Each application of manual restraint may be used only as a
therapeutic measure when a child presents a threat of physical harm to self or
others. Such threat shall include any dangerous behavior reasonably expected to
lead to physical harm to self or others. Manual restraint shall not be used
until after other less restrictive procedures or measures have been explored
and found to be inappropriate. Manual restraint shall not be used for a child
whose medical condition, mental illness, or developmental or psychological
status contraindicates the use of this technique, as documented in the child's
individual treatment plan.
a) Manual
restraint may be used to prevent runaway only when the child presents a threat
of physical harm to self or others, or as specified in the individual treatment
plan.
b) Manual restraint shall not
be used as discipline for rule infractions or as a convenience for
staff.
c) A child may not be
restrained for more than 15 minutes beyond the point at which the child ceases
presenting the specific behavior for which the restraint was ordered or any
other behavior for which restraint is an appropriate intervention, unless
specific clinical justification to the contrary is documented in the child's
treatment plan.
d) For every
restraint episode that exceeds 30 consecutive minutes, a registered nurse or a
licensed physician must be notified and consulted by telephone or in person
concerning the restraint. The licensed physician or registered nurse must
confirm, in writing, the content of the consultation and document that the
restraint does not pose an undue risk to the child's health given the child's
physical or medical condition. At the same time, the treatment team must
explore alternative treatment strategies, such as an emergency SASS assessment
or transporting the child to a hospital or mental health facility.
e) No child may be restrained for more than
two hours within a 24 hour period. However, within the two hours of restraint,
there may be no period of continuous restraint that exceeds one hour.
f) If a child has been in and out of manual
restraint for a total of two hours, the treatment team must explore alternative
treatment strategies, such as an emergency SASS assessment or transporting the
child to a hospital or mental health facility.
g) Manual restraint shall be administered in
such a manner as to avoid provoking further and escalating incidents of the
behavior in the child.
h) Manual
restraint shall not consist of, or be accompanied by, the use of mechanical
restraints, the use of excessive or unnecessary force, or any other action that
produces pain, covers the head or any part of the face, or in any way restricts
normal circulation and respiration of the child. Manual restraints that include
neck holds or a staff member lying across the torso of a client are
prohibited.
i) When manual
restraint is imposed upon any child whose primary mode of communication is sign
language, the child shall be permitted to have his or her hands free from
restraint for brief periods during the restraint, except when such freedom may
result in physical harm to the child or others.
j) Manual restraint shall be employed only by
persons who are certified as having successfully completed a competency based
training program presenting the specific procedures to be used. This
certification must be renewed through a competency based assessment at least
every 12 months. Current certification of competency shall be documented in the
individual's permanent personnel record. If an organized self-governance
program, as defined in Section
384.20, approved by
the governing body and the Department allows for peer participation, only peers
having completed such training may assist with the technique. This training
shall include demonstrated competency in the humane and efficient
implementation of the restraint program as demonstrated in applications of the
procedures on participants in the training.
k) Application of manual restraint requires
direct authorization, supervision and management by the mental health
professional, as defined in Section 384.20, designated as responsible for
making clinical decisions at the time restraint is applied. If this person is
not present when restraint is first applied, he or she must be summoned
immediately and maintain supervision and management of the restraint until the
restraint episode is concluded or he or she is relieved by a similarly
qualified and clinically responsible person. Supervision of a restraint episode
does not require in person supervision throughout the duration of the restraint
provided that the mental health professional has viewed the restraint in
person, has confirmed that the restraint is being applied according to the
agency's selected model and is confident that the restraint will continue to be
so applied. The mental health professional must review the restraint episode
immediately upon conclusion of the restraint to ensure that the restraint
continued and concluded in a manner that is consistent with the model and the
child's interest. Each use of manual restraint shall be reported as soon as
practicable and a written record forwarded within 24 hours to the administrator
of the facility or designee, the assigned caseworker in the facility, and the
social work supervisor. If the use of manual restraint results in an injury
requiring emergency medical treatment by medical personnel or exceeds 60
consecutive minutes, the senior agency administrator shall be contacted
immediately.
l) The written record
of manual restraint shall include: the date of the occurrence; the
precipitating incidents; the age, height, weight, sex and race of the
restrained child; the persons (including other residents) who participated in
restraining the child; any witnesses to the precipitating incident and
subsequent restraint; the exact methods of restraint used; the beginning and
ending time of the restraint; a detailed description of any injury arising from
the incident or restraint; and a summary of any medical care provided. The
supervisor in charge at the time of the incident and restraint shall review the
report submitted by staff, inquire into any irregularities, and sign and date
the written report indicating the date it was reviewed and approved or
disapproved.
m) The administrator
of the facility or designee shall review all written records of manual
restraint the next business day. The administrator or designee shall approve or
disapprove of the use of restraint under the circumstances described and shall
indicate review and approval/disapproval by signing and dating the report of
behavior treatment. If the administrator or designee disapproves of this
instance of manual restraint, the administrator or designee shall state the
reasons for disapproval and shall correct the improper use of manual restraint.
The decision concerning the need for further action, if any, should be
documented whenever any of the following occurs:
1) restraint is used repeatedly excessively
by any staff person;
2) restraint
is used repeatedly excessively on any child;
3) the duration of the restraint exceeds 30
minutes;
4) any provision in this
Part is violated; or
5) the
restraint results in any injury requiring emergency medical treatment by
medical personnel.
n)
Upon request, the administrator of the facility or designee shall notify the
child's parents (unless parental rights have been terminated), guardian or
attorney in writing, within two business days, when a child is subjected to
manual restraint, and shall provide such notice for any manual restraint that
results in injury to the child within 12 hours. Communication to the child's
parent or guardian shall be conducted in the parent's or guardian's primary
language or preferred mode of communication.