Fillable Survey Background, Instructions, and Definitions (Maryland State Department of Education)

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Survey Background, Instructions, and Definitions (Maryland State Department of Education)

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During the 2017 legislative session, Senate Bill 786 was passed. The Senate Bill requires that each
public agency, public school system, and nonpublic special education school in Maryland submit
annual data on restraint and seclusion to the Maryland State Department of Education. These data
will be compiled into a report that will be shared with the General Assembly.
The requested data includes the following: (1) Incidents of Restraint and Seclusion; (2) Professional
Development; (3) Observation of Seclusion Rooms; and (4) Review of Training Plans for the Use of
Seclusion.
Please complete the following items based upon the data that have been collected from July 1, 2017
to June 1, 2018. The survey will be open from June 1, 2018 to June 29, 2018.
Contact: For any questions about the data collection or survey, please contact Deborah Nelson by
email at deborah.nelson@maryland.gov or by phone at 410-767-0294.
Definitions
NONPUBLIC SCHOOL: a school that receives funds from the Maryland State Department of
Education for the purpose of providing special education and related services to students with
disabilities.
PUBLIC AGENCY: the Maryland State Department of Education, a local school system, the Maryland
School for the Deaf, the Maryland School for the Blind.
SECLUSION: confinement of a student alone in an enclosure or any other space from which the
student is physically prevented from leaving.
PHYSICAL RESTRAINT: the use of physical force, without the use of any devise or material, to
restrict the free movement of all or a portion of a student’s body. PHYSICAL RESTRAINT does not
include: Briefly holding a student in order to calm or comfort the student; Holding a student’s hand
or arm to escort the student safely from one area to another; Moving a disruptive student who is
unwilling to leave the area when other methods such as counseling have been unsuccessful; or
Breaking up a fight in the school building or on school grounds.
MECHANICAL RESTRAINT: Any device or material attached or adjacent to the student's body that
restricts freedom of movement or normal access to any portion of the student's body and that the
student cannot easily remove. MECHANICAL RESTRAINT does not include a protective or
stabilizing device.
(Definitions used for restraint and seclusion are from the current Maryland Education Article § 7-
1101)
Survey Background, Instructions, and Definitions
Maryland State Department of Education Restraint and Seclusion Data
Collection 2017-2018
1
1. Identify your Local Education Agency (LEA) or Reporting Agency
Allegany County
Anne Arundel County
Baltimore City
Baltimore County
Calvert County
Caroline County
Carroll County
Cecil County
Charles County
Dorchester County
Frederick County
Garrett County
Harford County
Howard County
Kent County
Maryland School for the Blind
Maryland School for the Deaf
Montgomery County
Prince George's County
Queen Anne's County
SEED School
Somerset County
St. Mary's County
Talbot County
Washington County
Wicomico County
Worcester County
Juvenile Services Education (JSE)
Maryland Nonpublic School (Insert Name)
Name:
Title:
Email Address:
Phone:
2. Respondent Information
RESTRAINT
3. Please provide the total number of restraint incidents, using either mechanical or physical restraints, in
your local school system, public agency, or nonpublic school during the 2017-2018 school year.
(Note: There may be multiple incidents per student.)
*
2
4. Please provide the total number of students restrainedusing either mechanical or physical restraints,
in your local school system, public agency, or nonpublic school during the 2017-2018 school year.
*
5. Provide the number of students with an IEP who were restrained, either using mechanical or physical
restraints, in your in your local school system, public agency, or nonpublic school during the 2017-2018
school year?
Autism:
Deaf-Blindness:
Deafness:
Developmental Delay:
Emotional Disability:
Intellectual Disability:
Multiple Disabilities:
Orthopedic Impairment:
Other Health Impairment:
Specific Learning
Disability:
Speech or Language
Impairment:
Traumatic Brain Injury:
Visual Impairment,
including Blindness
6. Provide the number of students with the following special education disabilities who were restrained,
using mechanical or physical restraints, in your local school system, public agency, or nonpublic school
during 2017-2018. (If a student has multiple disabilities, please count the one that is most indicative of a
student's primary disability).
3
General Education:
Mixed General
Education/Outside
General Education:
Separate Class:
Public Separate Day
School:
Private Separate Day
School:
Public Residential:
Private Residential:
Other:
7. Provide the number of students in the following placements who were restrained, using mechanical or
physical restraints, in your local school system, public agency, or nonpublic school during 2017-2018.
8. Provide the number of students restrained, either using mechanical or physical restraints, in your local
school system, public agency, or nonpublic school with a 504 Plan during the 2017-2018 school year?
