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Comparative Analysis of the Joint Commission Standards and the United States Department of Education Resource Document Principles on Restraint and Seclusion Use in Schools: Implications for Legislative Action

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This article provides a comparative analysis between the United States Department of Education Resource Document principles and the Joint Commission standards for restraint and seclusion. Restraint and seclusion procedures, which were initially restricted to psychiatric institutions and medical settings, have moved to the educational setting as the children transitioned from patients to students. The restraint and seclusion standards originated from the health care organizations’ Joint Commission standards, but the resulting educational standards vary greatly from state to state. Since restraint and seclusion procedures are derived from health care settings, it would be more beneficial for the education standards to be modeled after the Joint Commission standards. Therefore, the focus of this article is on the incongruities between the educational policies and the Joint Commission standards, which after analysis revealed there is only a 60% overlap between the standards. Additionally, it will emphasize the impact these incongruities in legislation have on crisis prevention for educators.
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6 :: THE JOURNAL OF CRISIS PREVENTION
Comparative Analysis of the Joint Commission Standards and
the United States Department of Education Resource Document
Principles on Restraint and Seclusion Use in Schools:
Implications for
Legislative Action
By Brian Conners, Ed.S., BCBA and Mary Saydah
This article provides a comparative analysis between the United States Department of Education Resource Document
principles and the Joint Commission standards for restraint and seclusion. Restraint and seclusion procedures, which
were initially restricted to psychiatric institutions and medical settings, have moved to the educational setting as the
children transitioned from patients to students. The restraint and seclusion standards originated from the health care
organizations’ Joint Commission standards, but the resulting educational standards vary greatly from state to state.
Since restraint and seclusion procedures are derived from health care settings, it would be more beneficial for the
education standards to be modeled after the Joint Commission standards. Therefore, the focus of this article is on the
incongruities between the educational policies and the Joint Commission standards, which after analysis revealed there
is only a 60% overlap between the standards. Additionally, it will emphasize the impact these incongruities in legislation
have on crisis prevention for educators.
anticipation of its passage to begin developing laws
and regulations at the state level. Additionally, the
United States Department of Education (2012) later
released a resource document outlining 15 guiding
principles on the use of restraint and seclusion in
schools. A recent policy analysis showed disparities and
inconsistencies between state laws and regulations and
the incorporation of the principles found in the United
States Department of Education Resource Document
(Marx & Baker, 2017).
PURPOSE OF THE PAPER
While other research has analyzed the use of the
principles from the United States Department of
Education Resource Document on restraint and
seclusion in state legislation, no research has compared
this resource document to the standards of the Joint
Commission. Therefore, the purpose of this paper
is to provide a comparative analysis of the United
States Department of Education Resource Document
principles on restraint and seclusion use in schools
In recent years, there has been a significant amount
of media attention surrounding the use of restraint
and seclusion procedures in schools (Ryan & Peterson,
2004). There have been hundreds of reports nationwide
of alleged abuse and death because of the misuse of
restraint and seclusion in public and private schools
(GAO-09-719T: Seclusions and Restraints). One of the
reasons for this issue could be that the same federal
regulations regarding restraint and seclusion that are
used to protect the rights of psychiatric patients where
these procedures originated do not apply to schools
(Ryan & Peterson, 2004). Therefore, with no federal
regulation in place, schools are left having to decide
what to do with students who pose a danger to self or
others and utilize these practices with minimal oversight.
To address this issue, the Keeping All Students Safe
Act (2010) was introduced as a federal bill to offer
guidelines for restraint and seclusion use in schools.
Unfortunately, this bill never made it through Congress
to become a federal law and regulation. However, this
movement encouraged states to become proactive in
THE JOURNAL OF CRISIS PREVENTION :: 7
to the Joint Commission standards utilized within
behavioral health care organizations.
