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

2. 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.

3. 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

4. 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

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

6. 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

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

8. 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.

9. 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:

10. 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:

11. 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.

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

13. 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

14. 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:

15. 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

16. 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

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

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

19. 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

20. 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.

21. 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?