Use of Seclusion

USE OF SECLUSION

SECLUSION means the confinement of a student alone in a room from which the student is physically prevented from leaving.

SECLUSION IS NOT TO BE USED IN THE SCHOOL, UNLESS:

·  There is an emergency situation and seclusion is necessary to protect a student or another person after other less intrusive interventions have failed or been determined to be inappropriate;

·  The student’s behavioral intervention plan and/or IEP describe the specific behaviors and circumstances in which seclusion may be used; or

·  The parents of a nondisabled student have otherwise provided written consent for the use of seclusion while a behavior intervention plan is being developed.

THE SETTING MUST:

·  Be free of objects and fixtures with which a student could inflict bodily harm;

·  Provide adequate lighting and ventilation; and

·  Allow staff to observe student from an adjacent area at all times.

STAFF ACTIONS WHILE A STUDENT IS IN SECLUSION: Assigned staff must be able to observe the student at all times while he/she is in seclusion. In addition, staff must provide the student with:

·  An explanation of the behavior that resulted in the student’s removal; and

·  Instructions on what the child would need to do the return to class.

SECLUSION CAN ONLY BE APPLIED BY SCHOOL PERSONNEL TRAINED IN THE APPROPRIATE USE OF SECLUSION.

WHEN SECLUSION IS USED, STAFF MUST:

·  Fill out the attached seclusion log;

·  Complete and sign the attached seclusion documentation form;

·  File a copy of the form in the student’s educational record;

·  Provide the student’s parent with verbal notification (note that contact must be documented) or send written notice within 24 hours, unless otherwise provided for in the student’s behavior intervention plan, or IEP; and

·  Forward copies to the Director of Special Education (for special education students) or the Director of Pupil Services (for non-disabled students).

BEST PRACTICES ALSO SUPPORTS:

·  Debriefing with staff involved in the incident;

·  Oral communication with the parent in addition to sending a copy of the seclusion documentation form;

·  Consideration of referral to pupil services, Interagency Council, or other outside agencies if the use of seclusion is often needed to address the student’s behavior; and

·  Development or revision of a crisis plan for the student in collaboration with the parents, therapists, etc.

SECLUSION DOCUMENTATION FORM

Date of Seclusion: ______

Student’s Name: / Date of Birth:
Is the student identified as a Special Education student? / ____ / Yes / ____ / No
Does the student have a Behavior Plan? / A Crisis Plan?
Is the use of seclusion part of the student’s behavior plan or crisis plan?
Has the student been referred to the Instructional Consultation Team?
The Pupil Service Team?
The IEP Team?

Precipitating Event Immediately Preceding the Behavior that Prompted Use of Seclusion:

______

Other Interventions Tried by Staff:

Provided Choices Removal of other students

Reduce Demands Voluntary removal of student to

Verbal Redirection another location

Calming Techniques Request for assistance

Reduced verbal interactions Exclusion

Other: ______

______

Behavior that Prompted Seclusion:

Threat of imminent, serious harm to self

Threat of imminent, serious harm to others

Threat of property destruction

Explain: ______

______

Justification for Initiating Seclusion:

______

Length of Time in Seclusion ______

(At a minimum, school personnel must reassess the student in seclusion every 30 minutes)

Page 2 – Seclusion Documentation Form

Student Behavior and Reaction During Seclusion:

______

Student Behavior at End of Seclusion:

______

Name and Signature of Person (s) Implementing and Monitoring Seclusion

______

Print Name Signature

______

Print Name Signature

______

Print Name Signature

______

Print Name Signature

______

Print Name Signature

Name and Signature of Administrator Informed of the Use of Seclusion

______

Print Name Signature

Copy to: Parent Student File Director of Pupil Services Director of Special Education

SECLUSION LOG

Date / Name of Student / Time In / Time Out / Reason for Use of Seclusion / Staff Member Implementing and Monitoring Use of Seclusion / Administrator Informed of the Use of Seclusion
Name:
Signature: / Name:
Signature:
Name:
Signature: / Name:
Signature:
Name:
Signature: / Name:
Signature:
Name:
Signature: / Name:
Signature:
Name:
Signature: / Name:
Signature:
Name:
Signature: / Name:
Signature:

The building administrator must complete and sign a Seclusion Report Form for any student who is in seclusion.