Miami-Dade County Public Schools Clinical Behavioral Services Division of Exceptional Student Education

CLINICAL SERVICES PROCEDURAL HANDBOOK

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School Board of Miami-Dade County Public Schools Ms. Perla Tabares Hantman, Chair Dr. Martin S. Karp, Vice Chair Dr. Dorothy Bendross-Mindingall Ms. Susie V. Castillo Mr. Carlos L. Curbelo Dr. Lawrence S. Feldman Dr. Wilbert “Tee” Holloway Dr. Marta Pérez Ms. Raquel A. Regalado Mr. Alberto M. Carvalho Superintendent of Schools Ms. Maria L. Izquierdo Chief Academic Officer Office of Academics and Transformation Dr. David K. Moore Assistant Superintendent Division of Academic Support Office of Academics and Transformation Ms. Ava Goldman Administrative Director Office of Academics and Transformation Division of Academic Support Exceptional Student Education and Student Support Mrs. Liliana Salazar District Director Division of Special Education Ms. Robin J. Morrison Instructional Supervisor Division of Special Education Clinical Behavioral Services

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Clinical Services: Clinician’s Procedural Handbook Table of Contents Section I: Overview Mission Statement Introduction Counseling Services Goal Cultural Sensitivity and Counseling Interventions

Pages 6 6 7 7

Section II: Roles and Responsibilities Chairperson Role Roles & Responsibilities of the E/BD Clinician New Employee Orientation Professional Development

9 10 12 13

Section III: Clinical Documentation & Important Information Clinical Records & Documentation Assessments Baker Act Procedures Case Conference Clinical File Cover Sheet Clinical Services Crisis Note Clinical Services Intake Clinician Schedule Consent Form for Mutual Exchange of Information Crisis Assessment E/BD Crisis Plan Functional Assessment of Behavior (FAB) Inclusion IEP Psychiatric Consultation Quarterly Clinical/Art Therapy Progress Summary School/Parental High Profile Concern SPED/EMS Service Log Student Services Case Management Form Team Meeting Transfer of Files Transition Miami-Dade County Public Schools: Clinical/Behavioral Services

15 15 15 20 21 21 22 22 23 23 23 24 25 26 26 28 28 29 29 29 30 31 3

Section IV: Division Procedures Daily Reporting Planned Absence Late Arrival Unplanned Absence Leave Requests E-mails In-County Travel Meetings Instructional Performance Evaluation Growth System (IPEGS)

33 33 33 33 34 34 34 35 35

Section V: Legal Information Baker Act Marchman Act Non-Discrimination Policy Technical Assistance Papers

37 38 40 41

Section VI: Forms Psychiatric Consultation Transfer of File Form Clinical File Cover Sheet New Employee Orientation Case Conference School/Parental High Profile Student Concerns Sample Crisis Intervention Plan Clinical Buddy Contact Log School Site Staff Support Form

80 83 84 85 86 88 89 93 94

Section VII: Miami-Dade County Public School – Important Websites Important Websites

96

Section VIII: Resource Information Community Resources

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SECTION I: OVERVIEW

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Mission Statement The Miami‐Dade County Public Schools (M‐DCPS) Programs for students with Emotional/Behavioral Disabilities (E/BD) is dedicated to fostering and developing students’ interpersonal and academic skills. The goal is to assist students in meeting academic and emotional challenges successfully. E/BD Clinicians strive to identify and mobilize the strengths of their students and families in an effort to assist them in becoming integral members of their community.

Introduction The purpose of this handbook is to function as an overview of administrative procedures and as an informational guide of resources for clinicians as they perform their roles. School administrators may also find this useful as it provides information on the varied roles of the E/BD clinical staff. As the needs of students participating in E/BD programs have expanded, the role of the clinical staff has also expanded to assist students in developing resources and skills to become positive members of their community.

For further information regarding Miami-Dade County Public Schools Emotional/Behavioral Disabilities Clinical Services Department contact: Nadyne Floyd Grubbs, LCSW District Clinical Chairperson 2201 NW 207 Street Miami Gardens, Florida 33056 Phone: 305 626‐3963 Fax: 305 626‐3962 [email protected]

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Counseling Services Goal All professionals providing counseling services for students participating in programs for E/BD are referred to as clinical staff or clinicians. Counseling services provided to students with E/BD will be referred to as clinical services. Clinicians who work within our programs may include the following job titles: art therapists, school counselors, school social workers, and school psychologists. Clinicians have a minimum of a master’s degree. Many possess licensure from the State of Florida. The goal of counseling services is to assist students in their ability to access their education. Counseling services involve a multimodal approach taking into account the individual needs of each child and focusing upon assisting students in meeting goals placed on the Individualized Education Plan (IEP). Techniques and strategies fundamental to play therapy, cognitive behavioral therapy, reality therapy, art therapy and behavioral therapy are some of the approaches utilized with students and/or families taking into account a multi‐systemic perspective. Clinicians strive to focus upon strength‐based interventions where the focus is on what the student can do and what can be built upon. Counseling service delivery is an interactive approach. Students, parents, teachers, administrators, and clinicians must work cooperatively with one another for maximum effectiveness. It is important to note the information released during counseling sessions are confidential in nature with the exception of situations where there is a possibility of harm to self or others is disclosed. In these situations, a crisis assessment is conducted and appropriate measures are then taken in order ensure the safety of all.

Cultural Sensitivity and Counseling Interventions Miami‐Dade County a n d M i a m i D a d e C o u n t y P u b l i c S c h o o l s is reflective of a diverse community of s t u d e n t s a n d families. Our students come from different countries all over the world with different experiences. Oftentimes, individuals from different cultures, ethnic and racial backgrounds are viewed as one homogenous group. However, this is rarely the case. It is essential that clinicians make every effort to become knowledgeable regarding the cultural demographics of their students and recognize the diversity between and among ethnic, racial, religious, and cultural backgrounds. The concept of culture is very important when delivering clinical services. Cultural aspects can impact all elements of the clinical process, from initially engaging with students and families to assessment and treatment. Recognizing how our own values and cultural constructs can impact how we perceive our clients and what we see as pathology, clinicians are challenged with focusing upon the strengths and protective factors of each group in an effort to help students and families reach their potential.

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SECTION II: ROLES AND RESPONSIBILITIES

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Chairperson Role The Chairperson for Clinical Services a n d t h e A r t T h e r a p y D e p a r t m e n t C h a i r p e r s o n are liaisons between the Instructional Supervisor for E/BD programs and school site clinicians. Collaborations with the administrators at the school, regional center, or district, are an ongoing occurrence to strengthen the continuum of services to students participating in E/BD programs. The main role of the chairperson or designee is to provide technical assistance to sites regarding mental health, clinical, legal, or procedural issues. Additionally, when new clinicians are hired, it is the responsibility of the chairperson to initiate and monitor the New Employee Orientation process. The chairperson conducts site visits to better individualize assistance to clinicians and to provide the Instructional Supervisor with information or concerns regarding specific sites. During site visits, the chairperson reviews clinical files, computer based documentation, assessment data, monitoring data, meets with the principal or designee, visits classrooms, meet with the behavior management teacher (if applicable) and observe a clinical session or clinician engaged in an aspect of service delivery. Clinicians may utilize this time to consult with the chairperson regarding difficult cases, s i t e c o n c e r n s , s t u d e n t successes, intervention strategies. The Clinical Services Monitoring Checklist Form and Clinical Services Monitoring Checklist Follow-up Form are used to provide documented feedback to the clinician and Instructional Supervisor for E/BD.

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Roles and Responsibilities of the E/BD Clinician Clinicians assigned to provide services to students in the M-DCPS E/BD programs are responsible for offering clinical and other support services, which may include, but are not limited to the following areas: 

Provides individual and/or group counseling to each student as determined by the IEP.

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Provides family counseling, education, and support and adjusts schedule to meet with families on an as-needed basis.

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Conduct at least twice month a Team Meeting with planned agenda to address student progress, coordinate interventions, review and develop IEP and Behavior Intervention Plans (BIPs) goals, and address programmatic concerns. (If there is a BMT on site, they are responsible for coordinating and conducting the meeting.)

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Conduct weekly case conferences to address student’s behavioral, emotional/mental health and academic updates, strategies implemented, response to intervention, review clinical/mental health data collected.

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Administers an approved assessment to students participating in the E/BD program.

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Assists in developing goals on the student’s IEP and BIP, and arranges the provision of services for all students (this plan is developed in conjunction with the teachers and determination of needs defined through classroom and clinical observations and conferences); develops behavioral and counseling goals that are consistent with the behavior management system, IEP and BIP.

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Maintains up-to-date documentation through SPED/EMS to document progress on identified behaviors, Quarterly Progress Reports, and Crisis Notes used as needed.

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Clinicians who are School Psychologists conduct the necessary comprehensive psychological reevaluations of E/BD students within the required time lines. For additional information, refer to the Psychological Services website at http://psy.dadeschools.net/pdfs/SST_manual_12.pdf for access to the Psychological Services Manual for procedures.

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Clinicians, who are not School Psychologists, meet with the psychologist assigned to their schools and provide information essential to the completion of the Re-evaluation (RT), including psychological and behavioral information.

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Coordinates psychiatric consultation services and prepares documentation and referral questions in advance.

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Consults with school, region, and district staff and participates in committee meetings and activities related to students and programming.

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Attends scheduled clinical meetings.

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Consults with administration, staff, and families in the development and support of a consistent behavioral management plan and crisis intervention for the school site.

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Retains a current listing of community mental health agencies and social service resources and maintains communication with other professionals serving students, as appropriate.

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Provides parent contact and case management services for each student, as needed.

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Consults with the region, school, and district administrative and support staff to ensure the implementation and maintenance of a quality program which conforms to district standards.

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Submits time sheet as scheduled and conforms to teacher working hours with the exception of required meetings.

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When appropriate, assists school staff with non-E/BD students who present a danger to self or others using School Board approved Safe Crisis Management procedures.

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Maintains clinical records for each student in an individual file, including but not limited to, intake information, crisis notes, case conferences, FABs, BIPs, psychological and psychiatric evaluations, psychiatric consultation, and the current IEP from IEP-at a-Glance on the SPED/EMS system.

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Documents provision of clinical services on the Student Case Management Student Services Form (FM 3673) for all services provided.

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Documents provision of clinical services and parental contacts on the SPED/EMS system.

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Maintains confidentiality and abides by the code of ethics established by M-DCPS and the appropriate organization for each discipline.

