Current through Reg. 50, No. 187; September 24, 2024
(1) Authorized
Levels of Response.
(a) Protective Action
Response, as authorized by the department, shall be the verbal and physical
intervention program utilized by direct care staff in state-, county-, or
municipally operated and contracted facilities and programs.
(b) Right Interactions (RI) is the department
approved Protective Action Response curriculum.
(c) Prior authorization for the use of
physical intervention techniques and mechanical restraints shall be obtained
from the supervisor or acting supervisor unless doing so could result in
physical harm to the youth, employee, or another person; property damage; or
the youth escaping or absconding from lawful supervision.
(d) All responses shall be commensurate with
the youth's type of resistance according to the RI Escalation Matrix and this
rule.
(e) Responses shall only be
used when reasonably necessary to control youth and only after all reasonable
alternatives have been exhausted, including verbal persuasion, warnings, and
verbal intervention techniques, or when the alternatives are considered
inappropriate due to the rapid escalation of dangerous behavior.
(f) In the event a youth is armed with a
weapon or firearm, all attempts to reasonably diffuse the situation through the
application of the RI Escalation Matrix have failed, and staff has determined
there is imminent danger of bodily harm or death, facility- and community-based
program employees shall, if possible, isolate or contain the youth and request
emergency assistance from law enforcement. The Right Interactions Escalation
Matrix (TLC 003, April 2023) is incorporated by reference into this rule and is
available electronically at
http://www.flrules.org/Gateway/reference.asp?No=Ref-15379.
(g) If the youth is in the process of
inflicting grave bodily harm or possible death upon others or self and all
attempts to reasonably diffuse the situation have failed, facility- and
community-based program staff shall immediately contact law enforcement.
Employees are authorized to use reasonable and necessary means to stabilize the
situation.
(h) The use of aerosol
or chemical agents, including but not limited to, oleoresin capsicum spray,
ammonia capsules, on a youth unless required for medical treatment of the youth
by a licensed medical professional is prohibited.
(i) The use of tasers is
prohibited.
(2)
Authorized Techniques.
(a) Administrators
shall submit a new RI Training Plan to the Director of Talent, Leadership, and
Culture or designee through the department's Regional Director or designee, and
thereafter notice of any change to this plan shall be submitted as described
above within 30 calendar days of the change's effective date. Newly contracted,
county- or municipally operated facilities shall submit their RI Training Plan
as described above no less than 30 calendar days prior to becoming operational.
The Right Interactions Training Plan (TLC 007, April 2023) is incorporated by
reference into this rule and is available electronically at
http://www.flrules.org/Gateway/reference.asp?No=Ref-15383.
(b) RI instructors shall only train employees
on the techniques identified on the approved training plan for the facility- or
community-based program for which they are training.
(3) Authorized Mechanical Restraints.
(a) The department authorizes mechanical
restraints designed and manufactured for the specific purpose of secure
transport or restraint.
(b)
Authorized mechanical restraints to be used within a facility are as follows:
handcuffs, leg cuffs, restraint belt, soft restraints, and waist
chains.
(c) There are two
authorized methods to use when handcuffing a youth: hands in front of the
youth, and hands behind the youth's back.
(d) All secure facilities shall use
mechanical restraints to transport youth. All non-secure programs shall use
mechanical restraints to transport any youth who has been assessed and
determined to be a security risk or risk to self and others and has
demonstrated that they cannot be transported by less restrictive methods. Leg
cuffs and front handcuffing shall be used to transport such youth.
(e) Prohibited use of mechanical restraints
includes the use of neck restraints, a restraint chair, securing of youth to a
fixed object, and securing of a youth's legs and hands together behind the
back.
(f) No more than two youth
may be chained or handcuffed together.
(g) A youth's legs and hands may be secured
together in the front with the use of waist chains or a restraint belt, in
which case the length of the chain securing the youth's legs and hands together
shall not prohibit the youth from standing in a full upright
position.
(h) If handcuffs are used
on pregnant youth, they shall be cuffed in front. Leg cuffs, waist chains, soft
restraints, and the restraint belt shall not be used on pregnant youth.
