Incident Continuous Monitoring Details (What is the student doing?) Staff Initials Start □ R 5m 10m 15m 20m 25m *30m

□ □ □ □ □ □ □ □ □ □ □ □ □

S R S R S R

□

Alert administrator or designee

S R S R S R

□

Administrator approval and justification required to continue physical restraint and/or seclusion S □ Opportunity for student to access bathroom and water □ Parent Notification: □ Who made contact: □ Method of contact: *At the thirty minute mark and every fifteen minutes thereafter, the following must happen: □ Administrator or designee signature is required to continue; OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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□ □

Parent(s)/Guardian(s) must be contacted immediately; and Administrative Approval for Continued Use of Physical Restraint and/or Seclusion form must be completed. Time Incident Continuous Monitoring Details (What is the student doing?) Staff Initials 35m 40m *45m 50m 55m *60m 65m 70m *75m

□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □

R S R S R

□

Administrator approval and justification required to continue

□

Student given opportunity to access bathroom and water

□

Administrator approval and justification required to continue

S R S R S R S R S R S R S

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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STUDENT MONITORING RECORD STUDENT MONITORING FORM Name of Student:_______________________ Name of School:_________________________ Date:_________________ Start Time:_______________ Time:

Incident Type:

5m

□ □

Seclusion Physical Restraint

□ □

Seclusion Physical Restraint

10m

15m

20m

25m

30m

□ □ □ □ □ □ □ □

Details of Student Behavior:

Seclusion Physical Restraint Seclusion Physical Restraint Seclusion Physical Restraint Seclusion Physical Restraint

□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □

Sitting Standing Laying Sitting Standing Laying Sitting Standing Laying Sitting Standing Laying Sitting Standing Laying Sitting Standing Laying

□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □

Yelling Swearing Hitting/Kicking Yelling Swearing Hitting/Kicking Yelling Swearing Hitting/Kicking Yelling Swearing Hitting/Kicking Yelling Swearing Hitting/Kicking Yelling Swearing Hitting/Kicking

Staff Initials:

□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □

Comments:

Quiet Voice Calm Body De-escalating Quiet Voice Calm Body De-escalating Quiet Voice

Alert Admin.

Calm Body De-escalating Quiet Voice Calm Body De-escalating Quiet Voice Calm Body De-escalating Quiet Voice

Bathroom?

□

Accepted

□

Rejected

Calm Body De-escalating Staff Initials: Comments:

Water?

□

Accepted

□

Rejected

Staff Initials:

Comments:

Parent contact made?

□

Yes

□

No

Staff Initials:

Comments:

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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Administration Approval (Required to continue): Time: Incident Details of Student Behavior: Type: 35m □ Seclusion □ Sitting □ Yelling

40m

45m

□

Physical Restraint

□ □

Seclusion Physical Restraint

□ □

Seclusion Physical Restraint

□ Standing □ Laying □ Sitting □ Standing □ Laying □ Sitting □ Standing □ Laying

□ □ □ □ □ □ □ □

Swearing Hitting/Kicking Yelling Swearing Hitting/Kicking Yelling Swearing

Hitting/Kicking Administration Approval (Required to continue): 50m □ Seclusion □ Sitting □ Yelling

□

55m

60m

□ □ □ □

Physical Restraint Seclusion Physical Restraint Seclusion Physical Restraint

□ □ □ □ □ □ □ □

Standing Laying Sitting Standing Laying Sitting Standing Laying

□ □ □ □ □ □ □ □

Swearing Hitting/Kicking Yelling Swearing Hitting/Kicking Yelling Swearing Hitting/Kicking

Staff Initials:

□ □ □ □ □ □ □ □ □

Quiet Voice

□ □ □ □ □ □ □ □ □

Quiet Voice

Comments:

Calm Body De-escalating Quiet Voice Calm Body De-escalating Quiet Voice Calm Body De-escalating

Calm Body De-escalating Quiet Voice Calm Body De-escalating Quiet Voice Calm Body

Bathroom?

□

Accepted

□

Rejected

De-escalating Staff Initials: Comments:

Water?

□

Accepted

□

Rejected

Staff Initials:

Comments:

Staff Initials:

Comments:

Parent □ Yes □ No contact made? Administration Approval (Required to continue):

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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PARENT(S)/GUARDIAN(S) NOTIFICATION LETTER This is a sample letter to notify the parent(s)/guardian(s) of a student who was involved in an incident with an untrained staff member. Replace all italicized words with the appropriate terms/names.

Dear Parent(s)/Guardian(s) On Date, Student Name was involved in an Incident Type. Personnel involved in the incident, who administered the Physical Restraint and/or Seclusion had not received training from a program approved by the Oregon Department of Education. In accordance with OAR 581-021-0556, this letter is to notify you that this occurred. The reason an untrained staff member was involved in the incident was reason. The debriefing meeting for this incident will be held on date at time. If you have any questions about this incident, please contact me via phone at phone number. Sincerely, Name, Title Signature

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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ADMINISTRATIVE APPROVAL FOR CONTINUED USE OF PHYSICAL RESTRAINT AND/OR SECLUSION Every fifteen minutes after the first thirty minutes of the physical restraint and/or seclusion, an administrator for the public education program must provide written authorization for the continuation of the physical restraint and/or seclusion. This includes providing justification for the physical restraint and/or seclusion continuing [OAR 581-021-0553(3)(c)].

Administrator Name (Please Print):________________________ Reason for continued use of: (Circle One)

Physical Restraint

Time:____________ Seclusion

_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Administrator Signature:_________________________________

Expiration Time of Approval (15 Minutes):

 

Administrator Name (Please Print):________________________ Reason for continued use of: (Circle One)

Physical Restraint

Time:____________ Seclusion

_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Administrator Signature:_________________________________

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

Expiration Time of Approval (15 Minutes):

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Quick Reference Guide to Physical Restraint and Seclusion ONLY enter into physical restraint and/or seclusion in the case of imminent danger to persons

DURING Physical Restraint and/or Seclusion: 1. Staff will constantly monitor student in physical restraint and/or seclusion; 2. Staff will notify administrator as soon as possible; 3. For physical restraint and/or seclusion exceeding thirty minutes: a. Administrator will sign approval every fifteen minutes; i. Use administrator approval form, provided by the district. b. District personnel will immediately notify parent(s)/guardian(s) verbally or electronically; c. Adequate access to bathroom and water will be provided to the student every thirty minutes.

AFTER Physical Restraint and/or Seclusion: 1. District personnel will notify parent(s)/guardian(s) by the end of the school day, verbally or electronically; 2. Written notification will be provided to parent(s)/guardian(s) within twenty-four hours; a. Use parent(s)/guardian(s) notification form, provided by the district. 3. An Incident Report will be completed by those involved in the physical restraint and/or seclusion; a. Use incident reporting form, provided by the district. 4. A Debriefing Meeting will be held within two school days after each incident of physical restraint and/or seclusion; a. Parent(s)/Guardian(s) must receive timely notification of a debriefing meeting to be held and of their right to attend the meeting; b. The notes from the meeting must be shared with the parent(s)/guardian(s); c. Use debriefing form, provided by the district.

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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Acronym Index

BIP – Behavior Intervention Plan DHS – Department of Human Services ECSE – Early Childhood Special Education EI – Early Intervention ESD – Education Service District FAPE – Free Appropriate Public Education IDEA – Individuals with Disabilities Education Act IEP – Individualized Education Program IFSP – Individualized Family Support Plan ISS – In-School Suspension ODE – Oregon Department of Education

OREGON DEPARTMENT OF EDUCATION OFFICE OF STUDENT SERVICES 

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