Current through Register Vol. 39, No. 6, September 16, 2024
(a) Foster parents
who utilize physical restraint holds shall not engage in discipline or behavior
management that includes:
(1) protective or
mechanical restraints;
(2) a drug
used as a restraint, except as outlined in Paragraph (b) of this
Rule;
(3) the seclusion of a child
in a locked room; or
(4) physical
restraint holds except for a child who is at imminent risk of harm to himself,
herself, or others until there is no longer any risk of imminent harm to any
party.
(b) Foster
parents shall not administer drugs to a foster child for the purpose of
punishment, foster parent convenience, substitution for supervision, or for the
purpose of restraining the child. A drug used as a restraint means a medication
used only to control behavior or to restrict a child's freedom of movement and
is not a standard medication to treat a psychiatric condition.
(c) Before a foster parent administers
physical restraint holds, each foster parent shall complete training that
includes 16 hours of initial training in behavior management, including
techniques for de-escalating problem behavior, the use of physical restraint
holds, monitoring of vital indicators, and debriefing children and foster
parents involved in physical restraint holds. Foster parents authorized to use
physical restraint holds shall annually complete eight hours of behavior
management training, including techniques for de-escalating problem behavior.
This training shall count toward the training requirements as set forth in
10A NCAC
70E .1117(6). Only foster
parents trained in the use of physical restraint holds may administer physical
restraint holds.
(d) Instructors
who train foster parents shall have met the following qualifications and
training requirements:
(1) demonstrate
competence by scoring 100 percent on testing in a training program aimed at
preventing, reducing, and eliminating the need for restrictive
interventions;
(2) demonstrate
competence by scoring 100 percent on testing in a training program teaching the
use of physical restraint;
(3)
demonstrate competence by scoring a passing grade on testing in an instructor
training program as determined by the North Carolina Division of Mental Health,
Developmental Disabilities and Substance Abuse Services;
(4) the instructors' training shall be
competency-based and shall include measurable learning objectives, measurable
testing (written and by observation of behavior) on those objectives, and
measurable methods to determine passing or failing the course;
(5) the content of the instructor training
shall be approved by the Division of Mental Health, Developmental Disabilities
and Substance Abuse Services;
(6)
be retrained annually and demonstrate competence in the use of physical
restraints;
(7) be trained in CPR
such as those provided by the American Red Cross, American Heart Association,
or equivalent organizations. Division staff shall determine that an
organization is substantially equivalent if the organization is already
approved by the Department or meets the same standard of care as the American
Heart Association or American Red Cross. The Division shall not accept
web-based trainings for certification in CPR;
(8) have been coached in teaching the use of
restrictive interventions two times with a positive review by the coach, and
instructors shall teach a program on the use of physical restraints once
annually; and
(9) complete a
refresher instructor training at least every two years;
(e) In administering physical restraints, the
following shall apply:
(1) foster parents
shall use only those physical restraint holds approved by the Division of
Mental Health, Developmental Disabilites, and Substance Abuse Services,
pursuant to
10A NCAC
27E .0108. Approved physical restraint holds
can be found at the following web site:
https://www2.ncdhhs.gov/mhddsas/providers/trainingandconferences/restraints.htm;
(2) a foster parent shall not use physical
restraints that will cause a child harm, given their medical condition or any
medications that they are taking;
(3) no child shall be restrained using a
physical object;
(4) no child or
group of children shall be allowed to participate in the physical restraint of
another child;
(5) physical
restraint holds shall:
(A) not be used for
purposes of discipline or convenience;
(B) be used only when there is imminent risk
of harm to the child or others and less restrictive approaches have
failed;
(C) be administered in the
least restrictive manner possible to protect the child or others from imminent
risk of harm; and
(D) end when
there is no longer any risk of imminent harm to any party;
(6) The foster parent shall:
(A) ensure that any physical restraint hold
used on a child is administered by a trained foster parent with a second
trained adult in attendance. Concurrent with the administration of a physical
restraint hold and for a minimum of 15 minutes subsequent to the termination of
the hold, a foster parent shall monitor the child's breathing, ascertain the
child is verbally responsive and has motor control and ensure the child remains
conscious without any complaints of pain. The supervising agency may seek a
waiver from the licensing authority for a foster parent to administer a
physical restraint hold without a second trained adult in attendance. The
licensing authority shall grant the waiver if it receives a written waiver
request; written approval from the child's parent, guardian, or custodian that
the administering of a physical restraint hold without a second trained person
present is acceptable; written approval from the supervising agency that the
foster parent is authorized to administer a physical restraint hold without a
second trained person present; documentation that there is approval by the
child and family team; and documentation in the person-centered plan or
out-of-home family services agreement that it is acceptable for the foster
parent to administer a physical restraint hold without a second trained person
present;
(B) terminate the physical
restraint hold or adjust the position to ensure that the child's breathing and
motor control are not restricted if at any time during the administration of a
physical restraint hold the child complains of being unable to breathe or loses
motor control;
(C) immediately seek
medical attention for the child if at any time it appears to be
necessary;
(D) conduct an interview
with the foster child about the incident following the use of a physical
restraint hold;
(7) The
supervising agency shall interview the foster parent administering the physical
restraint about the incident following the use of a physical restraint and
shall document the incident in a report. Each report shall include:
(A) the child's name, age, height, and
weight;
(B) the type of hold
utilized;
(C) the duration of the
hold;
(D) the trained foster parent
administering the hold;
(E) the
trained adult witnessing the hold;
(F) the less restrictive alternatives that
were attempted prior to utilizing physical restraint;
(G) the child's behavior that necessitated
the use of physical restraint; and
(H) whether the child's condition required
medical attention; and
(8) Physical restraints where a person ends
up in a prone or face down position shall be prohibited.
(f) Foster parents shall annually receive
written approval from the executive director of the supervising agency or his
or her designee before administering physical restraint holds. This written
approval shall be based upon the executive director's evaluation of the foster
parent's historical use of physical restraints. The foster parent shall retain
a copy of the written approval and a copy shall be placed in the foster home
record.
Authority
G.S.
131D-10.1;
131D-10.3;
131D-10.5;
143B-153;
Eff.
September 1, 2007;
Amended Eff. August 1, 2017;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. October 3,
2017.