Restraints may not be used on a youth during labor, delivery, or during
postpartum recovery. For purposes of this paragraph, "postpartum recovery"
shall include the period immediately following delivery, including the recovery
period when a youth is in the hospital or infirmary, up to 24 hours after
delivery, unless the physician after consultation with the department
recommends a longer period of time.
(i) Except as provided herein, during
transports, all violent and escape risk youth shall be handcuffed with their
hands in front with the use of a restraint belt or waist chains or the hands
shall be cuffed behind the back.
(4) Supervision of Youth in Mechanical
Restraints.
(a) Youth secured in mechanical
restraints for secure transport or in response to resistance shall be
supervised in accordance with this section.
1.
At no time shall a youth be left without constant, full, sight and sound
supervision by an employee.
2. The
youth shall not be placed in an upper bunk or in any position that does not
permit constant, full, sight and sound supervision.
3. Youth shall not be stripped of their
clothing.
4. Employees responsible
for providing constant, full, sight and sound supervision shall be RI certified
and have physical possession of the key to unlock the mechanical
restraints.
(b) In
addition to items identified in subparagraphs 63H-3.007(4)(a) 1.-4., F.A.C.
above, while a youth is placed in mechanical restraints as a response to
resistance, employees shall:
1. Employ verbal
intervention techniques designed to de-escalate the need for mechanical
restraints.
2. Continually monitor
the youth's type of resistance, aggressiveness, and willingness to comply with
instructions to determine whether removal of restraints is safe and
advisable.
3. Conduct breathing and
circulation checks at ten-minute intervals. These ten-minute checks shall be
documented on the Mechanical Restraints Supervision Log. The Mechanical
Restraints Supervision Log (TLC 002, April 2023) is incorporated by reference
into this rule and is available electronically at
http://www.flrules.org/Gateway/reference.asp?No=Ref-15378.
4. If a restrained youth continues to exhibit
negative, hostile, and/or aggressive behavior so that removal of mechanical
restraints is unsafe, the supervisor or acting supervisor shall interview the
youth and decide if it is safe to remove the mechanical restraints.
a. This interview shall occur no more than 30
minutes after the youth is placed in restraints.
b. If it is decided that it is unsafe to
remove the restraints, the supervisor or acting supervisor shall document the
decision on the Mechanical Restraints Supervision Log.
c. If authorization is obtained from the
Superintendent, Program Director, Administrator, or designee to continue the
use of restraints, another interview shall occur no more than one (1) hour
after the youth was placed in restraints.
d. Each time the decision is made that it is
unsafe to remove the restraints, the decision shall be documented as described
above.
(c)
Authorization Requirements for Youth in Mechanical Restraints as a Response to
Resistance
1. A youth may remain in mechanical
restraints up to 60 minutes with the supervisor's or acting supervisor's
authorization.
2. In order to keep
the youth in mechanical restraints for 60 to 120 minutes, the supervisor or
acting supervisor shall obtain authorization from the Superintendent,
Residential Program Director, Administrator, or designee who shall first
consult with a licensed medical and/or mental health professional before
authorizing additional time. This authorization shall be obtained within the
initial 60-minute timeframe and documented on the Mechanical Restraints
Supervision Log to include the name of the professional who was consulted, the
time contacted, and the amount of time authorized.
3. In order to keep the youth in mechanical
restraints beyond 120 minutes, the same procedures apply as described in
paragraph 63H-3.007(4)(b), F.A.C. above, for each subsequent 60-minute
timeframe.
4. If at any point
during the restraint it is determined that transportation to a medical or
mental health treatment center is necessary, the supervisor or acting
supervisor shall request verbal authorization from the Superintendent, Program
Director, Administrator, or designee to initiate procedures to transport the
youth. All authorizations and the time the authorization was received shall be
documented on the Mechanical Restraints Supervision
Log.
(5)
Documentation and Retention of Records.
