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MONTANA |
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Standard or Definition
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Administrative rules of Montana
DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES
CHAPTER 97
LICENSURE OF YOUTH CARE FACILITIES
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Restraint
Definition
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"Restraint"
means the extraordinary restriction of a child's freedom or freedom of
movement.
"Passive physical
restraint" means the least amount of direct physical contact required by
a staff member using approved methods of making such physical contact to
restrain a child from harming self or others.
“Mechanical
restraint" means the restriction by mechanical means of a child's
mobility and/or ability to use his/her hands, arms or legs.
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Restraint
Exclusions
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None.
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Chemical Restraint
Definition
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"Chemical
restraint" means the use of psychotropic medication to subdue, inhibit,
confine or control a child's behavior.
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Seclusion
Definition
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"Seclusion"
means isolation of a child in a locked room.
Seclusion may be used
to protect the child, other children, and staff and to give the child the
opportunity to regain control of his or her behavior and emotions by
providing definite external boundaries and decreased stimulation.
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Seclusion
Exclusions
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None.
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Criteria for
Restraint and Seclusion
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- Passive physical restraint of a child may be used to end a disturbance by the child
that immediately threatens physical injury to the child, other persons, or
property.
- A child care agency shall not use mechanical restraint without first becoming
licensed by the department to operate a residential treatment center.
- A residential treatment center which uses mechanical restraints shall use only
those forms of mechanical restraint which are approved by the department.
- The agency shall not use or apply any form of mechanical restraint which inflicts physical pain or is
likely to cause personal injury.
- Each child care agency which uses mechanical restraint shall have written policies
governing the use of such restraint. The policy shall describe, at a minimum:
- the philosophy for use of mechanical restraint;
- the procedure for use of mechanical restraint;
- the emergency evacuation procedures for special circumstances occurring while a child is in restraint (i.e. fire,
natural disaster);
- Mechanical restraint shall not be used as punishment.
A child care agency shall not use chemical restraint without first being licensed by
the department to operate a residential treatment center.
- Chemical restraint of a child may be used only if the child is a danger to himself or
others and cannot be controlled by any other type of restraint.
Each child care agency which uses chemical restraint shall have written policies
governing the use of such restraint. The policies shall describe at a
minimum:
- the philosophy for use of chemical restraint;
- the procedures for use of chemical restraint;
- the emergency evacuation procedures for special circumstances
occurring while a child is in restraint (i.e. fire, natural disaster)
- Chemical restraint shall not be used as punishment.
- Only child care agencies which operate a licensed residential treatment center may use
seclusion as a method of intervention.
- A seclusion room is a single room in a child care agency treatment center in
which a child may be confined.
- Seclusion may be used as a means of intervention only when the
child is in danger of harming himself, others, or property.
- Seclusion shall be used only for the time needed to change the
behavior necessitating its use. Seclusion shall not be used as punishment.
- Each child care agency which utilizes seclusion shall have a written statement of its
seclusion policies which describe, at a minimum:
- the philosophy for use of the room;
- the procedure for admittance;
- emergency procedures for special circumstances occurring while the
child is in placement (i.e., fire, internal or external disaster, etc.).
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Monitoring
Requirements
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A child care agency which uses mechanical restraint shall assign a staff member with
no other immediate responsibilities to continuously monitor any child placed
in restraint.
- The staff member shall ensure that the child's physical needs are
promptly met.
- The staff member must remain in continuous auditory and visual
contact with the child.
A staff member with no other immediate duties shall continuously monitor the child
placed in seclusion by visual or auditory means and shall remain within 20
feet of the room. If continuous monitoring is by auditory means, the staff
member shall visually check on the child at least every 10 minutes.
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Ordering and
Initiation
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The administrator of the child care agency which uses mechanical restraint or a
person designated by that administrator must authorize each use of mechanical
restraint. Each authorization shall be for one-half hour only. No child shall
be kept in mechanical restraint for more than 2 hours in any 12-hour period.
- Any child who needs to be mechanically restrained for more than 2
hours in any 12-hour period shall be transferred to an acute care psychiatric
facility.
A residential treatment center which uses chemical restraint shall ensure that
such restraint is administered by intramuscular injection by a person
qualified and trained in the administration of intramuscular injections.
- A child who is capable of accepting an oral
administration of chemical restraint shall not be deemed to require chemical
restraint.
A residential treatment center which uses emergency chemical restraint shall
ensure that each administration of chemical restraint is specifically ordered
by a physician who has personally examined the child.
- There shall not be standing orders related to
the use of chemical restraint.
A physician shall authorize each use of chemical restraint prior to the
administering of such restraint.
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In-person
Assessment
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None.
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Debriefing
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There must be a method for children to express grievances regarding the use of
mechanical restraint, chemical restraint, and seclusion.
The child shall be informed of the reason for seclusion at the time of the child's
placement in seclusion.
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Family &
Guardian Notification
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The agency shall make every effort to notify the placing agency and the child's
parent(s) or guardian of any situation regarding restraint or seclusion. If
possible, a representative of the placing agency and the child's parent(s) or
guardian shall attend the emergency meeting to assess the situation.
Documentary evidence of the attempt to notify the placing agency and the child's
parent(s) or guardian shall be placed in the child's case record.
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Notification of
Rights and Restraint and Seclusion Policies and Procedures at admission
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None.
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Training
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The child care agency must provide training in passive physical restraint to all staff
members who may be required to use passive physical restraint and shall
provide at least yearly refresher courses.
Staff of the residential treatment center who monitor or initiate the use of the room
shall be trained in the use of seclusion and be specifically authorized by
the facility.
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Documentation
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When a child in care requires chemical restraint on more than three occasions during
a 30-day period an emergency meeting shall be held to discuss the
appropriateness of the child's continued placement at the agency. This
meeting shall take place within 24 hours of the third incident requiring
chemical restraint and shall include the chief administrator of the agency or
his/her representative, a physician and all appropriate staff. A report of
this meeting, signed by all persons attending, shall be filed in the child's
case record and a copy sent to the placing agency.
Records of the use of the seclusion room, policies for the operation and supervision of
the room, the children's treatment records, staff records and the room itself
shall be made available to the department for inspection.
If the child care agency does not meet all requirements for the use of the seclusion
room, the department shall give written notice of the specific deficiencies
which shall be corrected. The child care agency shall cease secluding any
children in the room until corrections are made and authorization is given by
the department.
Upon the placement
of a child in seclusion, the following minimum items shall be recorded,
updated and maintained, if applicable:
- a written report which states the child's
name, date, time of placement, staff member initiating the placement,
qualified treatment practitioner authorizing placement and narrative
describing the following: the precipitating event, child's behavior before
placement, and actions taken by staff of a less restrictive nature in an
attempt to control, calm or contain the child;
- written notation of visual checks at least every 10 minutes and
notation of behavior and time occurring;
- notation regarding opportunity to use toilet facilities once per
hour;
- notations regarding when the child had opportunity to exercise;
- notation as to medications administered, time given and staff
administering;
- notation of all staff contact including a description of the
resolution of the placement incident which results in the termination of
seclusion.
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Reporting
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None.
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Quality Improvement
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None specified.
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