Handbook: Physical Restraint Procedures pursuant to 603 CMR 46.00

Physical restraint shall mean direct physical contact that prevents or significantly restricts a student’s freedom of movement. Physical restraint does not include: brief physical contact to promote student safety, providing physical guidance or prompting when teaching a skill, redirecting attention, providing comfort, or a physical escort.

Physical restraint shall be used only in emergency situations of last resort, after other lawful and less intrusive alternatives have failed or been deemed inappropriate, and with extreme caution. School personnel shall use physical restraint with two goals in mind:

(a) To administer a physical restraint only when needed to protect a student and/or a member of the school community from assault or imminent, serious, physical harm; and

(b) To prevent or minimize any harm to the student as a result of the use of physical restraint.

Use of Restraint

Mechanical restraint, medication restraint, and seclusion shall be prohibited in public education programs.

Prone restraint shall be prohibited in public education programs except on an individual student basis, and only under the following circumstances:

  1. The student has a documented history of repeatedly causing serious self-injuries and/or injuries to other students or staff;
  2. All other forms of physical restraints have failed to ensure the safety of the student and/or the safety of others;
  3. There are no medical contraindications as documented by a licensed physician;
  4. There is psychological or behavioral justification for the use of prone restraint and there are no psychological or behavioral contraindications, as documented by a licensed mental health professional;
  5. The program has obtained consent to use prone restraint in an emergency as set out in 603 CMR 46.03(1)(b), and such use has been approved in writing by the principal; and,
  6. The program has documented 603 CMR 46.03(1)(b) 1 – 5 in advance of the use of prone restraint and maintains the documentation.

Physical restraint, including prone restraint where permitted, shall be considered an emergency procedure of last resort and shall be prohibited in public education programs except when a student’s behavior poses a threat of assault, or imminent, serious, physical harm to self or others and the student is not responsive to verbal directives or other lawful and less intrusive behavior interventions, or such interventions are deemed to be inappropriate under the circumstances.

All physical restraints, including prone restraint where permitted, shall be administered in compliance with 603 CMR 46.05.

Physical restraint shall not be used:

(a) As a means of discipline or punishment;

(b) When the student cannot be safely restrained because it is medically contraindicated for reasons including, but not limited to, asthma, seizures, a cardiac condition, obesity, bronchitis, communication-related disabilities, or risk of vomiting;

(c) As a response to property destruction, disruption of school order, a student’s refusal to comply with a public education program rule or staff directive, or verbal threats when those actions do not constitute a threat of assault, or imminent, serious, physical harm; or

(d) As a standard response for any individual student. No written individual behavior plan or individualized education program (IEP) may include use of physical restraint as a standard response to any behavior. Physical restraint is an emergency procedure of last resort.

Physical restraint in a public education program shall be limited to the use of such reasonable force as is necessary to protect a student or another member of the school community from assault or imminent, serious, physical harm.

Referral to law enforcement or other state agencies. Nothing in these regulations prohibits:

(a) The right of any individual to report to appropriate authorities a crime committed by a student or other individual;

(b) Law enforcement, judicial authorities or school security personnel from exercising their responsibilities, including the physical detainment of a student or other person alleged to have committed a crime or posing a security risk; or

(c) The exercise of an individual’s responsibilities as a mandated reporter pursuant to G.L. c. 119, § 51A. 603 CMR 46.00 shall not be used to deter any individual from reporting neglect or abuse to the appropriate state agency.

Policy and Procedures

(a)   Methods for preventing student violence, self-injurious behavior, and suicide, including individual crisis planning and de-escalation of potentially dangerous behavior occurring among groups of students or with an individual student;

Methods for Preventing Student Violence, Self-Injurious Behavior, and Suicide

Prevention/De-Escalation Techniques

Prevention includes using positive steps taken before a behavioral crisis occurs.

