Current through Register Vol. 39, No. 6, September 16, 2024
(a) A
residential child-care facility shall have written policies and procedures on
discipline and behavior management, including the type and use of physical
restraint holds, if utilized. A copy of the written policies and procedures
shall be provided to and discussed with each child and the child's parents,
guardian, or legal custodian prior to or at the time of admission. Policies and
procedures shall include:
(1) a way of
interacting with and teaching children that emphasize praise and encouragement
for exhibiting self control and desired behavior; and
(2) methods for protecting children and
others when a child is out of control.
(b) A residential child-care facility shall
implement standards for behavior that are appropriate for the child's age,
intelligence, emotional makeup, and past experiences.
(c) A residential child-care facility shall
not engage in discipline or behavior management that includes:
(1) corporal and physical
punishment;
(2) cruel or abusive
punishment, as established in
G.S.
7B-101(1) and
(15);
(3) discipline of one child by another
child;
(4) denial of food, sleep,
clothing, or shelter;
(5) denial of
family contact, including family time, telephone, or mail contacts with
family;
(6) exercise or work to the
point of physical exhaustion;
(7)
verbal abuse, threats, or humiliating remarks about himself or herself or his
or her family;
(8) mechanical
restraints;
(9) a drug used as a
restraint, except as set forth in Paragraph (e) of this Rule;
(10) seclusion or isolation time-out; except
as outlined in Paragraph (d) of this Rule;
(11) physical restraints except as outlined
in Paragraph (f) of this Rule.
(d) "Time-out" means the removal of a child
to a separate unlocked room or area from which the child is not physically
prevented from leaving. The residential child-care facility may use isolation
time-out as a behavioral control measure when the facility provides it within
hearing distance of a staff member. The length of the isolation time-out shall
be appropriate for the child's age, intelligence, emotional makeup, and past
experiences.
(e) "A drug used as a
restraint" means a medication used to control behavior or to restrict a child's
freedom of movement that is not a standard medication for the child's medical
or psychiatric condition. A drug used as a restraint shall be employed only if
required to treat a medical condition. It shall not be employed for the purpose
of punishment, staff convenience, or as a substitute for adequate
staffing.
(f) "Physical restraint"
of a child means physically holding a child who is at imminent risk of harm to
himself or herself or others until the child is calm. A residential child-care
facility shall only use physical restraint holds approved by the Division of
Mental Health, Developmental Disabilities, and Substance Abuse Services,
pursuant to
10A NCAC
27E .0108, which is hereby incorporated by
reference, including subsequent amendments and editions. Approved physical
restraint holds can be found at the following website:
https://www2.ncdhhs.gov/mhddsas/providers/trainingandconferences/restraints.htm.
(g) Physical restraints where a person ends
up in a prone or face down position are prohibited.
(h) Physical restraint holds shall be
administered only by staff trained in the use of physical restraint holds. No
child or group of children shall be allowed to participate in the physical
restraint of another child.
(i) The
residential child-care facility shall not use physical restraints that will
cause a child harm, given his or her medical condition or any medications that
he or she is taking.
(j) No child
shall be physically restrained utilizing a physical object.
(k) Physical restraint holds shall:
(1) not be used for purposes of discipline or
convenience;
(2) only be used when
there is imminent risk of harm to the child or others and less restrictive
approaches have failed;
(3) be
administered in the least restrictive manner possible to protect the child or
others from imminent risk of harm; and
(4) end when there is no longer any risk of
imminent harm to any party.
(l) A residential child-care facility shall:
(1) ensure that any physical restraint hold
utilized on a child is administered by a trained staff member with a second
trained staff member in attendance. An exception may occur when no other staff
member is present or can be called for assistance. Concurrent with the
administration of a physical restraint hold and for a minimum of 15 minutes
after the termination of the hold, a staff member shall monitor the child's
breathing, ascertain the child is verbally responsive and motorically in
control, and ensure the child remains conscious without any complaints of pain.
