West Virginia Code of State Rules
Agency 78 - Human Services
Title 78 - LEGISLATIVE RULE DEPARTMENT OF HUMAN SERVICES BUREAU FOR SOCIAL SERVICES
Series 78-03 - Minimum Licensing Requirements for Residential Child Care and Treatment Facilities for Children and Transitioning Adults and Vulnerable and Transitioning Youth Group Homes and Programs in West Virginia
Section 78-3-15 - Restrictive Behavioral Interventions
Universal Citation: 78 WV Code of State Rules 78-3-15
Current through Register Vol. XLI, No. 38, September 20, 2024
15.1. Legal Compliance.
15.1.1. Restrictive behavior
management techniques include restraint (physical, mechanical, or chemical) and
seclusion. The organization shall have a policy with specific procedures to
govern the use of these techniques. The policy shall delineate the
circumstances under which these techniques may be used and shall describe which
techniques may be used in precise language. Unless indicated otherwise in this
rule, restraints are to be used only in an emergency when there is imminent
risk of the child physically harming himself or herself or others, including
employees. Non-physical interventions are the first choice as an intervention
unless safety issues demand an immediate physical response. Restrictive
behavior management techniques are not to be used as a part of an approved plan
of care.
15.1.2. Group restraints
incorporating peers as restrainers or observers are prohibited in any treatment
environment.
15.1.3. Seclusion,
chemical and mechanical restraints shall be used only in facilities with
explicit permission to do so as described in this rule (i.e. psychiatric
residential treatment facilities and intermediate care facilities).
15.2. General Guidelines.
15.2.1. Restrictive behavior management
techniques shall be used only in emergency situations to protect individuals
from harming themselves or others and not as part of an on-going plan of
care.
15.2.2. Use of the techniques
shall conform to federal guidelines unless the guidelines are less stringent
than those described in this rule.
15.2.3. The organization shall maintain
comprehensive data on the use of any restrictive behavior management practices,
collected individually for each organization or program it manages, and shall
summarize and review that data quarterly. An annual report shall be made to the
governing body by the safety committee or officer.
15.2.4. At admission, each child shall be
assessed for his or her potential need for use of restrictive behavior
management interventions. The assessment shall include:
15.2.4.a. The potential for risk of harm to
himself, herself, or others;
15.2.4.b. Antecedents (if known) to out of
control behavior;
15.2.4.c.
Effectiveness (if known) of previous use of these interventions;
15.2.4.d. Psychological or social factors
such as psychosis, claustrophobia or; a history of sexual or physical abuse
that would influence the use of the practices; and
15.2.4.e. Medical factors that might put the
person at risk in a restraint.
15.2.5. If the child is judged likely to
require the use of restrictive behavior management techniques, employees shall
be alerted to any considerations identified in the assessment and trained
appropriately.
15.2.6. The
organization shall ensure and document that the parent or legal guardian:
15.2.6.a. Received notification in writing at
the time of admission that these interventions are used by the
organization;
15.2.6.b. Received a
copy of the behavior management protocol; and
15.2.6.c. Was notified immediately if a
restraint was used unless the guardian has requested otherwise.
15.2.7. The organization shall
prohibit the following:
15.2.7.a. Use of
restrictive behavior management techniques in non-crisis or emergency
situations, as a form of coercion or discipline, or for the convenience of
employees;
15.2.7.b. Excessive or
inappropriate use of restrictive behavior management techniques; and
15.2.7.c. The application of restrictive
behavior management interventions by other persons served or any person other
than trained, qualified employees.
15.2.8. The condition of the restrained or
secluded person shall be monitored. Consciousness, respiration, agitation,
mental status, skin color and skin integrity should be monitored
continuously.
15.2.9. Employees
identified as medical professionals should have the authority to prevent a
specific intervention based on health issues.
15.2.10. Properly trained employees should
have the authority to stop a specific behavioral intervention based on health
issues.
15.2.11. The employee shall
discontinue restrictive behavior management interventions immediately if they
produce adverse side effects such as illness, severe emotional or physical
stress or physical damage and obtain immediate medical treatment for the
child.