  1. Interrupting: Interrupting is the first thing to do when trying to break a chain of behaviors, distracting the individual to another topic or something in the environment.
  2. Ignoring: Ignoring is used during the early stages of negative behavior to which the behavior is not visibly responded, in order to avoid inadvertently reinforcing it.  It does not mean that early danger signs are truly ignored and does not mean that dangerous behaviors are ever ignored.
  3. Redirecting: Redirecting is used to manage a potentially dangerous behavior by deflecting or redirecting the behavior, and then reinforcing a more appropriate behavior by rewarding the individual for displaying the more appropriate behavior. 

Prevention also involves assuring staff has training; appropriate staffing; policies/procedures in place including behavioral support plans; appropriate programming; ability to recognize individuals strengths, weaknesses and triggers. 

Crisis Planning:

  1. Follow-up Response to Threats of Violence Or Suicide

Threats of violence or self-injury, made by a student or group of student(s) should be report to the school principal and reviewed with the school psychologist or school crisis team, regardless of whether a student’s behavior resulted in the use physical restraint. Based on the situation, the school psychologist  or school crisis team may recommend or require that the student(s) undergo a Risk Assessment, or if the student is in obvious crisis, a referral to the local hospital will be made.

 Protocol for Student Suicidality:

When teacher or staff member becomes aware of any student experiencing at-risk behavior (verbal statements, writing, report from peers, parents etc.) they will report immediately to counseling staff and/or crisis team.

At risk for self-injury/suicide is defined as: Any student who indicates through actions speech or writings that they may be at risk of harming themself physically.

SST: Student Support Team. A predefined group of district staff who will be familiar with response guidelines for students in crisis. SST may include:

  • Director
  • Assistant Director
  • School Nurse
  • School Adjustment Counselor
  • Guidance Counselor
  • Special Education Coordinator

Protocol: The identified child will be directly supervised by a member of the SST throughout the process.

  1. Upon observation of at-risk behaviors or suspicion of risk for self-injury, the school staff member will immediately contact a school administrator.
  2. The identified child will be accompanied by an adult to an available member of the SST
  3. If the child is thought to be at imminent risk of self-injurious behavior, the SST members shall follow protocol for a medical emergency, call an ambulance and/or Mobile Crisis Services and have the child evaluated at an emergency room. A staff member shall accompany the child in the ambulance and remain with them in the E.R. until a parent or guardian arrives.
  4. Parents/guardians will be contacted.
  5. If the risk is not thought to be imminent, the child’s parents will be contacted and they will be asked to immediately pick up the child and bring them to an appropriate professional  (i.e. the child’s pediatrician,  psychotherapist, mental health counselor) for further evaluation and intervention.
  6. Incident Report Form will be completed by an administrator and parents signature will be obtained.
  7. The identified child’s re-entry to the district will follow the re-entry protocol for students at risk for self-injurious behavior.

De-escalation of potentially dangerous behavior:

General guidelines for de-escalating potentially dangerous behavior include:

  1. Remain calm -To possibly help prevent the likelihood of a student experiencing distress from escalating his/her behavior use a neutral and level tone of voice, control one’s facial expressions and use a supportive non-threatening body language.
  2. Obtain Assistance – Whenever possible, school personnel should immediately take steps to notify school administrators, the school’s administrative response team and/or other school personnel of a potentially dangerous situation and to obtain additional assistance.
  3. One Person Speaks – In order to minimize the likelihood of confusion and/or the likelihood of a student experiencing distress from escalating his/her behavior having one person providing overall direction to the response and the follow up procedures is advisable. This often may be either the first trained staff person on the scene or the staff person with the most information about the particular situation.
  4. Remove Student If Possible – The feasibility of having a student experiencing distress leave an area with other students and move to another more private and safe area in order to de-escalate should be considered.
  5. Remove Other Students – If it is not feasible to have a student experiencing distress move to a more private and safe area in order to de-escalate, consider the feasibility of having other staff assist and monitor the removal of other students to another area within the school until the student de-escalates.

(b)  Methods for engaging parents in discussions about restraint prevention and the use of restraint solely as an emergency procedure;

Methods for Engaging Parents and Students

Any parent/guardian with concerns about the use of physical restraint at any school within LMACS may request a meeting with the building Principal or the Superintendent to discuss such concerns. Any individual who believes that a physical restraint of a student may have been unwarranted or conducted inappropriately may also make use of the Grievance Procedure described in Section 10, below.  

