Summary of Seclusion and Restraint Statutes, Regulations, Policies and Guidance, by State and Territory: Information as Reported to the Regional Comprehensive Centers and Gathered from Other Sources (ms word)

Section 4. Therapeutic restraint

4.1 Permitted uses of therapeutic restraint

Appropriately trained staff may physically intervene with a student to prevent injury or harm to the student or others. Therapeutic restraint may be used for either an emergency intervention or as part of an intervention plan. The intervention shall occur only after less intrusive efforts to control the behavior have been attempted. The intervention shall involve the least amount of physical contact necessary, shall be implemented consistent with the standards of a training program as specified in §4.5 and consistent with local policy. The use of therapeutic restraint shall require the presence of at least two adults at all times. Title 20-A, §4009 permits a single individual to use a reasonable degree of force in emergency situations to control or remove the student.

4.2 Time limits on the use of therapeutic restraint

Use of therapeutic restraint shall be limited in duration consistent with local policy and the student’s individualized intervention plan but may not exceed one hour. If a student is still presenting dangerous behaviors after this time period, the use of therapeutic restraint may be continued with written authorization of the program administrator or designee.

4.3 Exclusions

Protective equipment or devices that are part of a treatment plan prescribed by a physician or psychologist for treatment of a chronic condition are not prohibited by these regulations.

4.4 Mechanical or Chemical Restraints Prohibited

The term ‘therapeutic restraint’ does not include mechanical or chemical restraints used to control or modify a student's behavior. Chemical restraints include but are not limited to medication, noxious sprays or gases. Prescribed medication administered by a health care provider consistent with a student's health care plan are permitted. Mechanical restraints are prohibited.

4.5 Training

Except as provided by Title 20-A, §4009, individuals who implement or supervise the implementation of therapeutic restraint shall have successfully completed an appropriate training program in the identification and de-escalation of potentially harmful behaviors and the safe use of passive physical therapeutic restraints. This training includes, but is not limited to, Non-Abusive Psychological and Physical Intervention (NAPPI), Mandt, Crisis Prevention Institute, Therapeutic Crisis Intervention Training, and other training as determined appropriate by local policy.

Section 5. Aversives

5.1 Use of Aversive Therapy or Treatment Prohibited

A school administrative unit or an approved private school may not use aversive therapy or treatment in order to modify or change a student's behavior. Aversive therapy or treatment includes the application of unusual, noxious or potential hazardous substances, stimuli or procedures to a student. Such substances, stimuli and procedures include but are not limited to: water spray, hitting, pinching, slapping, noxious fumes, extreme physical exercise, costumes or signs.

STATUTORY AUTHORITY: 20-A MRSA §4502(5)(M)

EFFECTIVE DATE:

July 29, 2001—added as sub-section 17(D) to Chapter 125, “Basic Approval Standards: Public Schools and School Units.”

EFFECTIVE DATE:

April 27, 2002—filing 2002-104 accepted March 28, 2002: sub-section 125.17(D) removed from Chapter 125 and established as new Chapter 33, “Regulations Governing Timeout Rooms, Therapeutic Restraints and Aversives in Public Schools and Approved Private Schools”

http://www.maine.gov/sos/cec/rules/05/071/071c033.doc

B. Below is a link to a letter sent by Commissioner Gendron to superintendents, principals, special education directors and teachers that clearly defines Maine laws and provides guidance to education professionals based on a current bill that was recently presented to the Joint Committee on Education and Cultural Affairs, which is underway to further address this issue.

C. Letter #003 Restraints Causing Restriction of the Airway [07/14/2009]

ADMINISTRATIVE LETTER NO: 3

POLICY CODE: JKF

TO: Superintendents, Principals, Directors of Special Education, Teachers

FROM: Susan A. Gendron, Commissioner

DATE: July 14, 2009

RE: Restraints Causing Restriction of the Airway

A bill was presented this session to the Joint Committee on Education and Cultural Affairs to prohibit physical restraint of a disabled student that results in the student lying face down on the floor while pressure is applied to the student’s back. LD 1096—An Act To Protect School Children from Dangerous or Abusive Restraint and Seclusion. http://janus.state.me.us/legis/LawMakerWeb/summary.asp?ID=280032005 The Department not only strongly supports the effort to prohibit this type of restraint, we would broaden the prohibition to include all children and any position which restricts the free movement of the diaphragm or chest so as to interrupt normal breathing and speech. Any body position that restricts the airway or that interferes with the muscular or mechanical means of getting air into and out of the body—the body’s “bellows function”—will result in death unless the restriction ends in time.

Some students, such as those who are overweight or who have asthma, may be more prone to airway constraint than other students when placed in particular positions. A combination of conditions, mental and physical, including the use of certain medications, can place individuals at particular risk. www.gao.gov/archive/1999/he99176.pdf , pp. 7 and 8.

The Child Welfare League of America reported in 2002 that 8 to 10 children in the United States die each year due to restraints, and that other children suffer a range of injuries including broken bones and damaged joints. These data were identified with a broader population survey than schools only. Neither the federal government nor the states comprehensively track the use of restraint or seclusion data, or related injuries, so the true extent of the harm from restraint is unclear. www.gao.gov/archive/2000/he00026t.pdf , p. 4.

Unsafe practices must be avoided. The regulations permit therapeutic restraints only “to prevent injury or harm to the student”, Ch. 33 §§ 2.3 and 4.1. Local policy may be determined only for therapeutic restraints. Ch. 33 § 1.3. www.maine.gov/sos/cec/rules/05/chaps05.htm

Dangerous restraints of the type addressed in this letter are generally discouraged by the training programs referenced in § 4.5 of Ch. 33 according to the Department’s information and are considered non-therapeutic.

Accordingly, pending the results of a review and revision of Ch. 33, the use of any restraint that restricts the free movement of the diaphragm or chest or that restricts the airway so as to interrupt normal breathing or speech of students is prohibited. All school personnel who may restrain or assist with a restraint shall be notified of this prohibition. During the course of every restraint, a student’s breathing and speech shall be monitored to protect against airway stress. Action causing unintended airway stress shall cease immediately. Any restraint shall immediately be reported to the school nurse who shall assess the student promptly.

http://www.maine.gov/tools/whatsnew/index.php?topic=edu_letters&id=76197&v=article