15.3. Training.
15.3.1. All employees with direct contact
with children shall receive documented training in the organization's
restrictive behavior management practices.
15.3.2. All direct care, supervisory and
clinical employees shall receive initial and ongoing competency-based training
on the organization's restrictive behavior management policies, procedures, and
practices appropriate for the type of program.
15.3.3. The training shall include:
15.3.3.a. Recognizing situations, including
medical conditions that may lead to a crisis;
15.3.3.b. Recognizing unique situations that
preclude the use of restraints (medical issues, sexual reactivity,
etc.);
15.3.3.c. Understanding how
employee behavior can influence the behavior of persons served; and
15.3.3.d. Using appropriate methods for
de-escalating volatile situations, including verbal techniques, mediation,
distraction and diversion and other non-restrictive ways of dealing with
aggressive or out of control behavior.
15.4. Physical Restraint.
15.4.1. Written procedures shall govern the
use of physical restraint. They shall specify that:
15.4.1.a. Physical restraint may be used only
in emergency or crisis situations to protect individuals from harming
themselves or others;
15.4.1.b.
Employees shall use the least restrictive, safest, and most effective methods
generally accepted in the field;
15.4.1.c. Physical restraint may be used in
each instance only when less restrictive measures have proven to be ineffective
or in an immediately dangerous situation that precludes the use of other
interventions;
15.4.1.d. The
decision to use physical restraint shall take into account an analysis that
determines that the risk of the individual's behavior to himself, herself or
others outweighs the potential risk of the use of physical restraint. This
analysis shall be documented as soon as possible after the use of the
restraint;
15.4.1.e. Physical
restraint shall be discontinued as soon as possible;
15.4.1.f. All direct service employees shall
have access to a copy of written policies and procedures regarding the
appropriate and limited use of physical restraint;
15.4.1.g. A continuing monitoring system
shall be kept documenting the names of employees restraining children, the
names or identifiers for children restrained, the date and the time of
restraint, other individuals involved, the circumstances and reasons for
physical restraint, the amount of time the child is restrained, less
restrictive measure utilized, and documentation of supervisory review and
clinical justification;
15.4.1.h.
Use of physical restraint shall be documented in the person's case
record;
15.4.1.i. Use of a physical
restraint shall result in completion of a report;
15.4.1.j. Significant injuries occurring
during a physical restraint shall be reported to the Institutional
Investigative Unit under mandatory reporting requirements; and
15.4.1.k. The organization shall have
documentation of notification of the parent or guardian unless he or she
indicates in writing that he or she does not wish the notification or unless
the parent or guardian has specified parameters for notification (i.e., in case
of injury during restraint).
15.4.2. The organization shall have
designated staff who shall review each incident of physical restraint no later
than one working day after its use.
15.4.3. Physical restraint may not be used:
15.4.3.a. To force a child into
compliance;
15.4.3.b. In response
to cursing or screaming;
15.4.3.c.
For refusal to participate in an activity; or
15.4.3.d. For failure to join a group
activity.
15.4.4. The
use of physical restraints shall be discontinued as soon as possible and shall
be limited to guidelines of the crisis intervention model the organization
follows and state and federal law.
15.4.5. Employees shall make periodic
attempts to free the child during the period in which the restraint is
employed.
15.4.6. If the restraint
extends longer than recommended guidelines, the organization shall document the
reason for the extended restraint and describe action taken to prevent further
use of extended physical restraint.
15.4.7. Following each instance of physical
restraint, a meeting shall be held within 24 hours that includes the
appropriate employees (the employees restraining children and supervisory
employees) and the person restrained (if developmentally and clinically
appropriate) to:
15.4.7.a. Evaluate the
well-being of the person served and identify the need for counseling or other
services related to the incident;
15.4.7.b. Identify antecedent behaviors and
modify the care plan as appropriate; and
15.4.7.c. Analyze how the incident was
handled.
15.4.8.
Employees and designated supervisory employees shall discuss necessary changes
to procedures or employee training, or both, in order to preclude further
restraints to the maximum extent possible. Recommendations shall be
documented.
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