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)

Kentucky

Current Statutes, Regulations, Policies and/or Guidance

Currently, Kentucky does not have any statutes or regulations on student seclusion and restraint. The state does offer guidance. Guidance is available in two areas: (1) for procedures and best practices for time out rooms (see www.state.ky.us/agencies/behave/bi/TO.html and (2) three-tiered behavior intervention plan providing best practice for schools (see www.state.ky.us/agencies/behave/bi/bi.html). KDE also has a policy letter on the use of time-out in schools. A copy of it is embedded within the guidelines on effective use of time-out posted on the Behavior Home Page (see Web site above).

Recommended best practices in policy, regulation or guidance documents

Kentucky has evidence (see two bulleted items below) of the following recommended best practices in policy, regulation or guidance documents.

• 
  If seclusion and restraint techniques are permitted as behavioral interventions, the SEA addresses these interventions in the context of behavioral intervention plans
  

The following Web site offers guidance for using time out:
www.state.ky.us/agencies/behave/bi/TO.html

• 
  Provides resources for training of appropriate staff people
  

The following two Web sites provides resources:

www.state.ky.us/agencies/behave/bi/TO.html

www.state.ky.us/agencies/behave/bi/bi.html

Future Plans

The Restraint and Seclusion Advisory Committee, a group of stakeholders (the majority of whom KDE has established long-standing relationships with) met on September 29, 2009, to examine current guidance and practice and make recommendations to Kentucky’s Commissioner of Education and to KDE.

Additional Information

KDE and the Department of Special Education and Rehabilitation Counseling at the University of Kentucky maintain “The Behavior Homepage.” (See http://www.state.ky.us/agencies/behave/homepage.html.) It serves as a one-stop Web site to access information about student behavior.

The Kentucky Center on Instructional Discipline (KCID) is a federal- and state-funded center housed at Eastern Kentucky University’s Center for School Safety. KCID reaches approximately 300 schools to implement Positive Behavior Intervention and Support (PBIS). The Commissioner of Education, Dr. Terry Holliday, has shared Secretary Duncan’s letter with all KY superintendents and has reminded them of resources available through KCID. His letter to superintendents implies further guidance in the future.

The Academic and Behavior Response to Intervention (ABRI) Center is a state-funded pilot project through the Kentucky Department of Education that is operated at the University of Louisville. The Center works with districts to address both academic and behavioral interventions through proactive, evidence-based instructional practices.

KDE does not have a system to monitor what is occurring at the local level regarding the use of student restraint and seclusion except in the case of a student identified with a disability. In this case they monitor systems of general supervision.

Kentucky hosts the nationally recognized annual three-day Behavior Institute each summer with over 1,400 participants. National and state experts provide training to both special and general educators to support students with challenging behaviors through positive, proactive instructional strategies through tiered interventions. For students with the most challenging behaviors, teachers are taught to use verbal de-escalation strategies as a primary tool with restraint as a last possible resort.

Louisiana

State Web Site Search

No policy exists that addresses these issues. There is nothing regarding restraint/seclusion in Bulletin 1530, Louisiana IEP Handbook for Students with Disabilities (last updated Dec. 2008), nor in Bulletin 1706, Subpart A-Regulations for Students with Disabilities (last updated Oct. 2008).

Professional development offering for personnel working with children with disabilities during 2003–2004 school year in Nonviolent Crisis Prevention/Intervention (two-day training, 12 hours total).

DOE Web site shows professional development offering for instructor certification training in Nonviolent Crisis Prevention Intervention from a Crisis Prevention Institute trainer from Brookfield, Wisconsin. This four- day certification course was offered Jan 18–21, 2005, and Feb 1–4, 2005, for up to 30 individuals per session.

There are one or two criminal statutes from 1969, R.S. 14:328 and R.S. 14:329.5, that prohibit a person from willfully obstructing or impeding any student of an education institution in the lawful pursuit of his educational activities through the use of restraint, abduction, coercion or intimidation or by any action as result of which force and/or violence are present or threatened. However, these statutes are directed at riot prevention and the right of campus ingress and egress rather than the physical restraint of students by teachers or other staff.