METHOD
For the purposes of this investigation, the principles
from the United States Department of Education
Resource Document (2012) and the Joint Commission
standards were obtained through internet searches. The
Joint Commission standards were retrieved through a
Crisis Prevention Institute (2013) document and were
utilized for this comparative analysis as further internet
searches could not produce more recent standards that
have been made publicly available. Upon obtaining
the standards, both documents were independently
reviewed to identify commonalities and differences
between the standards. The two reviewers then met and
reviewed their findings. A 100% agreement was found
between the reviewers.
RESULTS
Table 1 illustrates the alignment of Joint Commission
standards to the United States Department of Education
Resource Document principles on restraint and
seclusion.
An analysis of the principles in comparison to the Joint
Commission Standards indicated only a 60% overlap.
Incongruities in the standards were found in the
following areas or categories: 1) policy development,
2) evaluating and re-evaluating individuals during
restraint and seclusion procedures, 3) monitoring of
individuals who are being restrained and secluded,
and 4) reporting of injuries and/or death of individuals.
Furthermore, additional principles from the United
States Department of Education Resource Document
were not applicable to the Joint Commission standards
including areas like restraint and seclusion practices
being applied to all children—not just children with
disabilities—using behavioral strategies to address
problem behavior, reviews of policies, and parental
input and consent.
DISCUSSION
There is a clear incongruity between the Joint
Commission standards and the principles of the United
States Department of Education Resource Document.
With only a scant 60% overlap between the Joint
Commission standards from 2013 and the United States
Department of Education Resource Document from
2012, there is much room for improvement to create
safe, consistent guidelines that all schools should follow.
One missing standard in the United States Department
of Education is the omission of policies and procedures
to guide the use of restraint and seclusion in schools.
Without this, the decision about what policies and
procedures should be in place to protect students with
dangerous behaviors is left up to each state and further
in some cases, each school. Hospitals and psychiatric
institutions have been using restraint and seclusion
techniques for years with effective policies. Why does
the United States Department of Education not follow
their lead and adopt similar protective codes? The
implementation of consistent policies across schools in
the United States would ensure that best practices for
restraint and seclusion are used.
In addition, the United States Department of Education
does not have procedures for evaluating and
re-evaluating the student who is being restrained
or secluded. They also lack a policy for monitoring
individuals who are being both restrained and secluded.
Without checking the student’s physical and mental
well-being consistently while undergoing restraint and
seclusion, there is no assurance that the student’s health
is being protected. The student’s safety and health
should be the first concern because it is this lack of
evaluation of a student being restrained or secluded
that may have contributed to the increase in injuries and
deaths related to restraint and seclusion in recent years.
To maintain the safety of the individual being restrained
and/or secluded, which should be the primary concern,
the United States Department of Education needs to
adopt policies for regular monitoring the physical and
mental well-being of a student being restrained and/or
secluded like those that the Joint Commission standards
have in place.
Finally, the United States Department of Education
principles, unlike the Joint Commission standards, lacks
regulations on reporting injuries and deaths associated
with restraint and seclusion. Without a procedure to
report any injuries or deaths that occurred because of
restraint or seclusion procedures being misused, there
is no standard for investigating what went wrong in
the restraint or seclusion implementation. Additionally,
there is no mandatory reporting system allowing
a simple way to track the trends of effective crisis
prevention and intervention in schools. Without this,
there are no standards to guide best practice of restraint
and seclusion procedures in educational facilities.
Furthermore, this also does not hold staff accountable
for errors in the techniques to allow for improvement in
training procedures in the schools. All this information
would be valuable to inform organizations in developing
even safer restraint and seclusion techniques.
Due to the controversial nature of restraint and
seclusion, proper legislation to protect both the
students it is used on and the staff who need it to
8 :: THE JOURNAL OF CRISIS PREVENTION
Table 1: Comparison of Joint Commission Standards to United States Department of Education
Resource Document Principles on Restraint and Seclusion
Joint Commission Standard (Crisis
Prevention Institute, 2013)1
Applicable United States Department of Education (2012) Resource Document
Principles2
Standard PC.03.05.01: The [organization]
uses restraint or seclusion only when it can
be clinically justified or when warranted by
patient behavior that threatens the physical
safety of the patient, staff, or others (p. 2).
