Current through Reg. 50, No. 13; March 28, 2025
(a) The IDT must
develop and implement person-centered proactive supports, training, and
treatment with the goal of making the use of restraints unnecessary.
(b) When evidence indicates that the
individual's behaviors result in a behavioral crisis or sustained self-injury
or make it difficult to provide needed medical or dental care, the IDT,
including the individual and LAR, with the involvement of a PCP and other
relevant professional staff, must assess and identify any issues or
contraindications for the use of restraint, including:
(1) any physical, behavioral, psychiatric, or
medical conditions that constitute a risk; and
(2) any considerations in the use of
restraint due to the individual's communication level, cognitive functioning
level, height, weight, emotional condition (including whether the individual
has a history of having been physically or sexually abused), and age.
(c) The IDT must ensure that a PCP
reviews and updates, as necessary in response to changes in condition and at
IDT meetings, but at least annually, any conditions, factors, or limitations on
specific physical techniques, drugs, or mechanical devices used for
restraint.
(d) For individuals
participating in a program outside the facility, the IDT must coordinate with
staff from the outside program to assess and develop interventions consistent
with the ISP and any action plans and invite staff from the outside program to
participate in IDT meetings at which interventions are discussed.
(e) An ISP action plan must:
(1) be developed to decrease and ultimately
eliminate the use of restraint for the individual, with consideration of
protection from harm and safety issues;
(2) include an interdisciplinary analysis
that identifies the circumstances that contribute to causing the dangerous
behaviors that result in the use of restraint;
(3) identify actions, data collection, and
the responsible persons for implementing the actions;
(4) address a broad range of changes, which
may include changing living arrangements, implementing calming procedures, and
incorporating preferences in programs;
(5) include a PBSP and other therapeutic
plans, as applicable; and
(6)
contain individualized instructions to direct support professionals in the safe
and effective use of restraint procedures.
(f) A facility must develop or revise an
interdisciplinary ISP action plan in response to significant events, including
but not limited to, the following:
(1) more
than three behavioral crises in a 30-day rolling period have required the use
of restraints;
(2) restraint use
has not decreased over time and may be likely to continue at a stable rate
unless an action plan is developed;
(3) the individual's characteristics require
that standard restraint procedures be adapted to meet his or her
needs;
(4) a pattern of injuries to
the individual or others is observed as restraint procedures are carried
out;
(5) an individual has
sustained, self-injurious behavior, and supervision and treatment have not been
successful in reducing harm; or
(6)
an individual's behavior is presenting a risk to medical or dental treatment or
to healing.
(g) A
facility must develop and implement an ISP action plan by:
(1) reviewing the individual's relevant
adaptive skills and biological, medical, and psychosocial factors;
(2) reviewing possible contributing
environmental conditions;
(3)
completing or revising structural and functional assessments of the behavior
leading to use of restraint;
(4)
developing or revising a PBSP based on the structural and functional
assessments of the behavior leading to the use of restraint that identifies the
individual's particular strengths, specifies the behavior to be addressed,
prescribes alternative, positive adaptive behaviors to be taught or
strengthened to replace the dangerous behavior that requires the use of
restraint, and describes prevention procedures to be followed as the
individual's behavior indicates an escalation of behaviors that are dangerous
and likely to result in restraint;
(5) as applicable, developing or revising
other programs to reduce or eliminate the use of restraint that are not part of
the PBSP, such as treatment or strategies to minimize or eliminate the need for
medical restraints;
(6) as
applicable, developing or revising a crisis intervention plan or medical
restraint plan, including staff instructions on how to safely and appropriately
use a recommended restraint procedure with a specific individual, any changes
in the type of restraint used, the maximum duration of the restraint, and the
criteria for terminating the restraint;
(7) as applicable, developing or revising a
protective mechanical restraint plan for self-injurious behavior, including
procedures for gradually increasing the time the individual is able to stay
safe but not be in restraints and any changes in the type of restraint used;
and
(8) specifying the persons
responsible for activities, including obtaining legally adequate consent from
the individual or LAR before implementing the plan, providing required staff
training, monitoring activities, evaluating effectiveness, and ensuring any
necessary reviews by the Human Rights Committee.
(h) The IDT must review, assess, and revise
an ISP action plan at least annually and more frequently as necessary. The IDT
must review, at least quarterly and more frequently as necessary, an individual
who was restrained for a behavioral crisis or for whom medical restraint was
used. The IDT must review a protective mechanical restraint plan for
self-injurious behavior at least monthly and more frequently as
necessary.
(i) The IDT may consult
with a facility discipline director, state office discipline coordinator, or
outside consultant to explore alternative treatment strategies.