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New Employee Orientation The New Employee Orientation process is designed to assist new employees in understanding their role and responsibilities to enable them to provide quality service to students participating in the Emotional Behavioral Disabilities program. This process has three phases. P h a s e I is the initial New Employee Overview; Phase II is the Clinical Buddy Support System; and Phase III is the Summary. P h a s e I in the New Employee Orientation process is the Overview. The chairperson or designee is responsible for conducting the Overview. During this session the following are discussed: Clinical Services Procedural Handbook; Clinical Art Therapy Procedural Handbook; school site protocols; Programs for Students with Emotional/Behavioral Disabilities website; LEAPS assessment; SSIS assessment; ASEBA assessment; LECATA assessment; the Silver Drawing Test; Clinical Buddy Support; and scheduling of the Summary meeting date. Phase II of the New Employee Orientation process is the Clinical Buddy Support System. This phase is designed to provide direct peer support to the new E/BD clinician. An established clinician, the Clinical Buddy, is paired with the new clinician and through this process; the new clinician is oriented to the role and responsibilities of the position for their assigned school site. The new employee will shadow one different clinician for one day. The clinical Buddy will monitor and support the new employee for six weeks. Topics to be addressed in this process include: • Review Emotional/Behavioral Disabilities Program Manual • Review Clinical Behavioral Services Manual • Review Clinical Services Clinician’s Handbook of Procedures • Review documentation requirements of the position • Review hierarchical chain of command at the school sites • Assist w i t h h e l p i n g n e w e m p l o y e e d e v e l o p o r g a n i z a t i o n a l systems t o manage documentation and tasks which are required of all clinicians (IPEGS, schedules, crisis reporting, child abuse, crisis plans) • Review with employee professional development meeting dates • Answer questions or refer new employee to the chairperson • Meet with the new employee at their site twice during the semester; a n d new employee meets at Clinical Buddy’s site twice during the semester • Phone contact weekly to see if there are any questions Phase III is the Summary Meeting conducted by the chairperson or designee at the end of six weeks. The Clinical Buddy may be invited to this session. During this session the new employee submits their Buddy Contact Log and School Site Staff form. At this time questions are answered and recommendations for continued support are made if necessary. See Appendix Section for the Clinical Buddy Contact Log and School Site Support Form.

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Professional Development As instructional employees of M‐DCPS, clinicians are required to meet any licensure or certification requirements of their positions. Meeting these requirements is the sole responsibility of the employee; specific questions regarding certification requirements should be directed to M‐DCPS Certification Office. Clinicians are encouraged to register and attend all Professional Development trainings scheduled for E/BD Clinicians only. Additional trainings offered through other departments can be attended based on schedule availability. All new clinicians will be properly trained on the SPED/EMS system for counseling service documentation and the IEP. Clinicians should have a working knowledge of the Individualized Education Plan development process. Staff will be provided with registration trainings dates for Safe Crisis Management (SCM) and Functional assessment of Behavior (FAB). The professional development training portal is utilized to register for all professional development activities. Access to the portal is through the employee section at www.dadeschools.net.

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SECTION III: CLINICAL DOCUMENTATION & IMPORTANT INFORMATION

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Clinical Records and Documentation Clinicians are required to maintain clinical records and documentation in the Clinical File, SPED/EMS and ISIS. Access to clinical records is governed by the Federal Education and Rights and Privacy Act (FERPA). Clinical records are considered school records and as such, parents and administration may view these documents upon request. This Section describes documentation that is kept in the Clinical File and where forms can be accessed.

Assessments Social skills assessments may be conducted to obtain additional intervention strategies to assist the student in improving emotional behavioral issues that impact learning. The “Notice of Intent and Parent/Guardian Consent to Conduct an Evaluation” must be received from the parent before the assessment can be conducted. This form gives M-DCPS consent to conduct assessments. It should be completed and reviewed with the parent/guardian and signed before any assessment or psychiatric consultation is conducted. In the section beginning, “With your consent” the assessment name or Psychiatric Consultation should be written on the line “Other”. You can access this form at http://forms.dadeschools.net/webpdf/4961.pdf.

Baker Act Procedures The following procedures are to be used as a guide and as a set of general recommendations for assisting in the reentry process. They do not preempt the use of good clinical judgment regarding individual cases. In difficult or complex situations, consultation is essential. Consultation services can be provided by District Programs such as the Division of Psychological Services, Division of Student Services, School Social Work Programs, Programs for Students with Emotional/Behavioral Disabilities, and/or the District Crisis Team. Procedures to Take Prior to Involuntary Transport 1. Once the student presents at risk behaviors such as, self-harm or harm to others, he/she should be under the supervision, at all times, of an adult school site staff member and a M-DCPS Mental Health Services Professional (School Counselor, School Social Worker, School Psychologist, E/BD Clinician, or TRUST Specialist) should be notified. 2. The M-DCPS Mental Health Services Professionals should conduct an immediate risk assessment to determine if the student presents danger of harm to self or others. The purpose of the risk assessment is to assess the need for immediate services to ensure safety. o The risk assessment must include evaluation of suicidal/homicidal ideation, plans, previous violent behavior, history of mental illness and treatment, Miami-Dade County Public Schools: Clinical/Behavioral Services

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current stressors, compliance with current psychiatric medications, and substance use/abuse. 3. Principal or administrative designee must be immediately contacted and informed throughout the process. 4. If imminent risk of harm towards self or others is present the M-DCPS Mental Health Services Professional should contact 305-995-COPS and request that a CIT (Crisis Intervention trained) School Resource Officer be deployed to the school. 

Imminent risk constitutes behaviors that are correlated with active or passive danger to self or others. Examples of active danger are suicidal/homicidal ideations, attempts, or plans. Examples of potential passive danger could be the presence of auditory or visual hallucinations name; active psychotic processes.

5. The M-DCPS Mental Health Services Professionals should share the findings of the assessment, including pertinent observations with the School Resource Officer. 6. A School Resource Officer may strongly consider the accounts of credible witnesses such as M-DCPS Mental Health Services Professional in determining if a student meets criteria for the Baker Act. 7. School Resource Officer or a M-DCPS LICENSED Mental Health Professional will complete documents (Report of Law Enforcement Officer Initiating Involuntary Examination or Certificate of Professional Initiating Involuntary Examination) necessary to accompany the student to the nearest receiving facility. o Licensed Mental Health Professionals as adapted from Florida State Statute 394.455 are M-DCPS staff with the following licensure:     

Clinical Psychologists as defined in s. 490.003 (3) Clinical Social Worker as defined under Chapter 491 (4). Mental Health Counselor as defined under Chapter 491 (37) Marriage and Family Therapist as defined under Chapter 491 (36) Psychiatric Nurse as defined under Chapter 464 (23)

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For LICENSED M-DCPS Mental Health Professionals (i.e. clinical psychologists, licensed clinical social workers, licensed mental health counselors, licensed marriage and family therapists, or psychiatric nurses): The role of School Police is to receive the completed Certificate of Professional Initiating an Involuntary Examination and determine the method of INVOLUNTARY transportation to the nearest receiving facility.

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For Certified M-DCPS Mental Health Professionals (i.e. School Counselors, School Social Workers, School Psychologists, TRUST Specialists, and E/BD Clinicians) who are

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unable to initiate a Baker Act: The role of School Police is to respond to the school site and meet with the Certified M-DCPS Mental Health Professional. The Certified M-DCPS Mental Health Professional will provide the School Police Officer with information regarding the student’s risk behavior which may meet criteria for an involuntary examination (Baker Act). The School Police Officer may conduct a separate assessment and determine if the student meets criteria, or they may choose to initiate based on the professional’s recommendations as a credible witness. They will determine the method of INVOLUNTARY transportation to the nearest receiving facility. Procedures to Take Following a Baker Act 1. All M-DCPS Mental Health Professionals must document on the Integrated Student Information System (ISIS) Student Case Management System the following codes: RS (Risk Assessment) and RI (Risk Intervention). All M-DCPS Mental Health Professionals must also document all services on the SPED/EMS System. 2. M-DCPS Mental Health Professionals should contact the receiving facility and speak with the Assessment/Intake Supervisor to inform them of the behaviors the student displayed and to please remind the parent to sign a HIPAA Release in order to aide in providing continuity of services. 3. Contact parent(s)/legal guardian(s) and explain that their child presented with behaviors indicating severe risk and is currently being transported to a mental health facility for emergency evaluation. If a parent asks why I was not called first, explain that in all medical emergency situations, emergency services must be initiated immediately to prevent further harm. Encourage the parent to sign the HIPPA Release form and include at least two M-DCPS Mental Health Professionals on the form. 4. It is highly recommended that the M-DCPS Mental Health Services Professional seek the parent or legal guardian’s signature on the Consent Form for Mutual Exchange of Information (FM# 2128) form as soon as possible. The purpose of this form is to enhance communication with the hospital or community mental health facility involved in the treatment of a student and to coordinate effective services for the safety and well-being of the student. 5. Contact the District Crisis Team (305)-995-2273 and provide necessary information. 6. Contact SEDNET (The Multiagency for Students with Emotional/Behavioral Disabilities), Ms. Alina Rodriguez, SEDNET Project Manager at 305-598-2436 or via email at [email protected]. SEDNET provides student case management services specific to ensuring a student’s educational placement is appropriate to meet their current academic and educational needs once they return to school from an inpatient mental health facility. 7. The Mutual Exchange of Information should be faxed to the SEDNET office at 305-5984639. Miami-Dade County Public Schools: Clinical/Behavioral Services

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8. Once the Consent Form for Mutual Exchange of Information (FM#2128) is completed and sent to SEDNET, a copy should be placed in the student’s cumulative folder in order to release school district staff from liability in speaking to outside agencies and staff. Care should be exercised to the level and extent of disclosure with school staff. Limited information pertaining to safety concerns should be disclosed to only appropriate and necessary school staff. 9. Prior to returning to school for general education students: An emergency SST (Student Support Team) meeting is required immediately after a student has been hospitalized, either at the school site or outside the school site, as a result of a Baker Act. The process should be initiated as soon as the school becomes aware of the hospitalization. In this case, the SST will be used to identify appropriate interventions that will be necessary to support the student’s emotional well-being and success upon his/her return to school. Due to the need for immediate action, care must be taken to avoid delaying the SST meeting. Information that is immediately pertinent to the student’s crisis needs to be gathered before the SST meets. The emergency SST meeting should include the student (if possible or available), student’s parent(s)/guardian(s), school counselor, school social worker, TRUST Specialist, school psychologist, E/BD Clinician, administrator, and other school personnel, as deemed necessary. 10. Prior to returning to school for special education students: An emergency RT (Reevaluation) meeting is required immediately after a student has been hospitalized, either at the school site or outside the school site, as a result of a Baker Act. The process should be initiated as soon as the school becomes aware of the hospitalization. The Individual Education Plan (IEP) and the Behavior Intervention Plan (if created) should be reviewed and or modified in order to identify appropriate interventions that will be necessary to support the student’s emotional well-being and success upon his/her return to school. Due to the need for immediate action, care must be taken to avoid delaying the RT meeting. Information that is immediately pertinent to the student’s crisis needs to be gathered before the RT meets. The RT meeting should include the student (if possible or available), student’s parent, school counselor, school social worker, TRUST Specialist, school psychologist, E/BD Clinician, administrator, and other school personnel, as deemed necessary. 11. The SST/PST/RT Team should address the following: o The nature of the crisis o Current Diagnosis o Risk Behavior and Behaviors of Concern o Discharge Recommendations o Community-Based Services o Parent/Student/Teacher Concerns o Physical Safety Concerns o Data Review (Attendance, Academic, Behaviors, Disciplinary, Psychological/Medical Reports) Miami-Dade County Public Schools: Clinical/Behavioral Services

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o Academic Concerns or Supports o Need for additional evaluation o Need for onsite support services (i.e. counseling, modification of schedules, increased supervision, etc.) 12. A Behavior Intervention Plan (BIP), if none exists, based on a Functional Assessment of Behavior (FAB) should be developed to guide intervention and support services If the student has a BIP, the BIP must be reviewed and revision of the BIP should take place, if needed. Review behavioral data from the monitoring of the BIP to ensure appropriate mental health services and interventions will be in place upon student’s return to school. The current risk behaviors of concern need to be addressed on the BIP. 13. The M-DCPS Mental Health Services Professional assigned to the student should closely monitor the student’s progress. Procedures for Student Re- Entry 

If the SST or RT Meeting was not convened prior to the student returning to school: SST/PST or RT team members are updated by the M-DCPS Certified Mental Health Services Professional(s) assigned to the student about the crisis and made aware of student’s expected return date. The SST/RT meeting is required to occur as soon as possible to address potential mental health needs. The person(s) responsible for ongoing service delivery to the student must be in attendance. See previous section for requirements of meeting including the creation of a BIP.

