(a) An emergency safety intervention is allowable only when unanticipated child behavior places the child or others at serious threat of violence or injury if no intervention occurs.
(b) Allowable emergency safety interventions include physical restraint and/or seclusion.
(c) Prohibited Emergency Safety Interventions. The following emergency safety interventions are prohibited: - (i) Aversive conditioning, which means the application of startling, painful or noxious stimuli (e.g., pepper spray);
- (ii) Use of pressure point techniques, which means the application of pain for the purpose of achieving compliance;
- (iii) Chemical restraint, which means a drug used to control acute, episodic behavior that restricts the movement or function of a child; and
- (iv) Use of mechanical restraints, except in Juvenile Detention programs.
(d) Physical/Manual Restraint. - (i) The purpose of physical restraint shall be to provide only that degree of physical control that the child is unwilling or unable to provide for him or herself and to prevent physical harm to self or others;
- (ii) The following precautions must be observed at all times:
- (A) The organization shall ensure that a child is released from a restraint as soon as the child gains control; and
- (B) An organization shall not permit the application of a restraint if a child has a documented physical or mental condition that would contraindicate its use, unless a licensed physician or licensed mental health professional has previously and specifically authorized its use in writing. Such documentation shall be maintained in the child's file.
- (iii) Policy and Procedure. Each program choosing to use physical restraint shall have a written physical restraint policy. The written policy shall include at a minimum the following information:
- (A) The name of the nationally certified or accredited program which provided or provides the physical restraint training for staff members prior to restraining a child. Such program shall be approved by the certifying authority prior to implementation;
- (B) Which staff members and foster parents shall be approved by the organization to use physical restraint with children in care;
- (C) The type and number of hours of ongoing training each staff member and foster parent shall be required to take;
- (D) What and how the preventive/de-escalation techniques and positive behavioral intervention shall be used by staff prior to any physical restraint;
- (E) How the program observes and evaluates the use of physical restraint on a child at the facility or foster home including evaluation of appropriateness and effectiveness of preventive/de-escalation techniques on each physical restraint;
- (F) The type of written documentation the facility and foster parent maintains of each physical restraint that describes the details of the incident and the staff and foster parent involvement;
- (G) The type of written documentation the facility and foster parent maintains that describes the debriefing with the child and staff and foster parent following the restraint;
- (H) The requirement that staff and foster parent not restrain children in areas of the facility/home that may pose a threat to the health and safety of the child including, but not limited to, soft, pliable surfaces, concrete, asphalt or areas which may result in broken glass;
- (I) How the program monitors the physical well-being of the child during and after the restraint, including but not limited to breathing, pulse, color, and signs of choking or respiratory distress;
- (J) Emergency procedures, including first aid and how medical personnel will be contacted, that shall be used if a child, staff member and foster parent is injured during a restraint; and
- (K) The internal review process of the program to assess all injuries.
- (iv) Restraint Training. If the organization is using physical restraint, all staff and foster parents using physical restraint shall be oriented and trained in a nationally recognized program for appropriate behavioral intervention procedures which shall include:
- (A) Participation in annual, ongoing training that concludes with successful completion of a mandated competency test;
- (B) Periodic observation of each staff member performing a physical restraint must be done by a supervisor of the facility who has been trained in restraint; and
- (C) If a supervisor of the facility or designee determines a staff member did not correctly perform a physical restraint or performed an inappropriate or unnecessary physical restraint, the staff member must be immediately retrained and be restricted from performing further restraints until retraining can occur.
- (v) Notification of Physical Restraint Usage.
- (A) At the time of admission to the program, the child, child's parent and/or legal guardian, shall be told, in a language or manner of communication understandable to him/her, of the purpose of restraint, the restraint model/method used and the type of behavior that might result in the child being restrained; and
- (B) All use of physical restraint of a child must be reported to the parent/legal guardian and reported in writing to the certifying authority within two (2) working days following occurrence.
- (vi) Charting Restraint Incidents. The following information must be included in the documentation:
- (A) The name of the child, date and time of day, staff members and foster parent involved, his/her position at the facility, his/her involvement in the physical restraint, how long the restraint lasted, and the signature of the reporter and date and time of the documentation;
- (B) The precipitating incident(s) and the child's behavior before the restraint occurred;
- (C) What specific actions were taken to de-escalate the situation and control, calm, or contain the child and the effect of these de-escalating actions upon the child;
- (D) A description of the debriefing and evaluation with the child and with the staff and foster parent; and
- (E) The child's physical and emotional/behavioral condition prior to, during, and following the restraint.
