Restraint and Seclusion in Schools Parent Survey

Since the beginning of the 2011-2012 school year, Minnesota has a new law about when and how schools can use restraints and seclusion to address challenging behavior of children with disabilities.

Many disability advocacy groups have been following this law and we would like to hear about your experiences with it. This survey has about 20 questions and should take about 15-20 minutes to fill out. We GREATLY appreciate your time.

Please contact Dan Stewart at the Minnesota Disability Law Center (MDLC) if you have any questions. He can be reached at djstewart@midmnlegal.org or 612.746.3783.

Question Title

* 1. Please list your name and contact information. You MAY REMAIN ANONYMOUS if you wish by simply going to Question 2.

Your Name:

Phone:

Email:

Child's School District:

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* 2. How did you find out about this survey? I found out from...

NAMI-Minnesota

The Arc

The Minnesota Consortium for Citizens with Disabilities (CCD)

PACER

The Minnesota Association of Children's Mental Health

The Autism Society of Minnesota

The Minnesota Organization on Fetal Alcohol Syndrome

The Minnesota Association of Child Caring Agencies

The Minnesota Disability Law Center

A friend or other parent

Other (please specify)

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* 3. How old is your child now?

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* 4. What grade is your child in now?

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* 5. What is your child's disability? (list all)

Autism Spectrum Disorders (ASD)

Emotional or Behavior Disorders (EBD)

Deaf or Deaf-Blind

Developmental Cognitive Disability (DCD)

Other Health Disability (OHD)

Physically Impaired

Severly Multiply Impaired

Specific Learning Disability

Speech/Language

Visually Impaired

Traumatic Brain Injury

Developmental Delay

Other (please specify)

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* 6. Since the beginning of the 2011-2012 school year, please tell us if your child was RESTRAINED, put into a PRONE RESTRAINT (placed front or face down on the ground or other surface), placed alone in SECLUSION or LOCKED ROOM, or was held by STRAPS or OTHER DEVICES.

Please list all that apply.

My child was RESTRAINED (meaning physical contact that holds or immobilizes a student) by adults at school because of his or her behavior.

My child was placed in a PRONE RESTRAINT (placed front or face down on the ground) at school because of his or her behavior.

My child has been placed in a room alone (in SECLUSION or LOCKED ROOM) in school because of his or her behavior.

My child was held by STRAPS or OTHER DEVICES at school because of his or her behavior.

Other (please specify)

Question Title

* 1. Please list your name and contact information. You MAY REMAIN ANONYMOUS if you wish by simply going to Question 2.

Question Title

* 2. How did you find out about this survey? I found out from...

Question Title

* 3. How old is your child now?

Question Title

* 4. What grade is your child in now?

Question Title

* 5. What is your child's disability? (list all)

Question Title

* 6. Since the beginning of the 2011-2012 school year, please tell us if your child was RESTRAINED, put into a PRONE RESTRAINT (placed front or face down on the ground or other surface), placed alone in SECLUSION or LOCKED ROOM, or was held by STRAPS or OTHER DEVICES.Please list all that apply.

* 6. Since the beginning of the 2011-2012 school year, please tell us if your child was RESTRAINED, put into a PRONE RESTRAINT (placed front or face down on the ground or other surface), placed alone in SECLUSION or LOCKED ROOM, or was held by STRAPS or OTHER DEVICES.

Please list all that apply.