(c)   A description and explanation of the program’s alternatives to physical restraint and method of physical restraint in emergency situations;

Alternatives to Physical Restraint in emergency situations

There are a variety of appropriate responses or interventions that should be used first when seeking to prevent challenging behaviors, student violence, self-injurious behaviors, or to de-escalate potentially dangerous or disruptive behavior among groups of students or with an individual student.

The following are examples of strategies that the district uses to support students prior to exhibiting challenging behaviors or as alternative to physical restraint when students begin exhibiting agitation:

Positive behavioral interventions: The district employs a variety of services and strategies to address the social, emotional and behavioral well-being of all our students.

  1. Anti-bullying curriculum is provided throughout the district utilizing developmentally appropriate lessons and activities
  2. Social Skills curricula is provided to students through classroom, small group and individualized instruction
  3. Counseling services are available for all students across the district and provided by licensed, certified staff.  Counseling is provided in individualized settings
  4. SST members receive training in signs of suicide and self-injurious behaviors
  5. Reentry meetings are scheduled for all students returning to school from psychiatric hospital programs
  6. Alternate educational options are available to ensure that students continue to receive instruction while addressing any social/emotional/behavioral needs that may prevent a student from accessing the general education setting
  7. District has established a working relationship with several community agencies and can refer students as needed

Verbal redirection

  1. Active listening
  2. Use of calm, non-threatening tones and language
  3. Offering the student(s) a choice
  4. Discussing options or possible resolutions with the student(s)
  5. Verbal directive to cease behavior

Opportunity for a break

Physical Escort

A physical escort is a temporary touch or holding, without the use of force, of the hand, wrist, arm, shoulder or back for the purpose of inducing a student who is agitated or upset to walk to a safe location.  Physical Escorts must be brief in nature.

Staff Training Requirements

All staff will be trained on the program’s restraint prevention and behavior support policy and requirements when restraint is used. Such training shall occur within the first month of each school year and, for employees hired after the school year begins, within a month of their employment.

Training shall include information on the following:

(a) The role of the student, family, and staff in preventing restraint;

(b) The program’s restraint prevention and behavior support policy and procedures, including use of time-out as a behavior support strategy distinct from seclusion;

(c) Interventions that may preclude the need for restraint, including de-escalation of problematic behaviors and other alternatives to restraint in emergency circumstances;

 (d) When behavior presents an emergency that requires physical restraint, the types of permitted physical restraints and related safety considerations, including information regarding the increased risk of injury to a student when any restraint is used, in particular a restraint of extended duration;

 (e) Administering physical restraint in accordance with medical or psychological limitations, known or suspected trauma history, and/or behavioral intervention plans applicable to an individual student; and

 (f) Identification of program staff who have received in-depth training pursuant to 603 CMR 46.03(3) in the use of physical restraint.


In-Depth Training Requirements

At the beginning of the school year, the building Principal or their designee will identify those designated staff who will participate in in-depth training and who will then be authorized to serve as school-wide resources to assist in ensuring proper administration of physical restraint.

Designated staff members shall participate in in-depth training in the use of physical restraint, with at least one refresher training annually.

In-depth training will include:

  1.   Appropriate procedures for preventing the need for physical restraint, including the de-escalation of problematic behavior, relationship building and the use of alternatives to restraint;
  2.   A description and identification of specific dangerous behaviors on the part of students that may lead to the use of physical restraint and methods for evaluating the risk of harm in individual situations in order to determine whether the use of restraint is warranted;
  3.   The simulated experience of administering and receiving physical restraint, instruction regarding the effect(s) on the person restrained, including instruction on monitoring physical signs of distress and obtaining medical assistance;
  4. Instruction regarding documentation and reporting requirements and investigation of injuries and complaints;
  5.   Demonstration by participants of proficiency in administering physical restraint; and
  6. Instruction regarding the impact of physical restraint on the student and family, including but not limited to psychological, physiological, and social-emotional effects.