- (vii) Debriefing. Following every restraint, a face-to-face discussion between staff and/or foster parent(s) involved in the intervention and the child shall take place in order to:
- (A) Minimize the psychological harm inherent in the use of restraints;
- (B) Help staff, foster parent and child plan for alternative interventions to reduce the need for restraints in the future; and
- (C) Encourage culture change among facility staff and foster parent.
- (viii) Review of Restraint. A supervisor or licensed mental health professional, of the organization, shall review each physical restraint within 48 hours of each restraint if:
- (A) It appears that the child is being physically restrained one (1) or more times per day for more than four (4) days, the child's ITPC must be reviewed by the certifying authority;
- (B) Any particular de-escalation technique appears to be causing escalation in the behavior of a child or a group of children, the use of the technique shall be evaluated for its effectiveness. De-escalation techniques that are not effective or are counter-productive must be terminated at the earliest opportunity; or
- (C) A staff member and foster parent appears to be involved in a larger number of physical restraints than other staff members and foster parents and is not a part of a specially trained team, or is unsuccessful at using de-escalation effectively, the program administrator/executive director must conduct a thorough review of the staff member's and foster parent's interactions with children, prior restraint training, and need for further training as required by organization policies.
(e) Seclusion refers to the involuntary confinement of a child alone in a room where the child is physically prevented from leaving when all other reasonable means to control or calm the child have failed; - (i) A Seclusion Room is a safe and secure individual room in which a child, who is beyond control and a danger to himself/herself or others, may be temporarily confined;
- (ii) Seclusion Policy and Procedures:
- (A) The facility shall have written policies and procedures for dealing with children who are temporarily beyond control and are a danger to themselves or others. These shall include identifying, developing, and promoting preventive strategies and the use of safe and effective alternatives to using the Seclusion Room;
- (B) When the Seclusion Room is used, a written statement of purpose, organization policy or operational procedures shall include the following:
- (I) The philosophy and use of the room;
- (III) The evaluation of the child while in the room;
- (IV) Emergency procedure while in seclusion;
- (V) Child's grievance procedure regarding the use of the room; and
- (VI) Release from the Seclusion Room.
- (C) Use of the Seclusion Room is expressly prohibited as a means of dealing with non-violent or non-assaultive behaviors.
- (iii) If a child is placed in the Seclusion Room more than three (3) times in a seventy-two (72) hour period (or a maximum of six [6] hours in a seventy-two [72] hour period), the ITPC for the child shall be reviewed and revisions made if necessary.
- (iv) Time Limits. Time limits are as follows:
- (A) One (1) hour for children nine (9) years of age and under; and
- (B) Two (2) hours for children ten (10) years of age and above.
- (v) Staff Requirements.
- (A) There shall be a Seclusion Room supervisor who is designated and trained to be responsible for the use of the Seclusion Room;
- (B) The supervisor shall be either a full-time staff member or a licensed mental health professional;
- (C) If the Seclusion Room supervisor is not a licensed mental health professional, there shall be a contract with a licensed mental health professional to provide consultation with the Seclusion Room supervisor and staff; and
- (D) A staff member shall be present when a child is placed inside the room and shall have constant visual contact with the child.
- (vi) The facility that operates a Seclusion Room shall appoint a review team, which includes a neutral observer.
- (A) The neutral observer may be a staff member of the facility or human services professional;
- (B) The neutral observer shall not be the Seclusion Room supervisor or the person who placed the child in the Seclusion Room;
- (C) The review team shall determine within seventy-two (72) hours if the situation resulting in the seclusion of a child in a Seclusion Room merited such a decision; and
- (vii) The facility shall identify staff members, who have ongoing training and supervision in the area of seclusion policy and procedures, authorized to place a child in the Seclusion Room within its statement of Seclusion Room policy. Authorized staff shall be employed as:
- (A) Administrator/Executive Director;
- (C) Licensed, provisionally licensed and/or certified mental health professional; or
- (viii) Authorization.
