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MISSOURI
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Standard or
Definition
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Dept. of Social
Services, Division 40-Division of Family Services, Chapter 71-Licencing Rules
for Residential Care Agencies
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Restraint
Definition
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“Physical restraint” is physical holding involving
restriction of a child’s voluntary movement to temporarily restrain an
agitated, violent or aggressive child who presents a likelihood of serious
physical harm to him/herself, others or of doing serious property damage.
“Mechanical restraints” are any device, instrument or
physical object used to confine or limit a child’s freedom of movement,
except when necessary for orthopedic, surgical and other medical purposes, or
when necessary to transport a child that may abscond or cause injury during
transportation.
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Restraint Exclusions
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None specified.
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Chemical Restraint
Definition
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“Chemical restraints” are drugs which are prescribed or
administered to temporarily restrain a child who presents a likelihood of
serious physical harm to him/herself or others.
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Seclusion
Definition
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Referred to as “locked isolation.”
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Seclusion
Exclusions
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None specified.
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Criteria for
Restraint and Seclusion
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All agencies using physical control techniques
must have written policies—defining the method of control; identifying
personal used in implementing these methods; and establishing the training
required for these persons. These
policies shall address the use of crisis intervention, including techniques
to be used prior to physical restraint and include:
A) The
use of 2 staff, one of whom is fully qualified;
B) An
immediate notice to the supervisor; and
C) A
written report to the administrator.
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Restraint methods shall be used only to end
disturbances that threaten physical injury to the child, physical injury to
others, or to take from a child a dangerous object which the child has
threatened to use against him/herself or against other or do serious property
damage.
·
An agency shall not use mechanical restraint.
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Strap-boards, strait-jackets or homemade
restraint devices such as tape shall not be used.
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Agencies utilizing locked isolation shall
submit a plan for the emergency evacuation of isolated residents to the
licensing unit.
·
Locked isolation shall be used only as a
management method after all other measures have been exhausted, and never to
replace other more positive measures of control.
·
Locked isolation shall be used only when a
child presents a danger to him/herself or others or poses a threat of serious
property damage.
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Locked isolation shall be used in the shortest
intervals possible until the child regains reasonable self-control.
·
The maximum time a child may remain in locked
isolation is two hours, unless extensions are approved at the end of every
two-hour period by the administrator or a qualified desginee. A child shall not remain in locked islation
more than a twelve hour period. If the
child has not regained control after twelve hours, a medical order shall be
obtained.
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Not more than one child shall be in a locked
isolation room. A locked isolation
room shall be utilized for any other purpose.
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Monitoring
Requirements
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When a child is placed in locked isolation, staff shall
physically monitor the child in at least fifteen minute intervals unless
closed circuit television contact is maintained. Staff shall remain in close proximity to
the child in locked isolation with no more than one locked door between the
staff and the child. Close proximity
means that staff are close enough to the child(ren) to be able to hear any
sounds to child(ren) might make that would indicate a need for
assistance.
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Ordering and
Initiation
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None.
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In-person
Assessment
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None specified.
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Debriefing
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None.
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Family &
Guardian Notification
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None.
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Notification of
Rights and Restraint and Seclusion Policies and Procedures at admission
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The agency shall have written policies and procedures
prohibiting discipline which may adversely affect a child’s health or
physical or psychological well-being.
A copy shall be given to all residents, families, staff and placing
agencies. The following forms of
discipline shall not be used:
A) Cruel
and unusual punishment;
B) Excessive
or inappropriate work;
C) Denial
of means, daily needs and the program provided by the individual service
plan;
D) Verbal
abuse, ridicule or humiliation;
E) Permission
for a child to discipline another child;
F) Chemical
restraints;
G) Mechanical
restraints;
H) Denial
of planned visits, telephone calls or mail contacts with family;
I)
The use of foods intended to produce an adverse
reaction;
J)
Physical or emotional abuse;
K) Confinement
in any space not designed for isolation and observation;
L) Requirement
that a child remain silent for long periods of time or other unreasonable
verbal restrictions;
M) Corporal
punishment including, but not limited to, slapping, hitting, spanking,
paddling, shaking, belting, marching, standing rigidly in one spot, use of excessive
physical exercises such as running laps or doing push-ups or any method which
harms or endangers the child;
N) Locked
isolation for the purpose of discipline;
O) Withholding
of an opportunity for a minimum of eight hours of sleep in a 24-hour period;
P) Withholding
of shelter, clothing, essential personal needs, essential program services;
or
Q) Withholding
of meals, mail, allowances, or family visits.
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Written policies for the use of locked
isolation shall be made available to the child’s parent(s), or guardian or
legal custodian, or both, and when appropriate, to the child.
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Training
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·
An agency shall establish and submit to the
licensing unit an annual written plan for at least forty hours of training
each year for the executive director, child care staff, professional staff,
and recreation and activity staff. All
training must be documented with the dates, location, the subject, and the
name of the person(s) who conducted the training. The training may include, but not be
limited to, short-term courses, seminars, institutes, workshops and
in-service training provided on-site by qualified professionals.
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The training plan shall include, but not be
liminted to:
1) Developmental
needs of children;
2) Child
management techniques;
3) Basic
group dynamics;
4) Appropriate
discipline, crisis intervention, de-escalation techniques and behavior
management techniques;
5) The
direct care and professional staff roles in the facility;
6) Interpersonal
communication;
7) Proper,
safe methods and techniques of restraint;
8) First
aid and cardiopulmonary resuscitation (CPR) training; and
9) Suicide
prevention.
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The agency shall train all new staff in the
use of locked isolation.
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Documentation
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·
Individual case records for all children
accepted for care shall be maintained for a least five years after a child is
discharged from care and shall include copies of critical incident reports
(which shall include, but not be limited to, physical restraint, isolation
and injury).
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All instances of physical restraint shall be
documented on incident reports and filed in the child’s record.
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The agency shall maintain a record when locked
isolation is used, which shall include:
A) The
name of the child, the date and the time the child was placed in locked
isolation;
B) The
circumstances that led to the placement of the child in locked isolation;
C) The
name of the staff person who requested placement of the child in locked
isolation, the staff person who approved locked isolation and the name of the
staff personal who monitored the child; and
D) The
almost of time the child remained in locked isolation, the frequency of
monitoring and the time of and reasons for the release.
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Reporting
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If the agency does not meet all requirements for the use
of locked isolation, the division shall give written notice of the specific
deficiencies and the agency shall not use locked isolation until corrections
are made and approved by the division.
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Quality Improvement
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For agencies permitting the use of physical
restraint, the administrator shall review its usage at least quarterly.
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For agencies permitting the use of locked
isolation, the administrator shall review its usage at least monthly.
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