{"text_format":"1","workbook":"xlsx","n_sheets":4,"sheets":["Instructions","Agency and Site Information","Child Information","No entry needed"],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":0,"defined_names":1,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Instructions","index":0,"n_rows":59,"n_cols":13,"rows_kept":59,"cut":false,"hidden":false,"merged":[[57,0,57,19],[31,5,31,10],[39,12,39,14],[34,5,34,10],[23,0,23,19],[50,0,50,19],[5,1,5,19],[35,1,35,4],[14,1,14,19],[44,1,44,4],[26,5,26,10],[40,12,40,14],[6,1,6,19],[30,1,30,4],[38,1,38,4],[1,0,1,19],[28,5,28,10],[7,1,7,19],[37,1,37,4],[16,1,16,19],[38,12,38,14],[9,1,9,19],[39,1,39,4],[18,1,18,19],[47,0,47,19],[8,1,8,19],[58,0,58,19],[32,1,32,4],[30,12,30,14],[31,1,31,4],[27,12,27,14],[40,1,40,4],[19,1,19,19],[60,0,60,19],[34,1,34,4],[37,5,37,10],[36,12,36,14],[53,0,53,19],[36,5,36,10],[28,12,28,14],[26,1,26,4],[37,12,37,14],[55,0,55,19],[25,0,25,19],[20,1,20,19],[42,12,42,14],[33,5,33,10],[52,0,52,19],[12,1,12,19],[28,1,28,4],[34,12,34,14],[36,1,36,4],[29,5,29,10],[32,5,32,10],[48,0,48,19],[29,12,29,14],[32,12,32,14],[27,5,27,10],[41,12,41,14],[45,0,45,19],[31,12,31,14],[42,1,42,4],[56,0,56,19],[11,1,11,19],[41,1,41,4],[22,0,22,19],[43,12,43,14],[13,1,13,19],[43,1,43,4],[33,1,33,4],[51,0,51,19],[27,1,27,4],[35,5,35,10],[29,1,29,4],[26,12,26,14],[35,12,35,14],[30,5,30,10],[24,0,24,19],[15,1,15,19],[38,5,38,10],[2,1,2,19],[49,0,49,19],[17,1,17,19],[46,0,46,19],[33,12,33,14],[10,1,10,19]]}
[null,null,null,null,null,null,"Updated 1/2/2026"]
["Agency and Site Information"]
[null,"Choose the time frame from the drop down box."]
[null,"Type in your agency name"]
[null,"Type Yes or No  to the question \"Do any homes have a capacity of 5 or more (Yes/No)."]
[]
["A.)","Enter the total number of Sites that were actively used during this reporting period including those opened or closed during this reporting period. This information should be documented for each setting column."]
["B.)","Enter the total number of Children in Care who resided in this setting during this reporting period including those who exited or moved during this reporting period. This information should be documented for each setting column."]
["C.)","Enter the total number of incidents involving restraint in this setting during this reporting period. This information should be documented for each setting column. If none enter \"0\"."]
["D.)","Enter the total number of incidents in this setting during this reporting period involving restraint that resulted in a reportable injury to a child arising from the use of a restraint . This information should be documented for each setting column. If none enter \"0\"."]
["E.)","Enter the total number of Children in Care who were placed in a restraint more than three times in this setting during this reporting period. This information should be documented for each setting column. If none enter \"0\"."]
["F.)","Enter the total number of incidents during this reporting period wherein a child in care in this setting was placed in a restraint and a person participating in the restraint was not certified in the application of the type of restraint used. This information should be documented for each setting column. If none enter \"0\"."]
["G.)","Enter the total number of incidents involving involuntary seclusion in this setting during this reporting period. This information should be documented for each setting column. If none enter \"0\"."]
["H.)","Enter the total number of incidents involving involuntary seclusion in a locked room in this setting during this reporting period. This information should be documented for each setting column. If none enter \"0\"."]
["I.)","Enter the total number of room(s) that were used or could have been used for involuntary seclusion in this setting during this reporting period. This information should be documented for each setting column. If none enter \"0\"."]
