Kansas Administrative Regulations
Agency 28 - DEPARTMENT OF HEALTH AND ENVIRONMENT
Article 4 - MATERNAL AND CHILD HEALTH
Section 28-4-338 - Behavior management
Universal Citation: KS Admin Regs 28-4-338
Current through Register Vol. 43, No. 12, March 20, 2024
(a) Policies.
(1) Each secure residential treatment
facility shall establish and implement written policy providing for a behavior
management system that assists youth to develop inner control and manage their
own behavior in a socially acceptable manner. The policy shall provide the
following:
(A) Expectations that are age
appropriate and that allow for special abilities and limitations; and
(B) positive and negative
consequences related to each expectation.
(2) Each facility shall establish written
rules of youth conduct that define expected behaviors and related consequences.
(A) A rule book containing expected
behaviors, ranges of consequences, and disciplinary procedures shall be given
to each youth and youth care staff member.
(B) An acknowledgment of receipt of the rule
book shall be signed by each youth and kept in each youth's record.
(C) If a literacy or language problem
prevents a youth from understanding the rule book, a staff member or translator
shall assist the youth in understanding the rules.
(3) Each staff member who has direct contact
with youth shall be thoroughly familiar with the rules of youth conduct, the
rationale for the rules, and the intervention options available.
(b) Discipline.
(1) Discipline that is humiliating,
frightening, or physically harmful to the youth shall not be used at any time.
Each youth shall be protected against all forms of neglect, exploitation, or
degrading forms of discipline. No youth shall be isolated or confined in any
dark space. Electronic monitoring or an audio communication system shall not
replace the required presence of a youth care staff member.
(2) Corporal punishment shall not be used.
(3) Under no circumstances shall
any youth be deprived of meals, clothing, sleep, medical services, exercise,
correspondence, parental contact, or legal assistance for disciplinary
purposes. If a youth is in involuntary seclusion during normal school hours,
school work shall be provided to the youth.
(4) Under no circumstances shall any youth be
allowed to supervise or to administer discipline to another youth.
(c) Involuntary seclusion.
(1) Involuntary seclusion shall be permitted
within a secure residential treatment facility only when a youth is out of
control, continually refuses to obey reasonable and lawful requests, or behaves
in a way that presents a threat to self or others.
(2) Each secure residential treatment
facility shall establish and implement written policies and procedures that
govern the use of involuntary seclusion. The policies and procedures shall
include provisions that meet the following conditions and requirements:
(A) Permit the use of involuntary seclusion
if all other less restrictive methods to prevent immediate, substantial bodily
injury to the youth or others have been attempted and have failed to prevent
immediate and substantial bodily injury to the youth or others and if all
alternative measures to prevent injury are not sufficient to accomplish this
purpose;
(B) require a written
order by the program director of the secure residential treatment facility,
physician, psychologist, or other approved staff member each time a youth is
placed in or released from involuntary seclusion;
(C) ensure that no more than one youth is
placed in an involuntary seclusion room at any one time;
(D) provide for a search of each youth and
removal of any items that may be used to injure oneself or others before
admission to the involuntary seclusion room;
(E) ensure that each youth is provided
appropriate clothing at all times;
(F) ensure that each youth in involuntary
seclusion is provided with a mattress on a clean, level surface above floor
level;
(G) ensure that each youth
receives all meals and snacks normally served and is allowed time to exercise
and perform necessary bodily functions;
(H) ensure that each youth has prompt access
to drinking water and washroom facilities;
(I) ensure that the designated staff member
on duty makes appropriate entries in the youth's records regarding the use of
involuntary seclusion;
(J) ensure
that at least one youth care staff member is in the proximity of each youth in
involuntary seclusion at all times, with direct, physical observation at least
every 15 minutes. At the time of each observation, all of the following
activities shall occur:
(i) Interactive
intervention shall be attempted, unless the youth is sleeping;
(ii) the result of the intervention shall be
recorded; and
(iii) the condition
of the youth shall be recorded;
(K) ensure constant supervision if a youth is
considered suicidal; and
(L)
provide for an assessment of the need for continued involuntary seclusion at
each shift change and for documentation of the reasons that involuntary
seclusion is continued.
