Current through Reg. 50, No. 187; September 24, 2024
(1) When less
restrictive means of control are not effective, facilities and programs are
authorized to utilize a Secure Observation Room for observation of an At Risk
or Potential Suicide Risk youth who manifests behavior which constitutes a
strong potential threat to the youth's safety or to the safety of others For
example, the At Risk youth appears extremely restless, agitated, fearful, or
his/her behavior appears unpredictable, volatile or highly impulsive.
(a) A Secure Observation Room shall be used
for observation of At Risk youths only when other less restrictive means of
control are not effective or appropriate.
(b) The Secure Observation Room shall not be
used for youth who present an Imminent Threat of Suicide. Such youth shall be
transported for emergency mental health services as set forth in Rule
63N-1.011, F.A.C.
(2) If
a Potential Suicide Risk youth requires placement in an individual cell,
whether locked or unlocked, due to potentially self-injurious behavior or
behavior which threatens the safety of others, Secure Observation shall be
implemented.
(3) When a youth on
Precautionary Observation requires placement in behavioral confinement or
controlled observation, the youth must be placed in a Secure Observation Room.
When a youth already on Secure Observation requires placement in behavioral
confinement due to misbehavior, the youth must remain in the Secure Observation
Room during behavioral confinement.
(4) Procedures for Placement in a Secure
Observation Room.
(a) The superintendent,
program director or designee shall confer with the Designated Mental Health
Clinician Authority or other Licensed Mental Health Professional as to whether
Secure Observation is appropriate for a specific youth. The superintendent,
program director or designee's consultation with the Licensed Mental Health
Professional shall be documented on the Mental Health/Substance Abuse Referral
Summary (MHSA 014) or a form developed by the program which contains all the
information required in form MHSA 014.
(b) When the decision has been made to place
a youth in a Secure Observation Room, the following shall occur:
1. The Secure Observation Room shall be
inspected immediately prior to the youth's placement to ensure that it is safe
and secure.
2. A staff member of
the same sex will conduct a visual check of the youth to determine if there are
any observable injuries that would make placement in the Secure Observation
Room inappropriate.
a. The Health Status
Checklist (MHSA 008, August 2006) which is incorporated by reference and is
available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-03791,
shall be completed to document the youth's physical condition. The form MHSA
008 may be obtained by contacting: DJJ, Office of Health Services, 2737
Centerview Drive, Tallahassee, FL 32399.
b. If a physical injury is observed, the
youth complains of injury or illness, or the youth has been observed to have
experienced a fall, impact or blow to such an extent that injury would be
expected, medical personnel shall be immediately notified for an assessment and
treatment prior to placement in a Secure Observation Room.
3. The youth must be searched by a staff
member of the same sex.
a. At the time of the
search, all jewelry, pocket items, hair ties, and hair pins must be
removed.
b. All clothing items
which could be used for self-injury such as shoes, shoelaces, socks, and belt
must be removed. However, the youth shall not be stripped.
c. The youth shall not to be required to
dress in any garment or put on any covering that is sexually
revealing.
(5) A youth shall not remain in a Secure
Observation Room for more than eight hours unless a Licensed Mental Health
Professional has been consulted and agrees to a limited time extension. A
Licensed Mental Health Professional must provide written concurrence for a
youth to remain in a Secure Observation Room beyond 24 hours for any reason,
including behavioral confinement.
(6) Each youth placed in a Secure Observation
Room due to At Risk or Suicide Risk Behaviors shall be immediately referred for
an Assessment of Suicide Risk. The youth in Secure Observation must receive an
Assessment of Suicide Risk or Follow-Up Assessment of Suicide Risk within 8
hours of the youth's placement in the Secure Observation Room for any reason,
or if the youth is placed in the Secure Observation Room during the evening or
night shift, the Follow-Up Assessment of Suicide Risk shall be conducted during
the following morning shift.
(7)
Structural Specifications of a Secure Observation Room. The structure of a
Secure Observation Room shall meet the following specifications:
(a) Size: A minimum of 35 square feet of
unencumbered space. Unencumbered space is usable space that is not encumbered
by any furnishing or fixture. At least one dimension of the unencumbered space
is no less than 7 feet.
(b) Doors:
Solid core hardwood or metal that has a shatter-resistant observation window or
metal frame with wire mesh (holes no larger than 3/16 inch). The door
observation window must permit constant visual and sound monitoring of the
youth. A door with bars or expanded metal door is acceptable if small wire mesh
or lexan shields the bars from the inside.
(c) Floors/Walls: Solid, smooth and high
impact resistant without protrusions.
(d) Ceilings: Solid, single piece ceiling
which is out of the youth's reach and has no appendages that can be grasped or
tied onto with cloth or other materials.
(e) Vents: Must be covered with small mesh or
a metal plate (holes no larger than 3/16 inch). Vents must be unreachable to
the youth. Edges of wire mesh or metal covering must not be exposed. Vents
should not be immediately accessible from the toilet, sink or bed.
(f) Lighting: Light fixtures should be
recessed and covered with shatter-resistant material such as lexan.
(g) Windows: Must be made of
shatter-resistant material or glass windows that are not shatter resistant must
be covered with security-rated screens or other materials that prevent access
to the glass.
(h) Toilet/Sink:
Fixtures must be smooth and devoid of handles or parts that cloth or other
material could be tied to or hung from. Must be mounted against the wall with
water shut off valve outside of room.
(i) Electrical Switches/Outlets: Electrical
outlets are not permitted and switches must be located outside the
room.