["J.)","Enter the dimensions of room(s) that were used or could have been used for involuntary seclusion in this setting during this reporting period. This information should be documented for each setting column. Example: Room 1: 10x10, Room 2 10x12. If none enter \"0\"."]
["K.) ","Enter the total number of children who were placed in a restraint more than three times in this setting during this reporting period. This information should be documented for each setting column. If none enter \"0\"."]
["L.)","Enter the total number of incidents during this reporting period wherein a child in care in this setting was placed in involuntary seclusion and a person participating in the seclusion was not trained in it's use. This information should be documented for each setting column. If none enter \"0\"."]
["M.)","Enter the total number of Children in Care who were placed in a restraint and in involuntary seclusion in this setting during this reporting period. This information should be documented for each setting column. If none enter \"0\"."]
["N.)","Select the drop down for the appropriate residential type."]
[]
[]
["Child Information"]
["All children in care during this quarter will be listed. The following will explain each question asked about the child. "]
["Enter the child's identifier (First three letters of their last name followed by the first two letters of their first name). Enter information for each child across the row headed by the child in care's identifier"]
["From the drop down menu, choose the child in care's identified race/ethnicity.  This may be repeated for each race/ethnicity with which the child in care identifies by returning to the drop down menu and choosing another identified race/ethnicity."]
[null,"Hispanic and Latino/a/x",null,null,null,"American Indian and Alaska Native",null,null,null,null,null,null,"Asian"]
[null,"Central American",null,null,null,"American Indian",null,null,null,null,null,null,"Asian Indian"]
[null,"Mexican",null,null,null,"Alaska Native",null,null,null,null,null,null,"Cambodian"]
[null,"South American",null,null,null,"Canadian Inuit, Metis, or First Nation",null,null,null,null,null,null,"Chinese"]
[null,"Other Hispanic or Latino/a/x",null,null,null,"Indigenous Mexican, Central American, or South American ",null,null,null,null,null,null,"Communities of Myanmar"]
[null,null,null,null,null,null,null,null,null,null,null,null,"Filipino/a"]
[null,"Native Hawaiian and Pacific Islander",null,null,null,"Black or African American",null,null,null,null,null,null,"Hmong"]
[null,"Charmoru (Chamorro)",null,null,null,"African  American",null,null,null,null,null,null,"Japanese"]
[null,"Marshallese",null,null,null,"Afro-Caribbean",null,null,null,null,null,null,"Korean"]
[null,"Communities of Micronesian Region",null,null,null,"Ethiopian",null,null,null,null,null,null,"Laotian"]
[null,"Native Hawaiian",null,null,null,"Somali",null,null,null,null,null,null,"South Asian"]
[null,"Samoan",null,null,null,"Other African (Back)",null,null,null,null,null,null,"Vietnamese"]
[null,"Other Pacific Islander",null,null,null,"Other Black",null,null,null,null,null,null,"Other Asian"]
[]
[null,"White",null,null,null,"Middle Eastern/ North African",null,null,null,null,null,null,"Other"]
[null,"Eastern European",null,null,null,"Middle Eastern",null,null,null,null,null,null,"Other"]
[null,"Slavic",null,null,null,"North African",null,null,null,null,null,null,"Don’t Know"]
[null,"Western European",null,null,null,null,null,null,null,null,null,null,"Don't want to answer"]
[null,"Other White"]
["From the drop down menu, choose the child in care's biological gender. "]
["From the drop down menu, choose the child in care's identified gender. "]
["From the drop down menu, choose the child in care's current migrant status.  If the migrant status has changed during this reporting period, choose the most recent."]
["From the drop down menu, choose the child in care's primary language."]
["From the drop down menu, identify if the child in care utilizes an augmented communication device."]
["From the drop down menu, identify if the child in care is economically disadvantaged."]
["Enter the total number of incidents that resulted in this child being placed in a restraint during this reporting period.  If none enter \"0\"."]
