1. Seclusion & Restraint: Prevention, Practices, Policy, & Politics
Tim Lewis, Ph.D.
University of Missouri
OSEP Center on Positive Behavioral
Interventions and Supports
pbis.org

2. This Afternoon PAGE numbers out of sequence in Handout
Big Ideas – prompts to learn more
Issues with the use of Seclusion & Restraint
Recommendations
Alternatives
Prevention
Understanding function of behavior
Instructional strategies & Environmental supports
PAGE numbers out of sequence in Handout

3. Behavior is functionally related to the Teaching Environment
The Key
Behavior is functionally related to the Teaching Environment

4. Big Ideas
Build Positive Behavior Support Plans that teach pro-social “replacement” behaviors
Create environments to support the use of pro-social behaviors
School-wide
Classroom
Individual student

5. Starting Point…. Educators cannot “make” students learn or behave
Educators can create environments to increase the likelihood students learn and behave
Environments that increase the likelihood are guided by a core curriculum and implemented with consistency and fidelity

6. Seclusion & Restraint

7. Restraint
To restrain involves ‘‘preventing from doing, exhibiting, or expressing something,’’ and restraining means ‘‘limiting, restricting or keeping under control’’ (Webster, 2009)
Physical
Chemical
Mechanical

8. Restraint Should Not be viewed as a behavior reductive technique
Response to crisis when imminent danger or harm is present
Only with trained personnel
Document, Document, Document
Use information to prevent from happening again

9. Seclusion
“Seclusion is the involuntary confinement of a student alone in a room or area from which the student is physically prevented from leaving” (CCBD, 2009)
NOT:
Appropriate use of “Time Out”
Brief removal from access to reinforcement
“Cool down” or “Safe spot”

10. Seclusion
Limited to no research demonstrating behavior reductive potential
Associated with side effects including:
Aggression
Escape/Avoidance
Withdrawal

11. Danger with Both
Negative Reinforcement --- Contingent removal of an aversive stimulus upon the occurrence of the target behavior that is associated with an increase in future occurrences of that behavior
In Plain English = danger of being overused, misused, and abused because educators are “reinforced” for removing students displaying significant problem behavior

12. Further Danger Negative student outcomes
Potential for physical harm (adults and students)
Legal, social, & moral sanctions
Use does not teach

13. US Gov Accountability Office 2009

14. Good News
70% of state policies recommend pro-active and positive behavior support strategies
Professional organizations (e.g., CCBD, NAMI, OSEP center on PBIS) also recommend pro-active and positive behavior support strategies

15. Even Better News pbismissouri.org
Missouri has invested in building a state-wide regional network of support to districts/schools in positive behavior support
pbismissouri.org

16. For More Information
CCBD’s Position summary on the use of physical restraint procedures in school settings.
CCBD’s Position summary on the use of seclusion in school settings.
MSBA / DESE Model Policy
Michigan Department of Education Supporting student behavior: Standards for the emergency use of seclusion and restraint.

17. 7 Minutes Review the self assessment pp. 21-24 of handout
With your neighbor, discuss strengths/concerns
Identify sessions during the institute than can assist in addressing concerns

18. Evidence/Research-Based Practices
So What do We do Instead
Evidence/Research-Based Practices

19. Research-Based Practices
Academic
“Effective instruction”
Antecedent / setting modifications
Peer tutoring
Direct Instruction
Self-management targeting academic related skills
Opportunities to Respond

20. Research-Based Practices
Behavior
Environmental modifications and supports
Contingent positive performance based feedback
Self Management
Social Skill Instruction (with maintenance and generalization strategies)

21. Research-Based Practices
Related Supports*
Comprehensive case management / wrap around
Family supports/ parent training
*limited empirical support

22. Putting Research-Based Practices In Place
Systems
Systems
Putting Research-Based Practices In Place
Systems
Prevention, Early Intervention and Individualized Student Supports through Positive Behavior Support

23. Remember…. Educators cannot “make” students learn or behave
Educators can create environments to increase the likelihood students learn and behave
Environments that increase the likelihood are guided by a core curriculum and implemented with consistency and fidelity

24. The Challenge
The “core curriculum” is often “punishment” to try and reduce problem behavior in school
However, “punishing” problem behaviors (without a proactive support system) is associated with increases in (a) aggression, (b) vandalism, (c) truancy, and (d) dropping out.