Principle 1: Every effort should be made to prevent the need for the use of restraint and
for the use of seclusion (p. 12).
Principle 3: Physical restraint or seclusion should not be used except in situations where
the child’s behavior poses imminent danger of serious physical harm to self or others
and other interventions are ineffective and should be discontinued as soon as imminent
danger of serious physical harm to self or others has dissipated (p. 12).
Principle 6: Restraint or seclusion should never be used as punishment or discipline (e.g.,
placing in restraint for out-of-seat behavior), as a means of coercion, or retaliation, or as a
convenience (p. 12).
Standard PC.03.05.03: The [organization]
uses restraint or seclusion safely (p. 2).
Principle 2: Schools should never use mechanical restraints to restrict a child’s freedom
of movement, and schools should never use a drug or medication to control behavior
or restrict freedom of movement (except as authorized by a licensed physician or other
qualified health professional) (p. 12).
Principle 5: Any behavioral intervention must be consistent with the child’s rights to be
treated with dignity and to be free from abuse (p. 12).
Principle 7: Restraint or seclusion should never be used in a manner that restricts a child’s
breathing or harms the child (p. 12).
Standard PC.03.05.05: The [organization]
initiates restraint or seclusion based on an
individual order (p. 3).
Principle 2: Schools should never use mechanical restraints to restrict a child’s freedom
of movement, and schools should never use a drug or medication to control behavior
or restrict freedom of movement (except as authorized by a licensed physician or other
qualified health professional) (p. 12).
Standard PC.03.05.07: The [organization]
monitors patients who are restrained or
secluded (p. 3).
Principle 11: Every instance in which restraint or seclusion is used should be carefully
and continuously and visually monitored to ensure the appropriateness of its use and the
safety of the child, other children, teachers, and other personnel (p. 13).
Standard PC.03.05.09: The [organization]
has written policies and procedures that
guide the use of restraint or seclusion (p. 4).
No alignment.
Standard PC.03.05.11: The [organization]
evaluates and reevaluates the patient who
is restrained or secluded (p. 5).
No alignment.
Standard PC.03.05.13: The [organization]
continually monitors patients who are
simultaneously restrained and secluded
(p. 5).
No alignment.
Standard PC.03.05.15: The [organization]
documents the use of restraint or seclusion
(p. 6).
Principle 8: The use of restraint or seclusion, particularly when there is repeated use for
an individual child, multiple uses within the same classroom, or multiple uses by the same
individual, should trigger a review and, if appropriate, a revision of behavioral strategies
currently in place to address dangerous behavior; if positive behavioral strategies are not
in place, staff should consider developing them (p. 12).
Principle 15: Policies regarding the use of restraint and seclusion should provide that
each incident involving the use of restraint or seclusion should be documented in writing
and provide for the collection of specific data that would enable teachers, staff, and other
personnel to understand and implement the preceding principles (p. 13).
Standard PC.03.05.17: The [organization]
trains staff to safely implement the use of
restraint or seclusion (p. 7).
Principle 10: Teachers and other personnel should be trained regularly on the
appropriate use of effective alternatives to physical restraint and seclusion, such as
positive behavioral interventions and supports and, only for cases involving imminent
danger of serious physical harm, on the safe use of physical restraint and seclusion (p. 12).
Standard PC.03.05.19: The [organization]
reports deaths associated with the use of
restraint and seclusion (p. 8).
No alignment.
THE JOURNAL OF CRISIS PREVENTION :: 9
control dangerous behaviors is paramount. With
apt legislation that follows the Joint Commission
standards model, restraint and seclusion in schools
can be safer, monitored more closely, and be all
around more effective. Therefore, it is important for
educators, administrators, school-based mental health
professionals, and other school professionals to
advocate for appropriate legislation at the federal level
to provide better oversight and accountability of these
practices.
