Md. Code Regs. 13A.08.04.05

Current through Register Vol. 51, No. 22, November 1, 2024

Section 13A.08.04.05 - General Requirements for the Use of Restraint or Seclusion

A. Use of Restraint.

(1) Physical Restraint.

(a) The use of physical restraint is prohibited in public agencies and nonpublic schools unless:

(i) Physical restraint is necessary to protect the student or another individual from imminent, serious physical harm; and

(ii) Other less intrusive, nonphysical interventions have failed or been demonstrated to be inappropriate for the student.

(b) Physical restraint shall only be implemented and monitored by school personnel who are trained in the appropriate use of physical restraint consistent with Regulation .06C of this chapter.

(c) In applying physical restraint, school personnel shall only use reasonable force as is necessary to protect a student or other person from imminent, serious physical harm.

(d) Physical restraint:

(i) Shall be removed as soon as the student no longer poses a threat of imminent, serious physical harm; and

(ii) May not exceed 30 minutes.

(e) In applying physical restraint, school personnel may not:

(i) Place a student in a face down position;

(ii) Place a student in any other position that will obstruct a student's airway or otherwise impair a student's ability to breathe, obstruct school personnel's view of a student's face, restrict a student's ability to communicate distress, or place pressure on a student's head, neck, or torso; or

(iii) Straddle a student's torso.

(2) Mechanical Restraint.

(a) The use of mechanical restraint is prohibited in public agencies and nonpublic schools unless a public agency or nonpublic school is accredited by and meets the requirements of the Joint Commission.

(b) Section A(2)(a) of this regulation does not prohibit school personnel from using a protective or stabilizing device:

(i) As prescribed by a health professional; or

(ii) For a student with a disability, in accordance with the student's IEP or behavior intervention plan.

(3) Documentation of the Use of Restraint.

(a) Each time school personnel use restraint on a student, school personnel involved in the restraint shall debrief and document the incident using a form developed by the Department that includes:

(i) Other less intrusive, nonphysical interventions that have failed or been determined inappropriate;

(ii) The precipitating event immediately preceding the behavior that prompted the use of restraint;

(iii) The behavior that prompted the use of a restraint;

(iv) The type of restraint;

(v) The length of time in restraint;

(vi) The student's behavior and reaction during the restraint;

(vii) The names of the school personnel who observed the behavior that prompted the use of restraint;

(viii) The names and signatures of the school personnel implementing and monitoring the use of restraint; and

(ix) The names of the school personnel who observed the behavior that prompted the use of restraint; and

(b) The debrief and documentation shall occur as soon as possible after the event.

(4) The documentation described in §A(3) of this regulation shall be maintained in the student's educational record and available for inspection by the student's parent or legal guardian in accordance with COMAR 13A.08.02.

(5) Each time restraint is used, parents shall be provided oral or written notification within 24 hours.

B. Use of Seclusion.

(1) The use of seclusion is prohibited in public agencies.

(2) The use of seclusion is prohibited in nonpublic schools unless:

(a) Seclusion is necessary to protect the student or another individual from imminent, serious physical harm;

(b) Other, less intrusive interventions have failed or been demonstrated to be inappropriate for the student;

(c) A qualified health care practitioner is on-site and is directly observing the student during the seclusion; and

(d) The health care practitioner concludes that seclusion is not contraindicated for the physical, psychological, or psychosocial health of the student.

(3) Before a health care practitioner may use seclusion as a behavioral health intervention for a student in a nonpublic school, the health care practitioner shall:

(a) Receive training in all topics required under Regulation .06 of this chapter; and

(b) Be clinically familiar with the student.

(4) Seclusion Room.

(a) At a minimum, a room used for seclusion shall:

(i) Be free of objects and fixtures with which a student could self-inflict bodily harm;

(ii) Provide school personnel an adequate view of the student from all angles; and

(iii) Provide adequate lighting and ventilation.

(b) The door of a seclusion room shall not be fitted with a lock unless it releases automatically when not physically held in the locked position by school personnel on the outside of the door.

(5) School personnel shall:

(a) Remain in close proximity to the door of a seclusion room at all times;

(b) Actively observe a student placed in seclusion at all times; and

(c) Provide a student placed in seclusion with:

(i) An explanation of the behavior that resulted in the removal; and

(ii) Instructions on the behavior required to return to the learning environment.

(6) Seclusion shall only be implemented and monitored by school personnel trained in the appropriate use of seclusion consistent with Regulation .06C of this chapter.

(7) A seclusion event:

(a) Shall be appropriate to the student's developmental level and severity of the behavior;

(b) May not restrict the student's ability to communicate distress; and

(c) May not exceed the shorter of:

(i) 30 minutes; or

(ii) A point in time during which the student no longer poses a threat of imminent, serious physical harm.

(8) Documentation of Seclusion.