Emotional (e.g.,
depression, anxiety):
Behavioral (e.g., ADHD):
Physical (e.g., chronic
health condition):
Other:
9. Provide the number of students who were restrained in your local school system, public agency, or
nonpublic school during 2017-2018, using mechanical or physical restraints, with 504 Plans that addressed
the following areas:
4
African American:
Asian:
White:
Hispanic/Latino:
American Indian/Alaskian:
Hawaiian/Pacific Islander:
Two or More Races:
Other:
10. Provide the number by race and ethnicity of the students who were restrained, using mechanical or
physical restraints, in your local school system, public agency, or nonpublic school during 2017-2018.
Male:
Female:
Transgender:
11. Indicate the number by gender of the students who were restrained, using mechanical or physical
restraints, in your local school system, public agency, or nonpublic school during 2017-2018.
5
4 years old:
5 years old:
6 years old:
7 years old:
8 years old:
9 years old:
10 years old:
11 years old:
12 years old:
13 years old:
14 years old:
15 years old:
16 years old:
17 years old:
18 years old:
19 years old:
20 years old:
21 years old:
Other:
Other:
12. Indicate the number of students who were restrained, using mechanical or physical restraints, by age
in your local school system, public agency, or nonpublic school during 2017-2018.
SECLUSION
13. Please provide the total number of seclusion incidents, in your local school system, public agency, or
nonpublic school during the 2017-2018 school year. (Note: There may be multiple incidents per student.)
6
14. Please provide the total number of students secluded in your local school system, public agency, or
nonpublic school during the 2017-2018 school year.
15. Provide the number of students with an Individualized Education Program (IEP) who were secluded
in your local school system, public agency, or nonpublic school during the 2017-2018 school year?
Autism:
Deaf-Blindness:
Deafness:
Developmental Delay:
Emotional Disability:
Intellectual Disability:
Multiple Disabilities:
Orthopedic Impairment:
Other Health Impairment:
Specific Learning
Disability:
Speech or Language
Impairment:
Traumatic Brain Injury:
Visual Impairment,
including Blindness
16. Provide the number of students with the following special education disabilities who were secluded in
your local school system, public agency, or nonpublic school during 2017-2018. (If a student has multiple
disabilities, please enter the one that is most indicative of a student's primary disability).
7
General Education:
Mixed General
Education/Outside
General Education:
Separate Class:
Public Separate Day
School:
Private Separate Day
School:
Public Residential:
Private Residential:
Other:
17. Provide the number of students in the following placements who were secluded in your local school
system, public agency, or nonpublic school during 2017-2018.
Emotional (e.g.,
depression, anxiety):
Behavioral (e.g., ADHD):
Physical (e.g., chronic
health condition):
Other:
18. Provide the number of students who were secluded in your local school system, public agency, or
nonpublic school during 2017-2018 with 504 Plans that addressed the following areas:
19. Provide the number of students secluded in your local school system, public agency, or nonpublic
school with a 504 Plan during the 2017-2018 school year?
8
African American:
Asian:
White:
Hispanic/Latino:
American Indian/Alaskian:
Hawaiian/Pacific Islander:
Two or More Races:
Other:
20. Provide the number by race and ethnicity of the students who were secluded in your local school
system, public agency, or nonpublic school during 2017-2018.
Male:
Female:
Transgender:
21. Provide the number by gender of the students who were secluded in your local school system, public
agency, or nonpublic school during 2017-2018.
9
4 years old:
5 years old:
6 years old:
7 years old:
8 years old:
9 years old:
10 years old:
11 years old:
12 years old:
13 years old:
14 years old:
15 years old:
16 years old:
17 years old:
18 years old:
19 years old:
20 years old:
21 years old:
22. Provide the number of students by age who were secluded in your local school system, public
agency, or nonpublic school during 2017-2018.
PROFESSIONAL DEVELOPMENT
10
23. Identify the professional development provided to school staff on content related to restraint and
seclusion during the 2017-2018 school year (check all that apply).
Positive Behavior Interventions, Strategies, and Supports
Trauma Informed Interventions
Evidence-Based Crisis Prevention and Intervention Training (i.e., CPI) Program
Training in the Use of Seclusion
Other (please specify)
CERTIFICATION FOR OBSERVATION OF SECLUSION ROOMS
24. A member of the local school system, public agency, or nonpublic school has observed seclusion
rooms.
Yes
No
Other (please specify)
25. A member of the local school system, public agency, or nonpublic school has reviewed training plans
for seclusion.
Yes
No
Other (please specify)
26. Findings from observations of seclusion rooms:
27. Findings from observations of training plans for seclusion:
11
28. Additional Comments:
12
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Survey Background, Instructions, and Definitions (Maryland State Department of Education)

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Completed 22 December 2020

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