If at any time during the administration of a physical restraint hold the child
complains of being unable to breathe or loses motor control, the staff member
administering the physical restraint hold shall terminate the hold or adjust
the position to ensure that the child's breathing and motor control are not
restricted. If at any time it appears to be necessary, a staff member shall
immediately seek medical attention for the child. Following the use of a
physical restraint hold, a staff member shall conduct an interview with the
child about the incident, and the staff administering the physical restraint
hold shall be interviewed by a supervisor about the incident;
(2) document each incident of a child being
subjected to a physical restraint hold on an incident report. This report shall
include the following:
(A) the child's name,
age, height, and weight;
(B) the
type of hold utilized;
(C) the
duration of the hold;
(D) the staff
member administering the hold;
(E)
the staff member witnessing the hold;
(F) the supervisory staff who reviewed the
incident report;
(G) less
restrictive alternatives that were attempted prior to utilizing physical
restraint;
(H) the child's behavior
that necessitated the use of physical restraint;
(I) whether the child's condition
necessitated medical attention;
(J)
planning and debriefing conducted with the child and staff to eliminate or
reduce the probability of reoccurrence; and
(K) the total number of restraints of the
child since admission.
Within 72 hours, supervisory staff shall review the
incident report to ensure that correct steps were followed and shall forward
the report to the parents, guardian, or legal custodian and the licensing
authority on a report developed by the licensing authority. If a child dies as
a result of a physical restraint hold, the residential child-care facility
shall report the death of the child to the parents, guardian or legal custodian
and to the licensing authority within 72 hours;
(3) submit a report to the licensing
authority by the 10th day of each month stating the
number of physical restraint holds used during the previous month on each child
and any injuries that resulted;
(4)
ensure that any physical restraint hold utilized on a child is administered by
a trained staff member who has completed at least 16 hours of training in
behavior management, including techniques for de-escalating problem behavior,
the appropriate use of physical restraint holds, monitoring of the child's
breathing, verbal responsiveness, and motor control. Training shall also
include debriefing children and staff involved in physical restraint holds.
Thereafter, staff authorized to use physical restraint holds shall annually
complete at least eight hours of behavior management training, including
techniques for de-escalating problem behavior. Instructor qualifications and
training requirements include:
(A) instructors
shall demonstrate competence by scoring 100 percent on testing in a training
program aimed at preventing, reducing and eliminating the need for restrictive
interventions;
(B) instructors
shall demonstrate competence by scoring 100 percent on testing in a training
program teaching the use of physical restraint;
(C) instructors shall 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;
(D) the 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;
(E) the content of the instructor training
shall be approved by the Division of Mental Health, Developmental Disabilities
and Substance Abuse Services;
(F)
instructors shall be retrained annually and demonstrate competence in the use
of physical restraints;
(G)
instructors shall be trained in CPR, such as those provided by the American Red
Cross, American Heart Association, or substantially 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;
(H) instructors shall 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 at least once annually; and
(I) instructors shall complete a refresher
instructor training at least every two years;
(5) complete an annual review of the
discipline and behavior management policies and techniques to verify that the
physical restraint holds being utilized are being applied properly and safely.
This review shall be documented and submitted to the licensing authority as
part of the biennial licensing renewal application; and
(6) maintain reports of physical restraint
holds in a manner consistent with the facility's risk management policies
(clinical decisions and activities undertaken to identify, evaluate, and reduce
the risk of injury to clients, staff, and visitors and reduce the risk of loss
to the facility) and make them available to the licensing authority upon
request.
Authority
G.S.
131D-10.5;
143B-153;
Eff. July
1, 1999;
Temporary Amendment Eff. July 20, 1999;
Temporary Amendment Eff. May 15, 2000;
Amended Eff. November 1,
2009; October 1, 2008; April 19, 2001;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. April 5, 2016;
Amended Eff.
October 1, 2017.
