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WISCONSIN |
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Standard or Definition |
WISCONSIN DEPARTMENT OF HEALTH & FAMILY SERVICES
Chapter HFS 52.42 Behavior management and control
As of June, 2003 |
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Restraint Definition |
"Physical hold restraint" means that a resident is temporarily physically restrained by a staff member. |
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Restraint Exclusions |
Center staff may not employ any cruel or humiliating measure such as…use of chemical or physical restraint of physically enforced separation or a time-out room as punishment.
A center may not use on a resident any aversive measure that is painful or discomforting to a resident or any measures that are potentially injurious to a resident. |
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Chemical Restraint Definition |
A center may not use intrusive and restrictive behavior management techniques such as behavior-modifying drugs or other forms of physical restraint as defined under s. 48.599(1), Stats., not identified in this section unless the center receives approval for their use from the department and where applicable, procedures in accordance with provisions found in this chapter are followed. |
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Seclusion Definition |
"Physically enforced separation" means that a resident is temporarily physically removed to a time-out room or area, including, where applicable, a locked unit. |
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Seclusion Exclusions |
"Physically enforced separation" does not include sending a resident on the resident's own volition to the resident's room or another area for a cooling off period as part of a de-escalation technique. |
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Criteria for Restraint and Seclusion |
A center staff member may physically intervene in a crisis situation affecting a resident only if all of the following conditions are present:Use of physical hold restraint or physically enforced separation takes place as a last resort when the resident's behavior is imminently dangerous to life, health or safety of the resident or others or threatens significant destruction of property.De-escalation techniques are used before physical intervention techniques are used.The Staff member has completed a department-approved crisis intervention training course.
Physical hold restraint or physically enforced separation used as a physical crisis intervention may be for no longer than the time necessary for the resident to calm down and be able to reenter the general center environment.
Use of physically enforced separation shall meet the following additional conditions:
- Except as otherwise provided for a locked unit, initial use of physically enforced separation may not extend for more than one hour without authorization from the center director or a professional staff person designated by the center director.
- Except as otherwise provided for a locked unit, if a resident is authorized under subd. 2 to be in physically enforced separation for more than one hour and the physically enforced separation lasts for more than 2 hours, or if the resident experiences multiple episodes in a day which prompt use of physically enforced separation for a cumulative period of more than 2 hours during the day, center staff shall consider the need to arrange another more appropriate placement for the resident.
- Physical hold restraint on a resident shall not be used to circumvent the requirement of the one-hour limit for using a time-out room or a locked unit.
No resident may be placed in a locked unit unless the center has first obtained department approval to operate a locked unit, the locked unit meets the requirements of this subsection (HFS 52.42.7) |
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Monitoring Requirements |
(a) A center shall assign to a professional staff member the responsibility to monitor and review, on an ongoing basis, the use of all center behavior management measures identified under par. (b) for appropriateness and consistency.(b) Monitoring and review shall cover violation of house rules and their resulting consequences, the use of physical hold restrain and physically enforced separation in crisis intervention, the use of a locked unit when used to facilitate a resident's treatment plan under sub. (7)(a) 3., and all related center policies and procedures.
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Ordering and Initiation |
Restraint: No information provided.
Seclusion: No resident may be placed in a locked unit unless the center has first obtained department approval to operate a locked unit, the locked unit meets the requirements of this subsection and one of the following applies:
- Use of a locked unit is ordered by a physician, to protect the health of the resident or other residents.
- Use of a locked unit is for purposes of ensuring physically enforced separation when intervening in a crisis involving the resident.
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In-person Assessment |
The staff member using physically enforced separation of a resident shall review need for continued use every 10 minutes while the resident is in physically enforced separation and shall log the time of each review and the emotional status of the resident.
Appropriately trained staff shall directly supervise the use of a locked unit. |
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Debriefing |
No information provided. |
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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 |
Restraint: No information provided
Seclusion: A resident may be in a locked unit only if there is a written informed consent document signed by the resident's parent or guardian and legal custodian or by an order of a court or other lawful authority or as provided under subd. 5. A copy of the informed consent document, court order or document from another lawful authority shall be filed in the resident's treatment record. Parent or guardian and legal custodian written informed consent to placement of a resident in a locked unit shall be effective for no more than 45 days from the date of the consent and may be withdrawn sooner unless otherwise specified in a court order or by another lawful authority. Parent or guardian and legal custodian written informed consent for continued use of a locked unit may be renewed for 30 day periods except as otherwise specified in a court order or by another lawful authority. Except as otherwise specified in a court order or by another lawful authority, the parent or guardian or the legal custodian may withdraw his or her written informed consent to the resident being placed in a locked unit at any time, orally or in writing. The resident shall be transferred to an unlocked unit promptly following withdrawal of informed consent. |
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Training |
Appropriately trained staff are staff who have received the training under s. HFS 52.12 (5)(b) 4., and (c). |
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Documentation |
For each incident where physical hold restraint or physically enforced separation of a resident was necessary, the staff person on duty shall document in an incident report the following:
- The resident's name, age and sex.
- A description of the incident.
- The date, time and location of the incident and methods used to address the resident's behavior, including duration of each crisis intervention episode.
- Results achieved from methods used to address resident behavior.
- The name of each staff member involved in using the technique or approach with the resident at the time of the incident of when the incident was discovered.
- Injuries received by either the resident or a staff member in using physically enforced separation or physical hold restraint, how the injuries happened and any medical care provided.
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Reporting |
The professional staff member designated with the responsibility to monitor and review…the use of all center behavior and management measures identified under par. (b) for appropriateness and consistency shall receive a written incident report of each use of a physical hold restraint or physically enforced separation by a staff member. |
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Quality Improvement |
No information provided. |
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