25. Good News…
Research reviews indicate that the most effective responses to school violence are:
Social Skills Training
Academic Restructuring
Behavioral Interventions
= instructional strategies - “teaching”

26. School-wide Positive Behavior Support
SW-PBS is a broad range of systemic and individualized strategies for achieving important social and learning outcomes while preventing problem behavior
OSEP Center on PBIS

27. Essential Features at the School Level
Teams of educators within the school (administrator)
Data-based decision making
Instructional Focus
Teach & Practice
Acknowledge student mastery of social skills
Positive Feedback

28. Positive Behavior Support Social Competence & Academic Achievement
OUTCOMES
Supporting
Decision
Making
Supporting
Staff Behavior
DATA
SYSTEMS
PRACTICES
Supporting
Student Behavior

29. Designing School-Wide Systems for Student Success
Academic Systems
Behavioral Systems
Intensive, Individual Interventions
Individual Students
Assessment-based
High Intensity
Intensive, Individual Interventions
Individual Students
Assessment-based
Intense, durable procedures
1-5%
1-5%
Targeted Group Interventions
Some students (at-risk)
High efficiency
Rapid response
5-10%
5-10%
Targeted Group Interventions
Some students (at-risk)
High efficiency
Rapid response
Universal Interventions
All students
Preventive, proactive
80-90%
Universal Interventions
All settings, all students
Preventive, proactive
80-90%

30. Universal School-Wide Features
Clearly define expected behaviors (Rules)
All Settings
Classrooms
Procedures for teaching & practicing expected behaviors
Procedures for encouraging expected behaviors
Procedures for discouraging problem behaviors
Procedures for data-based decision making
Family Awareness and Involvement

31. Benton Elementary School
I am….
All Settings
Classroom
Hallways
Cafeteria
Bathrooms
Playground
Assemblies
Safe
Keep bodies calm in line
Report any problems
Ask permission to leave any setting
Maintain personal space
Walk
Stay to the right on stairs
Banisters are for hands
Push in chairs
Place trash in trash can
Wash hands with soap and water
Keep water in the sink
One person per stall
Use equipment for intended purpose
Wood chips are for the ground
Participate in school approved games only
Stay in approved areas
Keep body to self
Enter and exit gym in an orderly manner
Respect-
ful
Treat others the way you want to be treated
Be an active listener
Follow adult direction(s)
Use polite language
Help keep the school orderly
Be honest
Take care of yourself
Walk quietly so others can continue learning
Eat only your food
Use a peaceful voice
Allow for privacy of others
Clean up after self
Line up at first signal
Invite others who want to join in
Enter and exit building peacefully
Share materials
Applaud appropriately to show appreciation
A Learner
Be an active participant
Give full effort
Be a team player
Do your job
Be a risk taker
Be prepared
Make good choices
Return to class promptly
Use proper manners
Leave when adult excuses
Follow bathroom procedures
Be a problem solver
Learn new games and activities
Raise your hand to share
Keep comments and questions on topic

32. RAH – at Adams City High School (Respect – Achievement – Honor)
Classroom
Hallway/
Commons
Cafeteria
Bathrooms
Respect
Be on time; attend regularly; follow class rules
Keep location neat, keep to the right, use appropriate lang., monitor noise level, allow others to pass
Put trash in cans, push in your chair, be courteous to all staff and students
Keep area clean, put trash in cans, be mindful of others’ personal space, flush toilet
Achievement
Do your best on all assignments and assessments, take notes, ask questions
Keep track of your belongings, monitor time to get to class
Check space before you leave, keep track of personal belongings
Be a good example to other students, leave the room better than you found it
Honor
Do your own work; tell the truth
Be considerate of yours and others’ personal space
Keep your own place in line, maintain personal boundaries
Report any graffiti or vandalism

33. Designing School-Wide Systems for Student Success
Academic Systems
Behavioral Systems
Intensive, Individual Interventions
Individual Students
Assessment-based
High Intensity
Intensive, Individual Interventions
Individual Students
Assessment-based
Intense, durable procedures
1-5%
1-5%
Targeted Group Interventions
Some students (at-risk)
High efficiency
Rapid response
5-10%
5-10%
Targeted Group Interventions
Some students (at-risk)
High efficiency
Rapid response
Universal Interventions
All students
Preventive, proactive
80-90%
Universal Interventions
All settings, all students
Preventive, proactive
80-90%

34. Tier II (small group)
Efficient and effective way to identify at-risk students
Screen
Data decision rules
Informal assessment process to match intervention to student need & function of problem behavior
Small group Social Skill Instruction
Self-management
Academic Support
Part of a continuum – must link to universal school-wide PBS system

