Interim Guidance on Use of Seclusion and Restraints in Certified Day
Treatment Programs for Children
PDF Version of BQA 06-020
(PDF 32 KB)
Date: September 11, 2006 -- DDES-BQA Memo 06-020
To: Area Administrators / Human Services Area Coordinators
County COP Coordinators
County Department of Community Program Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Mental Health Coordinators
County Waiver Coordinators
DDES Bureau Directors
DDES Section Chiefs
Tribal Chairpersons/Human Services Facilitators
Outpatient Rehabilitation
Facilities for the Developmentally Disabled
Mental Health and Alcohol or Other Drug Abuse (AODA) Treatment Programs
From: Otis Wood, Director, Bureau Quality Assurance
Interim Guidance on Use of Seclusion and Restraints in Certified Day
Treatment Programs for Children
Subject
This memo outlines the current Wisconsin law that requires that the use of
seclusion, isolation, and restraints for children should only be used in
an emergency unless the use is approved by the Department on a
case-by-case basis.
Current law permits the use of seclusion, isolation, and restraints in
emergency situations when it is likely the client may physically harm
himself/herself or others. See paragraph 51.61(1)(i), Wis. Stats.
Wisconsin's laws direct Department review of program policies and approval
of the application of those policies on a case-by-case basis for
individuals assessed to potentially need seclusion, isolation, or
restraint as a regular part of their treatment/behavioral plan.
HFS 40 specifies staff ratio and qualifications, as well as other
standards that a Day Treatment Program must meet to be certified according
to levels I, II, or III. An initial screen for admission and a
multi-disciplinary team assessment is required to determine that an
appropriate match of the child's needs and program services can be
attained. Mental health, substance abuse, medication, physical health,
behaviors, and dangerous conditions relating to these and other standard
elements of the assessment and planning process are required. Adequate
training and staff competencies in these areas must be addressed at all
levels of treatment. Prevention of crisis in order to avoid the use of
restraint or seclusion is a priority due to the high risk of injury and
trauma.
The Federal Children's Health Act, P.L. 106-310, provides additional
guidance in the definition and development of national standards on the
use of restraints and seclusion. Interim procedures under that law require
a program to develop an interim procedure to "(i) ensure that a
supervisory or senior staff person with training in restraint and
seclusion who is competent to conduct a face-to-face assessment (as
defined in regulations promulgated by the Secretary), will assess the
mental and physical well-being of the child or youth being restrained or
secluded and assure that the restraint or seclusion is being done in a
safe manner; (ii) ensure that the assessment required under clause (i)
take place as soon as practicable, but in no case later than 1 hour after
the initiation of the restraint or seclusion; (iii) ensure that the
supervisory or senior staff person continues to monitor the situation for
the duration of the restraint and seclusion."
Wisconsin statutes and administrative rules are referenced below that
highlight certain, but not all, required actions related to restraint,
isolation, or seclusion. In addition, federal law regarding needed areas
of training provides additional direction for policy development and
training of program personnel working with children. Training identified
is specific and essential for safe use of restraint or seclusion in
emergency situations.
- Sec. 51.61 (1)
(i) 1, Wis. Stats.
- Patient rights. All patients shall… Have a right to be free from physical restraint and isolation except
for emergency situations or when isolation or restraint is a part of a
treatment program. Isolation or restraint may be used only when less
restrictive measures are ineffective or not feasible and shall be used for
the shortest time possible…. Each facility shall have a written policy
covering the use of restraint or isolation which ensures that the dignity
of the individual is protected, that the safety of the individual is
ensured and that there is regular, frequent monitoring by trained staff to
care for bodily needs as required. Isolation or restraint may be used for
emergency situations only when it is likely that the patient may
physically harm himself or herself or others. The treatment director shall
specifically designate physicians who are authorized to order isolation or
restraint, and shall specifically designate licensed psychologists who are
authorized to order isolation.
-
HFS 94.10, Wis. Admin. Code - Isolation, seclusion and physical
restraints. Any service provider using isolation, seclusion , or physical
restraint shall have written policies that meet the requirements specified
under s. 51.61 (1) (i) 2., Stats. For a community placement, the use of
isolation, seclusion or physical restraint shall be specifically approved
by the department on a case-by-case basis and by the county department if
the county department has authorized the community placement. In granting
approval, a determination shall be made that use is necessary for
continued community placement of the individual and that supports and
safeguards necessary for the individual are in place.
-
HFS 40.14, Wis. Admin. Code Client rights. - Policies and Procedures.
All programs shall comply with s. 51.61., and Ch. HFS 94 on the rights of
clients.
- P.L.106-310 Sec. 595 Children's Health Act of 2000 - Requirement
Relating to the Rights of Residents of Certain Non-Medical,
Community-Based Facilities for Children and Youth. …"(A) the
restraints or seclusion are imposed only in emergency circumstance and
only to ensure the immediate physical safety of the resident, a staff
member, or others and less restrictive interventions have been determined
to be ineffective; and (B) the restraints or seclusion are imposed only by
an individual trained and certified, by a State-recognized body (as
defined in regulation promulgated by the Secretary) and pursuant to a
process determined appropriate by the State and approved by the Secretary,
in the prevention and use of physical restraint and seclusion, including
the needs and behaviors of the population served, relationship building,
alternatives to restraint and seclusion, de-escalation methods, avoiding
power struggles, thresholds for restraints and seclusion, the
physiological and psychological impact of restraint and seclusion,
monitoring physical signs of distress and obtaining medical assistance,
legal issues, position asphyxia, escape and evasion techniques, time
limits, the process for obtaining approval for continued restraints,
procedures to address problematic restraints, documentation, processing
with children, and follow-up with staff and investigation of injuries and
complaints.
The Department intends to issue additional policy clarification and
information on the availability of resources for training and technical
assistance at a later date. A federal document of policies and training
modules "Roadmap to Seclusion and Restraint Free Mental Health
Services" in CD ROM may be obtained free of charge from the Center
for Mental Health Services at www.samhsa.gov
. An additional document,
which may be useful to programs reviewing and developing policy and
procedures, is the Wisconsin Department of Public Instruction (WDPI)
September 2005 "Guidelines for the Appropriate Use of Seclusion and
Physical Restraint in Special Education Programs."
I encourage you to contact us if you have concern on these issues, or
questions about training and policy development regarding seclusion or
restraints. For questions, or to provide comments related to this memo,
please email Jeff Hinz at hinzje@dhfs.state.wi.us
Jeff Hinz, Supervisor, Women, Youth and Families Unit
Bureau of Mental Health and Substance Abuse Services
Division of Disability and Elder Services
1 W. Wilson Street, Room 433
PO Box 7851
Madison, WI 53707-7851
Fax: (608) 261-7800
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