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RHODE ISLAND |
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Standard or Definition |
Rhode Island Statute Chapter 42-72.9
Children's Right to Freedom from Restraint Act
Section 42-72.9-4
and State of Rhode Island Department of Children, Youth and Families, "Child Care Regulations: Addendum A-Regulations Regarding the Use of Crisis Intervention, Restraint and Seclusion Within Covered Residential Facilities."
As of June, 2003 |
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Restraint Definition |
"Therapeutic physical restraint" (used interchangeably with the term "physical restraint") means the acceptable use of a staff member's body to immobilize or reduce the free movement of a child/youth's arms, legs, torso, or head, in order to ensure the physical safety of a child/youth or other individual in the facility. |
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Restraint Exclusions |
The term does not include: (i) briefly holding a person in order to calm or comfort the person; (ii) restraint involving the minimum contact necessary to safely escort the person from one area to another. |
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Chemical Restraint Definition |
"Chemical restraint" means a medication used to control behavior or restrict the patient's freedom of movement and is not a standard treatment for the child's medical or psychiatric condition. |
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Seclusion Definition |
"Seclusion" means the involuntary confinement of a child/youth in a room in a Covered Facility, whether alone or with staff supervision, in a manner that prevents the child/youth from leaving. |
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Seclusion Exclusions |
This definition does not pertain to the use of "time out" as an acceptable form of short-term behavioral management nor does it pertain to covered facilities where the terms of seclusion are defined pursuant to particular judicial decrees. |
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Criteria for Restraint and Seclusion |
No service provider shall administer a physical, mechanical, or chemical restraint on a child, unless the following conditions are met:
- service provider in a covered facility may impose restraints only to prevent immediate or imminent risk of harm to the physical safety of the child, staff, or other individuals in the facility. Restraints shall be removed at the earliest possible time that the child can commit to safety and no longer poses a threat to himself or herself or others;
- The use of mechanical restraints on children and youth must be administered in strict accordance with policies developed by the service provider and is limited to those covered facilities granted specific authority to use mechanical restraint methods by their respective state licensing authorities after review and approval of their policies. The use of mechanical restraints at the Rhode Island training school for youth will be governed exclusively by rules and regulations promulgated by DCYF in accordance with § 42-72.9-9 on or before January 1, 2001;
- A physical, mechanical, or chemical restraint may be used only when less restrictive interventions have not succeeded in de-escalating a situation in which the child's and/or other's safety is at risk;
- Except in the case of an emergency, any use of restraint on a child in the school program of a covered facility must be in accordance with the child's individual education program;
- Any use of restraint on a child must be in accordance with safe and appropriate restraining techniques and be administered only by service providers that have both initial and ongoing education and training in the proper and safe use of restraints as established by nationally recognized training programs;
The use of chemical restraints on children and youth must be administered in strict accordance with policies developed by the service provider and is limited to those covered facilities granted specific authority to use chemical restraints by their respective state licensing authorities after review and approval of their policies. All chemical restraints must be ordered in writing by a physician and administered in accordance with the standards adopted by the joint commission on accreditation of healthcare organizations (JCAHO). |
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Monitoring Requirements |
The condition of the child in a restraint must be continually assessed, monitored, and reevaluated and the restriction of patient child movement or activity by restraint must be ended at the earliest possible time, considering the physical safety of the child being restrained and other individuals in the facility. For the purposes of this section, "monitor" means (i) direct observation, or (ii) observation by way of video monitoring within physical proximity sufficient to provide aid as may be needed. |
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Ordering and Initiation |
Any use of restraint on a child must…be administered only by service providers that have both initial and ongoing education and training in the proper and safe use of restraints as established by nationally recognized training programs.
Restraints may not be written as a standing order or on "as needed" (PRN) basis. |
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In-person Assessment |
See "Monitoring Requirements" above. |
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Debriefing |
The Covered Facility must ensure that all children/youth directly and indirectly involved in a restraint or seclusion are provided the opportunity to debrief the incident as soon as practicable but no longer than within twenty-four (24) hours of the incident. |
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Family & Guardian Notification |
No information provided. |
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Notification of Rights and Restraint and Seclusion Policies and Procedures at admission |
No information provided. |
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Training |
Covered Facilities are required to use only nationally recognized crisis intervention and physical restraint training programs, which are approved by the Department.
Each Covered Facility muse ensure that every new Service Provider successfully completes the training prescribed below in regard to crisis intervention and restraint prior to that Service Provider being authorized to be solely responsible for any child or children in the care of the Covered Facility. Covered Facilities and/or Parent Agencies must also ensure that all new Service Providers are given the opportunity to complete such training within thirty (30) days from their date of hire. The required new Service Provider training includes, but is not limited to :
- A minimum of sixteen (16) hours of training in the Covered Facility's approved crisis intervention and restraining model or the prescribed number of minimum hours identified within the model, whichever is greater.
- Such training shall include role-playing in de-escalation, demonstration by the Service Provider of each hold and self-protection method taught, and written pre-training and post-training tests.
- Successful completion of this training must be verified by a written sign-off from the trainer stating that the Service Provider has successfully completed the training program and that he/she can competently implement the components of the training program. A copy of this documentation shall be kept in the Service Provider's personal file.
- When not included as a part of the Covered Facility's approved crisis intervention and restrain training model, each Service Provider shall also successfully complete training in the following:
- Avoidance of power struggles
- Aggressive behavior related to a medical condition
- Physiological impact of restraint
- Monitoring physical signs of distress and obtaining medical assistance
- Legal issues
- Positional asphyxia
- Self protection techniques
- Process for obtaining approval for continued restraint
- Documentation
- Investigation of injuries and complaints.
- Each Covered Facility and/or Parent Agency shall ensure that all staff, on a minimum of an annual basis, receive a minimum of eight (8) hours of refresher training.
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Documentation |
In accordance with RIGL 42-72.9-6, any use of physical, mechanical or chemical restraint or seclusion must be documented using an Incident Report and must be documented in a progress note in the child's medical, educational, treatment or case record maintained by the covered facility. |
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Reporting |
All restraints must be recorded by the individuals administering the restraints and reviewed by supervisory personnel as soon as practicable but no later than forty-eight (48) hours after the restraint was administered. |
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Quality Improvement |
Each Covered Facility shall develop methods by which the use of restraint and seclusion is monitored and internally reviewed to identify patterns and practices of service providers as a group or as individuals. Such methods shall include mechanisms by which data acquired by these reviews will be used to positively affect practices within the Covered Facility and within individual service providers. |
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