14 Del. Admin. Code § 935-93.0

Current through Register Vol. 28, No. 7, January 1, 2025

Section 935-93.0 - Restrictive Procedures

93.1 A licensee shall receive written permission from OCCL before a facility or program uses the restrictive procedures of chemical restraint, physical restraint, or seclusion.

93.2 A licensee shall have and follow written policies and procedures governing the appropriate use of chemical restraint, physical restraint, or seclusion, as applicable. These policies and procedures shall:

93.2.1 Prohibit the use any restrictive procedure on a child below age 6.

93.2.2 Require restrictive procedures to only be permitted under the following conditions:

93.2.2.1 A trauma-informed treatment model is used;

93.2.2.2 The child is a danger to self or others;

93.2.2.3 The child's behavior is seriously disruptive;

93.2.2.4 Other ways to manage the child's dangerous behavior have failed; and

93.2.2.5 Staff members administering a restrictive procedure were trained to administer that procedure.

93.2.3 Identify the types of behavior or conditions for which each type of restrictive procedure, as applicable, would be permitted;

93.2.4 Require that each type of restrictive procedure, as applicable, may only be used when less restrictive interventions would not effectively reduce the risk;

93.2.5 Require documentation that a licensee's use of each type of restrictive procedure, as applicable, is in accordance with established, accepted clinical practice and is age-appropriate;

93.2 6 Require these procedures be used only as additional techniques to accompany positive reinforcement techniques;

93.2.7 Require that a technique be used only when its use outweighs the risk of potential harm associated with its use;

93.2.8 Prohibit, at a minimum, any of the following aversive punishment procedures:

93.2.8.1 The use of noxious substances;

93.2.8.2 The use of instruments causing temporary incapacitation;

93.2.8.3 Any restraints on a child who is pregnant;

93.2.8.4 Any restraint that may constrict a child's breathing;

93.2.8.5 Placing pressure on a child's neck or throat;

93.2.8.6 Placing pressure on a child's mouth, except for the purpose of extracting a body part from a bite or possible choking item;

93.2.8.7 Using a restrictive procedure when the primary purpose is to inflict pain; or

93.2.8.8 Using restraint equipment and physical restraint techniques for punishment, discipline, or retaliation.

93.2.9 Require a restrictive procedure to be administered only by staff who have been specifically trained in its use and authorized to apply such strategies. Staff members are prohibited from intentionally:

93.2.9.1 Pulling a child's hair;

93.2.9.2 Pinching a child's skin;

93.2.9.3 Twisting a child's arm or leg in a way that would cause pain or injury to the child;

93.2.9.4 Kneeling or sitting on any part of a child;

93.2.9.5 Placing a choke hold on a child;

93.2.9.6 Bending back a child's finger;

93.2.9.7 Shoving or pushing a child into the wall, floor, or other stationary object;

93.2.9.8 Placing of hands, feet, elbows, knees or any object on a child's neck, throat, genitals or other intimate parts;

93.2.9.9 Causing pressure to be placed or creating a risk of causing pressure to be placed, on a child's stomach, chest, joints, throat or back by a knee, foot or elbow; or

93.2.9.10 Allowing another child or children to assist in a physical restraint.

93.2.10 Describe the position and qualifications of the staff who have direct responsibility for applying and for supervising the application of each type of restrictive procedure, as applicable;

93.2.11 Restrict the use of each type of restrictive procedure, as applicable, to designated and authorized staff who have been given prior training in how to administer and supervise the application of such procedure including the following:

93.2.11.1 Documentation requirements;

93.2.11.2 Thresholds for using restrictive procedures;

93.2.11.3 The physiological and psychological impact of restrictive procedures;

93.2.11.4 How to monitor and respond to the resident's physical signs of distress;

93.2.11.5 Symptoms and interventions for positional asphyxia, as applicable;

93.2.11.6 Time limits for the use of physical restraint and seclusion;

93.2.11.7 Emergency release of a child from a locked seclusion room within two minutes of the onset of a fire or similar emergency, if applicable; and