(a) Each time a student is placed in seclusion, school personnel involved in the seclusion incident shall debrief and document the incident using a form developed by the Department that includes:

(i) Other less intrusive interventions that have failed or been determined inappropriate;

(ii) The precipitating event immediately preceding the behavior that prompted the use of seclusion;

(iii) The behavior that prompted the use of seclusion; and

(iv) The length of time in seclusion;

(v) The student's behavior and reaction during the seclusion;

(vi) The names and signatures of the school personnel implementing and monitoring the seclusion; and

(vii) The names and signatures of the staff members implementing and monitoring the seclusion.

(9) The documentation described in §B(8) of this regulation shall be maintained in the student's educational record and available for inspection by the student's parent or legal guardian in accordance with COMAR 13A.08.02.

(10) Each time seclusion is used, school personnel shall provide the student's parent with verbal notification or send written notice within 24 hours.

C. Referral to a Student Services, Section 504, or IEP Team.

(1) If restraint or seclusion is used for a student who has not been identified as a student with a disability, the student shall immediately be referred to the school's Student Support, Section 504, or IEP team.

(2) If restraint or seclusion is used for a student with a disability, and the student's Section 504 plan, IEP, or behavior intervention plan does not include the use of restraint or seclusion, the Section 504 or IEP team shall meet within 10 business days of the incident to consider:

(a) The need for a functional behavioral assessment;

(b) Developing appropriate behavioral interventions;

(c) Implementing a behavioral intervention plan;

(d) Training for school personnel; and

(e) Revisions to the Section 504 plan or IEP.

(3) If the behavior of a student with a Section 504 plan or IEP is adversely affected after the use of restraint or seclusion, the student's 504 or IEP team shall convene a meeting on an expedited basis or at the earliest opportunity to discuss alternative behavioral health treatments.

(4) Student with an IEP.

(a) For a student who has an IEP and is placed in seclusion, the IEP team, in consultation with the health care practitioner who observed the seclusion, shall review the student's physical, psychological, and psychosocial health history to determine whether seclusion is contraindicated for the student.

(b) A determination under this paragraph shall be made:

(i) At each annual review of the student's IEP; and

(ii) Within 10 days of a student's placement being changed.

(5) Physical restraint or seclusion may be included in a student's behavioral intervention plan, Section 504 plan, or IEP to address the student's behavior in an emergency situation, provided that school personnel:

(a) Determine restraint or seclusion has been used with the student;

(b) Review available data to identify any contraindications to the use of physical restraint or seclusion based on medical history or past trauma, including consultation with medical or mental health professionals as appropriate;

(c) Identify the less intrusive, nonphysical interventions that will be used to respond to the student's behavior until physical restraint or seclusion is used in an emergency situation; and

(d) Obtain written consent from the parent, consistent with §C(9) of this regulation.

(6) If restraint or seclusion is used for a student with a disability, and the Section 504 plan, IEP, or behavior intervention plan includes the use of restraint or seclusion, the student's IEP or behavior intervention plan shall specify how often the Section 504 or IEP team shall meet to review or revise, as appropriate, the student's Section 504 plan, IEP, or behavior intervention plan.

(7) When a Section 504 or IEP team meets to review or revise a student's Section 504 plan, IEP, or behavior intervention plan, as specified in §C(4) of this regulation, the Section 504 or IEP team shall consider:

(a) Existing health, physical, psychological, and psychosocial information, including any contraindications to the use of restraint or seclusion based on medical history or past trauma;

(b) Information provided by the parent;

(c) Observations by teachers and related service providers;

(d) The student's current placement; and

(e) The frequency and duration of restraint or seclusion incidents and behavior events that occurred since the IEP team last met.

(8) The local school system or nonpublic school shall provide the parent of the student with written notice in accordance with COMAR 13A.05.01.12A when a Section 504 or IEP team proposes or refuses to initiate or change the student's Section 504 plan, IEP, or behavior intervention plan that includes the use of restraint or seclusion.

(9) Parental Consent.

(a) The Student Support, Section 504, or IEP team shall obtain the written consent of the parent if the team proposes to include restraint or seclusion in the behavior intervention plan, Section 504 plan, or IEP to address the student's behavior.

(b) If the parent does not provide written consent, the team shall send the parent written notice within 5 business days of the team meeting that states:

(i) The parent has the right to either consent or refuse to consent to the use of restraint or seclusion; and

(ii) If the parent does not provide written consent or a written refusal within 15 business days of the team meeting, the team may implement the proposed use of restraint or seclusion.

(c) Written Refusal.

(i) If the parent of a student with an IEP provides written refusal, the IEP team may use the dispute resolution options listed in Education Article, § 8-413, Annotated Code of Maryland, to resolve the matter.

(ii) If the parent of a student with a Section 504 plan or behavior intervention plan from a Student Services team provides written refusal, there is no right to the dispute resolution options listed in the Education Article, § 8-413, Annotated Code of Maryland, to resolve the matter.

Md. Code Regs. 13A.08.04.05

Regulation .05A, B amended effective October 5, 2009 (36:20 Md. R. 1531)
Regulation .05C amended effective May 7, 2007 (34:9 Md R. 827); amended effective 45:14 Md. R. 697, eff. 7/16/2018; amended effective 50:22 Md. R. 977, eff. 11/13/2023