(j) Beds: Must provide a
security-rated plastic mattress suitable for floor use or suicide resistant
bed. The bed must be anchored to the floor or secured to the wall, be of one
piece construction (no springs) must be no higher than 18 inches from the floor
and have a plastic fire retardant mattress.
(8) Mental Health Supportive Services shall
be provided to the youth being maintained on Secure Observation, based upon the
individualized needs of the youth as determined by Mental Health Clinical
Staff.
(9) Youths placed in a
Secure Observation Room shall be maintained on One-to-One Supervision while in
the Secure Observation Room.
(a) The staff
person assigned to observe the youth in Secure Observation must record
observations of the youth's behavior in the Secure Observation Room on the
Suicide Precautions Observation Log (MHSA 006). The Suicide Precautions
Observation Log (MHSA 006) is reviewed and signed by the shift supervisor each
shift and by a Mental Health Clinical Staff Person daily.
(b) The shift supervisor shall be responsible
for ensuring that a listing of youths currently placed on Secure Observation is
passed on to the next shift, and that any concerns or observations regarding
youths on Secure Observation have been documented and communicated to the next
shift.
(c) When it is necessary to
temporarily remove the youth from the Secure Observation Room for any reason,
the youth shall be searched again before being placed back into the Secure
Observation Room.
(10)
Discontinuation/Termination of Secure Observation.
(a) The At Risk youth shall be maintained on
Secure Observation until he or she has received an Assessment of Suicide Risk
or Follow-Up Assessment of Suicide Risk by, or under the direct supervision of,
a Licensed Mental Health Professional.
(b) The Assessment of Suicide Risk or
Follow-Up Assessment of Suicide Risk findings and recommendations shall be
reviewed by the superintendent/program director or designee. Based upon the
Assessment of Suicide Risk findings, the Licensed Mental Health Professional
and facility superintendent/program director or designee will determine whether
Secure Observation is to be continued.
(c) When Assessment of Suicide Risk
findings/recommendations indicate the need for continued Suicide Precautions,
the following shall occur:
1. Documentation
that the Licensed Mental Health Professional concurs with the Assessment of
Suicide Risk findings/recommendations and that continued Suicide Precautions
through either a limited time extension of placement in Secure Observation or
placement of the youth on Precautionary Observation is required.
2. Unless there is a specific recommendation
in the Assessment of Suicide Risk that the youth shall remain in Secure
Observation, the youth shall be removed from the Secure Observation Room and
Suicide Precautions continued by placing the youth on Precautionary
Observation.
3. The youth shall
remain on Secure Observation or Precautionary Observation until subsequent
Follow-Up Assessment of Suicide risk conducted by, or under the direct
supervision of a Licensed Mental Health Professional, indicates Suicide
Precautions may be discontinued.
(d) The discontinuation of Secure Observation
and initiation of Precautionary Observation shall be documented by the
superintendent or program director or designee on the Suicide Precautions
Observation Log (MHSA 006) and in the facility log, and must be documented in
the youth's Active Mental Health/Substance Abuse File by the Mental Health
Clinical Staff.
(e) If an At Risk
youth in Secure Observation due to behavioral confinement receives a Follow-Up
Assessment of Suicide Risk which indicates that the youth is no longer a
suicide risk, he/she may be removed from the Secure Observation Room and
transitioned to a normal routine. However, if the youth cannot be transitioned
to a normal routine because he/she must continue behavioral confinement, then
the youth must remain in Secure Observation and on Suicide Precautions until
behavioral confinement is concluded.
1. A
Licensed Mental Health Professional shall provide written concurrence for a
youth to remain in a Secure Observation Room beyond 24 hours for any reason,
including behavioral confinement.
2. If the youth is in Secure Observation due
to behavioral confinement and the Licensed Mental Health Professional does not
concur with a youth's continued placement in Secure Observation due to his/her
deteriorating mental health status, the Licensed Mental Health Professional
shall immediately notify the facility superintendent or designee of his/her
recommendation that Secure Observation and behavioral confinement be
discontinued, and the youth must either be placed on Precautionary Observation
with One-to-One Supervision or transported for emergency mental health
services.
(f) When deemed
appropriate by the Licensed Mental Health Professional and
superintendent/program director or designee, the youth shall be removed from
Suicide Precautions (Secure Observation and/or Precautionary Observation).
1. Documentation of the Assessment of Suicide
Risk or Follow-Up Assessment of Suicide Risk findings which indicate Suicide
Precautions may be discontinued shall be reviewed by a Licensed Mental Health
Professional prior to the youth's removal from Suicide Precautions.
2. Documentation that the Licensed Mental
Health Professional concurs with the removal of Suicide Precautions (Secure
Observation or Precautionary Observation) and the superintendent/program
director or designee's written authorization is required for removal of a youth
from Suicide Precautions.
(g) Discontinuation of Secure Observation and
step-down to Close Supervision must be documented on the Assessment of Suicide
Risk Form (MHSA 004) or Follow-Up Assessment of Suicide Risk Form (MHSA
005).
(11) The youth
being removed from Secure Observation shall be placed on Close Supervision
during transition back into the facility/program's normal routine, until deemed
stable by the Designated Mental Health Clinician Authority or a Licensed Mental
Health Professional. The procedures set forth in Rule 63N-1.00953, F.A.C.,
shall be followed.
Rulemaking Authority 985.64(2) FS. Law Implemented
985.601(3)(a), 985.14(3)(a), 985.145(1), 985.18, 985.48(4), 985.64(2)
FS.
New 3-16-14.
