1. Restrictive Procedures Certification 2960.0710 Certification required. A license holder who wishes to use a restrictive procedure with a resident must meet the requirements of this part to be certified to use restrictive procedures with a resident.

2. Restrictive Procedures Plan 2960.0710 Subpart 2 Plan must be approved by DOC or DHS The plan must provide at least the following: A list of the restrictive procedures Description of the physical hold techniques used by the program

3. Restrictive Procedures Plan 2960.0710 Subpart 2 How the license holder will monitor and control the emergency use of restrictive procedures A description of the training that staff must have prior to them implementing the emergency use of restrictive procedures, which includes the following:

4. Restrictive Procedures Plan 2960.0710 Subpart 2C The needs and behaviors of residents Relationship building Alternatives to restrictive procedures De-escalation methods Avoiding power struggles

5. Restrictive Procedures Plan 2060.0710 Subpart 2C Documentation standards for the use of restrictive procedures How to obtain emergency medical assistance Time limits for restrictive procedures Obtaining approval for the use of restrictive procedures

6. Restrictive Procedures Plan 2960.0710 Subpart 2C Requirement for updated training at least every other year The proper use of the restrictive procedures approved for the facility

7. Restrictive Procedures Plan 2960.0710 Subpart 2D Annual written review of the use of restrictive procedures by the license holder The license holder must ensure that the resident receives treatment for any injury caused by the use of restrictive techniques

8. DHS Licensed Facilities 2960.0710 Subpart 3 License holders who are licensed and certified by the Department of Human Services to provide residential treatment for children with a severe emotional disturbance and children in need of shelter care may seek certification to use one or more of the following restrictive procedures:

9. DHS Licensed Facilities 2960.0710 Subpart 3 physical escort; physical holding; seclusion; and the limited use of mechanical restraint only for transporting a resident.

10. DOC Licensed Facilities 2960.0710 Subpart 4 License holders who are licensed by the Department of Corrections may seek certification to use one or more of the following restrictive procedures:

11. DOC Licensed Facilities 2960.0710 Subpart 4 physical escort; physical holding; seclusion; and mechanical restraints.

12. DOC Licensed Facilities 2960.0710 Subpart 4 Disciplinary room time. Disciplinary room time may be secure or non-secure. Disciplinary room time may be used as a consequence for resident behavior as permitted in the facility's restrictive procedures plan. If disciplinary room time is used at the facility, the facility restrictive procedures plan must:

13. DOC Licensed Facilities 2960.0710 Subpart 4 provide for a system of due process for residents who violate facility rules; contain a written set of facility rules of conduct which includes a description of the consequences or penalties for infractions of facility rules; and

14. DOC Licensed Facilities 2960.0710 Subpart 4 require that the written facility rules must be given to each resident and explained and made available to each resident at the time of admission. The facility rules must be explained to a resident in a language that the resident understands.

15. Physical Escort Requirements 2960.0710 Subpart 5 The physical escort of a resident is intended to be a behavior management technique that is minimally intrusive to the resident. It is to be used to control a resident who is being guided to a place where the resident will be safe and to help de-escalate interactions between the resident and others.

16. Physical Escort Requirements 2960.0710 Subpart 5 A license holder who uses physical escort with a resident must meet the following requirements: staff must be trained according to subpart 2, item C;

17. Physical Escort Requirements 2960.0710 Subpart 5 staff must document the use of physical escort and note the technique used, the time of day, and the name of the staff person and resident involved; and the use of physical escort must be consistent with the resident's case plan or treatment plan.

18. Use of Physical Holding or Seclusion 2960.0710 Subpart 6 Physical holding and seclusion are behavior management techniques which are used in emergency situations as a response to imminent danger to the resident or others and when less restrictive interventions are determined to be ineffective. The emergency use of physical holding or seclusion must meet the conditions of items A to M:

19. Use of Physical Holding or Seclusion 2960.0710 Subpart 6 an immediate intervention is necessary to protect the resident or others from physical harm; the physical holding or seclusion used is the least intrusive intervention that will effectively react to the emergency;

20. Use of Physical Holding or Seclusion 2960.0710 Subpart 6 the use of physical holding or seclusion must end when the threat of harm ends; the resident must be constantly and directly observed by staff during the use of physical holding or seclusion;

21. Use of Physical Holding or Seclusion 2960.0710 Subpart 6 the use of physical holding or seclusion must be used under the supervision of a mental health professional or the facility's program director; physical holding and seclusion may be used only as permitted in the resident's treatment plan;

22. Use of Physical Holding or Seclusion 2960.0710 Subpart 6 staff must contact the mental health professional or facility's program director to inform the program director about the use of physical holding or seclusion and to ask for permission to use physical holding or seclusion as soon as it may safely be done, but no later than 30 minutes after initiating the use of physical holding or seclusion;