(3) Electronic or auditory devices shall not
be used to replace staff supervision of youth in involuntary seclusion.
(4) A youth shall not remain in
involuntary seclusion for more than 24 hours without written approval of the
program director or the program director's designee. No staff person who was
involved in the incident leading to involuntary seclusion shall be permitted to
approve an extension of the involuntary seclusion.
(5) The program director or designee who
approved the extended involuntary seclusion shall visit with each isolated
youth at least once within each eight-hour period after the first 24 hours.
(6) Written approval of the
program director or program director's designee shall be required for each
eight-hour period that involuntary seclusion is extended, beyond the first 24
hours.
(7) Involuntary seclusion
shall not exceed 48 hours for any reason unless the youth continues to behave
in a way that presents a threat to oneself or others.
(8) If a youth requires more than 48
consecutive hours of involuntary seclusion or more than 72 cumulative hours of
involuntary seclusion within any seven-day period, or is placed on suicide
watch, an emergency staff meeting shall be held to discuss the appropriateness
of the youth's individual plan of care.
(A)
Participants in the emergency staff meeting shall include the following:
(i) The youth, if behavior permits;
(ii) the program director or the
program director's designee;
(iii)
a physician, clinical psychologist, or clinical social worker who has assessed
the youth; and
(iv) any other
appropriate staff member.
(B) The youth's parents or legal guardian
shall be notified of the emergency staff meeting and invited to participate.
Documentation of notifications shall be kept in the youth's record.
(C) The results of the emergency staff
meeting shall be recorded and maintained on file.
(9) All youth care staff and program
personnel shall be informed at all times of the current status of each youth in
involuntary seclusion.
(d) Restraint.
(1) Each facility shall establish and
implement written policies and procedures that govern the use of restraint.
(2) These policies and procedures
shall include the following:
(A) Limitations
on the use of physical restraint to instances of justifiable self-defense,
protection of the youth or others, or the protection of property;
(B) permission to use physical restraint only
if all other less restrictive methods of controlling the youth's dangerous
behavior were attempted and failed;
(C) a statement that chemical agents are not
to be used by secure residential treatment facility personnel;
(D) a statement that psychotropic medications
are not to be used for disciplinary reasons; and
(E) a statement that psychotropic medications
are to be administered only when medically necessary upon order of the youth's
physician.
(3) The
restraints selected shall be the least restrictive measure necessary to prevent
injury to the youth or others.
(4)
Restraint or involuntary seclusion shall never be used for punishment or for
the convenience of staff. Restraint or involuntary seclusion shall not be used
for more than three consecutive hours without medical reevaluation of its
necessity, except between the hours of 12:00 midnight and 8:00 a.m., unless
necessary for the safety and well-being of the youth.
(5) Each secure residential treatment
facility that uses restraint shall develop and insure implementation of a
comprehensive policy on the use of each restraint. The policy shall identify
the following:
(A) The forms of restraint in
use at the secure residential treatment facility, clearly demonstrating that
each specified form of restraint is required to appropriately serve youth;
(B) specific criteria for the use
of each form of restraint;
(C) the
staff members authorized to approve the use of each form of restraint;
(D) the staff members authorized
and qualified to administer or apply each form of restraint;
(E) the approved procedures for application
or administration of each form of restraint;
(F) the procedures for monitoring any youth
placed in each form of restraint;
(G) any limitations on the use of each form
of restraint, including time limitations;
(H) the procedures for immediate, continual
review of restraint placements for each form of restraint, except passive
physical restraint; and
(I)
procedures for comprehensive record keeping concerning all incidents involving
the use of restraint, including incidents of passive physical restraint if it
is used in conjunction with or leads to the use of any other form of restraint.
Disclaimer: These regulations may not be the most recent version. Kansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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