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When a student returns to school after a Baker Act from home, community or school, it is imperative that he/she is assessed for potential service needs. The SST/PST/RT team members determine whether previous levels of service delivery and supervision are adequate to stabilize the student and ensure student safety while in an academic environment. If the student receives special education services, an interim IEP and creation/modification of BIP may need to occur based upon a student’s need for safety. Limited information should be shared with school staff regarding aspects related to student health and wellbeing including medications and potential side effects. M-DCPS Mental Health Professionals will need to support hospital discharge recommendations.

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The SST/PST/RT Team should address the following: o The nature of the crisis o Current Diagnosis o Risk Behavior and Behaviors of Concern o Discharge Recommendations o Community-Based Services o Parent/Student/Teacher Concerns o Physical Safety Concerns o Data Review (Attendance, Academic, Behaviors, Disciplinary, Psychological/Medical Reports)

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o Academic Concerns or Supports o Need for additional evaluation o Need for onsite support services (i.e. counseling, modification of schedules, increased supervision, etc.) 

Due to research indicating increased suicide risk within the first month of hospital release, it is necessary for the M-DCPS Mental Health Professional to conduct an immediate counseling session (RP-Risk-Postvention Session) when the student returns and establish a daily “check-in session” with the student for at least the first week of their return to school. Minimally, for the first month of his/her return to schools, the M-DCPS Mental Health Professional must provide weekly counseling services to ensure the student’s safety. The sessions should entail the creation of a safety/emergency plan where the student explores coping strategies. Additional services are determined by the team.

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Parental contact and support is essential during crisis and post crisis incidences. The M-DCPS Mental Health Services Professional assigned to the student is responsible for maintaining contact with the parent and discussion of the student’s safety/emergency plan. Interventions should focus on how to help the student and family possibly prevent and better manage future situations. Provide support to the parent related to additional community-based services if needed.

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Documentation within the ISIS and SPED/EMS System must accompany ALL SERVICES delivered. The Risk-Postvention Service (RP) must be documented on the first day the student returns from a crisis event.

Case Conference Clinicians are responsible to coordinate bi-weekly Case Conferences to ensure continuity of mental health/behavioral services to students. Case conferences can take place during team meetings or as necessary due to a variety of reasons to include, change of clinician, new student, a student’s current situation. During this process, information regarding the functioning of the student academically, e mot i on a lly a n d or me n t a l he a lt h con ce rn a n d behaviorally are reviewed based on IEP goals, assessment findings, data collected. Through collaborations and consultations between clinical staff, community representatives (if applicable) s c h oo l a d m i n i st r a t o r s a n d instructional staff recommendations are made to help the student achieve their goal. The Case Conference form is completed on each student discussed. All persons attending must sign form. The form should be completed to reflect areas of concern, current responses and recommendations with follow-up timeframes. Completed forms are filed in the Clinical File Section II. See Appendix Section for Case Conference Form.

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Clinical File Cover Sheet Clinical File Cover Sheet is the first sheet in the clinical file. Clinicians are responsible for keeping the file in the correct order. Sections of the Clinical File The required sections of the clinical file are: I.

Clinical Cover Sheet, Student Information Forms, Student Demographic Forms (ISIS – PF8 Screen), Emergency Contact Forms (ISIS)

II.

Quarterly Clinical/Art Progress Report, Crisis Notes (attached with copy of Baker Act Form if applicable), and Student Case Management Forms; Case Conference Form

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Intake Form, LEAPS Assessment; ASEBA Assessment, SSIS Assessment, LECATA Assessment, Silver Drawing Test, Psychiatric Consultation, Psychiatric Case consultation, Current Psychological Evaluation, Individual Education Plan-at-a-Glance, FAB Forms and BIP

IV.

Individual Education Plan-at-a-Glance, FAB Forms and BIP

V.

Additional Forms – This section may include: Consent forms, art therapy documentation, copies of attendance reports and grades from ISIS, Certificate of Involuntary Examination, Report of Law Enforcement Officer Initiating Involuntary Examination, Student Case Management Forms (Referrals), Weekly/Monthly Inclusion Reports, and any pertinent information derived in the program such as a behavior contract

VI.

Student Work Products including activities from Art Therapy, LEAPS, and other activities. (See Appendix Section for Clinical File Cover Sheet.)

Clinical Services Crisis Note The Clinical Services Crisis Note form should be completed when a student exhibits behaviors that are a danger to self, others, or inconsistent with their normal behavioral responses to situations. All sections of the form should be completed using specific, clearly descriptive actions, nonverbal and verbal expressions. Written statements should reflect items checked. The “Plan” section needs to state what will be done, who will be responsible, when and where as applicable. The signature line should be completed as stated and legible. If a Baker Act occurs, a copy of the Certificate of Professional Initiating Involuntary Examination or Report of Law Enforcement Officer Initiating Involuntary Examination should be stapled to the Crisis Note. The Clinical Services Crisis Note SHOULD NOT be placed in the cumulative record; it should be placed in Section I in the clinical file. You can access this form at http://forms.dadeschools.net/webpdf/6596.pdf. Miami-Dade County Public Schools: Clinical/Behavioral Services

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Clinical Services Intake The Clinical Services Intake is the process used to gather information when a student enrolls in the program, returns to the program, or to update a change in the student’s life. Intake questions should be used to guide the clinician through the interview process and subsequent initial sessions. Care should be exercised so as not to become interrogative in nature recognizing rapport building is very important. This information should be updated throughout the year as needed. Additionally, for students who may return the following school year with the same clinician, it is important to update certain sections as there may be changes to the information. Note: It is not necessary to have EVERY question answered on this form in one session. Usually, more accurate information is released by both the parent and student when rapport and trust has already been established. Clinicians should not rush through t h e intake p r o c e s s within the first or second session but take a more methodical approach. The document should be updated and/or completed within 3 months of date of entry. You can access this form at http://forms.dadeschools.net/webpdf/7302.pdf.

Clinician Schedule The Clinician Schedule is submitted twice a year in September and January. The schedule should reflect activities done during the school work hours before or after students are present. This includes, bus duty, cafeteria duty, parent meetings, lunch, record keeping, team meetings. This document needs to be completed in its entirety. Student initials are used when referencing provision of individual or group services. The bottom of the document has a list of appropriate codes that can be used. The September submission date is the Monday after Labor Day. It should be complete with clinician name, school year and names(s) of school(s) assigned with days noted (ex: Renick MWF; Kruse T, TH or Renick M-F). The January submission date is the Monday after returning from Winter Break. It should be complete with clinician name, school year and names(s) of school(s) assigned with days noted (ex: Renick M, W, F; Kruse T, TH or Renick MF) and Update is completed (ex. January 2015). This schedule should reflect any changes including students, duties, meetings that occurred. If more than one school is assigned, one sheet can be used IF each school is clearly identified on the top of the form ”school” and on first line under days of the week. Although students are scheduled to receive services at a certain time and date, it is under stood that crisis situations do occur, which require flexibility. When scheduling students, the student’s academic and socio‐emotional progress should be taken into account. For example, a student who loves art class should not be removed from his favorite (and possibly his only) elective class or a student who is struggling in mathematics should not be removed from instruction in this area on a consistent basis. Miami-Dade County Public Schools: Clinical/Behavioral Services

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Obviously, crisis situations would impact this. When possible, a rotating schedule may be more productive for certain students because no one class would be impacted by the provision of services. You can access this form at: http://forms.dadeschools.net/webpdf/6632.pdf.

Consent Form for Mutual Exchange of Information The Consent Form for Mutual Exchange of Information needs to be obtained whenever information will be requested from providers outside of the school setting for a student, or when a student receives services at school through an outside agency. This form should be updated annually or if there is a change of school assignment. You can access this form at http://forms.dadeschools.net/webpdf/2128.pdf.

Crisis Assessment Student safety is a priority. When completing a crisis assessment it is important to use your clinical judgment. Areas of particular concern include: 1. Immediate Risk Predictors: method/plan, means/availability, time/place, lethality, prior attempts, and prior violent behavior. 2. Current Life Events and Trauma History 3. Psychiatric History/Health: diagnosis, severity, hospital discharge history, substance use, adherence to prescribed medications, physical illness/pain, history of loss, past stressors, family history of suicide/homicide. 4. Emotional/Behavioral Factors: hopelessness, severity of affective presentation, impulsiveness, problem‐solving/organizational skills, thinking/orientation, beliefs regarding the future. 5. Social Supports: number of identifiable/available supports, willingness to accept/use support, existence of adequate supervision, and connection with others.

E/BD Crisis Plan The E/BD Crisis Plan is a document that is required at all school sites where there is a program for students participating in programs for E/BD. Crisis plans provide a step‐by‐ step guide to school staff regarding what should take place under certain circumstances (ex. suicidal gesture, homicidal ideation/threats, suicidal ideation, bullying/harassment, etc.), when a student participating in E/BD programs is involved. For each assigned school, clinicians are required to facilitate the development of a crisis plan. The crisis plan is developed with input from the school site team. Team members to provide valuable input may include SPED Chairperson, assistant principal, the principal, SPED Program Specialist, and BMT. Once the crisis plan is written and signed for approval by principal, it must be reviewed and signed by staff that works with students enrolled in E/BD programs. Miami-Dade County Public Schools: Clinical/Behavioral Services

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The “Signature Page” has the signatures of the principal, teachers in a separate class setting, BMT, clinicians and the SPED office staff and anyone else who works with this student in the program. For full inclusion sites, a copy of distribution process should be attached to the Signature Page with signatures of the principal, BMT, clinicians and the student services staff. The “Signature Page” of the E/BD Crisis Plan must be submitted to the Clinical Services Chairperson by October 1st of each year. The principal, assistant principal(s), teachers in a separate class setting, BMTs, clinicians, student services staff, and anyone else who works with this student in the program should receive a copy of the plan and have it posted for easy visibility and easy access. In schools where there is full inclusion, the clinician needs to work with administration to have the crisis plan to all teachers. The plan should be reviewed at least two times in the school year during to ensure all names and contact numbers are up to date. The sample format for an acceptable E/BD Crisis Plan can be found in Section VI: Forms of this manual.

Functional Assessment of Behavior (FAB) The FAB process is a collaborative multidisciplinary process which is used to analyze the motivation of “misbehavior” as well as developing strategies to teach positive behaviors and reinforce these appropriate behaviors. The required elements of the FAB process are: • • • • • • • •

Consent to Evaluate (with Procedural Safeguards) Notification of Meeting (with Procedural Safeguards) Conduct the actual meeting Functional Assessment of Behavior Structured Interview A minimum of two instruments for data collection Behavior Intervention Plan (BIP) Add goals to IEP, if necessary Monitoring of the BIP

A good rule of thumb with regards to monitoring is to periodically review the BIP at least every 9 week period. Students enrolled in E/BD programs should have a current and relevant BIP which is coordinated with the student’s IEP. Clinicians should take an active role in this process. As professionals, it is essential that you lend your expertise in the analysis or investigation of the motivation of student behavior as well as in helping coordinate interventions and monitoring of the FAB. Additionally, if the “misbehavior” or “problem behavior” has not been corrected, the BIP should be modified. Alternative interventions should be utilized.