35. Designing School-Wide Systems for Student Success
Academic Systems
Behavioral Systems
Intensive, Individual Interventions
Individual Students
Assessment-based
High Intensity
Intensive, Individual Interventions
Individual Students
Assessment-based
Intense, durable procedures
1-5%
1-5%
Targeted Group Interventions
Some students (at-risk)
High efficiency
Rapid response
5-10%
5-10%
Targeted Group Interventions
Some students (at-risk)
High efficiency
Rapid response
Universal Interventions
All students
Preventive, proactive
80-90%
Universal Interventions
All settings, all students
Preventive, proactive
80-90%

36. Tier III (individualized support)
When small group not sufficient
When problem intense and chronic
Driven by Functional Behavioral Assessment
Connections to Mental Health and Community Agencies
Part of a continuum – must link to universal school-wide PBS system

37. Why Invest in SW-PBS?
Change in school discipline system creates an environment that promotes, teaches, and acknowledges appropriate behavior
Reduction in problem behavior resulting in less staff time dealing with problems, more student time in the classroom
Improved academic performance
Improved social behavior performance
Improved school safety, mental health connections, and individual interventions

38. Centennial School

39. Centennial School Police Contacts

40. The Connect Point Across the Continuum
Classroom Management & Instruction

41. The Challenge
Students spend majority of their school day in the classroom
Majority of “discipline problems” originate in the classroom and often result in removal from instruction
Remaining engaged in instruction essential to student academic and social success
“Culture” of education often reinforces ineffective practices and creates barriers to implementing effective practices

42. Basic Steps
Focus on what you want students to do “instead” (replacement behaviors)
Look for patterns of behavior that suggest “functional relationships”
Teach replacement behavior and provide multiple opportunities to practice
Deliver high rates of positive feedback/same similar outcome as problem behavior when students display replacement behavior

43. Setting up the Classroom Environment
Establishing expectations:
What do I want my classroom to look like?
How do I want children to treat me as a person?
How do I want children to treat one another?
What kind of information or values do I want to communicate to students about being an adult, an educator, a woman or a man in today's society?
How do I want children to remember me when the last day of school ends and I am no longer part of their daily lives?
How can I change my instruction to help pupils develop the skills I am trying to teach?
Bottom line = ask if students have pre-requisite and requisite skills to succeed based on each of the answers – if not, teach and practice

44. Classroom Essentials*
Classroom expectations & rules defined and taught
Procedures & routines defined and taught
Continuum of strategies to acknowledge appropriate behavior in place and used with high frequency (4:1)
Continuum of strategies to respond to inappropriate behavior in place and used per established school-wide procedure
Students are actively supervised
Students are given multiple opportunities to respond (OTR)
Activity sequence promotes optimal instruction time and student engaged time
Instruction is differentiated based on student need

45. How are you going to prevent it from happening again?
“Learning Errors”
How are you going to prevent it from happening again?
Minors addressed quickly and quietly/privately
School wide procedures for majors are followed
Upon “return,” debrief and plan to prevent
What does student need?
What can we do to help?

46. “Appropriate” Responses to Learning Errors
If student removed from learning environment, create opportunities to teach/practice replacement behaviors
Natural consequences (is it “punishment” from the student’s perspective)
Changes within and across environments to promote appropriate behavior

47. A Classroom Example…

48. Study Basics Subject: Setting Concern Seven years old
Identified with EBD and ADHD
Setting
General education 2nd grade classroom with 19 other students
One licensed teacher and one student teacher
Concern
Student exhibits high rates of off-task
Student shouts out answers and questions and comments at high rates and often inappropriate

49. “Function of Behavior”
Descriptive (interviews and teacher reported ABC/ Scatterplot data)
Function identified as Attention
Significant antecedents: multiple step direction and group settings
Very High rates of both problem behaviors reported/ inconsistency in accuracy of data collection

50. “Environment Assessment”
Significant variables:
clarity of expectations & directions
consistency of expectations
accessibility of class schedules
lack of enforced procedures (especially regarding to hand raising and verbalizations or entire class)

53. Understanding the Function of Behavior
Individual Student PBS Plans

54. Essential Steps to Individual PBS Plans
Request for assistance/Noted concern
Operationally define problem/replacement behavior
Background/archival data/ data collection/Environmental Assessment
Functional Behavioral Assessment
Indirect measures
Direct observation
Develop hypothesis regarding function of problem behavior
Develop a PBS plan
Social skill instruction
Self management
Environmental modifications
Implement, Monitor and Evaluate progress 54

