1. R ESTRICTIVE M EASURES O VERVIEW Presented by : CCCW Behavior Support Oversight Committee (BSOC)

2. W HAT W ILL W E B E C OVERING T ODAY ? Proactive and Behavior Support Plan overview. Definitions of Restrictive Measures per DHS 94. Emergency Restrictive Measures Plan. Roles of CCCW Interdisciplinary Teams, CCCW Behavior Support Oversight Committee (BSOC), and DHS/DLTS Restrictive Measures Approval Process (what needs to be included).

3. D ISCLAIMER We are putting the cart before the horse. Prior to even thinking about restrictive measures, we need to have a behavior support plan in place. Data documenting effectiveness or ineffectiveness. Restrictive measures are the last resort option.

4. P ROACTIVE S UPPORT P LANS Designed to prevent the likelihood of negative, maladaptive behaviors from emerging, and places focus on positive behaviors, one’s strengths, and abilities. Create an environment that is conducive of safe learning and expression, residents feel more comfortable and are more likely to respond favorably to staff support. Evolve with the individual and are updated routinely as we learn more about each person’s abilities, improvement in certain life areas, and effective interventions and interactions.

5. P ROACTIVE S UPPORT P LANS Is the big picture plan. How do we support the individual throughout the day - not just during crisis? More importantly, how do we assist the individual in being more independent, by assisting in modifying behaviors? Very clear step-by-step for consistency.

6. B EHAVIOR S UPPORT P LANS Specific to each individual behavior. Define the behavior (what does it look like). Precursors, onset, severity, how often it occurs, how long will it last - conclusion of the behaviors. Identified function of the behavior. Proactive prevention of behavior. Management of the behavior.

7. E FFECTIVENESS OF A P LAN Data collection, Data collection, Data collection. Review, Review, Review, Review. Team approach and input.

8. R ELATIONSHIP OF I NDIVIDUAL R IGHTS AND R ESTRICTIVE M EASURES Mail Access to Phone Prompt Treatment Visitors Storage Access to Funds Religion Voting Medications and Treatment Restraint Isolation Seclusion Least Restrictive Treatment and Conditions

9. W HAT IS A R ESTRICTIVE M EASURE ? 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

10. W HAT 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

11. M ANUAL R ESTRAINTS “Hands on,” holding limbs or body contingent upon behavior Restricting or preventing movement Not longer than 15 continuous minutes Examples:

12. M ANUAL R ESTRAINT D OES N OT I NCLUDE : 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.

13. M ECHANICAL R ESTRAINT 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) Examples:

14. M EDICAL R ESTRAINT 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 Examples:

15. M EDICAL R ESTRAINT CONT. – S HORT -T ERM U SE 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.

16. I SOLATION /S ECLUSION Involuntary physical or social separation from others by actions of staff Contingent upon behavior Examples:

17. P ROTECTIVE E QUIPMENT 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 Examples:

18. M ECHANICAL S UPPORT 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. Examples:

19. E XCEPTIONAL M EASURES Specific forms of restraint that are considered highly restrictive and present a higher level of risk Requires an additional level of review - Oversight Committee Waiving or modifying any process requirement is considered an exceptional measure, as well

20. E XCEPTIONAL F ORMS OF … M ANUAL R ESTRAINT 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

21. E XCEPTIONAL F ORMS OF … M ECHANICAL R ESTRAINT Restraint vests, jackets, body wraps Seclusion Wrist or ankle restraints Removal of mobility aids Restraint chairs Bed enclosures

22. E XCEPTIONAL F ORM OF … I SOLATION Seclusion Person is physically set apart from others Use of locked doors