Proper Administration of Physical Restraint

(1) Trained personnel. Only public education program personnel who have received training pursuant to 603 CMR 46.04(2) or 603 CMR 46.04(3) shall administer physical restraint on students. Whenever possible, the administration of a restraint shall be witnessed by at least one adult who does not participate in the restraint. The training requirements contained in 603 CMR 46.00 shall not preclude a teacher, employee or agent of a public education program from using reasonable force to protect students, other persons or themselves from assault or imminent, serious, physical harm.

(2) Use of force. A person administering a physical restraint shall use only the amount of force necessary to protect the student or others from physical injury or harm.

(3) Safest method. A person administering physical restraint shall use the safest method available and appropriate to the situation subject to the safety requirements set forth in 603 CMR 46.05(5). Floor restraints, including prone restraints otherwise permitted under 603 CMR 46.03(1)(b), shall be prohibited unless the staff members administering the restraint have received in-depth training according to the requirements of 603 CMR 46.043(3) and, in the judgment of the trained staff members, such method is required to provide safety for the student or others present.

(4) Duration of restraint. All physical restraint must be terminated as soon as the student is no longer an immediate danger to himself or others, or the student indicates that he or she cannot breathe, or if the student is observed to be in severe distress, such as having difficulty breathing, or sustained or prolonged crying or coughing.

(5) Safety requirements. Additional requirements for the use of physical restraint:

(a) No restraint shall be administered in such a way that the student is prevented from breathing or speaking. During the administration of a restraint, a staff member shall continuously monitor the physical status of the student, including skin temperature and color, and respiration.

(b) Restraint shall be administered in such a way so as to prevent or minimize physical harm. If, at any time during a physical restraint, the student expresses or demonstrates significant physical distress including, but not limited to, difficulty breathing, the student shall be released from the restraint immediately, and school staff shall take steps to seek medical assistance.

(c) If a student is restrained for a period longer than 20 minutes, program staff shall obtain the approval of the principal. The approval shall be based upon the student’s continued agitation during the restraint justifying the need for continued restraint.

(d) Program staff shall review and consider any known medical or psychological limitations, known or suspected trauma history, and/or behavioral intervention plans regarding the use of physical restraint on an individual student.

Follow-Up Procedures

After a student is released from a physical restraint, staff shall implement follow-up procedures, including:

1) Reviewing the incident with the student to address the behavior that precipitated the physical restraint;

2)  Reviewing the incident with the staff member(s) who administered the physical restraint to ensure proper restraint procedures were followed; and

3) Consideration of whether any follow-up is appropriate for students who witnessed the physical restraint, if any.

Physical Restraint Reporting Requirements

Program staff shall report the use of any physical restraint as specified in 603 CMR 46.06(2).

Informing the principal: The program staff member who administered the restraint shall verbally inform the principal of the restraint as soon as possible, and by written report no later than the next school working day. The written report shall be provided to the principal for review of the use of the restraint. If the principal has administered the restraint, the principal shall prepare the report and submit it to an individual or team designated by the superintendent or board of trustees for review. The principal or director or his/her designee shall maintain an on-going record of all reported instances of physical restraint, which shall be made available for review by the parent or the Department upon request.

Informing parents. The principal or director of the program or his/her designee shall make reasonable efforts to verbally inform the student’s parent of the restraint within 24 hours of the event, and shall notify the parent by written report sent either within three school working days of the restraint to an email address provided by the parent for communications about the student, or by regular mail postmarked no later than three school working days of the restraint. If the school or program customarily provides a parent of a student with report cards and other necessary school-related information in a language other than English, the written restraint report shall be provided to the parent in that language. The principal shall provide the student and the parent an opportunity to comment orally and in writing on the use of the restraint and on information in the written report.