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Inclusion Inclusion is the practice of educating students with and without disabilities together rather than separately. True inclusion means that students with disabilities receive access to the general education curriculum while simultaneously receiving specially designed instruction based on highly effective research‐based instructional strategies as needed. For inclusion to be successful it must be applied to all students regardless of their label. Inclusion is not all students, all day, as some students require more structure (e.g., a self‐contained setting). Inclusion does not mean that students are expected to do the same activities at the same time. Nor does it mean placing all students into general education (GE) classrooms without the necessary supports for the students and educators. Also, inclusion does not require students to be at any specific level of mastery before becoming a member of a general education classroom. An inclusive classroom adapts to the needs of the students. Supports may include providing accommodations and/or modifications, the use of instructional and assistive technology, or offering individual assistance from other people including peers and staff. The IEP team determines the individual student support needs and the least restrictive environment in which students can meet their IEP goals. Documented communication between the E/BD staff and the general education teacher is essential for progress monitoring and the appropriate implementation of the IEP. The challenge is to find a balance between creating a stimulating learning environment and providing the necessary support needs for the students. You can find additional resources at http://www.floridainclusionnetwork.com/. Inclusion is a collaborative process guided by on‐going assessment of student progress. As an E/BD clinician one’s role in inclusion is to provide:    

Consultation through team conference to plan, implement, and monitor Instructional and behavioral alternatives to ensure classroom, and student success in a general education setting. Support facilitation to provide direct support for students in the classroom. This includes direct modeling of behavior modification for teachers and paraprofessionals. Keep in mind, the frequency and intensity of support varies based upon the needs of the student and general education educator.

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Individualized Education Plan (IEP) The IEP is a legal document completed during an IEP meeting with parent/legal guardian. This meeting should be a result of a collaboration of professionals who are working with the student. Clinicians have an active role in assisting teachers in developing goals, detailing the description of the disability, and developing transition statements. The clinician should be developing behavioral goals with input from the classroom teacher. Goals should be developed that are based upon assessment data and the specific needs of the student in reference to academic, behavioral, emotional functioni ng. For additional information on the IEP process, go to: http://www.fldoe.org/ese/pdf/QualityIEPs.pdf. Parents/Guardians and school district personnel attending a meeting must sign the Prohibiting School Personnel from Discouraging Parents/Guardians from Inviting Another Person of Their Choice to a Meeting document at the meeting's conclusion stating whether any school district personnel has prohibited, discouraged, or attempted to discourage the parents from inviting a person of their choice to a meeting. You can access this form at http://forms.dadeschools.net/webpdf/7513.pdf.

Psychiatric Consultation M-DCPS contracts with a Board Certified Psychiatrist to provide psychiatric consultation to students identified by the EBD clinician. Consultation issues involve concerns about present mental health functioning, recent crisis events, clarification of diagnosis, responses to medication, request of parent, support to encourage parent/guardian to seek community resources and strategies for clinical intervention. Psychiatric Consultation should not be marked on the IEP since all students are not guaranteed a psychiatric consultation due to scheduling and the student’s individual needs. Dates for school site psychiatric consultations are established at the beginning of the school year. Clinicians are responsible for reporting scheduling conflicts to the Chairperson two weeks prior to scheduled date. The consulting psychiatrist will be contacted so that the schedule change is completed. Consultation services are provided to one school site per day for up four hours. The consulting psychiatrist meets with the selected student (s)/staff or family, depending on arrangements made by the site clinician who serves as liaison. The consulting psychiatrist is provided a current, signed by parent/guardian copy of the Notice of Intent and Parent/Guardian Consent to Conduct an Evaluation. A consultation summary is completed at the site by the consulting psychiatrist and given to the clinician. This summary is for the purpose of documenting the consultation with suggested intervention strategies. This summary is for the clinical file only. NO copy should be made of this document. The consulting psychiatrist will have the clinician sign a log documenting hours of service for each student served. Miami-Dade County Public Schools: Clinical/Behavioral Services

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The following procedures should be followed when psychiatric consultation services are being provided to students participating in programs for E/BD. Consultation Process: 1. As a result of team meetings and/or clinician observations, students may be referred based upon concerns regarding medications, crisis events, parent requests, clarification of diagnosis, present mental health functioning, as well as treatment planning. Two weeks prior to the scheduled consultation, at least three/four students should be identified. 2. When students have been recommended for a psychiatric consultation, parents should be notified by the clinician either by telephone or in person with the purpose of describing how such services would be beneficial. Parents should be alerted that written consent is required. Please explain that the form “Notice of Intent and Parental/Guardian Consent to Conduct an Evaluation” will be sent home and should be completed by the parent/guardian and returned in order for such services to be rendered. Clinicians must mark “Other” on the consent form and specify Psychiatric Consultation for the Program on the provided line. Clinicians should stress to the parent/guardian that this is a psychiatric consultation provided to the program. The purpose of consultation is to provide program staff with additional information or insight regarding possible interventions which optimally will improve service delivery. For consultation purposes, the psychiatrist may gather information from the student but will not provide direct or ongoing services to the student. Additionally, a current copy of procedural safeguards must accompany this form. You can access this form at http://forms.dadeschools.net/webpdf/4961.pdf 3. The clinician should have available the clinical file, which includes: the signed written consent form for the psychiatric consultation, a copy of the initial psychological evaluation and most recent evaluation, a copy of the IEP, and a copy of the BIP. A copy of the Psychiatric Consultation Form needs to be available. See Appendix Section for Psychiatric Consultation Form. 4. In situations where the clinician is scheduled to not be present the day the site has the consultation, the clinician must designate program/or school staff to serve as a host for the consulting psychiatrist. 5. Students should be made aware, in advance, if clinically appropriate that they will be seeing a psychiatrist. Parents should be notified in advance of the appointment and, should it be clinically appropriate, encouraged to attend the meeting or be available via the telephone. If parents would like the contracted psychiatrist to contact any attending psychiatrist, a Consent Form for Mutual Exchange of Information must be completed in advance. You can access this form at http://forms.dadeschools.net/webpdf/2128.pdf 6. The psychiatric consultation should take place in a confidential room or office. Miami-Dade County Public Schools: Clinical/Behavioral Services

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7. It is at the discretion of the clinician and/or psychiatrist whether the clinician is present during the consultation. At times, it may or may not be clinically appropriate for the clinician to be present. The student’s level of comfort should be taken into consideration when making the decision whether to be present at the initial phase of the consultation or remain during the whole consultation period. 8. The contracting psychiatrist will complete the “Psychiatric Consultation” Form. Although the consultation is considered public record, under no circumstances is the psychiatric consultation documentation to be distributed to the parent, other staff or placed with the cumulative record. The document will be reviewed by the psychiatrist and clinician and placed in Section II of the student’s clinical file. 9. Upon completion of the consultation, the psychiatrist may call parents and explain recommendations and findings if parents are available. When parents are unavailable or if time does not permit, the clinician should communicate the findings written on the consultation document with the parent at a later time. 10. If appropriate the clinician should communicate these confidential findings and recommendations to appropriate staff (i.e. E/BD teachers, Clinical Art Therapist, etc.) as soon as possible during a case conference meeting. Note: If clinicians encounter any difficulties with any procedure, E/BD Chairperson should be consulted or the Instructional Supervisor for E/BD programs.

Quarterly Clinical/Art Therapy Progress Summary The Quarterly Clinical/Art Therapy Progress Summary is completed at the end of each nine week reporting cycle to coincide with report cards for each student on your caseload. It is important to summarize progress on goals identified on the IEP and clinical assessment outcomes, student’s current level of functioning, goals obtained/ hindrances, response to program interventions and other areas addressed during the nine weeks. This summary is compiled from responses to interventions and supportive services documented in SPED/EMS. Once the progress summary is completed, the outcomes should be shared with the student to continue progress towards goal. The clinician is responsible for completing all sections of this form including accurate date and signature. You can access this form at http://forms.dadeschools.net/webpdf/6599.pdf.

School/Parental High Profile Concern The purpose of this form is to provide additional resources and provide assistance to sites. In situations where you as a staff member perceive a student case or parent concern may result in the situation elevating to possible legal intervention or region/district intervention, please follow the directions below: 1. Please notify the school’s chain of command. 1. Contact immediately via telephone or e-mail (need for consult) your District Support Representative (Department Chairperson or Curriculum Support Specialist) for programs for students with emotional/behavioral disabilities (E/BD). Miami-Dade County Public Schools: Clinical/Behavioral Services

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2. Complete this form in its entirety. 3. Fax, do not email, completed form to 305-626-3962, attention: Robin J. Morrison, Instructional Supervisor. 4. The concern will be referred to the appropriate District E/BD personnel to follow up. 5. Please continue to follow-up with recommendations and provide additional information to your support person. *See Section VI: Forms for School/Parental High Profile Concern*

SPED/EMS Service Log Access to the website is through the employee portal. Staff will be trained on how to use this system. The computer based SPED/EMS Service Log is used to document clinical services provided to the student directly or on behalf of the student. Student Individualized Educational Plans can be viewed through this system. As these data entries are seen as "student records", care should be exercised when documenting issues in order to ensure confidentiality. Documentation of services should be no more than one week behind.

Student Services Case Management Form Clinicians must document all services provided to students. The information on this form must be inputted on the ISIS system to show provision of services on a regular basis. If the movement of a student is probable, services need to be inputted daily, when the student leaves a school, ISIS does not accept inputs from another location. If service is provided to any student, it should be documented on this form and inputted in ISIS. Documentation of services should be no more than one week behind. CRISES ARE DOCUMENTED IMMEDIATELY. You can access this form by asking your school site administrator.

Team Meeting Team Meetings should occur at least twice a month. These meetings are coordinated by Behavior Management Teacher (BMT) or the E/BD Clinician if there is no BMT at that site. Team meetings discuss programmatic concerns, events, successes; review program behavioral data (ex. suspensions, point system), and address behavioral progress or concerns of a specific student. Team meetings should occur prior to an annual IEP meeting to review the data accumulated during the year on a student’s behavioral responses to academic and clinical/mental health interventions. Agendas and minutes for each meeting should be shared with all members of the team. Minutes of the meeting need to include the following:  Date  Attendees  Title: “Team Meeting”  Points discussed  Persons with responsibilities  Feedback dates for new interventions should be stated on the form. Miami-Dade County Public Schools: Clinical/Behavioral Services

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Documentation of these meetings should be kept in a folder or binder labeled “Team Meetings” centrally located so everyone has access. If in‐depth information needs to be discussed on a particular student then the Case Consultation Form should be used.

Transfer of Files The transfer of a clinical file occurs when a student changes clinicians within Miami Dade County Public Schools Emotional/Behavioral Disabilities Program. This could occur due to the following: 1. The student changes schools either through articulation or relocation 2. Art Therapy is added/deleted on the Individualized Education Plan 3. Change in clinical personnel at a school. When transferring, the clinical file should be up to date. Contact must occur between sending and receiving clinicians before a clinical file can be moved. Ideally, clinicians will meet and a brief summary of the student’s progress and pertinent information can be shared. If a meeting is not feasible then it is the responsibility of the sending clinician to obtain all of the necessary address information of the receiving clinician to forward the clinical file. When sending a file through inter‐office mail, the envelope must be marked “CONFIDENTIAL”. The receiving clinician must confirm receipt with the sending clinician. The transfer of files signature form must be completed by the sending and receiving clinician. Once completed, the form is then sent to the E/BD chairpersons who will acknowledge completion of transfer to both parties. If there is no reason to transfer a clinical file (Graduation) or no clinician to transfer to, the last clinical custodian retains the file for the required period as mandated by the school system. Additionally, if a student is transferred to a Center school or an Alternative Education setting, do not forward the file. The student has the opportunity to return to the least restrictive setting. See Section VI: Forms for Transfer of File Form.