23. Use of Physical Holding or Seclusion 2960.0710 Subpart 6 before staff uses physical holding or seclusion with a resident, staff must complete the training required in subpart 2 regarding the use of physical holding and seclusion at the facility;

24. Use of Physical Holding or Seclusion 2960.0710 Subpart 6 when the need for the use of physical holding or seclusion ends, the resident must be assessed to determine if the resident can safely be returned to the ongoing activities at the facility;

25. Use of Physical Holding or Seclusion Staff must treat the resident with respect Staff who implemented the physical holding or seclusion must document its use immediately after the incident concludes Documentation must include: –Detailed description of the incident –Why the procedure chosen needed to be used

26. Use of Physical Holding or Seclusion –Why less restrictive measures failed or were found to be inappropriate –The time the physical hold began & ended –Document within 15 minutes intervals the residents behavioral change and any change in physical status that may result from the use of the procedure –Names of all persons and witnesses involved

27. Use of Physical Holding or Seclusion Any room used for seclusion must be: –Well lighted –Well ventilated –Clean –Have an observation window which allows direct monitoring of a resident –Fixtures that are tamperproof –Electrical switches located outside the door

28. Use of Physical Holding or Seclusion –Doors that open out and are unlocked or; –Are locked with keyless locks and have immediate release mechanisms. Objects that may cause injury must be removed from the resident and the room before a resident is placed for seclusion.

29. Use of Mechanical Restraints A behavioral management device used only when: –transporting a resident –in an emergency as a response to imminent danger to a resident or others Used only when less restrictive interventions are ineffective

30. Use of Mechanical Restraints A facility must include mechanical restraints as part of their restrictive procedures plan The use of mechanical restraints must meet the following conditions: –Necessary to protect resident or others from harm –The least intrusive intervention to react to emergency

31. Use of Mechanical Restraints –The mechanical restraint must end when the threat of harm ends –The resident must be constantly and directly observed by staff during the use –Use of the mechanical restraint must be approved by the Program Director or a designee –May only be used as permitted in the residents treatment plan

32. Use of Mechanical Restraints –As soon as it may be safely done, but no later than 60 minutes after initiating use of a mechanical restraint, staff must contact the Program Director or designee to inform them about the use of the mechanical restraint and to ask permission to use the mechanical restraint –Prior to using a mechanical restraint, staff must have training in the use and types of mechanical restraints used at the facility

33. Use of Mechanical Restraints –When the need for the restraint ends, the resident must be accessed to determine if the resident can be safely returned to the ongoing activities at the facility –The staff person(s) involved must document the use of the restraint immediately after the incident concludes

34. Use of Mechanical Restraints The documentation must include: –Detailed description of the incident –Why the restraint was needed to prevent an immediate threat –Why less restrictive measures failed or were found to be inappropriate –The time the restraint began and ended

35. Use of Mechanical Restraints –Document within 15 minutes intervals the residents behavioral change and any change in physical status that may result from the use of the restraint –Names of all persons and witnesses involved in the use of the restraint

36. DOC-Disciplinary Room Time Use Disciplinary room time must be used only for major violations and be used according to the facility's restrictive procedures plan.

37. Disciplinary Room Time Use The license holder must also meet the following requirements to use DRT: –Staff give the resident written notice of the alleged violation of rule –Resident must be advised of their right to be heard by an impartial party –Resident must be advised of the right to an appeal the determination of the impartial party to a higher authority

38. Physical Holding or Seclusion- Additional Staff Training Staff must also have the following training: –documentation standards for physical holding and seclusion; –thresholds for employing physical holding or seclusion; –the physiological and psychological impact of physical holding and seclusion;

39. Physical Holding or Seclusion- Additional Staff Training –how to monitor and respond to the resident's physical signs of distress; –symptoms and interventions for positional asphyxia; and –time limits and procedures for obtaining approval of the use of physical holding and seclusion. * Training must be updated every two years

40. Administrative Review License holder must complete administrative review of any use of a restrictive procedure within three (3) days after its use. The review must be completed by someone other than the person who decided to use the restrictive technique or their immediate Supervisor.

41. Administrative Review The resident and their representative must have the opportunity to present evidence/argument about the procedure. The record of the review of the restrictive procedure must include: –Required documentation was recorded –Restrictive procedure was used per the treatment plan

42. Administrative Review –Standards related to the restrictive procedure were met –Staff was properly trained in the use of the restrictive procedure

43. Review Patterns of Use Quarterly the license holder must review patterns of the use of restrictive procedures The review must be done by the license holder or the facility advisory committee –The review must consider: Any patterns or problems in the use Any injuries Actions needed to correct deficiencies in the implementation of RT

44. Review Patterns of Use Actions needed to correct deficiencies in the programs implementation of RT An assessment of opportunities missed to avoid the use of RT Proposed actions to be taken to minimize the use of RT