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IOWA |
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Standard or Definition |
Iowa Code, Chapters 114 &115.
Licensing and Regulation of Comprehensive Residential Facilities for Children
As of June, 2003 |
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Restraint Definition |
"Physical restraint" means direct physical contact required on the part of a staff member to prevent a child from hurting self, others, or property. |
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Restraint Exclusions |
None. |
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Chemical Restraint Definition |
"Chemical restraint" means the use of chemical agents including psychotropic drugs as a form of restraint. The therapeutic use of psychotropic medications as a component of a service plan for a particular child is not considered chemical restraint. |
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Seclusion Definition |
"Secure facility" means any comprehensive residential facility which employs, on a regular basis, locked doors or other physical means to prevent children in care from leaving the facility. Secure facilities may only by used for children who have been adjudicated delinquent or placed pursuant to previsions of Iowa Code chapter 229.
"Nonsecure facility" means any facility which does not meet the definition of a secure facility.
"Control room" means a locked room used for treatment purposes in a comprehensive residential facility.
"Locked cottage" means an occupied comprehensive residential facility or an occupied unit of a comprehensive residential facility which is physically restrictive because of the continual locking of doors to prevent the children in care from leaving the facility. |
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Seclusion Exclusions |
None. |
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Criteria for Restraint and Seclusion |
Physical restraints and a control room are permitted in nonsecure facilities.
Secure facilities may use physical restraints, a control room, locked cottages, mechanical restraints, and chemical restraints.
A facility shall not use, apply, or administer restraint in any manner that causes physical injury.
A facility shall not use restraint as a disciplinary or punitive measure, for staff convenience, or as a substitute for programming.
The use of physical restraint shall be employed only to prevent behavior extremely disruptive to others or to prevent the child from injury to self, to others, or to property.
Mechanical Restraints: Mechanical restraints shall not inflict physical injury. No child shall be kept in mechanical restraint for more than two hours in a 12-hour period. Each child shall be released from mechanical restraint as soon as the restraints are no longer needed. When a child requires mechanical restraint on more than four occasions during any 30-day period, the facility shall hold an immediate emergency meeting to discuss the appropriateness of the child's continued placement at the facility.
Control Room: The control room shall be used only when a less restrictive alternative to quiet to allow the child to gain control has failed and when it is in the care plan. The following policies shall apply to the use of the control room:
- No more than one child shall be in a control room at any time.
- There shall be provisions for visual observation of the child at all times, regardless of the child's position in the room.
- The control room shall be checked thoroughly for safety and the absence of contraband prior to placing the child in the room.
- The child shall be thoroughly checked before placement in the control room and all potentially injurious objects removed including shoes, belts, and pocket items. The staff member placing the child in the control room shall document each check.
- In no case shall all clothing or underwear be removed and the child shall be provided sufficient clothing to meet seasonal needs.
- The child shall remain in the control room longer than one hour only with consultation and approval from the supervisor. Documentation in the child's case record shall include the time in the control room, the reasons for the control, and the reasons for the extension of time. Use of the control room for a total of more than 12 hours in any 24-hour period shall occur only after authorization of the psychiatrist or upon court order. In no case shall a child be in a control room for a period longer than 24 hours.
Locked Cottages: A facility shall be approved by the licensing authority as meeting the requirements of this chapter regarding locked cottages before locked cottages can be operated.
Awake nighttime staff is required in each locked cottage.
When a facility utilizes a locked cottage as one unit of its treatment program, it shall have written policies. The policies shall be provided to the child, the child's parents or guardian, and when the child has an attorney, the child's attorney at the time of admission. The policies shall include:
- The type of behavior which may result in locked cottage placement.
- The staff members who may authorize placement in the locked cottage as well as procedures for notification of supervisory personnel.
- Requirement for documentation in writing of particular behaviors of a particular child that led to the locked cottage placement.
- Requirement for documentation of the conditions that will allow the child to return to an unlocked cottage. These conditions shall be shared with the child.
- Requirement for documentation of the use of the locked cottage as a part of the treatment plan for a specific child.
- Specific policies as to the length of stay in the locked cottage.
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Monitoring Requirements |
Chemical Restraints: The child shall be monitored continuously by a person trained and qualified to observe potentially adverse side effects.
Mechanical Restraints: Any time that a child is placed in mechanical restraint a staff person shall be assigned to monitor the placement with no duties other than to ensure that the child's physical needs are properly met. The staff person shall remain in continuous auditory and visual contact with the child.
Control Room/Seclusion: A staff member shall always be within hearing distance of the control room, the child shall be visually checked by the staff at least every 15 minutes, and each check shall be recorded. |
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Ordering and Initiation |
Chemical Restraints: Each administration of chemical restraint shall be specifically ordered by a physician who has personally examined the child. There shall not be standing orders for the use of chemical restraint. The administrator of a residential facility or a person designated by that officer shall authorize the request for the use of chemical restraint.
Mechanical Restraints: Each use of mechanical restraint shall be authorized by the administrator or case supervisor. Each authorization of mechanical restraint shall not exceed one hour in duration. |
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In-person Assessment |
A secure facility shall continually review any placement of a child in any form of restraint other than physical restraint. The facility shall release the child from restraint immediately when the situation precipitating restraint no longer exists. |
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Debriefing |
No information provided. |
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Family & Guardian Notification |
Restraint: No information provided.
Seclusion: When a facility utilizes a locked cottage…the policies shall include:…Requirements for notification of the child's parents or guardian, the court, and the referring agency of a child's placement in the locked cottage. |
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Notification of Rights and Restraint and Seclusion Policies and Procedures at admission |
In addition to the requirements in 114.9 (4), parents or guardians shall be provided with information on conditions for the use of restraints.
The child's parents or guardian and the referring worker shall be aware of the control room as a part of the treatment program. |
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Training |
A secure facility which uses any form of restraint other than physical restraint shall ensure that all direct service staff are adequately trained in the following areas:
- The appropriate use and application or administration of each approved form of restraint.
- The facility's policies and procedures related to restraint.
- Crisis management techniques.
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Documentation |
Restraint: The rationale and authorization for the use of restraint and staff action and procedures carried out to protect the child's rights and to ensure safety shall be set forth clearly in the child's record by responsible professional staff.
Seclusion: When a facility utilizes a locked cottage…the policies shall include:…Requirement for written documentation of placements in the locked cottage in the child's case record. |
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Reporting |
No information provided. |
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Quality Improvement |
No information provided. |
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