Transition Individual Educational Plans (IEPs) have been a requirement of law since the passage of the Education for All Handicapped Children Act (EHA) known as Public Law 94‐142 in 1975. Legislators added a new component (transition) to the EHA when the law was amended and renamed Individual with Disabilities Education Act (IDEA) in 1997. IDEA was promulgated to ensure that all children with disabilities are provided a free appropriate public education (FAPE) that includes specially designed instruction and related services and supplementary aids and services that are designed to meet the student’s unique needs, and prepare them for employment and independent living. The IDEA, reauthorized and signed into law on December 3, 2004 as the Individuals with Disabilities Education Improvement Act, (IDEA 2004) changed the definition of transition Miami-Dade County Public Schools: Clinical/Behavioral Services

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services. In IDEA 2004, the term “transition services” means a coordinated set of activities for a child with a disability that: ¾ is designed to be within a results‐oriented process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child’s movement from school to post‐school activities, including post-secondary education; vocational education; integrated employment (including supported employment); continuing and adult education; adult services; independent living or community participation; ¾ is based on the individual child’s needs, taking into account the child’s strengths, preferences, and interests; ¾ includes instruction, related services, community experiences, the development of employment and other post‐school adult living objectives and, when appropriate, acquisition of daily living skills and functional vocational evaluation. “Transition IEP” (TIEP) is a Florida term that refers to an IEP that focuses on transition. Transition planning and services must be based on the student’s needs, take into account the student’s preferences and interests, and focus on the student’s desired post-school outcome. Transition planning and transition services should be designed to provide the student with the supports he or she needs to make a successful move into adult life.

The role of the E/BD clinician as it relates to transition includes such activities as:      

Participating in IEP meetings focused on transition; Maintaining communication with department chairpersons, program specialists, transition specialists, parents, and community agencies; Assisting students in identifying transition goals; Providing transition support to teachers, students, and parents from middle school to high school and from high school to the work force and; Providing document all discussions or activities related to transition in SPED/EMS Providing behavioral consultation and support to students and schools as needed.

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SECTION IV: DIVISION PROCEDURES

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Daily Reporting Upon arriving at your assigned school site each day, your attendance must be called into the EBD office at 305-995-1722. Calls must be made from the school phone; not your home phone or cell phone. Upon departing your assigned school site at the end of the day, the EBD office at 305-995-1722 to report you are leaving. Calls must be made from the school phone; not your home phone or cell phone.

Planned Absence 

Notify E/BD Office at 305-995-1722.



Also contact the school location that will be affected by your absence and your chairperson.



State your first and last name, employee number and indicate the type of absence (SICK, SICK RELATIVE, or PERSONAL).



Notice should be received no later than 2:00 p.m. the preceding day.

Late Arrival 

Notify EBD office at 305-995-1722 prior to 8:30 a.m.



Also contact the school location that will be affected by your late arrival and your Chairperson.



State your first and last name, employee number and indicate you will be late and give estimated time of arrival

Unplanned Absence 

Notify EBD office at 305-995-1722.



Also contact the school location that will be affected by your late arrival and your Chairperson.



State your first and last name, employee number and indicate the type of absence (SICK, SICK RELATIVE, or PERSONAL).

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Leave Requests Temporary/Professional Leave will be only awarded for District sponsored professional development activities including the two district wide designated professional development days, case management sessions, etc. Please note, staff members interested in participating in any self-selected professional development activities taking place during the workday must request personal leave and secure approval from Robin Morrison, Instructional Supervisor.

E-mails E-mails must be checked a minimum of twice a day. This practice will ensure that all staff is aware of any changes in plans within the department.

In-County Travel          

A request for in-county travel reimbursement/mileage must be submitted using the Voucher for Reimbursement of In-County Travel (Form 0148) and Payroll Department Employee Reimbursement (Form 2821). Completed forms should be submitted to the E/BD office. Only Robin Morrison, Instructional Supervisor can approve your request for in-county travel reimbursement/mileage. Supervisor name should be typed on FM# 0148 as the Supervisor of Charge Location. Employee Name and title should be typed on FM# 0148. Robin Morrison, Instructional Supervisor should be typed on the “Approved by” line on Form 2821. In-county travel must be turned in on a monthly basis or when you arrive at a $50.00 total. Please keep a copy for your records. Each employee is responsible for reviewing the In-county Travel Form before signing and submitting it for approval to be reimbursed. DO NOT SUBMIT TRAVEL FOR THE ENTIRE SCHOOL YEAR IN MAY.

For 9624 Only  Cost Center – 1962400  Charge Cost Center – 1962400  Fund – 100000  Functional-Area – 71000000-630000 9615 REMEMBER: When signing your In-County Travel, make sure your original signature is in BLUE INK. NO COPIES WILL BE ACCEPTED.

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Meetings 

Faculty Meetings: o Yes, if that is your assigned day to provide clinical services to the school.



Student Services Meetings: o Yes, if that is your assigned day to provide clinical services to the school.

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SST/PST Meetings: o Yes, only if you have been working with the student that the team is discussing.



Functional Assessment of Behavior (FAB)/Behavior Intervention Plan (BIP) Meetings: o Yes, participate in the FAB process for students you serve; these students can be E/BD, ASD, InD, General Ed. (if you are servicing the student); you are not the FAB Coordinator; you should have data if you are assisting to implement the BIP.



Manifestation Determination Meetings: o Yes, participate in these meetings for students you serve or have worked with. For emergency cases of students you have not served, contact Robin Morrison, Instructional Supervisor or your chairperson.

Instructional Performance Evaluation Growth System (IPEGS) IPEGS is the assessment tool used to evaluate the performance of all instructional staff.  

Any recent revisions to the system will be reviewed with staff. Further information regarding IPEGS may be found on the Professional Development website at http://ipegs.dadeschools.net/.

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SECTION V: LEGAL INFORMATION

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Baker Act A student may exhibit self‐injurious behavior, suicidal/homicidal ideation, intent or plan which requires immediate action. Involuntary Examination (Chapter 394, F.S.), the Baker Act, states that an individual may be taken to a receiving facility for involuntary examination if: • • •

•

He/she has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination. The person is unable to determine for him or herself whether an examination is necessary. Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; and it is not apparent that such harm may be avoided through the help of willing family members or friends or the provision of other services. There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to him/herself or others in the near future, as evidenced by recent behavior.

It is important for clinicians to be aware that a child or adolescent may not be able to provide consent to receive a voluntary examination due to age and/or mental status. Students who exhibit the above‐cited behaviors may agree during the school evaluation to voluntarily go to a crisis unit, but oftentimes later recant or become defiant. Additionally, parents may state that they are willing to transport the student to a crisis center, but this may not be a safe or reliable alternative. The child may jump out of the car, refuse to follow parent directives, or the parent may choose not to take the child to the crisis center. It is imperative that the clinician consider all of these factors when determining whether a Baker Act should be initiated. There are only three ways to initiate the Baker Act: • • •

An ex parte order (court order where a family member or adult petitions the court Police officer Professional certificate completed by a physician, clinical psychologist, clinical social worker, licensed mental health counselor, licensed marriage and family therapist, or psychiatric nurse.

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The statute utilizes specific language when detailing these methods: “the court may issue an ex parte order,” “a physician, clinical psychologist, psychiatric nurse, or clinical social worker may execute a certificate,” but “a police officer shall take a person who appears to meet the criteria, shall execute a written report detailing the circumstances under which the person was taken into custody.” The law does not indicate the police officer must observe the individual – it requires the police officer to report on the circumstances which led to the Baker Act. The law specifies that the criteria are based on recent behavior; a police officer can utilize credible witnesses as the basis of the Baker Act. The professional certificate requires clinicians to report on what specifically they observed; police officers only have to report on the circumstances which led them to Baker Act. It is important for law enforcement and clinicians to note the following. Section 394.459(10) F.S. states “any person who acts in good faith in compliance with the provisions of this part is immune from civil or criminal liability for his or her actions in connection with the admission, diagnosis, treatment, or discharge of a patient to or from a facility. However, this section does not relieve any person from liability if such person commits negligence.” As long as an individual acts in “good faith” they are immune “from civil or criminal liability”, but negligence, failure to act, is not covered under this immunity.

Marchman Act The Marchman Act is the Florida Substance Abuse Impairment Act – Florida Statute 397. Since substance abuse is such a prevalent issue in our society today obviously impacting our youth and potential family members, the authors of this handbook feel it would be of assistance to clinicians to have information on how potentially this act can assist families. Involuntary Admission Criteria: • • • •

Good faith reason to believe person is substance abuse impaired and because of the impairment Has lost power of self‐control over substance use; and either Has inflicted, or threatened or attempted to inflict, or unless admitted is likely to inflict, physical harm on self or others, or Is in need of substance abuse services and, by reason of substance abuse impairment, his/her judgment has been so impaired the person is incapable of appreciating the need for services and of making a rational decision in regard thereto.

(Mere refusal to receive services not evidence of lack of judgment) Emergency Admission Application: • • •

An application for emergency admission may be initiated. For a minor by the parent, guardian or legal custodian: For adults: o Certifying physician o Spouse or guardian o Any relative

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o Any other responsible adult who has personal knowledge of the person’s substance abuse impairment. For further information regarding the Marchman Act, please refer to the Clinical Services section of the E/B D Website and Staff Resources. The information regarding the Marchman Act was obtained from the Marchman Act Handbook available through accessing the following website: http://www.myflfamilies.com/service-programs/substance-abuse/marchman-act

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Non-Discrimination Policy The School Board of Miami-Dade County, Florida adheres to a policy of nondiscrimination in employment and educational programs/activities and strives affirmatively to provide equal opportunity for all as required by: Title VI of the Civil Rights Act of 1964 - prohibits discrimination on the basis of race, color, religion, or national origin. Title VII of the Civil Rights Act of 1964 as amended - prohibits discrimination in employment on the basis of race, color, religion, gender, or national origin. Title IX of the Education Amendments of 1972 - prohibits discrimination on the basis of gender. Age Discrimination in Employment Act of 1967 (ADEA) as amended - prohibits discrimination on the basis of age with respect to individuals who are at least 40. The Equal Pay Act of 1963 as amended - prohibits gender discrimination in payment of wages to women and men performing substantially equal work in the same establishment. Section 504 of the Rehabilitation Act of 1973 - prohibits discrimination against the disabled. Americans with Disabilities Act of 1990 (ADA) - prohibits discrimination against individuals with disabilities in employment, public service, public accommodations and telecommunications. The Family and Medical Leave Act of 1993 (FMLA) - requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to "eligible" employees for certain family and medical reasons. The Pregnancy Discrimination Act of 1978 - prohibits discrimination in employment on the basis of pregnancy, childbirth, or related medical conditions. Florida Educational Equity Act (FEEA) - prohibits discrimination on the basis of race, gender, national origin, marital status, or handicap against a student or employee. Florida Civil Rights Act of 1992 - secures for all individuals within the state freedom from discrimination because of race, color, religion, sex, national origin, age, handicap, or marital status. Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA) - Prohibits discrimination against employees or applicants because of genetic information. Veterans are provided re-employment rights in accordance with P.L. 93-508 (Federal Law) and Section 205.07 (Florida Statutes), which stipulate categorical preferences for employment. School Board Policies 1362, 3362, 4362, and 5517 prohibit harassment and/or discrimination against students, employees, or applicants on the basis of sex, race, color, ethnic or national origin, religion, marital status, disability, genetic information, age, political beliefs, sexual orientation, gender, gender identification, social and family background, linguistic preference, pregnancy, and any other legally prohibited basis. Retaliation for engaging in a protected activity is also prohibited. Revised : (07-11)

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Summary: This document revises information previously provided on the implementation of Rule 6A-6.03016, Florida Administrative Code (F.A.C.), Exceptional Student Education Eligibility for Students with Emotional/Behavioral Disabilities, based on the most recent revision of this rule. This document includes information on the general intervention requirements, evaluation, eligibility, and the bureau’s monitoring of implementation of this rule.