R.S. 17:416.9 requires schools to provide a safe environment for teachers and other school staff, but it doesn’t apply to students.

R.S. 17:416 allows the removal of disruptive students from the classroom, although it does not mention seclusion or restraints.

R.S. 17:223 and R.S. 17:416.1 allow corporal punishment of students, but do not define corporal punishment.

The only prohibition in state law against the use of seclusion or physical restraints is in laws protecting the rights of mental patients.

R.S. 28:171 (adults) and Children’s Code Article 1409(D) (minors) mirror one another and provide extensive and humane guidelines for the use of restraints and seclusion.

§ 28:171. Enumerations of rights guaranteed

D. Seclusion or restraint shall only be used to prevent a patient from physically injuring himself or others. Seclusion or restraint may not be used to punish or discipline a patient or used as a convenience to the staff of the treatment facility. Seclusion or restraint shall be used only in accordance with the following standards:

(1) Seclusion or restraint shall only be used when verbal intervention or less restrictive measures fail. Use of seclusion or restraint shall require documentation in the patient's record of the clinical justification for such use as well as the inadequacy of less restrictive intervention techniques.

(2) Seclusion or restraint shall only be used in an emergency. An emergency occurs when there is either substantial risk of self-destructive behavior, as evidenced by clinically significant threats or attempts to commit suicide or to inflict serious harm to self, or a substantial risk or serious physical assault on another person, as evidenced by dangerous actions or clinically significant threats that the patient has the apparent ability to carry out.

(3) A written order from a physician, psychologist, medical psychologist, or psychiatric mental health nurse practitioner acting within the scope of his institutional privileges shall be required for any use of seclusion or restraint. If, however, no physician, psychologist, medical psychologist, or psychiatric mental health nurse practitioner is immediately available, a registered nurse who has been trained in management of disturbed behavior may utilize seclusion or restraint. The nurse or the nursing supervisor shall then immediately notify a physician psychologist, medical psychologist, or psychiatric mental health nurse practitioner with institutional authority to order seclusion or restraint and provide him with sufficient information to determine whether seclusion is necessary and whether less restrictive interventions have been tried or considered. The physician, psychologist, medical psychologist, or psychiatric mental health nurse practitioner may issue a telephone order for seclusion or restraint, if such order is indicated.

(4) Written orders for the use of seclusion or restraint shall be time limited and not more than twelve hours in duration. The written order shall include the date and time of the actual examination of the patient, the date and time that the patient was placed in seclusion or restraint, and the date and time that the order was signed.

(5) A renewal order for up to twelve hours of seclusion or restraint may be issued by a physician, psychologist, medical psychologist, or psychiatric mental health nurse practitioner with institutional authority to order seclusion or restraint after determining that there is no less restrictive means of preventing injury to the patient or others. If any patient is held in seclusion or restraint for twenty-four hours, the physician, psychologist, medical psychologist, or psychiatric mental health nurse practitioner with institutional authority shall conduct an actual examination of the patient and document the reason why the use of seclusion or restraint beyond twenty-four hours is necessary, and the next of kin or responsible party shall be notified by the twenty-sixth hour.

(6) Staff who implement written orders for seclusion or restraint shall have documented training in the proper use of the procedure for which the order was written.

(7) Periodic monitoring and care of the patient shall be provided by responsible staff. A patient in seclusion or restraint shall be evaluated every fifteen minutes, especially in regard to regular meals, water, and snacks, bathing, the need for motion and exercise, and use of the bathroom, and documentation of these evaluations shall be entered in the patient's record.

(8) Patients shall be released from seclusion or restraint as soon as the reasons justifying the use of seclusion or restraint subside. If at any time during the period of seclusion or restraint a registered nurse determines that the emergency which justified the seclusion or restraint has subsided and a physician, psychologist, medical psychologist, or psychiatric mental health nurse practitioner with institutional authority to order seclusion or restraint is not immediately available, the patient shall be released. At the end of the period of seclusion or restraint ordered by the physician, psychologist, medical psychologist, or psychiatric mental health nurse practitioner the patient shall be released unless a renewal order is issued.

