It is the goal of the district that all students can learn and grow in a safe and peaceful environment that nurtures the students and models respect for oneself and others. On occasion, trained district employees and others may have to use behavior management interventions, physical restraint, and/or seclusion of students. The goal of these interventions is to promote the dignity, care, safety, welfare, and security of each child and the school community. With this objective in mind, the district will prioritize the use of the least restrictive behavioral interventions appropriate for the situation.
PHYSICAL RESTRAINT means a personal restriction that immobilizes or reduces the ability of a student to move their arms, legs, body, or head freely. Physical restraint does not mean a technique used by trained school employees, or used by a student, for the specific and approved therapeutic or safety purposes for which the technique was designed and, if applicable, prescribed. Physical restraint does not include instructional strategies such as physically guiding a student during an educational task, handshaking, hugging, or other non-disciplinary physical contact.
SECLUSION means the involuntary confinement of a student in a seclusion room or area from which the student is prevented or prohibited from leaving; however, preventing a student from leaving a classroom or school building are not considered seclusion. Seclusion does not include instances when a school employee is present within the room and providing services to the student, such as crisis intervention or instruction.
PHYSICAL RESTRAINT OR SECLUSION IS REASONABLE OR NECESSARY ONLY:
Prior to using physical restraint or seclusion, employees must receive training in accordance with the law. Any individual who is not employed by the district, but whose duties could require the individual to use or be present during the use of physical restraint or seclusion on a student will be invited to participate in the same training offered to employees on this topic.
When required by law, the Executive Director of Student Services [or designee] will ensure a post-occurrence debriefing meeting is held, maintain documentation, and fulfill reporting requirements for each occurrence of physical restraint or seclusion as required by law.
Adopted: 2/21
Reviewed: 10/23; 10/26
Related Policy: 502.1; 502.1-R; 502.7; 502.14-R; 502.14-E1-E3
Legal Reference (Code of Iowa): §§ 279.8; 280.21; 281 IAC 103
IASB Reference: 503.06
Mandatory Policy
The Linn-Mar Community School District will comply with 281 Iowa Administrative Code Chapter 103 for the use of physical restraint and seclusion of students, including, but not limited to:
Adopted: 1/21
Reviewed: 10/26
Revised: 10/23
Related Policy: 502.1; 502.1-R; 502.7; 502.14; 502.14-E1-E3
Legal Reference (Code of Iowa): §§ 279.8; 280.21; 281 IAC 103
IASB Reference: 503.06-R(1)
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Physical restraint or seclusion is used to protect the safety of the student or to protect others who are likely to be in jeopardy should a student’s actions continue. All instances of physical support in the form of restraint or seclusion will be documented.
Student's Name:
Building:
Date of Occurrence:
Grade:
Teacher:
Time of Seclusion:
Time of Restraint:
Duration of Total Occurrence in Minutes:
Employee’s Full Name, Title, and Date of Last Training on Restraints and/or Seclusion.
Include all who were involved with or implemented the restraint or seclusion, as well as those who observed the occurrence. Include the information of the administrator who approved the extended time, if applicable. Employees are to initial next to their name after the completed form is reviewed.
Describe the antecedent that led to the restraint/seclusion.
Provide a brief description of the trigger/cause-setting events of the behavior, including both the student and adult behaviors.
Student:
Adult:
What approaches were used to deescalate the student: (Check all that apply)
_____Use a calm, neutral voice
_____Validate feelings
_____Provide wait time
_____Provide reasonable choices
_____Move to an alternative place of safety (Calm down space, etc.)
_____Set positive limits
_____Verbal interventions/nonjudgmental questioning
_____Make the environment safe (Remove unnecessary items, etc.)
_____Provide visual and/or written redirections
_____Disengagements to release/escape
_____Other (Please specify)
Describe the less restrictive approaches checked above that were used as alternatives to restraint and seclusion.
Describe the student and adult behaviors during the restraint/seclusion.
Student:
Adult:
Describe the restraint/seclusion utilized and the reason why.
____Seclusion
____CPI Restraint & Name of the CPI Restraint Used
Why Used: ____Danger to Self ____Danger to Others
What was the exact safety concern:
Describe the student and adult behaviors after the restraint/seclusion:
Student:
Adult:
Is there any property damage: ____Yes ____No
List any repairs or replacements needed:
Injury Documentation:
If "yes" is checked for any items below, please complete and return an Injury Report Form.
Describe future approaches to the student’s behavior, including possible IEP meetings to address behavior concerns. Include any disciplinary actions that may be imposed on the student.
If the occurrence involved a period of physical restraint or seclusion that exceeds 15 minutes an administrator [or designee] must authorize approval of the continuation.
Time Approved:
Administrator's Name/Title:
Reason for length of occurrence:
If the occurrence involved a period of physical restraint or seclusion that exceeds 30 minutes from the last approval time, an administrator [or designee] must authorize approval of the continuation.
Time Approved:
Administrator's Name/Title:
Reason for length of occurrence:
If the occurrence lasts longer than 15 minutes a break for bodily needs should be offered if it is safe to do so.