Contact: Jennifer Jenkins Program Specialist (850) 245-0475 [email protected] Status: X

Revises and replaces existing Technical Assistance: K12:2008-53

Issued by the Florida Department of Education Division of Public Schools Bureau of Exceptional Education and Student Services http://www.fldoe.org/ese DR. MICHAEL GREGO CHANCELLOR OF PUBLIC SCHOOLS 325 W. GAINES STREET • SUITE 1502 • TALLAHASSEE, FL 32399-0400 • (850) 245-0509 • www.fldoe.org

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Table of Contents A.

Introduction and Definitions ..............................................................................................1 A-1. What is the purpose of this technical assistance paper (TAP)?...............................1 A-2 What are counseling services?.......................................................................................1 A-3. What are related services?.............................................................................................1 A-4. What is counseling as a related service? ....................................................................1

A-5. What is the difference between counseling and counseling as a related service? ...........................................................................................................................................2 B. Student Need for Counseling as Related Services under the Individuals with Disabilities Education Act (IDEA) .................................................................................2 B-1.

How is the need for counseling as a related service determined? ..........................2

B-2. Which students with disabilities require counseling as a related service? .............2 B-3. C.

Does every student with an emotional/behavioral disability (E/BD) need counseling as a related service? ..................................................................................2 Provision, Documentation, and Monitoring of Counseling as a Related Service under IDEA..........................................................................................................................3

C-1.

Who is qualified to provide counseling as a related service?...................................3

C-2. How is counseling as a related service documented and monitored? ....................3 D. Counseling as a Related Service for Students with Disabilities Eligible under Section 504 of the Rehabilitation Act of 1973 ...........................................................3 D-1.

Are districts responsible for providing counseling as a related service for students eligible under Section 504? ...........................................................................................3

D-2.

How is the need for counseling as a related service determined and documented for a student eligible under Section 504? ....................................................................4 E. Counseling as a Related Service for Students Who are Gifted ................................4 E-1.

Are districts responsible for providing counseling as a related service for students identified solely as gifted?..............................................................................................4

E-2.

How is the need for counseling as a related service determined and documented for a student who is gifted?............................................................................................4

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A.

Introduction and Definitions

A-1.

What is the purpose of this technical assistance paper (TAP)? The purpose of this TAP is to provide information regarding counseling as a related service, identify which students may need counseling as a related service, clarify who can provide counseling as a related service, and provide guidance on documenting counseling services.

A-2

What are counseling services? Counseling services are direct supports provided by trained and certified personnel to assist students with personal/social adjustment issues that present barriers to learning and student safety or well-being. Counseling services are available to all students through the district’s multitiered system of support and general education intervention procedures. Student services professionals employed by the district typically provide counseling and crisis intervention services. Section 1012.01(2)(b), Florida Statutes (F.S.), identifies school counselors, school social workers, and school psychologists as among the student personnel services staff with responsibility for addressing student personal and social adjustment, which includes counseling and crisis intervention.

A-3.

What are related services? Related services are the supportive services needed in order for a student with a disability to benefit from special education. Rule 6A-6.03411(1)(dd), Florida Administrative Code (F.A.C.), states: “Related services means transportation and such developmental, corrective, and other supportive services as are required to assist a student with a disability to benefit from special education, and includes speech-language pathology and audiology services, interpreting services, psychological services, physical and occupational therapy; recreation, including therapeutic recreation, early identification and assessment of disabilities in students, counseling services, including rehabilitation counseling, orientation and mobility services, and medical services for diagnostic or evaluation purposes. Related services also include school health services and school nurse services, social work services in schools, and parent counseling and training” (Title 34, Code of Federal Regulations [CFR] section 300.34). Related services are not defined in Section 504 of the Rehabilitation Act of 1973; however, guidance from the Office for Civil Rights indicates that related services refers to developmental, corrective, and other supportive services, including psychological, counseling, and medical diagnostic services and transportation (Frequently Asked Questions About Section 504 and the Education of Children with Disabilities http://www2.ed.gov/about/offices/list/ocr/504faq.html).

A-4.

What is counseling as a related service? Counseling as a related service is counseling that is provided when the individual educational plan (IEP) team or educational plan (EP) team determines that it is required in order for a student to benefit from exceptional education. For students who are eligible under Section 504, counseling is a related service when it is needed for the student to have access to school programs (34 CFR §104.33(b). Counseling services may include individual and group counseling with the student and family, psychological counseling for students and parents/families, and crisis prevention and intervention. Counseling services, in this context, 43

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are services provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel (Rule 6A-6.03411(1)(dd), F.A.C.). A-5.

What is the difference between counseling and counseling as a related service? Districts are responsible for implementing a coordinated system of supports for all students. Therefore, the provision of individual or group counseling services and supports may be integrated into the district’s coordinated intervention procedures and provided to any student in the district who needs counseling support. Although any student may receive counseling services, only a student with a disability or a student identified as gifted may receive counseling as a related service (Rule 6A-6.03411(1)(dd), F.A.C.).

B.

Student Need for Counseling as Related Services under IDEA

B-1.

How is the need for counseling as a related service determined? The IEP team is responsible for identifying the special education and related services needed for a student with a disability to receive a free appropriate public education (FAPE). In determining if related services are required for a student to benefit from his or her educational program, the team should consider, on a case-by-case basis, whether counseling services are necessary to facilitate the student’s academic, social/interpersonal, or emotional/behavioral progress. The IEP team is responsible for determining the nature and extent of the counseling services necessary and identifying the type of service provider. The decision regarding the need for counseling as a related service may occur during the initial development of the IEP, annually at the IEP meeting, during reevaluation, or any other time members of the IEP team request that it be addressed (Rule 6A-6.03411(1)(v), F.A.C.).

B-2.

Which students with disabilities require counseling as a related service? IEP teams must make decisions regarding the need for counseling as a related service based on the unique needs of the individual student. This determination is not based on a student’s particular disability or exceptional student education (ESE) eligibility category or the availability of resources. A student with any type of disability may be considered for counseling as a related service if the IEP team determines such support is needed to facilitate academic, social/ interpersonal, or emotional/behavioral progress and for the student to benefit from special education (Rule 6A-6.03411(1)(dd)1, F.A.C.). For example, if counseling as a related service is necessary to facilitate placement of a student in a less restrictive setting or is necessary to enable a student to participate more fully in the general curriculum or extracurricular activities, it must be provided.

B-3.

Does every student with an emotional/behavioral disability (E/BD) need counseling as a related service? Not necessarily, but many students identified as having an E/BD may need counseling services to benefit from special education. In particular, a student with an E/BD who is receiving all of his or her ESE services in a separate class, separate school, or other restrictive setting may need counseling as a related service to facilitate transition to a less restrictive setting. The IEP team should continually assess what constitutes the least restrictive environment (LRE) for a student and the supports needed to sustain student success in that environment and plan accordingly.

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C.

Provision, Documentation, and Monitoring of Counseling as a Related Service under IDEA

C-1.

Who is qualified to provide counseling as a related service? Counseling services means services provided by qualified social workers, psychologists, guidance counselors, and other qualified personnel (Rule 6A-6.03411(1)(dd)3.b., F.A.C.). Individuals qualified to provide counseling as a related service include school psychologists, school counselors, and school social workers (master’s level or higher is recommended) with Florida Department of Education certification; psychologists or school psychologists licensed under Chapter 490, F.S.; and licensed clinical social workers and licensed mental health providers as defined in and governed by Chapter 491, F.S. School districts may collaborate with other agencies to facilitate the provision of needed related services or contract with community providers to support counseling services documented on the student’s IEP. Contracted providers must meet the “qualified personnel” criteria defined above.

C-2.

How is counseling as a related service documented and monitored? Whenever counseling is necessary for the student to receive FAPE, it should be included on the student’s IEP and documented as a related service. The initiation date, anticipated duration, and frequency of counseling to be provided should be documented on the student’s IEP. The proposed service provider should be included in the IEP team’s decisions regarding the need for counseling services and the nature, frequency, and duration of services. The provider should also be part of progress monitoring and ongoing decisions regarding the continuation of counseling as a related service. The IEP team should use a problem-solving, data-informed decision-making process to determine the effectiveness of the intervention and needed modifications. A student’s response to counseling as an intervention should guide an IEP team’s decision about how long counseling as a related service should continue. Refer to the technical assistance document Guiding Tools for Instructional Problem Solving (2011) available at http://www.florida-rti.org/ for in-depth information on problem solving and data-based decision making.

D.

Counseling as a Related Service for Students with Disabilities Eligible under Section 504 of the Rehabilitation Act of 1973

D-1.

Are districts responsible for providing counseling as a related service for students eligible under Section 504? Yes. Section 504 requires that school districts provide FAPE to qualified students. Under Section 504, FAPE includes any related aids and services designed to meet the individual student’s needs to the same extent as the needs of students without disabilities are met (34 CFR §104.33). The Office for Civil Rights document, Frequently Asked Questions About Section 504 and the Education of Children with Disabilities, indicates that “related services” refers to developmental, corrective, and other supportive services, including psychological, counseling, and medical diagnostic services. A student may receive related “aids and services” under Section 504 if such services are necessary to provide FAPE.

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D-2.

How is the need for counseling as a related service determined and documented for a student eligible under Section 504? Once a student is determined to be eligible under Section 504 and in need of services and accommodations, the 504 team develops a Section 504 accommodation plan. Although Section 504 does not specify that a written plan be developed, the district must document activities and decisions made regarding students with disabilities. Although the required components of a 504 accommodation plan are not prescribed, best practice suggests an accommodation plan should address the need for counseling services and the nature, frequency, and duration of services on the student’s Section 504 plan.

E.

Counseling as a Related Service for Students Who are Gifted

E-1.

Are districts responsible for providing counseling as a related service for students identified solely as gifted? Section 1003.01(3)(b), F.S., defines special education services, in part, as “specially designed instruction and such related services as are necessary for an exceptional student to benefit from education.” The term “exceptional student” refers to both students with disabilities and students who are gifted in s. 1003.01(3)(a), F.S. In addition, Rule 6A6.03313(1), F.A.C., references the provision of FAPE to students who are gifted. Based on these statements, the EP team could determine that the student has a need related to the student’s giftedness that requires a related service in order for the student to receive FAPE.

E-2.

How is the need for counseling as a related service determined and documented for a student who is gifted? If the EP team determines that a student needs counseling as a related service to meet a need related to the student’s giftedness, it would be documented on the student’s EP (Rule 6A-6.030191, F.A.C.).