93.2.11.8 Procedures for obtaining approval for the use of a restrictive procedure.

93.2.12 Require the current service plan for that child permits the use of each type of restrictive procedure, as applicable, considering whether the restrictive procedure is proportionate to the severity of the child's behavior; the child's chronological and developmental age, size, and gender, physical condition, disability, medical condition, psychiatric condition, and personal injury, including any history of trauma, and used in a manner consistent with the child's treatment plan;

93.2.13 Require a legal, informed, written consent from the child's parent or referring agency is received before using each type of restrictive procedure, as applicable;

93.2.14 Require chemical restraints to be administered by a registered nurse either orally or via intramuscular injection, if applicable;

93.2.15 Prohibit the removal or limitation of the use of a mobility aid or other assistive device in a restraint unless there is a risk of imminent serious bodily injury and less restrictive interventions would not effectively reduce the risk.

93.2.16 Indicate time limitations and other restrictions on the use of each type of restrictive procedure, as applicable and require physical restraint and seclusion to end when the threat of harm ends;

93.2.17 Require a physical restraint to be applied for the minimum time necessary to accomplish the purpose. It shall not exceed 10 minutes without documentation on attempts made to release the child from the hold if more than 10 minutes is required. A licensee shall ensure a child is released from a physical restraint as soon as the child gains control, or before 10 minutes have elapsed, whichever occurs first;

93.2.18 Require the chief administrator or chief administrator's designee provides weekly administrative oversight of each use of each type of restrictive procedure, as applicable, to ensure that these procedures are humanely and appropriately applied; and

93.2.19 Require documentation for each use of each type of restrictive procedure, as applicable. This documentation shall contain the following information:

93.2.19.1 The name of the child;

93.2.19.2 The names of the staff who administered the procedure;

93.2.19.3 Behavior supports used to deter the behavior before the use of a restrictive procedure;

93.2.19.4 The names of witnesses;

93.2.19.5 The date, time, and duration of the procedure;

93.2.19.6 The place;

93.2.19.7 The circumstances surrounding the use of the procedure;

93.2.19.8 A description of the child's behavior; and

93.2.19.9 A health observation to state whether any injuries occurred.

93.2.20 Require written specific authorization from a licensed physician when a child has a known physical condition that would contraindicate its use;

93.2.21 Require the chief administrator, designee, or the direct care supervisor to be immediately notified when a child has been restrained for more than 10 minutes or when within a 24-hour period a child has been in seclusion more than 3 times or a total of 2 hours.

93.2.22 Require the chief administrator or the designee to conduct a review to determine the child's suitability to remain in placement in the facility or program or whether changes to the child's service plan are necessary and to take appropriate action in response to the review for the following situations:

93.2.22.1 Whenever a physical restraint has been used for more than 10 minutes;

93.2.22.2 If there are more than 3 seclusions for an individual child or 2 hours of seclusion within a 24-hour period; or

93.2.22.3 If a chemical restraint is administered.

93.2.23 Require the reviews for physical restraints and seclusions to be forwarded to DSCYF by following the DSCYF Reportable Events and Notification Procedures.

93.3 A licensee shall ensure when using the restrictive procedure of seclusion:

93.3.1 Children are placed in seclusion for no more than 45 consecutive minutes;

93.3.2 At least one staff member is responsible for providing continuous monitoring and observation of the child and is available to unlock the room, if locked, within 2 minutes of the onset of a fire or similar emergency;

93.3.3 The child is not secluded in a closet, bathroom, or unfinished basement or attic;

93.3.4 Rooms used for seclusion have tamper-proof fixtures and adequate space, temperature, light, and ventilation;

93.3.5 The room or area used has equipment and furnishings that do not present a physical hazard or suicide risk and objects that may be used by a child for self-injury are removed from the child before the child is placed in seclusion;

93.3.6 The room or area used has at least 75 square feet and a ceiling height of at least 8 feet;

93.3.7 A staff member returns the child to the group in a sensitive and non-punitive manner as soon as the child has regained control;

93.3.8 The child has access to toilet facilities, as needed; and

93.3.9 The child receives the same number and frequency of meals and snacks provided to other children in the facility or program.

14 Del. Admin. Code § 935-93.0

27 DE Reg. 599 (2/1/2024) (Final)