696]" 1111111 2/6 2011-10-28 14:32 OAK MOI/"Education Page 10: 3 RIVERSIDE COUNTY SPECIAL EDUCATION LOCAL PLAN AREA BEHAVIOR EMERGENCY REPORT 7M usunwdiswulian aim lam mm>> employ>>: mm: Minn. rhofimm'da Cavn'ysumi 5mm" Loawnnm {sewn} LaslName: FiislName: A9912 10 I 24 1201! 10/24! 20] I 11:30 am TIME Incideni Ended: 1'00 gm Municla ValIe classroom IA Daie of incident Dismmoi Residence: Murn'cm Valley District oi Aiiendance: School: 1an Weaver School SeningyLocaiion o! incident: Campiete this term to describe what mude including evenis Inai led up tome behavioral EMERGENCY UTILIZED Time incident Began: Check ail mat apply: 12 Essen Pranecuniammenm 7 12min, 3 min, 3 min, 5 min uengm oi Inns) [2 containment standing [descn'be) 9 min (length oi nme) Law invan/emam :1 Omar [95. 5150, Depanmenl ul Mania] Healin eLc.) Name(s) and posinons sLaII/omels 4 _Counselor 1, upper: Smfi' l. - _5upport 3m? 2, _Suppcn Staff Support Sxafr4, Suppori Staffs. --Suppon 6. "upper! Siai'f 7, -- Program Directs: enior 5mm No ubsarvabie injunes nr Iniunss susiained by siudenL-- No nbsarvabie injudes org Injuries suslained by others (including oihsr students and Stan) Suppm Staffz on forehead Olher peninsnl iniormatim' siie agninisflaluLnau at incidelt Copy of BER sen! to site 10/24/20]! Daia: IO 1 25 I II Date:10/24/ lI Dawwl DaimlJl/Zgjl Faveni noiifieu wilhin 24 hours Bywhom: - 1 Copy sent in adminisirawy oi district oi residence Copy piaced in Sindenl mam site and a! DisiricI Oflics) 08/11 Form EUR611 18:38 FrummRK GRDUE/Educahnn I, OAK 696 1111111 3/4 Page 2 of 3 RIVERSIDE COUNTY SPECIAL EDUCATION LOCAL PLAN AREA (SELPA) BEHAVIOR EMERGENCY REPORT The use and distribution or this form is limited to omplaydds of public school agencies within the Riverside County Special Education Local Plan Area (SELPA) .. .. ..- . ?wrung..-? I s. . nu .I ONE box: Mi? CI Student does not have a current Positive Behavior Intervention Plan. Within two days of the behavioral emergency, the designated responsible administrator shatl schedule an meeting to review the emergency report to determine the necessity for a functional analysis assessment, and to determine the need for an interim positive behavioral intervention plan. .- htav u-w . -. .uut-Mmo-u?I-?- w. .. . m- ?savanna. .. . behavior problem occurs or when a previously designated intervention is not attentive. the team shall convene to I. I VA Student has an existing Positive Behavior intervention Plan. When an incident involving a previously unseen serious 3 I i review the incident and determine if there is a need to modify the plan. BEHAVIORAL neronr i Describe what occurred including events that ted up to the emergency. Student ?nished his lunch and was on his way to PE at the courts. As student was walking to the courts. he then walked up to counselor I and swung his lunch pail with medium at her stating, ?hey see I take my lunch pail". The lunch pail hit Counselor on the chest with mcdium force; Counselor then removed the lunch pail off her and returned it to student, and stated ?put your lunch pail by the fence.? Student stood for a moment and then walked up to a car parked by the courts and threw his lunch pail with full force at the car. Classmom I Education Assistant (CEA) stated, ?Hey watch the car" to student. Student stopped and stood there and then walked up and kicked the car door with full force causing no damage. CEA intervened and had student walk away from car and began to process with him about not causing damage to cars and asked him. what was wrong? Student ignored CEA and began to walk across the parking lot. Staff tagged after him. A mail truck was coming across the parking lot and student then ran up to the truck and ran in front of it and yelled, ?Just hit me please!" Another Education Assistant (EA) arrived to assist. Both CEA and EA got student to step aside while truck went on by. Counselor arrived and attempted to process with student about why he was angry. Student was non~compiiant and refused to talk to counselor. Student then began clenching his ?sts and breathing hard. Both CEA and EA continued to tag after student as he continued through the parking lot towards the entrance. CEA attempted to gain student?s attention and asked him to walk back to class but student ignored staff?s Student then suddenly ran at EA and began to kick and punch staff with a closed fist in the chest and face with full force, and opening his hands scratching EA in the forehead. EA backed away from student's roach; student continued to chase EA attempting to punch, kick and spit. CEA and EA attempted to escort student to the quiet room but be dropped on the ground and began to kick at staff. Student got up and ran at staff again. EA continued to evade student's assault till Residential Staff (RS) arrived to assist. Due to student's continued i attack went hands on and placed student in a prone restraint on the gmund for 12 minutes as student would not calm down. Student continued to yell about ?the world coming to an and in 2012? and screaming at staff to lot leave him alone. Nursing came to assess student. Student began to scream at nursing stating, ?give me a shot!? continuously. After 12 min student was released from the restraint. Student then turned and ran at stuff again punching and kicking at anyone around him. almost kicking nursing staff. Staff and nursing was able to evade student?s attempts to kick and punch staff. Staff then attempted to escort and take him to the quiet room. Student. than began to turn and kick 3 BA with full force in the left leg and attempted to trip-EA as well as attempting to grab BA with his hands. EA continuously evaded and backed away from student. Student would not walk with staff so he :1 was again placed in a prone restraint for 13 minutes due his combative behaviors towards staff. Program 03m Form 28811 18:35 FromttIlPlK GRUUE/Education Pace-:83 R3932 2011-10-281432 OAK 696 1 1111111 Flt/4 Page 3 of 3 COUNTY SPECIAL EDUCATION LOCAL PLAN AREA (SELPA) BEHAVIOR EMERGENCY REPORT . A . .Wiimfl ., . I Staff than released student. Student then again charged staff kicking and punching at anyone around him. by backing away from student. Siudunl then begun to walk towards the entrance to the facility, Staff blocked him by standing in frontal' him attempting to redirect studcnt so he could not i 1 leave the facility due to his age, Sludcnt would not stop charging kicking and punching at staff so CEA and RS then placed student in a standing escort for minute until he began lo calm and walk with staff. 5 with student sum got him to walk to the quiet man-i but student then agnizt begun to micmpl to kick and bite at staff, CEA and RS then placed student in prone restraint again for 3 minutes. 1 Student again began to de-escalntc. Behavior Specialist (BS) arrived and began to process with student calmly discussing what student liked and what could he do to help student to return to class. Student kept snyin he wanted to watch the movie "the of the Christ" because stuff was crucifying hi in BS continued to pmcess with about what he needed to do to get back to class Student was calming and 1 talking about going back to class and doing his work. Student remained in the quiet room until he wit: 1 icady to return to class with no further incidents,'v IF USED DIAGRAM 'aEet'Jw {kreT't'm} A 6 MK I 9mm>>, Mudt \e'v 5 ameF Petsunls) completing this lntn't (Ftinl) Pcsiliun Name: Name: Signalute ofperscn completing this limit: 06111 Farm 3211 16:31 FrummnK GRUUE/Educatmn {0:1111111 FnieIZB'l its?-