["Enter the total number of incidents during this reporting period wherein this child was placed in a restraint by any person who is not certified in the use of that specific restraint.  If none enter \"0\"."]
["From the drop down menu, identify all applicable descriptions of the steps taken during this reporting period to decrease the use of restraint for this child.  This may be repeated for each applicable description by returning to the drop down menu and choosing another description.  If the child in care was involved in more zero to three incidents that involve restraint choose only the option: \"Three or fewer restraints/seclusion occurred during this reporting period\".  "]
["Enter the number of incidents with this child during this reporting period that resulted in an injury arising from the use of a restraint.  If none, enter \"0\"."]
["Enter the total number of incidents that resulted in this child being placed in involuntary seclusion in a locked room during this reporting period.  If none enter \"0\"."]
["Enter the total number of incidents that resulted in this child being placed in involuntary seclusion during this reporting period.  If none enter \"0\"."]
["Enter the total number of incidents during this reporting period wherein this child was placed in involuntary seclusion by any person who is not trained in its use.  If none enter \"0\"."]
["From the drop down menu, identify all applicable descriptions of the steps taken during this reporting period to decrease the use of involuntary seclusion for this child.  This may be repeated for each applicable description by returning to the drop down menu and choosing another description.  If the child in care was involved in more zero to three incidents that involve involuntary seclusion choose only the option: \"Three or fewer restraints/seclusion occurred during this reporting period\".  "]

{"sheet":"Agency and Site Information","index":1,"n_rows":18,"n_cols":2,"rows_kept":18,"cut":false,"hidden":false,"merged":[]}
["Reporting period:","10/01/2027 - 12/30/2027"]
["Agency Name: ","Advocates for Life Skills and Opportunities"]
["Do any homes have a capacity of 5 or more (Yes/No):","No"]
[]
["A.) Number of Sites Served during this reporting period",3]
["B.) Number of Children in Care in this setting during this reporting period",5]
["C.) Total # of Incidents involving restraint",1]
["D.) Total # of incidents resulting in a reportable injury to a child arising from the use of a restraint.",0]
["E.) Total # of children who were placed in restraint more than three times",0]
["F.) Total # of incidents in which a person who placed a child in care in a restraint was not certified in the use of the type of restraint used",1]
["G.) Total # of incidents involving involuntary seclusion",0]
["H.) Total # of Incidents involving involuntary seclusion in a locked room",0]
["I.) Number of rooms that have been used or would be used for involuntary seclusion",0]
["J.) Dimensions of room that has been used or could be used for involuntary seclusion",0]
["K.) Total # of children who were placed in involuntary seclusion more than three times",0]
["L.) Total # of incidents in which a person who placed a child in care in involuntary seclusion was not trained to use involuntary seclusion",0]
["M.) Total # of children who experienced both restraints and involuntary seclusions",0]
["N.) Setting Type","24-Hour Residential"]

{"sheet":"Child Information","index":2,"n_rows":6,"n_cols":16,"rows_kept":6,"cut":false,"hidden":false,"merged":[]}
["Child Name","Race/Ethnicity","Biological Gender","Gender Identified","Migrant Status","Primary Language","Does this child use an Augmentative Communication Device?","Is the child economically disadvantaged?","# of incidents that resulted in this child being placed in a restraint","# of incidents where this child was placed in a restraint by any person who is not certified in that restraint","# of incidents with this child that resulted in a reportable injury arising from the use of a restraint.","Summary description of the steps taken DURING THIS REPORTING PERIOD to decrease the use of restraint for this child","# of incidents where this child was placed In involuntary seclusion","# of incidents where this child was placed in a locked room, # of incidents where this child was placed in a locked room","# of incidents where this child was placed in involuntary seclusion by a person who is not trained in the use of involuntary seclusion","Summary description of the steps taken to decrease the use of involuntary seclusion for this child"]
["[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]",1,1,0,"Three or fewer restraints/seclusion occurred during this reporting period",0,0,0,"Three or fewer restraints/seclusion occurred during this reporting period"]
["[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]",0,0,0,"Three or fewer restraints/seclusion occurred during this reporting period",0,0,0,"Three or fewer restraints/seclusion occurred during this reporting period"]
["[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]",0,0,0,"Three or fewer restraints/seclusion occurred during this reporting period",0,0,0,"Three or fewer restraints/seclusion occurred during this reporting period"]
["[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]",0,0,0,"Three or fewer restraints/seclusion occurred during this reporting period",0,0,0,"Three or fewer restraints/seclusion occurred during this reporting period"]
["[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]","[REDACTED]",0,0,0,"Three or fewer restraints/seclusion occurred during this reporting period",0,0,0,"Three or fewer restraints/seclusion occurred during this reporting period"]

{"sheet":"No entry needed","index":3,"n_rows":28,"n_cols":11,"rows_kept":28,"cut":false,"hidden":true,"merged":[]}
["Race/Ethnicity","Gender","Gender","Migrant Status","Primary Language","Steps taken to decrease the use of restraint/seclusion for this child","Does this child use an Augmentative Communication Device?","Reporting Quarter","5 or more capacity","Facility Type","Is the child economically disadvantaged?"]
