Current through December 3, 2024
Section 214-RICR-60-00-1.22 - Use of RestraintA. Restraint is used only when transporting residents on or off grounds, when a resident's actions demonstrate that he or she is a danger to self or others and no other intervention has been or is likely to be effective in averting danger, or if a resident is engaging in significant destruction of state property. 1. Staff utilize the least restrictive method of restraint consistent with resident and community safety.2. A physical restraint is a behavior management technique involving the use of physical intervention as a means of restricting a resident's freedom of movement. Physical restraint may include: a. Providing a resident with a physical escort. A physical escort is touching or holding of the hand, wrist, arm, shoulder or back for the purpose of inducing an acting out resident to walk to a safer location.b. Holding resident in a standing, seated or horizontal position.3. Handcuffs, leg irons and hobblers are mechanical restraints used to temporarily control behavior. a. Residents are never handcuffed or shackled to any fixed or stationary object on or off Training School grounds.B. Transporting Residents 1. Mechanical restraints are used in movement of residents between the Training School's facilities and when necessary in transporting residents off grounds.2. Residents with special needs include, but are not limited to, females who are pregnant or residents whose physical mobility is compromised.a. The Training School limits the use of mechanical restraints on pregnant and postpartum girls to circumstances where the girl is a danger to herself or others or a flight risk and cannot reasonably be contained by other means. Post-partum is defined as:(1) The period immediately following delivery, as determined by the attending physician, including the entire period of hospitalization and(2) Up to seventy-two (72) hours after the birth whether or not the girl is hospitalized.b. Belly/waist chains and/or mechanical restraints of the leg or ankle are not utilized with pregnant or post-partum girls.c. When mechanical restraints are utilized with a pregnant or post-partum girl:(1) If a qualified medical provider requests the removal of restraints for emergency medical care, Training School staff comply and notify the Superintendent or Administrator on Call as soon as possible.(2) In other circumstances, if a qualified medical provider requests the removal of mechanical restraints, Training School staff request permission to seek guidance from the Superintendent or Administrator on Call. If the qualified medical provider states that the mechanical restraints must be removed immediately, Training School staff comply and notify the Superintendent or Administrator on Call as soon as possible.d. Girls are notified upon admission to the Training School and when known to be pregnant of this policy regarding the use of mechanical restraints during pregnancy and in the post-partum period.3. Mechanical restraints are applied within the building when residents are to be transported out of the building.4. When moving groups, staff may handcuff residents in pairs or in a chain-like line manner.5. When transported in a vehicle on a secure status on or off grounds, residents are handcuffed in front of the body for safety.6. Mechanical restraints are not unlocked, loosened or removed by staff or residents in a vehicle or a busette, unless it is determined that there is an imminent risk to resident safety.C. Use of Restraint in Crisis Intervention1. No resident is restrained for the purpose of punishment, discipline, convenience or retaliation by staff.2. Staff utilize de-escalation strategies described in pre-service and in-service training to defuse a volatile situation, assist a resident to regain behavioral control and avoid a physical restraint.3. Staff attempt verbal counseling, level system sanctions and direct warnings before resorting to a physical escort or restraint.4. If interventions described in §§ 1.18(C)(2) and (3) of this Part above are not effective, staff may utilize a physical escort to move a non-compliant resident to a different location for the safety of the resident and the facility. a. A safer location includes, but is not limited to, the resident's room or a location away from the general population.5. The interventions described in §§ 1.18(C)(2) through (4) of this Part are not utilized when a resident attacks another person suddenly and/or without warning and/or presents an imminent danger to self or others and/or attempts to escape.6. When circumstances allow, staff notify the Master Control Center of a situation that may require a resident to be restrained to ensure that a proper response can be developed and supported. In all cases, the Master Control Center is notified as soon as possible upon the use of a restraint.7. When circumstances allow, staff remove other residents, potential weapons and other hazards from the area where a resident seems likely to be restrained.8. The physical condition of a resident who is being restrained is monitored continuously by staff and this monitoring is documented in the Unit Log Book.9. Staff may not position or hold the resident in a manner which restricts breathing. Staff immediately release a resident who exhibits any sign of significant physical distress, such as difficulty breathing during restraint and provide the resident with immediate medical assistance.10. The clinic is notified and the resident is examined by a nurse as soon as practical after any restraint.11. The resident is released from restraint at the earliest possible time that he/she can commit to safety and no longer poses a threat to self or others.12. In instances involving resident and/or staff injury, medical personnel are notified immediately.13. The physical condition of a resident who is being mechanically restrained is monitored continuously by staff.14. Staff escort the resident to his/her room or to another safe area before releasing him/her from mechanical restraints. If the resident has not been released from mechanical restraint within fifteen (15) minutes, the Administrator on Call is contacted. a. The Administrator on Call approves all uses of mechanical restraint exceeding fifteen (15) minutes in length.b. Staff reassess the need for mechanical restraint every fifteen (15) minutes for the purpose of timely removal and documents this assessment through the filing of an Incident Physical Restraint Report.15. If a resident is injured during a restraint, his/her parents are notified.16. Staff document the use of physical or mechanical restraints in the Unit Log Book and on the Incident Physical Restraint Report.D. Suicide prevention and Special Watches1. The use of isolation, mechanical restraints, suicide gowns and or blankets, or removal of normal items of clothing and bedding are avoided and must be ordered by the mental health clinician evaluating the resident.214 R.I. Code R. 214-RICR-60-00-1.22