LIMITATIONS
There are some limitations to this study. The primary
limitation is that the Joint Commission standards for this
study were based on freely available standards because
unfortunately newer standards were not publicly
available for the researchers. Additionally, it could be
argued by educational professionals that standards from
behavioral health care organizations should not inform
educational policy as these are different disciplines;
however, restraint and seclusion procedures originated
within health care but carried over into educational
settings.
FUTURE DIRECTIONS
In future studies, the comparison could be made
between the 2017 Joint Commission standards and
the United States Department of Education Resource
Document to have the most updated analysis of the
current state of restraint and seclusion legislation
in educational facilities. Next, the United States
Department of Education Resource Document should
be updated and ideally would be aligned to more of
the health care standards for restraint and seclusion.
Furthermore, the resource document is five years old
and only offers guidance to states on this topic and is
not a federal mandate. Therefore, advocacy is needed
for federal legislation on this issue, preferably aligned
with the Joint Commission standards, as state policies
are inconsistent.
References
1Crisis Prevention Institute. (2013). The Nonviolent Crisis
Intervention® training program and the Joint Commission
standards on restraint and seclusion. Retrieved from
www.crisisprevention.com/CPI/media/Media/Resources/
alignments/Joint-Commission-Restraint-Seclusion-
Alignment-2013.pdf
2United States Department of Education. (2012). Restraint
and seclusion: Resource document. Retrieved from
www2.ed.gov/policy/seclusion/restraints-and-seclusion-
resources.pdf
GAO-09-719T: Seclusions and restraints: Selected cases of
death and abuse at public and private schools and treatment
centers: Testimony before the Committee on Education
and Labor, House of Representatives, 111th Cong. 3 (2009)
(testimony of Gregory D. Kutz).
Keeping All Students Safe Act of 2010, H.R. 4247, 111th
Cong. (2010). Retrieved from, thomas.loc.gov/cgi-bin/
bdquery/D?d111:1:./temp/~bdq4sA:@@@L&summ2=m&|/
bss/111search.html|
Marx, T. A., & Baker, J. N. (2017). Analysis of restraint and
seclusion legislation and policy across states: Adherence to
recommended principles. Journal of Disability Policy Studies,
28(1), 23-31.
National Dissemination Center for Children with Disabilities.
(2009). IDEA and categories of disabilities under IDEA law.
Retrieved from www.nichcy.org/Disabilities/Categories/Pages/
Default.aspx
Ryan, J., Robbins, K. Peterson, R., & Rozalski, M. (2009). Review
of state policies concerning the use of physical restraint
procedures in schools. Education & Treatment of Children,
32(3), 487-504.
Ryan, J., & Peterson, R. (2004). Physical restraint in school.
Behavioral Disorders, 29(2), 154-168.
BRIAN CONNERS, ED.S., BCBA is a Board Certified Behavior
Analyst and New Jersey Department of Education certified
school psychologist. He is a CPI Certified Instructor and is a
faculty associate for the Applied Behavior Analysis program
at Seton Hall University in the Department of Educational
Studies.
MARY SAYDAH is currently an undergraduate student at Seton
Hall University in the five-year program to obtain a B.S.E. in
elementary, early childhood, and special education with a M.A.
in special education in Applied Behavior Analysis.
Correspondence concerning this article should be addressed
to Brian Conners, Ed.S., BCBA, Seton Hall University, College
of Education and Human Services, Department of Educational
Studies, 400 South Orange Avenue, Jubilee Hall Rm. 431,
South Orange, New Jersey 07079. Contact: brian.conners@
shu.edu
ResearchGate has not been able to resolve any citations for this publication.
Article
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Recent injuries and fatalities among students due to the use of physical restraint procedures in schools, and the resulting media attention and litigation have started to place pressure on many state and local education agencies to develop policies or guidelines concerning their use in schools. The authors investigated existing state policies and guidelines concerning the use of physical restraint procedures in educational settings across the United States. Currently, thirty-one states were identified with established guidance concerning the use of these crisis intervention procedures. Several states are either developing or revising their existing policies or guidelines. The authors reviewed the policies and guidelines which were identified in order to compare common content elements found in these documents, and make recommendations for states, schools or districts interested in developing their own policies or guidelines.