(a) A
RI Report shall be completed after an incident involving the use of
countermoves, control techniques, takedowns, or the application of mechanical
restraints as a response as identified on the RI Escalation Matrix. The Right
Interactions Report (TLC 006, April 2023) is incorporated by reference into
this rule and is available electronically at
http://www.flrules.org/Gateway/reference.asp?No=Ref-15382.
(b) The employees who were engaged with the
youth shall complete the RI Report no later than the end of the employee's
workday.
(c) When mechanical
restraints are used as a result of resistance, the Mechanical Restraints
Supervision Log shall be completed.
(d) The RI Report shall be reviewed by the
administrator or designee within 72 hours of the incident, excluding weekends
and holidays.
(e) The Post RI
Interview shall be conducted as soon as possible, but no longer than 30 minutes
after the incident. The findings of the interview shall be documented on the RI
Report.
(f) If the Post RI
Interview indicates the need for a RI Medical Review, the youth shall be
referred to the licensed medical health professional (Physician, Physician
Assistant, Advanced Registered Nurse Practitioner, Registered Nurse, or
Licensed Practical Nurse) on site. If a medical health professional is not on
site and telemedicine is not available, then the youth must be sent off site
for this evaluation.
(g)
Descriptions of injuries and medical treatment provided shall be filed in the
youth's individual health care record.
(h) Facilities/programs shall retain a copy
of the RI Report for three (3) years following the youth's release from the
department's custody.
(6)
Medical Requirements for Training.
(a) If an
employee has a medical condition that prohibits performance of one or more
physical intervention techniques, the employee shall submit medical
documentation from their licensed physician to their supervisor.
(b) The RI Instructor shall direct any
employee that discloses a medical issue or injury during training to the
employee's supervisor for follow-up. The employee shall not engage in any RI
training until such time as the employee's physician states the employee can
perform all techniques without restriction.
(c) Documents from physicians are
confidential records and shall be maintained in accordance with state Personnel
rules, or if a contracted facility or program, in accordance with the
organization's applicable policy. The medical documentation shall not be
submitted to the RI Instructor. The supervisor shall not send any employee to
RI training unless the employee is in good medical
standing.
(7)
Certification.
(a) All direct care staff
shall become RI certified within 90 calendar days following their date of
hire.
(b) Employees shall be RI
certified by successfully completing the RI training designed for facility- or
community-based employees, whichever is applicable. Successful completion
requires:
1. Attendance and participation in
the 40-hour training specified in the RI curriculum. Employees shall actively
participate in the performance of all physical intervention techniques and
mechanical restraints being taught during the training session;
2. A minimum score of 75 percent on the RI
examination; and
3. One hundred
percent (100%) satisfactory performance of the techniques specified on the RI
Performance Evaluation form. The Right Interactions Performance Evaluation (TLC
005, April 2023) is incorporated by reference into this rule and is available
electronically at
http://www.flrules.org/Gateway/reference.asp?No=Ref-15381.
(c) All RI training must be conducted by a
certified RI Instructor.
(d) The
instructor to student ratio shall be not exceed 1:8 during the physical
techniques portion of a RI training session.
(e) The 80-hour RI Train-the-Trainer course
shall be delivered by at least one Lead Master RI
Instructor.
(8)
Cross-Over Training
(a) A RI-certified
facility-based employee who crosses over from a community-based to a facility
position, or vice versa, shall successfully complete all objectives of the RI
certification curriculum applicable to their new position which are not
duplicative of the RI certification objectives previously completed by the
employee. Such completion must occur within 90 calendar days following the
employee's cross-over date.
(b) The
RI Instructor shall train and evaluate the employee's performance on any
techniques that the employee has not been trained to perform. This evaluation
shall be completed on the RI Performance Evaluation form. If the employee is
unable to perform the new techniques, after remediation, the employee shall not
be considered RI certified for purpose of their employment in the new facility
or community-based program. If this training shall dually serve as the
employee's annual RI Update, all criteria identified in this rule for the
annual RI Update shall be successfully completed.
(9) Rehired Employee Training.
(a) If an employee is rehired within 12
calendar months of their RI certification or most recent annual RI Update, the
employee's RI certification is current.
(b) If an employee is rehired after 12
calendar months of separation, they are no longer considered certified and must
complete all requirements as outlined in this rule.
