W. Va. Code R. § 78-3-15

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 78-3-15 - Restrictive Behavioral Interventions

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.

W. Va. Code R. § 78-3-15