Current through Register Vol. 39, No. 6, September 16, 2024
(a) The
interventions specified in this Rule present a significant risk to the client
and therefore require additional safeguards. These procedures shall be followed
in addition to the procedures specified in Rule .0203 of this
Section.
(b) The following
interventions are designed for the primary purpose of reducing the incidence of
aggressive, dangerous or self-injurious behavior to a level which will allow
the use of less intrusive treatment/habilitation procedures. Such interventions
include the use of:
(1) seclusion, physical
restraint or isolation time-out employed as a measure of therapeutic
treatment;
(2) seclusion, physical
restraint or isolation time-out used on an emergency basis more than 40 hours
in a calendar month or one episode in which the original order is renewed for
up to a total of 24 hours in accordance with the limits specified in
Subparagraph (l)(8) of Rule .0206 of this Section;
(3) unpleasant tasting substances;
(4) planned non-attention to specific
undesirable behaviors when the target behavior is health threatening;
(5) contingent deprivation of any basic
necessity;
(6) contingent
application of any noxious substances which include but are not limited to
noise, bad smells or splashing with water; and
(7) any potentially physically painful
procedure or stimulus which is administered to the client for the purpose of
reducing the frequency or intensity of a behavior.
(c) Such interventions shall never be the
sole treatment modality for the elimination of target behavior.
(d) The intervention shall always be
accompanied by positive treatment or habilitation methods which shall
include, but not be limited to:
(1) the
deliberate teaching and reinforcement of behaviors which are
non-injurious;
(2) the improvement
of conditions associated with non-injurious behaviors such as an enriched
educational and social environment; and
(3) the alteration or elimination of
environmental conditions which are reliably correlated with
self-injury.
(e) Prior
to the implementation of any planned use of the intervention the following
written approvals and notifications shall be obtained. Documentation in the
client record shall include:
(1) approval of
the plan by the treatment/habilitation team;
(2) that each client whose
treatment/habilitation plan includes interventions with reasonably foreseeable
physical consequences shall receive an initial medical examination and periodic
planned monitoring by a physician;
(3) that the treatment/habilitation team
shall inform the internal client advocate that the intervention has been
planned for the client and the rationale for utilization of the
intervention;
(4) the
treatment/habilitation team shall explain the intervention and the reason for
the intervention to the client and the legally responsible person, if
applicable;
(5) the prior written
consent of the client or his legally responsible person shall be obtained
except for those situations specified in Rule .0206(g)(1) in this Section. If
the client or legally responsible person refuses the intervention, the State
Facility Director shall follow the right to refuse treatment procedures as
specified in this Subchapter;
(6)
that the plan shall be reviewed and approved by a review committee, designated
by the State Facility Director, which shall include that:
(A) at least one member of the review
committee shall be qualified through experience and training to utilize the
planned intervention; and
(B) no
member of the review committee shall be a member of the client's treatment
team;
(7) that the
treatment/habilitation plan may be reviewed and approved by the State Facility
Director; and
(8) if any of the
persons or committees specified in Subparagraphs (e)(1), (2), (4), (5) or (6)
of this Rule do not approve the continued use of a planned intervention, the
planned intervention shall be terminated. The State Facility Director shall
establish an appeal mechanism for the resolution of any disagreement over the
use of the intervention.
(f) Neither the consents nor the approvals
specified in Paragraph (e) of this Rule shall be valid for more than six
months. The treatment/habilitation team shall re-evaluate the use of the
intervention and obtain the client's and legally responsible person's consent
for continued use of the intervention at least every six months.
(g) The plan shall be reviewed at the meeting
of the Human Rights Committee following each evaluation within the constraints
of 10A
NCAC 28A .0209. The Committee, by majority
vote, may recommend approval or disapproval of the plan to the State Facility
Director or may abstain from making a recommendation. If the State Facility
Director does not agree with the decision of the Committee, the Committee may
appeal the issue to the Division in accordance with the provisions of
10A NCAC
28A .0208.
(h) The intervention shall be used only when
the treatment/habilitation team has determined and documented in the client
record the following:
(1) that the client is
engaging in behaviors that are likely to result in injury to self or
others;
(2) that other methods of
treatment or habilitation employing less intrusive interventions are not
appropriate;
(3) the frequency,
intensity and duration of the target behavior, and the behavior's probable
antecedents and consequences; and
(4) it is likely that the intervention will
enable the client to stop the target behavior.
(i) The treatment/habilitation team shall
designate a state facility employee to maintain written records on the
application of the intervention and accompanying positive procedures. These
records shall include the following:
(1) data
which reflect the frequency, intensity and duration with which the targeted
behavior occurs (scientific sampling procedures are acceptable);
(2) data which reflect the frequency,
intensity and duration of the intervention and any accompanying positive
procedures; and
(3) data which
reflect the state facility employees who administered the
interventions.
(j) The
interventions shall be evaluated at least weekly by the treatment team or its
designee and at least monthly by the State Facility Director. The designee of
the State Facility Director shall not be a member of the client's
treatment/habilitation team. Reviews shall be documented in the client
record.
(k) During the use of the
intervention, the Human Rights Committee shall be given the opportunity to
review the treatment/ habilitation plan within the constraints of
10A NCAC
28A .0209.
Authority
G.S.
122C-51;
122C-53;
122C-60;
122C-62;
143B-147;
Eff.
November 1, 1993;
Amended Eff. October 1, 2004; July 1,
1994;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. May 1, 2018.
