Restrictive Measures Overview Part 1 Presented by : Behavior Support Oversight Committee (BSOC)

Resources and Information For Today’s Training Chapter 51.61 DHS 94.10 Guidelines And Requirements For The Use of Restrictive Measures (DHS, DQA, DLTS) (February 2009). CCCW Restrictive Measures Policy.

What is a Restrictive measure? The definition of Restrictive Measures applies to the forms of restraint, isolation, and protective equipment identified below: Manual Restraints Mechanical Restraint Medical Restraint Isolation/Seclusion Protective Equipment Mechanical Support

Relationship of Individual Rights and Restrictive Measures Mail Access to phone Prompt Treatment Visitors Storage Access to funds Religion Voting Medications and treatment Restrictive Measures Restraint Isolation Seclusion Least Restrictive Treatment and Conditions

Categories of Restrictive Measures Manual Restraints Mechanical Restraint Medical restraint Isolation/Seclusion Protective equipment Mechanical support

What is a restraint? Any device, garment or physical hold that Restricts the voluntary movement of a person’s body or access to any part of the body And cannot be easily removed by the individual

Examples: Manual Restraints “Hands on”, holding limbs or body contingent upon behavior Restricting or preventing movement Not longer than 15 continuous minutes Examples:

Manual Restraint Does Not Include: Medical restraints. Holding limbs or body to provide functional movement and positioning. Holding limbs or body to prevent falling. Self protective blocking or passive redirecting aggressive behavior. Graduated guidance as part of an approved intervention.

Example: Mechanical Restraint A device applied to any part of a person’s body contingent upon behavior Restricts or prevents movement or normal use/functioning of the body part Cannot be easily removed by the individual Cannot impair hearing, vision, or speech (DHS) Example:

Example: Medical Restraint Apparatus or procedure that restricts voluntary free movement Cannot be easily removed by the individual Used prior to, during, or subsequent to a medical procedure Or to protect during the time a medical condition exists Example:

Medical Restraint cont. - Short-term Use MD writes an order for use during the first 10 days. Guardian is notified. If restraint continues past the initial 10 days then guardian consent is required. If this occurs regularly or becomes long-term then application for use is required.

Example: Isolation/Seclusion Involuntary physical or social separation from others by actions of staff Contingent upon behavior Example:

Example Protective Equipment Device that does not restrict movement but does prevent access Applied to any part of a person’s body to prevent tissue damage as a result of behavior Cannot be easily removed by the individual Example

Example: Mechanical Support An apparatus Properly aligns a person’s body or helps maintain balance Designed by a qualified professional in accordance with principles of good body mechanics, concern for circulation, and allow for change in position. Generally not a restraint, but could be if it meets the definition. Example:

Exceptional Measures Specific forms of restraint that are considered highly restrictive and present a higher level of risk Require an additional level of review- Oversight Committee Waiving or modifying any process requirement is considered an exceptional measure as well

Exceptional Forms of Manual Restraint Any form of horizontal restraint Physically forcing a person to lay in a horizontal position Takedowns Physically forcing a person to a prone position on the ground, floor, or mat

Exceptional Forms of Mechanical Restraint Restraint vests, jackets, body wraps Seclusion Wrist or ankle restraints Removal of mobility aids Restraint chairs Bed enclosures

Exceptional form of isolation: Seclusion Person is physically set apart from others Use of locked doors

Emergency Sudden, unexpected behavior that places the person or others in some danger of injury or onset of signs/symptoms known to be precursors of such behavior After two incidents within 6 months no longer is unanticipated Agency should have a written policy as to who can implement emergency restraint

Emergency cont. Agency must have a notification process An MD order is required if the emergency restraint episode exceeds 1 hour Emergency restraint is a county critical incident reportable event (DDES 2558) or to the MCO Event Recording system.

Example Frank is non-ambulatory and uses a highly modified wheelchair for proper body alignment. He often kicks his legs out; moves them off the foot rests, or lets them hang behind the foot rests. This has been resolved by providing a strap around each ankle that is in turn strapped down to the footrest holding his foot securely to the rest. The Physical Therapist has written into their evaluation “ankle straps secured to footrests for safety during transportation”. This is repeated in his support plan.   Is this a restraint?