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Home > Behavioral Health > Behavior Support and Intervention > Standard or Definition

 
 

NORTH CAROLINA

Standard or Definition 10 NCAC 41s .0613
DISCIPLINE and BEHAVIOR MANAGEMENT

As of July, 2003
Restraint Definition Physical restraint of a child means physically holding a child who is at imminent risk of harm to himself or others until the child is calm.
Restraint Exclusions None.
Chemical Restraint Definition Drug used as a restraint means a medication used to control behavior or to restrict a child's freedom of movement and is not a standard treatment for the child's medical or psychiatric condition. A drug used as a restraint shall be employed only if required to treat a medical condition. It shall not be employed for the purpose of punishment, staff convenience or as a substitute for adequate staffing.
Seclusion Definition Seclusion is not permitted.
Seclusion Exclusions None.
Criteria for Restraint and Seclusion Policies and procedures shall include:
  • Proactive means for interacting with and teaching children which emphasize praise and encouragement for exhibiting self control and desired behavior; and

  • Methods for protecting children and others when a child is out of control.
The residential child care facility shall implement standards for behavior which are reasonable and developmentally appropriate.

The residential child care facility shall not engage in discipline or behavior management which includes:
  • Corporal/physical punishment;
  • Cruel, severe, or humiliating actions;
  • Discipline of one child by another child;
  • Denial of food, sleep, clothing or shelter;
  • Denial of family contact, including family time, telephone or mail contacts with family;
  • Assignment of extremely strenuous exercise or work;
  • Verbal abuse or ridicule;
  • Mechanical restraints;
  • Drug used as a restraint, except as outlined in 10 NCAC 41S .0613(e);
  • Seclusion or isolation time-out; or
  • Physical restraints except as outlined in 10 NCAC 41S .0613(f).
If physical restraints are utilized:
  • Physical restraint holds shall be administered only by staff trained in the use of physical restraint holds. No child or group of children shall be allowed to participate in the physical restraint of another child;

  • Before employing a physical restraint, the residential child care facility shall take into consideration the child's medical condition and any medications the child may be taking.

  • No child shall be physically restrained utilizing a protective or mechanical device. Physical restraint holds shall:
    1. not be used for purposes of discipline or convenience;

    2. only be used when there is imminent risk of harm to the child or others and less restrictive approaches have failed;

    3. be administered in the least restrictive manner possible to protect the child or others from imminent risk of harm; and

    4. end when the child becomes calm.
Monitoring Requirements The residential child care facility shall: Ensure that any physical restraint hold utilized on a child is administered by a trained staff member with a second staff member in attendance. An exception may occur when no other staff member is present or can be called for immediate assistance. Concurrent with the administration of a physical restraint hold and for a minimum of 15 minutes subsequent to the termination of the hold, a staff member shall:
  1. monitor the child's breathing;

  2. ascertain that the child is verbally responsive and motorically in control; and

  3. shall ensure that the child remains conscious without any complaints of pain.
Ordering and Initiation No information provided.
In-person Assessment If at any time during the administration of a physical restraint hold the child complains of being unable to breathe or loses motor control, the staff member administering the physical restraint hold shall immediately terminate the hold or adjust the position to ensure that the child's breathing and motor control are not restricted. If at any time the child appears to be in distress, a staff member shall immediately seek medical attention for the child.
Debriefing Following the use of a physical restraint hold, a staff member shall conduct an interview with the child about the incident, and the staff administering the physical restraint hold shall be interviewed about the incident.
Family & Guardian Notification Within 48 hours, supervisory staff shall review the incident report to ensure that correct steps were followed and shall forward the report to the legal custodian and the licensing authority on a report form developed by the licensing authority. If a child dies as a result of a physical restraint hold, the residential child care facility shall immediately report the death of the child to the legal custodian and to the licensing authority.
Notification of Rights and Restraint and Seclusion Policies and Procedures at admission The residential child care facility shall have written policies and procedures on discipline and behavior management, including the type and use of physical restraint holds, if utilized. A copy of the written policies and procedures shall be provided to and discussed with each child and the child's parents or legal custodians prior to or at the time of admission.
Training The residential child care facility shall:
Ensure that any physical restraint hold utilized on a child is administered by a trained staff member who has completed at least 16 hours of training in behavior management, including techniques for de-escalating problem behavior, the appropriate use of physical restraint holds, monitoring of the child's breathing, verbal responsiveness and motor control. Training shall also include debriefing children and staff involved in physical restraint holds. Thereafter, staff authorized to use physical restraint holds shall annually complete at least eight hours of behavior management training, including techniques for de-escalating problem behavior.
Documentation The residential child care facility shall:
Document each incident of a child being subjected to a physical restraint hold on an incident report. This report shall include:
  • the child's name, age, height and weight;

  • the type of hold utilized;

  • the duration of the hold;

  • the staff member administering the hold;

  • staff member witnessing the hold;

  • supervisory staff who reviewed the incident report;

  • less restrictive alternatives that were attempted prior to utilizing physical restraint;

  • the child's behavior which necessitated the use of physical restraint;

  • whether the child's condition necessitated medical attention;

  • planning and debriefing conducted with the child and staff to eliminate or reduce the probability of reoccurrence; and

  • the total number of restraints of the child since admission.
Reporting The residential child care facility shall:
Submit a summary report to the Division of Social Services by the 10th day of each month indicating the number of physical restraint holds used during the previous month on each child and any injuries that resulted.
Quality Improvement The residential child care facility shall:
Complete an annual review of the discipline and behavior management policies and techniques to verify that the physical restraint holds being utilized are being applied properly and safely. This review shall be documented and submitted to the licensing authority as part of the annual licensing renewal application.



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