OAR 309-022-0175: Restraint and Seclusion

(1) Providers shall meet the following general conditions of personal restraint and seclusion: (a) Personal restraint and seclusion shall be used only in an emergency safety situation to prevent immediate injury to an individual who is in danger of physically harming himself or herself or others in situations, such as the occurrence of or serious threat of violence, personal injury, or attempted suicide; (b) Any use of personal restraint or seclusion shall respect the dignity and civil rights of the individual; (c) The use of personal restraint or seclusion shall be directly related to the immediate risk related to the behavior of the individual and may not be used as punishment, discipline, or for the convenience of staff; (d) Personal restraint or seclusion shall be used only for the length of time necessary for the individual to resume self-control and prevent harm to the individual or others, even if the order for seclusion or personal restraint has not expired, and shall under no circumstances exceed four hours for individuals ages 18 to 21, two hours for individuals ages 9 to 17, or one hour for individuals under age 9; (e) An order for personal restraint or seclusion may not be written as a standing order or on an as needed basis; (f) Personal restraint and seclusion may not be used simultaneously; (g) Providers shall notify the individual’s parent or guardian of any incident of seclusion or personal restraint within 24 hours; (h) Notification must include verbal and written notification and must include: (A) A description of the restraint or involuntary seclusion; (B) The date of the restraint or seclusion; (C) The times when the restraint or seclusion began and ended and the location of the restraint or seclusion; (D) Description of the individual’s activity that necessitated the use of restraint or seclusion; (E) De-escalation efforts used; (F) The names of each staff person involved. (i) If an individual in care suffers a reportable injury arising from the use of physical restraint or seclusion notification must include any photographs, audio or video recordings of the incident; (j) If incidents of personal restraint or seclusion used with an individual cumulatively exceed five interventions over a period of five days or a single episode of one hour within 24 hours, the psychiatrist or designee shall convene by phone or in person program staff with designated clinical leadership responsibilities to: (A) Discuss the emergency safety situation that required the intervention, including the precipitating factors that led up to the intervention and any alternative strategies that might have prevented the use of the personal restraint or seclusion; (B) Discuss the procedures, if any, to be implemented to prevent any recurrence of the use of personal restraint or seclusion; (C) Discuss the outcome of the intervention including any injuries that may have resulted; and (D) Review the individual’s service plan making the necessary revisions and documenting the discussion and any resulting changes to the individual’s service plan in the service record. (2) Personal Restraint: (a) Each personal restraint shall require an immediate documented order by a physician, licensed practitioner, or a licensed CESIS; (b) The order shall include: (A) Name of the individual authorized to order the personal restraint; (B) Date and time the order was obtained; and (C) Length of time for which the intervention was authorized. (c) Each personal restraint shall be conducted by program staff that completed and used Division-approved crisis intervention training. If in the event of an emergency, a non-Division approved crisis intervention technique is used, the provider’s on-call administrator shall review immediately the intervention and document the review in an incident report to be provided to the Division within 24 hours; (d) At least one program staff trained in the use of emergency safety interventions shall be physically present, continually assessing and monitoring the physical and psychological well-being of the individual and the safe use of the personal restraint throughout the duration of the personal restraint; (e) Within one hour of the initiation of a personal restraint, a psychiatrist, licensed practitioner, or CESIS shall conduct a face-to-face assessment of the physical and psychological well-being of the individual; (f) A designated program staff with clinical leadership responsibilities shall review all personal restraint documentation prior to the end of the shift in which the intervention occurred; and (g) Each incident of personal restraint shall be documented in the service record. The documentation shall specify: (A) Behavior support strategies and less restrictive interventions attempted prior to the personal restraint; (B) Required authorization; (C) Events precipitating the personal restraint; (D) Length of time the personal restraint was used; (E) Assessment of appropriateness of the personal restraint based on threat of harm to self or others; (F) Assessment of physical injury; and (G) The individual’s response to the emergency safety intervention. (h) For PRTF, Sub-Acute, SCIP and SAIP programs within 24 hours after the use of restraint, staff involved in an emergency safety intervention and the resident must have a face-to-face discussion. This discussion must include all staff involved in the intervention except when the presence of a particular staff person may jeopardize the well-being of the resident. Other staff and the resident's parent(s) or legal guardian(s) may participate in the discussion when it is deemed appropriate by the facility. The facility must conduct such discussion in a language that is understood by the resident's parent(s) or legal guardian(s). The discussion must provide both the resident and staff the opportunity to discuss the circumstances resulting in the use of restraint or seclusion and strategies to be used by the staff, the resident, or others that could prevent the future use of restraint or seclusion. (A) Within 24 hours after the use of restraint all staff involved in the emergency safety intervention, and appropriate supervisory and administrative staff, must conduct a debriefing session that includes, at a minimum, a review and discussion of: (i) The emergency safety situation that required the intervention, including a discussion of the precipitating factors that led up to the intervention; (ii) Alternative techniques that might have prevented the use of the restraint; (iii) The procedures, if any, that staff are to implement to prevent any recurrence of the use of restraint; and (iv) The outcome of the intervention, including any injuries that may have resulted from the use of restraint. (B) Staff must document in the resident's record that both debriefing sessions took place and must include in that documentation the names of staff who were present for the debriefing, names of staff that were excused from the debriefing, and any changes to the resident's treatment plan that result from the debriefings. (3) Providers shall be certified by the Division for the use of seclusion: (a) Authorization for seclusion shall be obtained by a psychiatrist, licensed practitioner, or CESIS prior to or immediately after the initiation of seclusion. Written orders for seclusion shall be completed for each instance of seclusion and shall include: (A) Name of the individual authorized to order seclusion; (B) Date and time the order was obtained; and (C) Length of time for which the intervention was authorized. (b) Program staff trained in the use of emergency safety interventions shall be physically present continually assessing and monitoring the physical and psychological well-being of the individual throughout the duration of the seclusion; (c) Visual monitoring of the individual in seclusion shall occur continuously and be documented at least every fifteen minutes or more often as clinically indicated; (d) Within one hour of the initiation of seclusion, a psychiatrist or CESIS shall conduct a face-to-face assessment of the physical and psychological well-being of the individual; (e) For PRTF, Sub-Acute, SCIP and SAIP programs within 24 hours after the use of seclusion, staff involved in an emergency safety intervention and the resident must have a face-to-face discussion. This discussion must include all staff involved in the intervention except when the presence of a particular staff person may jeopardize the well-being of the resident. Other staff and the resident's parent(s) or legal guardian(s) may participate in the discussion when it is deemed appropriate by the facility. The facility must conduct such discussion in a language that is understood by the resident's parent(s) or legal guardian(s). The discussion must provide both the resident and staff the opportunity to discuss the circumstances resulting in the use of seclusion and strategies to be used by the staff, the resident, or others that could prevent the future use of seclusion. (A) Within 24 hours after the use of seclusion, all staff involved in the emergency safety intervention, and appropriate supervisory and administrative staff, must conduct a debriefing session that includes, at a minimum, a review and discussion of: (i) The emergency safety situation that required the intervention, including a discussion of the precipitating factors that led up to the intervention; (ii) Alternative techniques that might have prevented the use of the seclusion; (iii) The procedures, if any, that staff are to implement to prevent any recurrence of the use of seclusion; and (iv) The outcome of the intervention, including any injuries that may have resulted from the use of seclusion. (B) Staff must document in the resident's record that both debriefing sessions took place and must include in that documentation the names of staff who were present for the debriefing, names of staff that were excused from the debriefing, and any changes to the resident's treatment plan that result from the debriefings. (f) The individual shall have regular meals, bathing, and use of the bathroom during seclusion, and the provision of these shall be documented in the service record; and (g) Each incident of seclusion shall be documented in the service record. The documentation shall specify: (A) The behavior support strategies and less restrictive interventions attempted prior to the use of seclusion; (B) The required authorization for the use of seclusion; (C) The events precipitating the use of seclusion; (D) The length of time seclusion was used; (E) An assessment of the appropriateness of seclusion based on threat of harm to self or others; (F) An assessment of physical injury to the individual, if any; and (G) The individual's response to the emergency safety intervention. (4) Any room specifically designated for the use of seclusion or time out shall be approved by the Division. If the use of seclusion occurs in a room with a locking door, the program shall be authorized by the Division for this purpose and shall meet the following requirements: (a) A facility or program seeking authorization for the use of seclusion shall submit a written application to the Division; (b) The application shall include a comprehensive plan for the need and use of seclusion of children in the program and copies of the facility's policies and procedures for the utilization and monitoring of seclusion, including a statistical analysis of the facility's actual use of seclusion, physical space, staff training, staff authorization, record keeping, and quality assessment practices; (c) The Division shall review the application and, after a determination that the written application is complete and satisfies all applicable requirements, shall provide for a review of the facility by authorized Division staff; (d) The Division shall have access to all records including service records, the physical plant of the facility, the employees of the facility, the professional credentials and training records for all program staff, and shall have the opportunity to fully observe the treatment and seclusion practices employed by the facility; (e) After the review, the chief officer shall approve or disapprove the facility's application and upon approval shall certify the facility based on the determination of the facility's compliance with all applicable requirements for the seclusion of children; (f) If disapproved, the facility shall be provided with specific recommendations and have the right of appeal to the Division; and (g) Certification of a facility shall be effective for a maximum of three years and may be renewed thereafter upon approval of a renewal application. (5) An ITS provider seeking certification shall have available at least one room that meets the following specifications and structural and physical requirements for seclusion: (a) The room shall be of adequate size to permit three adults to move freely and allow for one adult to lie down. Any newly constructed room shall be no less than 64 square feet; (b) The room may not be isolated from regular program staff of the facility and shall be equipped with adequate locking devices on all doors and windows; (c) The door shall open outward and contain a port of shatterproof glass or plastic through which the entire room may be viewed from outside; (d) The room shall contain no protruding, exposed, or sharp objects; (e) The room shall contain no furniture. A fireproof mattress or mat shall be available for comfort; (f) Any windows shall be made of unbreakable or shatterproof glass or plastic. Non-shatterproof glass shall be protected by adequate climb-proof screening; (g) There may be no exposed pipes or electrical wiring in the room. Electrical outlets shall be permanently capped or covered with a metal shield secured by tamper-proof screws. Ceiling and wall lights shall be recessed and covered with safety glass or unbreakable plastic. Any cover, cap, or shield shall be secured by tamper-proof screws; (h) The room shall meet State Fire Marshal fire, safety, and health standards. If sprinklers are installed, they shall be recessed and covered with fine mesh screening. If pop-down type, sprinklers shall have breakaway strength of under 80 pounds. In lieu of sprinklers, combined smoke and heat detectors shall be used with similar protective design or installation; (i) The room shall be ventilated, kept at a temperature no less than 64°F and no more than 85°F. Heating and cooling vents shall be secure and out of reach; (j) The room shall be designed and equipped in a manner that would not allow a child to climb off the floor; (k) Walls, floor, and ceiling shall be solidly and smoothly constructed to be cleaned easily and have no rough or jagged portions; and (L) Adequate and safe bathrooms shall be available.