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Emergency restrictive procedures are the least-restrictive procedures possibly used for the briefest time necessary to control severely aggressive or destructive behaviors that place the participant or others in imminent danger and when those behaviors could not have been reasonably anticipated. Emergency restrictive procedures are used only as necessary within the context of positive behavioral programming.
Each time a participant is restrained, a written report must document the details of the incident. This written report must be filed in the participant’s file maintained by the provider. The participant’s interdisciplinary team (IDT) must review each report by the next scheduled monthly team meeting to determine whether modifications to the treatment plan are needed.
The provider may use restraint as an emergency measure only if necessary to protect the participant or others from injury.
The provider's policy must include providing training on the appropriate procedures and techniques for physical restraint to staff members who have direct contact with participants. The procedures must clearly indicate the training required for all staff members at hire and at least annually thereafter.
The use of restraints to control inappropriate behavior:
- must be approved by the IDT, noted in the participants’ s Individualized Program Plan (IPP), and agreed to by the CRS counselor, as indicated by an attendance sheet with the CRS counselor’s and IDT members’ signatures and a short summary reflecting team discussions;
- must be used only as an integral part of the participant's IPP and specifically to reduce and eventually eliminate the behaviors for which the restraint, drugs or both are employed;
- must be monitored by the IDT closely in conjunction with the physician to ensure appropriateness, desired responses and adverse consequences;
- must be justified in that the harmful effects of the behavior clearly outweigh the potentially harmful effects of the restraint; and
- must be part of a developed plan that includes less-restrictive interventions to address behaviors that require more than two physical or chemical restraints in 30 days.
If chemical or physical restraints are used more than twice in 30 days, or more than once in 30 days for minors, the IDT must meet to discuss changing the participant’s treatment to address behaviors that place the participant or others at risk. Changes must be made to treatment approaches, treatment goals and strategies, and behavior management strategies must be developed.
If restraints are required to participate in the program, the IDT must determine whether the program is in the participant’s best interest or whether the participant should be discharged from the program.
The CRS counselor must be notified within 48 hours after restraint is used.
Documentation of the IDT meeting must indicate the modifications made to the treatment plans or treatment approaches. Efficacy of this intervention should be reflected in data and decreasing trends in the use of emergency restrictive procedures.