55. When To Conduct a Functional Assessment
When student exhibits patterns of challenging behavior
When a change in placement is made as a result of a school “discipline” procedure (IDEA)
When current behavioral intervention plan is not changing the pattern and/or outcome of behavior

56. IDEA
(f) Determination that behavior was a manifestation. If the LEA, the parent, and relevant members of the IEP Team make the determination that the conduct was a manifestation of the child's disability, the IEP Team must--
(1) Either--
(i) Conduct a functional behavioral assessment, unless the LEA had conducted a functional behavioral assessment before the behavior that resulted in the change of placement occurred, and implement a behavioral intervention plan for the child; or
(ii) If a behavioral intervention plan already has been developed, review the behavioral intervention plan, and modify it, as necessary, to address the behavior; and
(2) Except as provided in paragraph (g) of this section, return the child to the placement from which the child was removed, unless the parent and the LEA agree to a change of placement as part of the modification of the behavioral intervention plan.
IDEA.ED.GOV

58. FBA Basics
Behavior is functionally related to the teaching environment
Behavior is learned based on past outcomes
To Get
To Avoid
Behavior is maintained by predicting same/similar outcomes

59. Determining the Function
Examine:
Events that happen prior to school/class (Setting Events)
Events that prompt behavior (Antecedent)
Events that follow behavior (Consequence)

60. Antecedents Events that trigger or prompt a behavior
The student can predict the outcome of the behavior when the cue is present
What is happening before the behavior occurs?
Classroom environment
Academic activities
Transition

61. Consequences Events that follow a behavior
The environment “gives” something to the student and the student maintains or increases the behavior = what is being given is reinforcing to the student
The environment removes the student from an activity or situation and the behavior maintains of increases = the event the student is avoiding is aversive to the student

62. FBA: Indirect Interviews Student behavior rating scales
Environmental Assessment
Record Review

63. Indirect: Record Review
Attendance
Health history
Assessment data
Previous educational functioning
Onset of current problems
Discipline referrals
Past services or interventions
Effectiveness

64. Indirect: Classroom Assessment
Physical Space
Teacher Practices
Organization
Routines
Behavior Management
Informally as Part of Tier II process

65. FBA: Direct Direct Observation ABC Functional Analysis
Structural Analysis

66. To “Get” or “Avoid” Things student might get or acquire from behavior:
Attention
Something tangible
Access to preferred activities
Sensory stimulation
Things students may avoid
Attention from adults or peers
Work tasks
Responsibilities

67. Developing a Hypothesis
 When this occurs (setting condition) __________
The student does (problem behavior operationally defined) _______________
To get/avoid ___________

68. FBA-BIP/PBS-IEP Present Level Goals & Objectives
Hypothesis & supporting data
Dynamic – need to reassess when significant changes in environment
Goals & Objectives
Target replacement behavior
Conditions in which FBA targeted
Measurable criteria
Teaching plan separate from IEP

69. Key Features of Successful Plans
Behavior within objective based on a “functionally equivalent” replacement
Supplemental teaching plan clearly delineates
What environment changes should be made
What adults will do when replacement behavior displayed (Same/Similar Function!!!)
What adults will do if problem behavior displayed (Not feed function)

70. Homework
Review the School-wide / District-wide FBA Process Self Assessment (p. 28)

71. Pulling It All Together
Responding to Escalating Behavior

72. Acting Out Cycle Teach & Practice SWPBS / Classroom
5. Peak
Safety/Crisis Prevention
Teach &
Practice
SWPBS /
Classroom
4. Acceleration
6. De-escalation
3. Agitation
Consequence
Teach & Practice
Env Supports
Student Self-management
Environmental changes based
on FBA
2.Trigger
1. Calm
7. Recovery

73. Final Thoughts

74. 1. “It’s just behavior”
Its not personal… students engage in problem and appropriate behaviors to get needs met

75. 2. Behavior is learned
What you see is the result of risk factors within children’s past learning history (poverty, disability, academic failure, language, culture….)

76. 3. Research continues to demonstrate the most effective strategies are instruction based
Teach “what you want them to do instead”
Focus on academic and social success in terms of linear growth, not absolute

77. 4. Pause, step back,& smile
The most effective strategies will fail to impact students in the absence of sincerity, respect, and obvious joy in teaching

78. For More Information
OSEP Center for Positive Behavioral Interventions and Supports pbis.org Missouri School-wide Positive Behavior Support pbismissouri.org IDEAS that Work osepideasthatwork.org What Works Clearinghouse Ies.ed.gov/ncee/wwc