Current through Register Vol. 46, No. 39, September 25, 2024
(a)
Definitions. As used in this Part:
(1)
Restraint means the
containment of acute physical behavior by physical intervention.
Restraint as used in Part does not mean time out, confinement
of a child to their own room for treatment or disciplinary reasons or use of a
locked unit
(2)
Acute
physical behavior means only that behavior which clearly indicates the
intent to inflict physical injury upon oneself or others or to otherwise
jeopardize the safety of any person.
(3)
Physical restraint means
the use of staff to hold a child in order to contain acute physical
behavior.
(4)
Time
out means the removal of a child from a situation that is too
threatening or emotionally overwhelming for the child or where the child may
lead other children into an uncontrollable state or where the child has
exceeded the reasonable limits set by the staff.
(5)
Locked unit means a
program approved by the Office of Children and Family Services that is
contained within a closed unit and is designed to serve a special
population.
(6)
Discipline means methods for achieving, restoring, and
maintaining order and purposefulness through encouragement, guidance, and
teaching children to live as socialized beings.
(b) Restraints are an exceptional
intervention and shall be used only when other forms of intervention are either
inappropriate or have been tried and proved unsuccessful.
(1) Restraint will never be used for
punishment or for the convenience of staff.
(2) Restraint shall not be used to purposely
inflict pain, fear, or harm.
(3)
Room isolation, mechanical restraints, and pharmacological restraints may never
be used as a form of restraint for a child in foster care.
(4) Prone restraint must not be used as a
form of restraint for a child in foster care.
(c) An authorized agency shall not use any
method of restraint unless it has submitted its restraint policy to the Office
of Children and Family Services and such policy has been approved in writing by
the Office of Children and Family Services in accordance with subdivision (d)
of this section.
(d)
(1) To qualify for approval of its restraint
policy by the Office of Children and Family Services, an authorized agency
must be in compliance with the provisions of this section and maintain a
section of the agency's policy manual which clearly states the plan and
procedures for the use of restraint. Such a section and the authorized agency's
policy on restraint shall include at a minimum the following:
(i) preventive methods and procedures for
situations which might lead to the use of restraint;
(ii) appropriate alternatives to
restraint;
(iii) the circumstances
when restraint might be necessary;
(iv) methods of applying restraint and the
rules which must be observed in applying such restraint; and
(v) a description of the training agency
staff will receive as required by subdivision (f) of this section.
(2) No changes or modifications in
the authorized agency's policy on restraint shall be made without prior written
approval of the Office of Children and Family Services. All approved changes
shall be recorded in the agency's policy manual. The agency shall conduct its
program of restraint in accordance with its approved policy.
(3) The duration of the Office of Children
and Family Services approval will be for a period of two years. However, the
Office of Children and Family Services approval may be revoked in whole or in
part at any time that an agency is not using restraint in accordance with its
approved policy and any other provision of this section.
(4)
(i)
Agencies currently using restraint or planning to use restraint shall submit a
request for provisional approval to the Office of Children and Family Service
in a form and manner prescribed by the Office of Children and Family Services.
No agency shall continue to use restraint 90 days after adoption of these
regulations without written provisional approval by the Office of Children and
Family Services. Such request shall include the agency's plan for training
staff in the use of restraint as required by subdivision (f) of this section.
The initial training as required by subdivision (f) must be completed prior to
final approval by the Office of Children and Family Services.
(ii) The Office of Children and Family
Services shall review the agency's policy on restraint and the agency's plans
for training. The Office of Children and Family Services shall review all rooms
used for de-escalation to determine whether the room(s) meets the requirements
of subdivision (i) of section
442.2
of this Subchapter. Within 90 days of receipt of the request for approval, the
Office of Children and Family Services shall make a determination as to whether
the application is acceptable.
(iii) If the Office of Children and Family
Services determines that the application is unsatisfactory, the Office of
Children and Family Services shall notify the applicant in writing of the
denial of approval and the reasons therefor.
(iv) If the Office of Children and Family
Services determines that the applicant is in compliance with the standards and
regulations as set forth in this section, it shall notify the applicant in
writing of final approval of the application.
(e) Three months prior to the expiration of
the approved restraint policy, authorized agencies shall submit a request for
renewal of such policy to the Office of Children and Family Services. The
Office of Children and Family Services will review the agency's restraint
policy and incident reports and case records of children on whom restraint has
been used or injured as a result of a restraint incident. The agency will be
notified of continued approval of their restraint policy within 90 days from
the date the Office of Children and Family Services received their request for
renewal. Continued approval will be based upon the agency's continued
compliance with this section and a showing by the agency of continued need for
such policy.
(f)
Staff
training.
(1) All staff involved in
the use of restraint must complete at least six hours of training in the
agency's policy concerning:
(i) preventive
methods and procedures for situations which might lead to the use of
restraint;
(ii) appropriate
alternatives to restraint;
(iii)
the circumstances when restraint might be necessary; and
(iv) methods of applying restraint and the
rules which must be observed in so doing.
(2) All staff involved in the use of
restraint must complete such training prior to their use of restraint, except
as provided in paragraph (d)(4) of this section and must complete a review of
such training every six months following the initial training.
(g) post restraint health review
(1) A post-restraint health review, conducted
by a medical professional, is required within one hour of the conclusion of the
restraint for any child who has been restrained. A report of such examination
shall be kept in the child's medical record. When a restraint occurs outside of
the working hours of medical staff, the post-restraint health review must occur
as soon as practicable the next day.
(2) If it appears that a child may have
sustained an injury immediately prior to or during the use of restraint, the
child shall be examined by a physician or nurse immediately following the
period of restraint. A report of such examination shall be kept in the child's
medical record.
(3) All children
cared for in an institution as defined in section
441.2 of
this Part must receive a post-physical restraint health review in accordance
with the standards set forth by the Office of Children and Family
Services.
(h) Following
each instance during which restraint is used, a summary of the incident,
including efforts made to identify and resolve the problem that led to the use
of restraint, the reason restraint was determined necessary and the child's
reaction to the use of restraint, shall be recorded and kept in the progress
notes of the child's uniform case record.
(i) Following each instance during which
physical restraint is applied, the authorized agency that applied the physical
restraint must notify the restrained child's parent, guardian or other person
legally responsible, as applicable, the attorney for the child, and the
authorized agency with legal custody of the restrained child, if different, of
the use of physical restraint, any injuries sustained by the child as a result
of the physical restraint and any contacts with the Vulnerable Persons' Central
Register involving such restraint within 24 hours of the restraint, and
document all efforts to contact those not immediately reachable.
(j) Each authorized agency shall maintain
daily records of the number of children on whom restraints have been used,
including the name and age of each such child and the type of restraint
used.
