Restraint and seclusion during a pandemic
Students with behavioral issues may become agitated more easily upon the return to classrooms because of all the changes to their routine and school building. They may more quickly get to the point of needing to be restrained for their safety or the safety of their classmates. But the idea of staff getting that close to a student, even while wearing personal protective equipment, may make families and staff uneasy as the novel coronavirus outbreak continues.
“The precautions schools will have to take because of COVID-19 are definitely going to complicate things, without a doubt,” says Christine Sullivan, a school attorney at Berchem Moses PC in Milford, Conn. “More caution will need to be exercised in getting to that level even if the student is acting out.”
Ensuring staff is trained on de-escalation strategies to prevent the need for restraint and seclusion will be critical, Sullivan says. Also take these steps to ensure student and staff safety:
- Ease transition. Head off student distress regarding the return to school and change in routine that could trigger behavior necessitating restraint and seclusion by bringing in the student before school starts or on the first day and allowing him to reacclimate to the new way classrooms and the rest of the school building are set up and how everyone is going to look with PPE on. This may be particularly helpful if the student is moving from elementary to middle school or from middle to high school. “It would put the student’s mind at ease about where everything is,” Sullivan says. “The novelty of the whole thing is going to be problematic for some kids.”
- Maintain integrity of IEP, BIP. Ensure everyone understands that the student’s IEP and behavioral intervention plan are still in effect, even when social distancing and mask-wearing are required. If the student’s BIP details protocols for when a student may need to be restrained to keep him and others safe, staff members will have to follow those protocols. They must try every attempt to de-escalate the situation safely in accordance with the student’s BIP before using restraint and seclusion as a last resort but take additional precautions to prevent spread of the virus if they must restrain and seclude the student.
- Prepare for, respond to safety breaches. Ensure your staff members have gowns, gloves, face masks, and face shields to protect themselves in case the student pulls off her own mask and starts spitting or tries to pull off staff members’ masks, Sullivan says. “The fact that [staff members are] going to be wearing protective gear is just going to add another level of complexity to everything. Some kids may try to grab the gown or guard.” Recognize that evacuating other students from the room rather than trying to restrain the student may be the safer option in some situations, Sullivan says. But also crucial is ensuring staff members have additional masks and other PPE available to be replaced immediately when removed by a student. “You need another person to be available to give you another mask if the student pulls yours off,” she says. “The student may be very anxious and spitting or breathing very heavily, so you have to be very careful.” Document what occurred during a restraint and seclusion incident immediately afterward with additional information about any breaches in COVID-19 safety measures. “You have an obligation to document anything that happens, such as an injury or a risk of injury to the staff or the student,” she says.
- Promote student training. Seek the advice of a Board Certified Behavior Analyst if the student requires more direct instruction on following social distancing guidelines and wearing a mask and not removing the masks of others, Sullivan says. The student may benefit from using social narratives or other visual aids to follow the rules. “The BCBA can take additional data to figure out what is triggering the student’s new behavior,” she adds.
- Equip students with dedicated soothing strategies. Ensure the room a school uses for student seclusion is cleaned immediately after a student leaves so it is ready for the next student. Reduce the number of calming tools that students may share so things don’t have to constantly be cleaned and consider having dedicated items on hand for each student that no one else can touch.
Cara Nissman covers autism, school psychology, and IEP team issues for Special Ed Connection, a DA sister publication.