(10) Annual Training Requirement.
(a) All employees shall complete a minimum of
eight (8) hours of RI Update training.
(b) The training shall include, at a minimum,
the following:
1. A review of this rule
section, including curriculum revisions, and other facility or program RI
administrative policies and procedures.
2. Instructions on how and when to properly
complete the RI Report.
3. Practice
of all physical intervention techniques checked on the applicable RI Training
Plan and, at a minimum, practice in the use of all mechanical restraints
authorized by the facility's RI Training Plan.
4. Successful completion of the annual
in-service training requires 100 percent attendance and participation in the
training program. The training hours do not have to be consecutive.
5. If an employee fails to successfully
complete the annual update within 12 months of their last RI training, they
will no longer be authorized to use physical or mechanical intervention
responses and must attend a minimum of eight (8) hours of remedial training, to
include 100 percent satisfactory performance of the techniques specified on the
employee's RI Training Plan using the RI Performance Evaluation.
6. If an employee fails to successfully
complete the annual update within 16 months of their last RI training, the
employee is no longer considered RI certified and must attend the 40-hour RI
certification course for either community- or facility-based staff but shall
not be required to re-take the RI certification
exam.
(11)
Testing Requirements.
(a) If a candidate
fails the RI written examination, they are only required to attend the remedial
classroom training.
(b) RI
Instructors shall conduct a practical examination utilizing the RI Performance
Evaluation. The completed evaluation shall be uploaded into the SkillPro
learning management system.
(c) If
an employee failed the RI Performance Evaluation, when remedial training is
provided, the RI Instructor candidate or employee is only required to attend
the performance-based segment of the training.
(d) Test candidates shall have no more than
three (3) attempts to pass the written exam.
(e) Test candidates shall adhere to the
following schedule for second and third attempts to pass the written exam:
1. The second attempt shall occur no less
than 7 calendar days after, and no more than 45 calendar days after, the first
attempt.
2. The third attempt shall
occur no less than 14 calendar days after, and no more than 45 calendar days
after, the second attempt.
(f) For annual in-service training, the RI
Performance Evaluation shall be used for the RI Update to document the practice
of the techniques identified on the RI Training Plan. The completed evaluation
shall be uploaded into the SkillPro learning management system.
(g) One RI Performance Evaluation form shall
be used for each attempt that a facility or program employee makes to pass the
performance evaluation. The term "attempt" is described below.
1. ATTEMPT 1: If an employee fails one (1) to
three (3) techniques, the RI Instructor shall remediate and re-evaluate the
employee on the failed techniques. Upon conclusion of the employee's
performance of the remediated techniques, this shall be the employee's first
attempt at passing the evaluation. If the employee fails to satisfactorily
demonstrate the failed techniques after remediation, the employee shall attend
remediation on a different date for Attempt 2 and at that time shall be
evaluated on the failed techniques. An employee who fails four (4) or more
techniques on Attempt 1 shall attend remediation on a different date for
Attempt 2 and at that time shall be evaluated on the failed
techniques.
2. ATTEMPT 2: If an
employee fails one (1) to three (3) techniques, the RI Instructor shall
remediate and re-evaluate the employee on the failed techniques. Upon
conclusion of the employee's performance of the remediated techniques, this
shall be the employee's second attempt at passing the evaluation. If the
employee fails to satisfactorily demonstrate the failed techniques after
remediation, the employee shall attend remediation on a different date for
Attempt 3 and at that time shall be evaluated on the failed techniques. An
employee who fails four (4) or more techniques on Attempt 2 shall attend
remediation on a different date for Attempt 3 and at that time shall be
evaluated on the failed techniques.
3. ATTEMPT 3: If an employee fails one (1) to
three (3) techniques, the RI instructor shall remediate and re-evaluate the
employee on the failed techniques. Upon conclusion of the employee's
performance of the remediated techniques, this shall be the employee's third
attempt at passing the evaluation. If the employee fails to satisfactorily
demonstrate the failed techniques after remediation, the employee is considered
to have failed their third attempt. An employee who fails four (4) or more
techniques on Attempt 3 shall not have an opportunity to receive remediation
and is considered to have failed their third attempt.