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Summary: This document provides guidance regarding the use, documenting, reporting, and monitoring of restraint and seclusion with students with disabilities in school districts, including (a) when restraint and/or seclusion might be used, (b) considerations when selecting a training program for restraint, (c) what should be documented, (d) parent notification and reporting, and (e) monitoring use. It also contains information about the recently amended statute, section 1003.573, Florida Statutes, Use of restraint and seclusion on students with disabilities Contact:

Jennifer Jenkins Program Specialist (850) 245-0475 [email protected]

Status: X

Revises and replaces existing technical assistance paper: Guidelines for the Use, Documentation, Reporting, and Monitoring of Seclusion and Restraint with Students with Disabilities, DPS 2010-168, September 8, 2010

Issued by the Florida Department of Education Division of Public Schools Bureau of Exceptional Education and Student Services http://www.fldoe.org/ese DR. MICHAEL GREGO CHANCELLOR OF PUBLIC SCHOOLS 325 W. GAINES STREET • SUITE 514 • TALLAHASSEE, FL 32399-0400 • (850) 245-0509 • www.fldoe.org

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Table of Contents A. A-1. A-2. B. B-1 B-2. B-3. B-4. B-5. B-6. B-7. C. C-1. C-2.

D. D-1. D-2. E. E-1. E-2.

E-3. E-4.

E-5.

E-6.

Introduction and Background ........................................................................ 1 What is the purpose of this technical assistance paper (TAP)? ........................ 1 Are there standards regarding the use of restraint and seclusion on students with disabilities? .................................................................................. 1 Restraint........................................................................................................... 2 What is restraint? .............................................................................................. 2 Is there a difference between the term “escort” and “transport”? ...................... 3 Are there any restrictions regarding the use of restraint? .................................. 3 What are the circumstances when restraint might be used with students with disabilities? .................................................................................. 3 What constitutes serious bodily injury? ............................................................. 4 Are there guidelines that districts should follow when considering which personnel may implement restraint procedures? .................................... 4 Is reporting of restraint or seclusion required for students in a Department of Juvenile Justice (DJJ) facility or county jail? .............................. 5 Seclusion ......................................................................................................... 5 What is seclusion? ............................................................................................ 5 How does section 1003.573, F.S., further clarify what schools and districts must report, document, and monitor with regard to incidents of seclusion? ..................................................................................................... 5 Training ............................................................................................................ 6 What training should personnel receive? .......................................................... 6 Are there guidelines for selecting a training program? ...................................... 7 Documenting and Reporting .......................................................................... 8 What are the documenting and reporting requirements when restraint and/or seclusion are used? ............................................................................... 8 If injuries occur or medical treatment is necessary for a student after an incident of seclusion or restraint, should steps be taken to provide treatment and notify the parents about injuries? ............................................... 9 How do schools report a restraint that occurred for less than one minute? ............................................................................................................. 9 If the incident report is written and provided to the parent/guardian on the day of the incident, could this suffice as meeting the requirement to provide written notice? ................................................................................ 10 Do the documenting, reporting, and monitoring requirements specified in section 1003.573, F.S., apply only to students with disabilities who have an individual educational plan (IEP)? ............................ 10 Do the documenting, reporting, and monitoring requirements specified in section 1003.573, F.S., apply to students with disabilities receiving educational services in DJJ or residential facilities? ........................ 10

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E-7.

E-8.

E-9.

E-10.

E-11.

E-12.

E-13.

E-14. E-15.

E-16.

E-17.

E-18. E-19. F.

Do the documenting, reporting, and monitoring requirements specified in section 1003.573, F.S., apply to incidents of seclusion and restraint that occur outside of the school day? ......................................... 10 Must the district report incidents that occur in child care or other early childhood settings, in the home for students who are served on hospital/ homebound (H/H), or in private schools if the student has a service plan? ................................................................................................... 11 Should restraint or seclusion of students placed by the school district or a state agency in out-of-county or out-of-state residential facilities be reported? .................................................................................................... 11 Do the documenting, reporting, and monitoring requirements specified in section 1003.573, F.S., apply when seclusion and/or restraint are used by a school resource officer (SRO)?................................... 12 If the SRO conducted the restraint, can the officer’s name be included in the web-based reporting system as the individual “using the restraint”? ........................................................................................................ 12 What if the SRO conducts the restraint and does not use the district’s procedures for that restraint (e.g. the district uses Professional Crisis Management intervention techniques and the officer’s restraint does not conform to those procedures)? What should be reported in the web-based reporting system? ......................................................................... 12 If a student is being restrained or secluded and then a law enforcement officer takes custody of the student under the provisions of the Baker Act, how should documentation be handled?.............................. 12 How should parents be informed of a district’s policies regarding the use of seclusion and restraint?........................................................................ 13 If a student residing in foster care or a group home is secluded or restrained, to whom should the written notice and written incident report required in section 1003.573, F.S., be provided?.................................. 13 What should the school do if the parent or guardian fails to provide written acknowledgement of receipt of either the written notice or the incident report?................................................................................................ 13 What are the differences between the reporting done in accordance with section 1003.573, F.S., and the Office for Civil Rights (OCR) reporting requirement in the state student database regarding discipline referrals? ......................................................................................... 13 If the student has reached the age of majority, to whom is notification and incident reporting provided? ..................................................................... 14 When injuries occur to staff members, should this be included in the “description of injury” text box in the web-based reporting system? ................ 14 Monitoring...................................................................................................... 14

F-1. F-2. F-3. F-4.

What should monitoring at the classroom level include? ................................. 14 What should monitoring at the school level include?....................................... 15 What should monitoring at the district level include?....................................... 16 What documentation or evidence of district monitoring is expected? Would evidence that someone logged into the system be sufficient? ............. 16

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F-5. G.

What does monitoring at the state level include? ............................................ 16 District Policies and Procedures ................................................................. 16

G-1. Are districts required to have policies and procedures regarding restraint and/or seclusion? .............................................................................. 16 G-2. Do the policies and procedures described in the Exceptional Student Education Policies and Procedures document apply to students with Section 504 plans? If so, how is this documented?......................................... 17 G-3. What should districts do to ensure appropriate restraint and seclusion practices, including documenting, reporting, and monitoring, for students with disabilities? ................................................................................ 17 Appendix A .................................................................................................................. 18 Appendix B .................................................................................................................. 20 Appendix C .................................................................................................................. 21

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Technical Assistance Paper Guidelines for the Use, Documentation, Reporting, and Monitoring of Restraint and Seclusion with Students with Disabilities A.

Introduction and Background

A-1.

What is the purpose of this technical assistance paper (TAP)? In 2007, the Bureau of Exceptional Education and Student Services (Bureau) convened a workgroup composed of school officials, agency representatives, parents, advocates, and other interested parties to provide information and make recommendations to the Bureau to address the use of restraint with students in special education programs. Legislation passed during the 2010 session created section 1003.573, Florida Statutes (F.S.), which established documenting, reporting, and monitoring requirements on the use of restraint and seclusion for students with disabilities. The 2011 Legislature amended this law resulting in the revision of technical assistance being disseminated. There are concerns among students, educators, and parents about the use of restraint and seclusion with students in special education programs. These concerns include: the use of restraint and seclusion when less-intrusive measures are preferable; lack of adequate training for staff; inadequate documentation of restraint and seclusion procedures; failure to notify parents when restraint and seclusion are used; and failure to use data to further analyze/address the function of the precipitating behavior(s). Florida schools should ensure that students are treated with respect and dignity in an environment that provides for the physical safety and security of students and staff. There are instances in which students pose a threat to the safety of themselves or others. The purpose of restraint and seclusion is to prevent injury to self and/or others; these procedures are not to be used to punish a student, as a deterrent, or to “teach a student a lesson.” It is important to recognize that the use of restraint and seclusion may have an emotional impact on students. Such interventions should only be used in emergency situations when an imminent risk of serious injury or death to the student or others exists and in a manner that conveys respect for the dignity of the student.

A-2.

Are there standards regarding the use of restraint and seclusion on students with disabilities? Yes. Section 1003.573, F.S., required the Florida Department of Education (FDOE) to develop standards for documenting, reporting, and monitoring the use of restraint and seclusion. These standards shall be provided to districts by October 1, 2011. These standards require districts to develop written policies and

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procedures on reporting, documenting, and monitoring the use of restraint and seclusion. Included in these procedures are the provisions for training personnel on the use of restraint and seclusion, the reporting and documenting and monitoring procedures and a plan to reduce the use of restraint and seclusion (see Appendix A). B.

Restraint

B-1

What is restraint? Restraint is an emergency intervention sometimes used in schools when students are exhibiting disruptive or dangerous behavior. Restraint is not an instructional tool for the development of pro-social behavior. Rather, it is one method to prevent students from harming themselves or others. It should only be used in emergency situations when an imminent risk of serious injury or death to the student or others exists. Section 1003.573, F.S., does not provide a definition for restraint but does require documenting, reporting, and monitoring of restraint with students with disabilities. The Bureau has determined that all documenting, reporting, and monitoring requirements for restraint, discussed later in this TAP, shall be based upon the same definitions issued by the Office for Civil Rights (OCR) for reporting instances of restraint and seclusion for all students. For the purpose of this TAP and the documenting, reporting, and monitoring requirements for restraint, definitions are as follows: Physical restraint Physical restraint immobilizes or reduces the ability of a student to move his or her torso, arms, legs, or head freely. The term physical restraint does not include a physical escort. “Physical escort” means a temporary touching or holding of the hand, wrist, arm, shoulder, or back for the purpose of inducing a student who is acting out to walk to a safe location. When reporting the physical restraint, there is a requirement to document the type of restraint using terms in accordance with terminology defined by the Bureau. Those terms include seated, standing, prone (lying face down), supine (lying face up), immobilization during transport and mechanical restraint (see definition below). Mechanical restraint Mechanical restraint is the use of any device or equipment to restrict a student’s freedom of movement. The term does not include devices implemented by trained school personnel or devices used by a student that have been prescribed by an appropriate medical or related service professional and are used for the specific and approved purposes for which such devices were designed, such as:

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• • • •

Adaptive devices or mechanical supports used to achieve proper body position, balance, or alignment to allow greater freedom of mobility than would be possible without the use of such devices or mechanical supports Vehicle safety restraints when used as intended during the transport of a student in a moving vehicle Restraints for medical immobilization Orthopedically prescribed devices that permit a student to participate in activities without risk of harm

These definitions may also be found on the FDOE website at http://www.fldoe.org/eias/dataweb/database_1011/st81_1.pdf. B-2.

Is there a difference between the term “escort” and “transport”? Transports, by definition, may require physical force or exertion in order to propel a student into motion while immobilizing their arms and torso with one or more persons assisting. Transports with immobilization should be reported as restraints. “Immobilization during transport” is included on the Bureau’s webbased reporting system as a drop-down choice under the type of restraint used. Escort involves inducing the student to walk without physical force or immobilization and would not be reported as restraint.

B-3.

Are there any restrictions regarding the use of restraint? Yes. Section 1003.573(4), F.S., expressly prohibits the use of mechanical or physical restraint that restricts a student’s breathing.

B-4.

