Current through Register Vol. 46, No. 39, September 25, 2024
(a) The use of
restraints in limited secure facilities shall be governed by the provisions of
section
441.17
of this Title, except as provided in this section.
(b) The use of prone restraints shall not be
permitted in a limited secure facility.
(c) There must be an individualized treatment
or behavior support plan for each youth in care that addresses permissible and
precluded means of restraint, taking into consideration the medical,
psychological and developmental conditions and needs of the youth. Staff
responsible for the care of the youth must be provided with information on the
permissible restraints for each youth and the reasons for any limitations in
the type of restraints that may be used for each youth. The individualized
treatment or behavior support plan must be updated and revised whenever there
is any significant change in the physical, psychological or developmental
condition of the youth.
(d)
Mechanical restraints may be used in limited secure facilities in accordance
with the provisions of this section if such use is part of the facility's
restraint policy which has been approved pursuant to section
441.17
of this Title. Seat belts, shoulder harnesses or wheelchair locks used in
vehicular transportation shall not be considered types of mechanical restraint.
(1) The permissible uses of mechanical
restraints in limited secure facilities shall consist solely of handcuffs and
footcuffs and may only be used by staff who have been appropriately trained in
the use of such restraints. Handcuffs and footcuffs must be of a size
appropriate for the youth on whom they are used.
(2) Mechanical restraints may be used on a
youth only if there has been a prior individualized assessment that has found
that the use of mechanical restraints is permissible for that youth. Any
limitations or prohibitions on the use of mechanical restraints for a youth
must be followed by staff.
(3)
Mechanical restraints may be used on a youth inside a limited secure facility
only if, after all appropriate pro-active, non-physical behavior management
techniques followed by all less restrictive physical behavior management
techniques have been tried and failed, the youth continues to be out of control
and presents a serious and evident danger to him or herself or others.
Mechanical restraints must be removed as soon as the youth is sufficiently
under control so that the youth can be managed safely using other less
restrictive, approved methods. Mechanical restraints may be used to transport a
youth from a limited secure facility to court or other outside activities if an
individualized assessment conducted at the time of the transport determines
that the youth presents a clear danger to public safety or to him or
herself.
(4) Staff must provide
constant, direct, visual supervision of any youth in mechanical restraints for
the protection of the youth's safety, to evaluate that the youth is properly
restrained, and to determine the continued need for the use of mechanical
restraints.
(5) In no case may a
youth be handcuffed or footcuffed to any object.
(6) Handcuffs and footcuffs may not be
attached to each other.
(7) Use of
mechanical restraints for a youth must be initially authorized by the director
of the facility or a person designated by the director. The authorization must
be obtained prior to the use of mechanical restraints and re-authorized
throughout the use of the restraints at specified intervals as set forth in the
facility's restraint policy.
(8)
Staff must be aware of, and follow, all therapeutic and medical restrictions
for individual youth as they pertain to the use of mechanical
restraints.
(9) At least one staff
member with a key to the mechanical restraints must be on the scene at all
times when mechanical restraints are being used until the restraints are
removed.
(10) Any injuries or
health concerns found or observed by staff and any health concerns expressed by
youth after any use of mechanical restraint must be addressed
appropriately.
(e) Room
isolation, as defined in section
441.17
of this Title, may be used in limited secure facilities in accordance with the
provisions of this section, if such use has been approved in writing by the
office as part of an authorized agency's restraint policy. Room isolation means
confinement of a youth in a bedroom or other room specifically designed and
designated for such use to calm and control acute physical behavior of that
youth which presents an immediate risk of physical injury to the youth or
others or of escape from the facility or from custody.
(1) Room isolation may be used only after
less restrictive interventions have been exhausted and found to be ineffective.
It may only be used for the least amount of time necessary for the youth to
regain self-control.
(2) Room
isolation shall not be used for youth who are on special supervision status for
suicide, have significant intellectual or developmental disabilities, or have a
seizure disorder.
(3) The approval
of the facility director or designee must be obtained prior to placing a youth
in room isolation unless the facility staff determines that immediate room
isolation is necessary for safety reasons. In such cases, the facility director
or designee must be notified as soon as possible, but no later than 15 minutes,
after room isolation begins. Absent a showing of necessity, the duration of
room isolation shall not be continued beyond two hours. Authorization for
continuing room isolation must be obtained at least every two hours.
(4) Each isolated youth shall have access to
bathroom and toilet facilities.
(5)
Each isolated youth shall receive meals and fluids on the same schedule as
youth in the regular program.
(6)
As soon as practicable after the commencement of room isolation, each isolated
youth must be seen by medical or clinical staff to determine whether the youth
has any known injury or medical condition requiring removal from room
isolation. If such staff are unavailable, the shift supervisor shall determine
whether on-call medical personnel need to be contacted.
(7) At least one staff person must be
positioned in a manner that enables the staff person to hear the youth should
the youth request assistance. Staff must visually observe the youth at least
every 15 minutes and shall vary the check-in times so that they are not
predictable to the youth. At least every 15 minutes, staff must attempt to
engage the youth in a release strategy in a manner consistent with the youth's
behavior services plan.
(8) Each
room used for isolation shall be heated, lighted and ventilated as any other
room in the facility. An isolation room shall have:
(i) a door that locks from the outside and
that has an observation window made of unbreakable material that allows a total
view of the room;
(ii) no exposed
electrical outlets;
(iii)
sufficient wall construction to withstand attacks from a violent youth of
reasonable height and weight; and
(iv) normal bedroom furnishings unless the
facility director or designee has determined that some or all of the
furnishings must be removed for safety reasons.
(9) Each facility shall maintain daily
records regarding youth who are placed in locked isolation rooms including the
name and age of each youth, the duration of each isolation, the reasons for
using isolation, the individual who approved the isolation, the methods of
intervention that were tried and proved unsuccessful, the steps that were taken
to reduce the amount of time the youth was in isolation, and attempts to
contact the parent/guardian of each youth.
(f) Any use of restraints must be recorded
and reported in the manner and format required by the office.