- (A) At the time of admission of the child to the facility, the child's parent or legal guardian shall be informed of the use of the Seclusion Room and the circumstances under which it will be employed and a written consent must be obtained from the child's parent or legal guardian authorizing the use of the Seclusion Room;
- (B) If the consent form is unsigned, the child may not be placed in a Seclusion Room and an alternative plan shall be developed; and
- (C) Prior to the placement of the child in the Seclusion Room, the child shall be oriented, in a language or manner of communication understandable to him/her, to the room regarding the purpose of its use and the type of behavior that might result in its use and the child shall sign a statement indicating such orientation was complete.
- (ix) At the time of placement of the child in the Seclusion Room all articles of potential harm to the child (e.g., sharp objects, belt) shall be removed from his/her person.
- (x) Documentation.
- (A) Each incident of seclusion shall be documented. The following information must be included:
- (III) Name of the staff member;
- (IV) The staff member who was notified of the placement;
- (V) The precipitating incident and the child's behavior before placement in the room;
- (VI) Actions taken by staff members of a less restrictive nature to try to control, calm, or contain the child;
- (VII) Observable physical and emotional/behavioral condition of the child when entering the Seclusion Room; and
- (VIII) The child shall be in constant visual contact of direct care staff. At least every fifteen (15) minutes there shall be documentation which shall include the time and a description of what the child was doing;
- (IX) When the child was last given access to restroom facilities;
- (X) When and what type of medications were given and by whom, if applicable;
- (XI) When the child's last staff contact occurred; and
- (XII) Initials of the person supervising.
- (B) The resolution process shall be documented as follows:
- (I) Description of the resolution between staff members and the child at the termination of the use of the room and process used in assisting the child to reenter the group; and
- (II) The observable physical and emotional/behavioral condition of the child after leaving the Seclusion Room including attitude, affect and emotional intensity;
- (C) The review team report shall include:
- (I) Record of persons on the review team;
- (II) Conclusions as to the appropriateness of placing the child in the Seclusion Room;
- (III) The record review process; and
- (IV) The identification of issues that need to be addressed, and how they will be assessed and evaluated.
- (D) The record of the use of the Seclusion Room shall be reviewed daily by the Seclusion Room supervisor.
- (E) The record of the use of the Seclusion Room shall be reviewed weekly by the facility administrator.
- (xi) Physical Requirements for a Seclusion Room.
- (A) The Seclusion Room shall be located in reasonable proximity to the living unit or other areas of activity;
- (B) The Seclusion Room shall be a minimum of eight (80) square feet in size;
- (C) The Seclusion Room shall be kept in a clean and sanitary condition;
- (D) All switches for light, heat and ventilation, as well as other electrical outlets, shall be outside the room and shall be accessible only to staff;
- (E) There shall be no features by which a child might injure him or herself within the Seclusion Room (e.g., utility pipes, sprinkler system, cleaning equipment and materials, mirrors);
- (F) Exterior windows to the outside of the building are not recommended. If the Seclusion Room does have exterior windows, the window panes shall be of shatter resistant material and have psychiatric screening;
- (G) There shall be an observation window from which all parts of the room are visible for purposes of supervision;
- (H) The windows shall be made of non-breakable, shatter-resistant materials and the facility shall document maintenance by a professional;
- (I) There shall be an approved ventilation system;
- (J) The Seclusion Room shall be constructed to meet all appropriate fire regulations;
- (K) The child shall not be subjected to glaring lights and all lights shall be recessed into the ceiling and covered with a non breakable, shatter resistant guard that is flush with the ceiling;
- (L) There shall be no more than one (1) locked door between the child and the staff member, unless a mechanism for supportive monitoring is in place; and
- (M) If the Seclusion Room is soundproof, there must be an intercom system that is activated when a child is in the room.
- (xii) Approvals Necessary to Operate the Seclusion Room.
- (A) It is the responsibility of the facility to provide the certifying authority with the written approval of the fire official prior to the initial use of the Seclusion Room;
- (B) The certifying authority must approve the Seclusion Room prior to the initial use of the room;
- (C) If it is found at the time of inspection of the Seclusion Room that the facility does not meet all the regulations for operation of the room, the following will occur:
- (I) The certifying authority shall give written notice of specific deficiencies to be corrected; and
- (II) The facility shall cease confining any child in the Seclusion Room until corrections are completed and authorization is given by the certifying authority.
049-3 Wyo. Code R. § 3-25