["American Indian and/or Alaska Native","Male","Male","Naturalized Citizen","Amharic, Somali","Three or fewer restraints/seclusion occurred during this reporting period","Yes","01/01/2025 - 03/31/2025","Yes","24-Hour Residential","Yes"]
["Asian","Female","Female","Conditional Permanent Resident","Arabic","Update has been made to the FBA","No","04/01/2025 - 06/30/2025","No","Host Home","No"]
["Black or African American",null,"Gender Neutral","Lawful Permanent Resident","ASL","Update has been made to the PBSP","Unknown","07/01/2025 - 09/30/2025"]
["Hispanic or Latino, Latina, Latinx",null,"Non-Binary","Temporary Visitor","Burmese","Staff retrained to this child's PBSP",null,"10/01/2025 - 12/31/2025"]
["Indigenous Mexican, Central and/or South American",null,"Trans Male","Undocumented Immigrant","Cambodian","General retraining of staff",null,"01/01/2026 - 03/31/2026"]
["Middle Eastern and/or North African",null,"Trans Female","US Citizen","Chinese","ISP Team has convened",null,"04/01/2026 - 06/30/2026"]
["Native Hawaiian or Pacific Islander",null,"Other","Other","English","Changes made to the ISP",null,"07/01/2026 - 09/30/2026"]
["White",null,null,null,"Farsi","Assistive Device/Technology added to child's ISP",null,"10/01/2026 - 12/31/2026"]
["Other",null,null,null,"French","Adaptations made to meet identified sensory needs",null,"01/01/2027 - 03/31/2027"]
[null,null,null,null,"German","Consultation with psychiatrist/medication prescriber",null,"04/01/2027 - 06/30/2027"]
[null,null,null,null,"Hindi","Consultation with Primary Care Physician/Dentist",null,"07/01/2027 - 09/30/2027"]
[null,null,null,null,"Hmong","Environmental changes to the setting interior",null,"10/01/2027 - 12/30/2027"]
[null,null,null,null,"Japanese","Door Window Dings Added"]
[null,null,null,null,"Korean","Environmental changes to the child's bedroom"]
[null,null,null,null,"Mam","Environmental changes to the setting exterior / property"]
[null,null,null,null,"Marshallese","Changes made to the child's schedule"]
[null,null,null,null,"Mien","Changes made to the child's protocols"]
[null,null,null,null,"Oromo","Following a review of the restraints, no steps were taken to decrease the use of restraint/seclusion during this reporting period"]
[null,null,null,null,"Romanian"]
[null,null,null,null,"Russian"]
[null,null,null,null,"Samoan, Hawaiian"]
[null,null,null,null,"Spanish"]
[null,null,null,null,"Tagalog, Ilocano"]
[null,null,null,null,"Thai"]
[null,null,null,null,"Ukrainian"]
[null,null,null,null,"Vietnamese"]
[null,null,null,null,"Other"]