Time break offered:
Student: _____Accepted ____Declined
If break was not offered, please explain why:
Parent/Guardian Notification:
Parents/guardians will be notified as soon as practicable once the occurrence is under control but no more than one hour after or the end of the school day, whichever occurs first.
Spaces below for documenting multiple attempts to notify parents/guardians are listed in case they cannot be reached on the first attempt.
Notification Attempt One:
Employee Attempting Notification:
Parent/Guardian Contacted:
Time/Manner of Notification:
Was notification successful: ____Yes ____No
Notification Attempt Two:
Employee Attempting Notification:
Parent/Guardian Contacted:
Time/Manner of Notification:
Was notification successful: ____Yes ____No
Notification Attempt Three:
Employee Attempting Notification:
Parent/Guardian Contacted:
Time/Manner of Notification:
Was notification successful: ____Yes ____No
A written copy of this form was sent to the student’s parents or guardians within three school days of the occurrence. Unless the parent or guardian agreed to receive the report by email, fax, or hand delivery; the report must be sent by mail and postmarked by the third day following the occurrence. This report cannot be placed in a student’s backpack.
Enclosed with a copy of this form was an invitation for the parents or guardians to participate in a debriefing meeting scheduled in accordance with law set for the following:
Date:
Time:
Location:
Reporter's Name:
Date:
Building Administrator/Designee Signature:
Documentation Provided by: (Please check one)
_____By mail and postmarked within three school days of occurrence
_____By electronic email upon written request of the parent/guardian
_____By electronic fax
_____By hand delivery
_____Other by written request of the parent/guardian (Please specify other mode below)
Copies provided to: Parent/guardian, student file, and Executive Director of Student Services
Adopted: 2/21
Reviewed: 10/23
Revised: 10/26
Related Policy: 502.14; 502.14-R; 502.14-E2-E3
IASB Reference: 503.06-E(1)
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[This letter and the enclosed report may be transmitted electronically via email or fax, picked up in person, or mailed. If the district and the parent/guardian do not agreement on how to transmit this letter, it must be mailed via postage prepaid, first class mail to the parent/guardian within three (3) school days of the occurrence.]
Date: _________________________________
Dear [Names of Parents/Guardians],
Recently your student, [student’s full legal name], was involved in an occurrence
at school that required the physical restraint and/or seclusion of your student as defined by 281 Iowa Administrative Code, Chapter 103. A report related to this occurrence is enclosed with this letter.
The law requires debriefing meetings be held for such occurrences in the following circumstances:
This letter is intended to inform you that a debriefing meeting will be held on [date within 5 days of transmission of letter, time, place] because of [reason from bulleted list above]. The following employees will be in attendance at this meeting [list names and titles of employees]. We are inviting you to attend this debriefing meeting to engage with us on topics related to this occurrence.
If you would like to reschedule the debriefing meeting, please contact me as soon as possible via email [email address] or telephone [telephone number], and at least one school day prior to the date and time listed for this debriefing meeting. Your student is allowed to attend this meeting with your consent, and you are welcome to bring a representative of your choosing if you wish. If you plan to bring a representative to this meeting, please let us know at least one school day prior to the meeting so that we have an opportunity to make arrangements.
We look forward to working with you to foster the continued health, safety, and educational growth of your student.
Administrator’s Name and Title
Date
Enclosure:
*Report related to student occurrence
Adopted: 2/21
Reviewed: 10/23
Revised: 10/26
Related Policy: 502.14; 502.14-R; 502.14-E1; 502.14-E3
IASB Reference: 503.06-E(2)
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[The following individuals must attend the debriefing meeting: employees who administered physical restraint or seclusion; an administrator or employee not involved in the occurrence; the administrator or employee who approved continuation of the physical restraint or seclusion; other relevant personnel designated by the school; if indicated by student’s behavior in occurrence, an expert in behavioral/mental health or other discipline. The following individuals must be invited to attend the debriefing meeting: the parent/guardian of the student and the student with parent/guardian’s consent.]
Student Name:
Building:
Date of Original Occurrence:
Date of Debriefing Meeting:
Time of Meeting:
Location of Meeting:
Names, titles of employees, and/or relation to student of individuals attending the debriefing meeting (must include the employees involved and at least one employee who was not involved):
Documentation reviewed during the meeting (must include at least the occurrence report and BIP, IHP, IEP, and/or safety plan if applicable):
Identification of patterns or behavior and proportionate response, if any, in the student and employees involved:
Possible alternative responses, if any, to the incident/less restrictive means, if any:
Additional resources, if any, that could facilitate alternative responses in the future:
Plans for additional follow up actions, if any:
This form has been reviewed and completed by the undersigned employee. A written copy of this form has been sent to the student’s parent/guardian within three (3) school days of the debriefing meeting.
Names and Title of Employee Completing Form:
Date:
Date Delivered to Parent/Guardian:
Method of Transmittal:
Adopted: 2/21
Reviewed: 10/23
Revised: 10/26
Related Policy: 502.14; 502.14-R, 502.14-E1-E2
IASB Reference: 503.60-E(3)