(h) Employees shall be evaluated using the RI
Performance Evaluation form on all physical intervention techniques that are
specified on their RI Training Plan.
(12) Training Instructor Fidelity and
Certification Renewal.
(a) RI Instructors
shall conduct 20 hours of RI training annually to maintain certification.
Instructors that do not conduct 20 hours of RI training within one calendar
year shall have their instructor privileges suspended until such time as they
attend remedial training conducted by a Lead Master RI Instructor.
(b) Instructors shall attend and participate
in an eight- (8-) hour in-service training program once every two years as
conducted by a Lead Master RI Instructor.
(c) Instructors shall notify the Office of
Talent, Leadership, and Culture via the RI Fidelity email address of all
scheduled RI classes at least 72 hours prior to the commencement of the
training. This requirement does not apply to impromptu annual update trainings
delivered due to the unexpected availability of staff on a given day or
shift.
(d) Instructors shall not be
limited in teaching RI to only their facility, program, or unit.
(e) Any RI Instructor who separates from
their employment with the department, county, municipality, or contracted
facility, program, or entity with a memorandum of understanding are no longer
considered to be a certified RI Instructor.
(f) If a RI Instructor is rehired by the
department or county, municipality, or contracted facility, program, or entity
with a memorandum of understanding within 12 months of separation, their RI
certification shall be reinstated by successfully completing RI training for
facility- or community-based employees pursuant to this rule.
(g) The facility, provider, or administrator
shall notify the Training Entity within 72 hours of a RI Instructor's
separation from the department or contract provider via the RI Fidelity email
address.
(h) At no time shall a RI
Instructor be financially compensated for the delivery of the RI curriculum
other than the salary they receive from their current employer for work time.
RI Instructors shall not be permitted to list themselves as a vendor in the My
Florida Marketplace system.
(i) The
Lead Master RI Instructors shall coordinate with Master RI Instructors
regarding the monitoring and development of instructor performance in the
delivery and application of the RI curriculum. At a minimum, Master RI
Instructors shall:
1. Deliver a minimum of 40
hours of RI training each calendar year, which may include either a RI and/or
RI Train-the-Trainer class. The Train-the-Trainer class shall be facilitated by
a Lead Master RI Instructor.
2.
Participate in quarterly Master RI Instructor meetings that will be conducted
in-person, virtually, or via conference call.
3. Complete RI fidelities and provide
technical assistance when requested.
(13) RI Fidelity Requirement: All department
and contract providers shall adhere to the following procedures when RI
incidents resulting in injury or allegations of abuse are reported, for
requests for program/facility technical assistance, and for the monitoring of
the training and implementation of the RI program.
(a) Superintendents, program monitors, and
Regional Directors shall submit reports of RI incidents resulting in injury
requiring outside medical attention, allegations of abuse stemming from the use
of RI, or requests for technical assistance to the Training Entity via the RI
Fidelity email address. All requests shall include the following:
1. RI Fidelity Request form. The Right
Interactions Fidelity Request (TLC 004, April 2023) is incorporated by
reference into this rule and is available electronically at
http://www.flrules.org/Gateway/reference.asp?No=Ref-15380.
2. A copy of the RI Report.
3. A copy of supporting multimedia (if
available).
(b) Within 24
hours of receipt of the RI Fidelity Request Form, excluding weekends and
holidays, a representative of the Office of Talent, Leadership, and Culture
will assign the request to a Master RI Instructor.
(c) Once all documentation is received,
depending on the nature and severity of the incident, a minimum of five (5)
days will be needed to complete the review.
1.
Upon completion of the review, the Master RI Instructor will submit the
completed RI Fidelity Request Form to the requestor or Incident Operation
Center.
2. Documentation of RI
Fidelity incidents or requests submitted to the Training Entity will be
maintained by the Training Entity.
Rulemaking Authority 985.645 FS. Law Implemented 944.241,
985.645 FS.
New 3-6-22, Amended
8-3-23.