(9) Mechanical restraints shall be designed and used so as not to cause physical injury to the patient and so as to cause the least possible discomfort.

(10) Facilities using seclusion or restraint shall have written policies concerning their use in place before they can be used. These policies shall include standards and procedures for placing a patient in seclusion or restraint, and for informing him of the reason he was put in seclusion or restraint and the means of terminating such seclusion or restraint.

(11) Nothing in this Section shall be construed to expand the scope of practice of psychology as defined in R.S. 37:2351 et seq. to authorize the ordering, administering, or dispensing of medications, or to authorize any practice not permitted under the privileges granted by the institution.

(12) The department shall adopt rules and regulations in accordance with the Administrative Procedure Act to govern the use of seclusion and restraint. Such rules and regulations shall respect the patient's individual rights, protect the patient's health, safety, and welfare, and be the least restrictive of the patient's liberty. The department shall adopt rules and regulations to provide for enforcement procedures and penalties applicable to a person who violates the requirements of this Section.

E. A patient may be placed alone in a room or other area pursuant to behavior shaping techniques such as "time-out". Such confinement may only be used as part of a written treatment plan, shall not be used for the convenience of staff, and may be used only according to the following standards and procedures:

(1) Placement alone in a room or other area shall be imposed only when less restrictive measures are inadequate.

(2) Placement alone in a room or other area shall only be ordered by a qualified professional trained in behavior-shaping techniques and authorized in accordance with the written policies and procedures of the facility to order the use of behavioral-shaping techniques.

(3) The period of placement alone in a room or other area shall not exceed thirty minutes.

(4) The patient shall be observed and supervised by a staff member.

(5) The period of placement alone in a room or other area shall not exceed a total of three hours in any twenty-four-hour time period. If the placement alone in a room or other area exceeds a total of three hours in any twenty-four-hour time period, it shall then be considered seclusion and shall be governed by the procedures and standards set forth in Subsection D of this Section.

(6) The date, time, and duration of the placement shall be documented.

(7) In treatment facilities where patients are placed alone in a room or other area as a behavior-shaping technique, there shall be written policies and procedures governing use of such behavior-shaping technique.

§ 40:2010.7. Definitions

For the purpose of R.S. 40:2010.6 through R.S. 40:2010.9, unless the context otherwise requires:

(1) "Sponsor" means an adult relative, friend, or guardian of a resident who has an interest or responsibility in the resident's welfare, and preferably who is designated as the responsible party on the resident's admission forms.

(2) "Physical restraint" means, but is not limited to, any article, device, or garment that interferes with the free movement of the resident and that he is unable to remove easily. It also includes a geriatric chair and a locked room door.

(3) "Chemical restraint" includes any drug listed in the schedules of controlled substances under R.S. 40:964 as a substance having a depressant effect on the central nervous system, or chlorpromazine hydrochloride.

(4) "Ancillary service" means, but is not limited to, podiatry, dental, audiology, vision, physical therapy, occupational therapy, psychological and social services, and planning services.

Art. 1409. Rights guaranteed

D. Physical restraints or seclusion shall only be used to prevent a minor patient from physically injuring himself or others. Physical restraints or seclusion may not be used to punish or discipline a patient or used as a convenience to the staff of the treatment facility. Restraint and seclusion shall be used only in accordance with the following standards:

(1) Restraint or seclusion shall only be used when verbal intervention or less restrictive measures fail. Use of restraint or seclusion shall require documentation in the patient's record of the clinical justification for such use as well as the inadequacy of less restrictive intervention techniques.

(2) A written order from a physician or a psychologist acting within the scope of his institutional privileges shall be required for any use of restraint or seclusion. If, however, no physician or psychologist is immediately available, a registered nurse who has been trained in management of disturbed behavior may utilize restraint or seclusion. The nurse or the nursing supervisor shall then immediately notify a physician or a psychologist with institutional authority to order seclusion and provide him with sufficient information to determine whether restraints or seclusion are necessary and whether less restrictive interventions have been tried or considered. The physician or psychologist may then issue a telephone order for seclusion or restraint, if such order is indicated.