What are the circumstances when restraint might be used with students with disabilities? Section 1003.573(1)(b)8.b., F.S., states that the required incident report must include a description of the student’s behavior leading up to the incident, “including an indication as to why there was an imminent risk of serious injury or death to the student or others.” Restraint should only be used in emergency situations when an immediate and significant threat to the physical safety of the student and/or others exists. Restraint should be used only for the period of time needed to contain the behavior of concern and eliminate the immediate threat of harm to self and/or others. Additionally, the settings in which restraint is used should include practices that incorporate positive behavior supports and have trained staff that use positive behavioral intervention and strategies consistently with students to ensure that restraint is only used as a last resort. Restraint procedures might be used to intervene with students with disabilities in the following circumstances: • Aggression: Demonstration of behaviors that pose a clear threat to the physical safety of others; examples include repeated hitting, kicking, head 53

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• •

B-5.

butting, or use of any other part of the body or an object that may injure another person Self injury: Demonstration of behaviors that pose a clear threat to the physical safety of the student; examples include repeated head-banging, faceslapping, and eye-poking Unsafe behaviors that pose a significant risk (e.g. climbing on furniture, running away, property destruction that creates imminent risk of serious injury or death)

What constitutes serious bodily injury? Rule 6A-6.03312(1)(d), Florida Administrative Code (F.A.C.), Discipline Procedures for Students with Disabilities, defines serious bodily injury to mean “bodily injury which involves a substantial risk of death; extreme physical pain; protracted and obvious disfigurement; or protracted loss or impairment of the function of bodily member, organ, or mental faculty.”

B-6.

Are there guidelines that districts should follow when considering which personnel may implement restraint procedures? Restraint should be used only by school personnel who are qualified through school district-approved training in the appropriate application of specific techniques and in the procedures associated with the use of this level of intervention. School personnel who have received training not associated with their employment with the school district (e.g. former corrections staff, former residential setting staff), should be trained in the specific district-approved techniques and should not apply techniques or procedures acquired elsewhere. School districts should consider whether it is appropriate for employees working in specific settings to be trained in restraint techniques (e.g. school bus drivers, bus aides, job coaches, employment specialists, cafeteria workers). There may be situations in which staff members who have not received training are confronted with an emergency situation that poses an immediate and significant threat to the physical safety of a student or others. In those situations, staff should be guided by existing district policies—including those required by sections 1003.573, F.S., Use of restraint and seclusion on students with disabilities; 1003.32, F.S., Authority of teacher; responsibility for control of students; district school board and principal duties; and 1006.11, F.S., Standards for use of reasonable force. The 2011 Florida Legislature amended section 1003.573, F.S., to require that districts describe a plan for selecting personnel to be trained in their Exceptional Student Education Policies and Procedures (SP&P) document. These policies must be submitted to the Department no later than January 31, 2012.

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B-7.

Is reporting of restraint or seclusion required for students in a Department of Juvenile Justice (DJJ) facility or county jail? Incidents of restraint or seclusion of students with disabilities receiving educational services in DJJ or jail must be reported for those incidents that occur during the time designated as school time in those settings.

C.

Seclusion

C-1.

What is seclusion? Seclusion is an emergency intervention sometimes used in schools when students are exhibiting disruptive or dangerous behavior. Seclusion is not an instructional tool for the development of pro-social behavior. Rather, it is one method to prevent students from harming themselves or others. It should only be used in emergency situations when an imminent risk of serious injury or death to the student or others exists. Section 1003.573, F.S., does not provide a definition of seclusion. However, OCR now requires that the FDOE report all instances of seclusion and restraint for all students (not just those with disabilities). Documentation, reporting, and monitoring requirements for seclusion, discussed later in this TAP, are based on the definition issued by OCR with additional parameters described in section 1003.573, F.S. The OCR defines seclusion as “the involuntary confinement of a student alone in a room or area from which the student is physically prevented from leaving. It does not include a time-out, which is a behavior management technique that is part of an approved program, involves the monitored separation of the student in a non-locked setting, and is implemented for the purpose of calming.” This definition may also be found on the FDOE website at http://www.fldoe.org/eias/dataweb/database_1011/st81_1.pdf.

C-2.

How does section 1003.573, F.S., further clarify what schools and districts must report, document, and monitor with regard to incidents of seclusion? Section 1003.573(5), F.S., clearly states that school personnel may not close, lock, or physically block a student in a room that is unlit and does not meet the rules of the State Fire Marshal for seclusion rooms. While not all school districts allow the use of seclusion, for districts that do allow it, a seclusion room must meet the requirements identified in Rule 69A-58.0084, F.A.C., Seclusion Timeout Rooms (see Appendix B). Districts are reminded that in accordance with Rule 69A-58.0084, F.A.C., an electro-magnetic locking device is the only approved device to secure a seclusion room and that such a device can only be engaged by “constant human contact.” Additionally, all seclusion rooms must have a view panel that meets the dimensions stipulated in Rule 69A-58.0084, F.A.C., in order 55

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to “allow a staff member to continuously keep the student under observation.” Covering the view panel with any material is expressly prohibited. Given OCR’s definition of seclusion, including “alone in a room or area from which the student is physically prevented from leaving,” the documenting, reporting, and monitoring requirements defined in section 1003.573, F.S., include any time a student is confined in a room or other space and prevented from leaving. Therefore, reportable incidents of seclusion include those that take place in rooms that meet the requirements of the State Fire Marshal rules. If seclusion of a student with a disability occurs in a room not designed for seclusion, reporting is still required. D.

Training

D-1.

What training should personnel receive? It is required by section 1003.573, F.S., that districts provide training in the use of restraint and seclusion. Such training should be provided to building administrators and instructional personnel as determined by the district’s plan for selecting personnel for training on restraint and seclusion. It is recommended that trainings include, but are not limited to: • Procedures for de-escalating problematic behaviors before they increase to a level or intensity necessitating physical intervention • Information regarding the risks associated with restraint, and procedures for assessing individual situations and students to determine if its use is appropriate and sufficiently safe • The actual use of specific techniques that range from the least to most restrictive, with ample opportunity for trainees to demonstrate proficiency in their use • Techniques for implementing restraint with multiple staff members working as a team • Techniques for assisting the student to re-enter the instructional environment and re-engage in learning • Instruction in the documentation and reporting requirements as required by section 1003.573, F.S., and specified in district policies • Procedures to identify and deal with possible medical emergencies resulting from the use of restraint It is recommended that districts provide refresher training on restraint techniques at least annually, or in accordance with guidelines of the training program used for all staff members who have successfully completed the initial training component (see the list of characteristics of an effective training model in D-2).

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D-2.

Are there guidelines for selecting a training program? There are many training programs available from vendors around the country. The FDOE does not endorse any particular training model. Project REST 1 has identified characteristics of effective training models. Districts may find this list of characteristics of an effective training model useful when selecting a training model for restraint: • Is externally developed and has a record of successful implementation in a variety of settings (i.e. developed by a program or individual independent of the school) • Includes a curriculum that is available for review • Emphasizes prevention of the type of events that require physical intervention, including relationship building, positive approaches to prevention of escalation, and an emphasis on de-escalation skills • Promotes safety as the only acceptable reason to use physical intervention • Includes instruction in the physiological effects of restraint and the monitoring of physical distress signs, including positional asphyxia • Includes instruction in personal safety and evasion techniques • Includes instruction in safe holding techniques (this instruction must include discussion and modeling, an opportunity to physically practice the techniques, and a requirement that the staff member demonstrate competency in the model) • Includes techniques on how to help the student process or debrief the event • Includes information on how staff members are to debrief the event, including reviewing the event to understand how it evolved and to uncover areas of improvement for future situations; assisting staff members in managing the stress of the event; documentation of the event; and communication about the event to appropriate parties, including parents, the school administration, and, as needed, other students and staff members • Requires that staff successfully complete post-training assessments of knowledge and skills • Specifies a minimum training/refresher training schedule (training should be conducted on at least an annual basis; the needs of the students and staff may dictate more frequent training/refresher training) The Child Welfare League of America (CWLA) identified practices that should be prohibited from use in any program. 2 These practices are: • Pain inducement to obtain compliance • Bone locks 1

2

“Family Resource Center for Disabilities and Special Needs,” June 2004, Manual of Recommended Practice, Project REST, Restraint: Efficacy, Safety and Training, Charleston, SC: Author. State Regulations for Behavior Support and Intervention: A Promising Model (p. 15), by Bullard, L., Fulmore, D., Gupta, N., and Johnson, K., 2004, Washington, D.C.: CW LA Press.

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• • • • • • • •

• • •

Hyperextension of joints Peer restraint Use of seclusion rooms that do not meet agency, licensing, or accreditation standards Use of restraint when the child would be medically compromised Mechanical restraint Restraint and seclusion used simultaneously with mechanical restraint devices Pressure or weight on the chest, lungs, sternum, diaphragm, back, or abdomen, causing chest compression Straddling or sitting on any part of the body, or any maneuver that places pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the child’s head or neck, or that otherwise obstructs or restricts the circulation of blood or obstructs an airway Any type of choking, hand chokes, and any type of neck or head hold Any technique that involves pushing on or into the child’s mouth, nose, eyes, or any part of the face, or covering the face or body with anything, including soft objects such as pillows or washcloths Any maneuver that involves punching, hitting, poking, pinching, or shoving

E.

Documenting and Reporting

E-1.

What are the documenting and reporting requirements when restraint and/or seclusion are used? Section 1003.573, F.S., requires that parents be informed whenever restraint and seclusion are used with a student with a disability (see Appendix C). Effective July 1, 2011, the documentation and reporting requirements include the following: Schools are required to notify a parent or guardian each time restraint and/or seclusion are used. This notification must be in writing and provided before the end of the school day in which the restraint and/or seclusion occurs. Reasonable efforts must be taken to notify the parent or guardian by telephone or electronic mail or both, in accordance with standards established by the Bureau (see Appendix A). The notification must include the type of restraint used and any injuries occurring during or resulting from restraint or seclusion. The school shall obtain and keep in its records the parent or guardian’s signed acknowledgment of the written notification. If parents fail to return signed acknowledgement of their receipt of notification, written documentation should be maintained with a minimum of two attempts made to notify parents. In addition to the written notification described above, an incident report shall be prepared within 24 hours after a student is released from seclusion and/or restraint. The content of the report must include:

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• • • • • • • • • • •

The name, grade, race, ethnicity, gender, and exceptionality of the student The date, time, and location of the event and the duration of the seclusion and/or restraint The type of restraint used, as defined by the Bureau, and a description of the restraint and the crisis management technique used The name of the person using or assisting in the seclusion and/or restraint of the student The name of any nonstudent who was present to witness the seclusion and/or restraint A description of the incident to include the context in which the seclusion and/or restraint occurred The behavior leading up to the decision to use seclusion and/or restraint including an indication as to why there was an imminent risk of serious injury or death to the student or others Any positive behavioral strategies used to prevent or de-escalate the behavior What occurred immediately after the termination of seclusion and/or restraint Any injuries, marks, or medical emergencies Evidence of steps taken to notify the parent or guardian

Schools are required to provide the parent or guardian with the completed incident report in writing by mail within three school days after the event. The school shall obtain and keep in its records the parent or guardian’s signed acknowledgment that the incident report was received. Schools must make a minimum of two additional attempts to obtain written parent acknowledgment when parents fail to respond to initial notices or incident reports and maintain documentation of these attempts. Incident reporting must be submitted to the school principal, the district director of exceptional student education (ESE), and the Bureau. E-2.

If injuries occur or medical treatment is necessary for a student after an incident of seclusion or restraint, should steps be taken to provide treatment and notify the parents about injuries? Yes. It is always important to contact parents immediately if injuries occur. You should include this in the initial notification and the incident report, along with a description of the injury.

E-3.

How do schools report a restraint that occurred for less than one minute? Incidents of restraint or seclusion of less than one minute must be reported in the web-based system. The system will create a statement of “< 1 minute” when the same start and end time are reported. For example, if the start time and end time of restraint/seclusion are both entered as 8:31, then the system will generate the “