Contents of report. The written report required by 603 CMR 46.06(2) and (3) shall include:

(a) The name of the student; the names and job titles of the staff who administered the restraint, and observers, if any; the date of the restraint; the time the restraint began and ended; and the name of the principal or designee who was verbally informed following the restraint; and, as applicable, the name of the principal or designee who approved continuation of the restraint beyond 20 minutes pursuant to 603 CMR 46.05(5)(c).

(b) A description of the activity in which the restrained student and other students and staff in the same room or vicinity were engaged immediately preceding the use of physical restraint; the behavior that prompted the restraint; the efforts made to prevent escalation of behavior, including the specific de-escalation strategies used; alternatives to restraint that were attempted; and the justification for initiating physical restraint.

(c) A description of the administration of the restraint including the holds used and reasons such holds were necessary; the student’s behavior and reactions during the restraint; how the restraint ended; and documentation of injury to the student and/or staff, if any, during the restraint and any medical care provided.

(d) Information regarding any further action(s) that the school has taken or may take, including any consequences that may be imposed on the student.

(e) Information regarding opportunities for the student’s parents to discuss with school officials the administration of the restraint, any consequences that may be imposed on the student, and any other related matter.

Reporting to Department of Elementary and Secondary Education:

Report all physical restraints to the Department. Every program shall collect and annually report data to the Department regarding the use of physical restraints. Such data shall be reported in a manner and form directed by the Department.

Report all restraint-related injuries to the Department. When a physical restraint has resulted in an injury to a student or program staff member, the program shall send a copy of the written report required by 603 CMR 46.06(4) to the Department postmarked no later than three school working days of the administration of the restraint. The program shall also send the Department a copy of the record of physical restraints maintained by the principal pursuant to 603 CMR 46.06(2) for the 30-day period prior to the date of the reported restraint. The Department shall determine if additional action by the program is warranted and, if so, shall notify the program of any required actions within 30 calendar days of receipt of the required written report(s).

Periodic review of data and documentation

Individual student review. The principal shall conduct a weekly review of restraint data to identify students who have been restrained multiple times during the week. If such students are identified, the principal shall convene one or more review teams as the principal deems appropriate to assess each student’s progress and needs. The assessment shall include at least the following:

(a) review and discussion of the written reports submitted in accordance with 603 CMR 46.06 and any comments provided by the student and parent about such reports and the use of the restraints;

(b) analysis of the circumstances leading up to each restraint, including factors such as time of day, day of the week, antecedent events, and individuals involved;

(c) consideration of factors that may have contributed to escalation of behaviors, consideration of alternatives to restraint, including de-escalation techniques and possible interventions, and such other strategies and decisions as appropriate, with the goal of reducing or eliminating the use of restraint in the future;

(d) agreement on a written plan of action by the program.

If the principal directly participated in the restraint, a duly qualified individual designated by the superintendent or board of trustees shall lead the review team’s discussion. The principal shall ensure that a record of each individual student review is maintained and made available for review by the Department or the parent, upon request.

Administrative review. The principal shall conduct a monthly review of school-wide restraint data. This review shall consider patterns of use of restraints by similarities in the time of day, day of the week, or individuals involved; the number and duration of physical restraints school-wide and for individual students; the duration of restraints; and the number and type of injuries, if any, resulting from the use of restraint. The principal shall determine whether it is necessary or appropriate to modify the school’s restraint prevention and management policy, conduct additional staff training on restraint reduction/prevention strategies, such as training on positive behavioral interventions and supports, or take such other action as necessary or appropriate to reduce or eliminate restraints.

Grievance Procedures

This grievance procedure is established to ensure procedures are in place for receiving and investigating complaints regarding physical restraint practices. Any individual who believes that a physical restraint of a student may have been unwarranted or conducted inappropriately may file a complaint by utilizing this procedure:

  1. The complaint must be submitted to the Executive Director
  2. The Director will meet with the complainant within ten (10) school days of receipt of the complaint.
  3. A thorough investigation will be conducted which may include interviewing witnesses, staff involved and/or the student; reviewing all written documentation leading up to and pertaining to the incident and all reports filed with the Department of Elementary and Secondary Education.
  4. A written report will be developed by the Director and provided to the complainant.