(3) Written orders for the use of restraint or seclusion shall be time limited and not more than twelve hours in duration. The written order shall include the date and time of the actual examination of the patient, the date and time that the patient was placed in restraint or seclusion, and the date and time that the order was signed.

(4) A renewal order for up to twelve hours of restraint or seclusion may be issued by a physician or a psychologist with institutional authority to order seclusion or restraint after determining that there is no less restrictive means of preventing injury to the patient or others. If any patient is held in restraint or seclusion for twenty-four hours, the physician or psychologist with institutional authority shall conduct an actual examination of the patient and document the reason why the use of seclusion or restraint beyond twenty-four hours is necessary, and the parent, tutor, or caretaker shall be notified by the twenty-sixth hour.

(5) Staff who implement written orders for restraints and seclusion shall have documented training in the proper use of the procedure for which the order was written.

(6) Periodic monitoring and care of the patient shall be provided by responsible staff. A patient in restraint or seclusion shall be evaluated every fifteen minutes, especially in regard to regular meals, water, and snacks, bathing, the need for motion and exercise, and use of the bathroom, and documentation of these evaluations shall be entered in the patient's record.

(7) Patients shall be released from restraint or seclusion as soon as the reasons justifying the use of restraints or seclusion subside. If at any time during the period of restraint or seclusion a registered nurse determines that the emergency which justified the seclusion or restraint has subsided and a physician or psychologist is not immediately available, the patient shall be released. At the end of the period of restraint or seclusion ordered by the physician or psychologist the patient shall be released unless a renewal order is issued.

(8) Mechanical restraints shall be designed and used so as not to cause physical injury to the patient and so as to cause the least possible discomfort.

(9) Facilities using seclusion or restraint shall have written policies concerning their use. These policies shall include standards and procedures for placing a patient in seclusion or restraint, and for informing him of the reason he was put in seclusion or restraint and the means of terminating such seclusion or restraint.

(10) Nothing in this Article shall be construed to expand the scope of practice of psychology as defined in R.S. 37:2351 et seq. to authorize the ordering, administering, or dispensing of medications, or to authorize any practice not permitted under the privileges granted by the institution.

(11) The department shall adopt rules and regulations in accordance with the Administrative Procedure Act to govern the use of seclusion and restraint. Such rules and regulations shall respect the minor patient's individual rights, protect the minor patient's health, safety, and welfare, and be the least restrictive of the minor patient's liberty. The department shall adopt rules and regulations to provide for enforcement procedures and penalties applicable to a person who violates the requirements of this Section.

E. A patient may be placed alone in a room or other area pursuant to behavior shaping techniques such as "time-out". Such placement may only be used as part of a written treatment plan, shall not be used for the convenience of staff, and may be used only according to the following standards and procedures:

(1) Placement alone in a room or other area shall be imposed only when less restrictive measures are inadequate.

(2) Placement alone in a room or other area shall only be ordered by a qualified professional trained in behavior-shaping techniques and authorized in accordance with written policies and procedures of the facility to order the use of behavior-shaping techniques.

(3) The period of placement alone in a room or other area shall not exceed thirty minutes.

(4) The patient shall be observed and supervised by a staff member.

(5) The period of placement alone in a room or other area shall not exceed a total of three hours in any twenty-four hour time period. If the placement alone in a room or other area exceeds a total of three hours in any twenty-four hour time period, it shall then be considered seclusion and shall be governed by the procedures and standards set forth in Paragraph D of this Article.

(6) The date, time, and duration of the placement shall be documented.

(7) In treatment facilities where patients are placed alone in a room or other area as a behavior-shaping technique, there shall be written policies and procedures governing use of such behavior-shaping technique.

State Education Agency Plans:

• 
  Share information with Children’s Justice Act (CJA) Task Force.
  
• 
  Develop guidance and advisement of districts to consider using some of their stimulus dollars for PBIS implementation.
  
• 
  For the purposes of safety, uniformity and use of best practices, the department is seeking legislation and/or developing policy on the humane and effective use of seclusion and/or physical restraints.