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This review examines each state’s educational legislation and policies on restraint and seclusion in relationship to their alignment with the U.S. Department of Education’s (U.S. DOE) Restraint and Seclusion: Resource Document. Although the Resource Document is not a federal mandate, it provides the U.S. DOE’s recommendations for policy and legislation to reduce the use of restraint and seclusion in schools and create safe learning environments for all students. State educational legislation and policies on restraint and seclusion were coded and compared with the U.S. DOE Resource Document’s 15 guiding principles. Results were variable and found that some states’ policies adhered more to the guiding principles than their legislation. In addition, some states recognize the document in their legislation and policy. A summary of the descriptive data and current state statuses are reported.
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The current emphasis on educating children in the least restrictive environment has resulted in the use of physical restraint procedures across all educational placement settings, including public schools. Since its initial use, restraint has been controversial. Professionals who use physical restraint claim that it is necessary to safely manage dangerous behaviors. Child advocates, however, argue that far too many children suffer injury and death from the very staff charged with helping them. The authors review research literature, legislation, and court decisions on topics related to the use of restraint in schools and identify position statements and recommended practices from nationally recognized professional organizations and advocacy groups. Recommendations are given for research, policy, and procedures for the use and practice of physical restraint in schools.
The Nonviolent Crisis Intervention® training program and the Joint Commission standards on restraint and seclusion. Retrieved from www.crisisprevention.com/CPI/media
Crisis Prevention Institute. (2013). The Nonviolent Crisis Intervention® training program and the Joint Commission standards on restraint and seclusion. Retrieved from www.crisisprevention.com/CPI/media/Media/Resources/ alignments/Joint-Commission-Restraint-SeclusionAlignment-2013.pdf 2
IDEA and categories of disabilities under IDEA law Retrieved from www.nichcy.org/Disabilities/Categories/Pages/ Default Review of state policies concerning the use of physical restraint procedures in schools
  • J Ryan
  • K Robbins
  • R Peterson
  • M Rozalski
National Dissemination Center for Children with Disabilities. (2009). IDEA and categories of disabilities under IDEA law. Retrieved from www.nichcy.org/Disabilities/Categories/Pages/ Default.aspx Ryan, J., Robbins, K. Peterson, R., & Rozalski, M. (2009). Review of state policies concerning the use of physical restraint procedures in schools. Education & Treatment of Children, 32(3), 487-504.
BCBA is a Board Certified Behavior Analyst and New Jersey Department of Education certified school psychologist. He is a CPI Certified Instructor and is a faculty associate for the Applied Behavior Analysis program at Seton Hall University in the Department of Educational Studies
  • Ed S Brian Conners
BRIAN CONNERS, ED.S., BCBA is a Board Certified Behavior Analyst and New Jersey Department of Education certified school psychologist. He is a CPI Certified Instructor and is a faculty associate for the Applied Behavior Analysis program at Seton Hall University in the Department of Educational Studies.
The Nonviolent Crisis Intervention® training program and the Joint Commission standards on restraint and seclusion
Crisis Prevention Institute. (2013). The Nonviolent Crisis Intervention® training program and the Joint Commission standards on restraint and seclusion. Retrieved from www.crisisprevention.com/CPI/media/Media/Resources/ alignments/Joint-Commission-Restraint-Seclusion-Alignment-2013.pdf
Keeping All Students Safe Act of
Keeping All Students Safe Act of 2010, H.R. 4247, 111th
IDEA and categories of disabilities under IDEA law
National Dissemination Center for Children with Disabilities. (2009). IDEA and categories of disabilities under IDEA law. Retrieved from www.nichcy.org/Disabilities/Categories/Pages/ Default.aspx
Retrieved from, thomas.loc.gov/cgi-bin/ bdquery/D?
  • Cong
Cong. (2010). Retrieved from, thomas.loc.gov/cgi-bin/ bdquery/D?d111:1:./temp/~bdq4sA:@@@L&summ2=m&|/ bss/111search.html|