Standard or Definition

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KENTUCKY

Standard or Definition 922 KAR 1:390. Standards for residential child-caring facilities
As of March 2003

Restraint Definition "Therapeutic hold" means a technique used by a specially-trained staff member for the purpose of restricting a child's freedom of movement, in order to maintain a safe environment for the child and others.

Restraint Exclusions
Mechanical restraint is prohibited.

Chemical Restraint Definition "Chemical restraint" means a drug used as a restraint that is a medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychiatric condition.

Seclusion Definition "Seclusion" means the temporary placement of a child in a room in a residential treatment facility to prevent harm to the child or others.

Seclusion Exclusions
When seclusion is used, a residential child-caring facility shall:

1. Before a child is placed in seclusion, develop and maintain clearly-written policy and procedures governing the placement of a child in seclusion, including a requirement for a de-escalation plan in the child’s ITP;

2. Provide a copy of the policy and procedures to staff members responsible for placement of a child into seclusion.

Criteria for Restraint and Seclusion
·         Unless there is imminent danger to staff, child, or an adult member of a family, physical restraint shall not be used.

·         Seclusion shall be used only in an emergency or crisis situation when:

1. A child is in danger of harming himself or another; and

2. The effort made to de-escalate the child's behavior prior to placement was ineffective.

·         Seclusion shall not be used for:

1. Punishment;

2. Discipline; or

3. Convenience of staff.

·         Within a twenty-four (24) hour period of time, the maximum amount of time that a child remains in latched seclusion shall not exceed the following:

1. Age nine (9) and younger, fifteen (15) minutes; and

2. Age ten (10) and older, one (1) hour.

Monitoring Requirements A staff member shall observe visually a child who is in seclusion every five (5) minutes.

Ordering and Initiation Approval from the treatment director or treatment staff designee as established in 922 KAR 1:300, Section 3, shall be obtained prior to or within fifteen (15) minutes of the placement of a child in seclusion.

In-person Assessment See “Training”.

Debriefing
·         If a child requires repeated placement in seclusion, a treatment team meeting shall be conducted by the treatment director to reassess the child's ITP, including referring the child to a higher level of care.

·         Immediately upon the child's exit from seclusion, treatment staff shall provide therapeutic intervention.

Family & Guardian Notification None.

Notification of Rights and Restraint and Seclusion Policies and Procedures at admission Upon admission, the crisis intervention program shall provide the child and his parent, guardian, or other legal representative with a clearly written and legible statement of rights and responsibilities

Written policy and procedure developed in consultation with professional and direct-care staff shall provide:

a. For behavior management of a child, including the use of time-out; and

b. An explanation of behavior management techniques to a child and his parent, guardian, or other legal representative.

Training
Require a staff member who uses seclusion as part of the forty (40) hour annual training program established in 922 KAR 1:300, Section 3, to complete at least sixteen (16) hours of training in approved methods of de-escalation and the use of seclusion, from a nationally-recognized accreditation organization approved by the cabinet, to include:

a. Assessing physical and mental status, including signs of physical distress;

b. Assessing nutritional and hydration needs;

c. Assessing readiness to discontinue use of the intervention; and

d. Recognizing when medical or other emergency personnel are needed.

Documentation
Staff shall document, in the child's record, the following information regarding seclusion of a child:

1. An intervention to de-escalate the child's behavior prior to placement;

2. Date and time of placement;

3. Date and time of removal;

4. Reason for placement;

5. Name of each staff member involved;

6. Treatment director's or designee's approval;

7. Five (5) minute visual observation by staff of the child's placement; and

8. Intervention provided by treatment staff when the child leaves seclusion.

Reporting See “Documentation.”

Quality Improvement None.

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