Rule 290-2-29-.20 - Second Chance Home Programs-Behavior Management and Emergency Safety Interventions(1)Second Chance Home Programs. Behavior Management. Every home shall develop and implement policies and procedures on behavior management. Such policies and procedures shall set forth the types of residents served and room, board and watchful oversight capacities in accordance with its program purpose, the anticipated behavioral problems of the residents, and acceptable methods of managing such problems.(2)Second Chance Home Programs. Behavior Management. Behavior management principles and techniques shall be used in accordance with the individual service plan and written policies and procedures governing service expectations, treatment goals, safety, security, and these rules and regulations.(3)Second Chance Home Programs. Behavior Management. Behavior management shall be limited to the least restrictive appropriate method, as described in the resident's service plan and in accordance with the prohibitions as specified in these rules and regulations.(4)Second Chance Home Programs. Behavior Management. The following forms of behavior management shall not be used: (a) Assignment of excessive or unreasonable work tasks;(b) Denial of meals and hydration;(d) Denial of shelter, clothing, or essential personal needs;(e) Denial of essential program services;(f) Verbal abuse, ridicule, or humiliation;(g) Chemical restraint, manual holds, and seclusion used as a means of coercion, discipline, convenience, or retaliation;(h) Denial of communication and visits unless restricted;(i) Corporal punishment; and(j) Seclusion not used appropriately as an emergency safety intervention.(5)Second Chance Home Programs. Behavior Management. Residents shall not be permitted to participate in the behavior management of other residents or to discipline other residents, except as part of an organized therapeutic self-governing program in accordance with accepted standards of practice that is conducted in accordance with written policy and is supervised directly by designated staff. A parenting resident may participate in the behavior management of his or her own child under staff supervision.(6)Second Chance Home Programs. Behavior Management. Homes shall submit to the Department electronically or by facsimile a report within 24 hours whenever an unusual incident occurs regarding behavior management, including any injury requiring medical treatment beyond first aid that is received by a resident as a result of any behavior management.(7)Second Chance Home Programs. Behavior Management. All forms of behavior management used shall also be documented in case records in order to ensure that such records reflect behavior management problems.(8) Second Chance Home Programs. Emergency Safety Interventions. (a) Emergency safety interventions, including physical restraint, mechanical restraint, chemical restraint, seclusion, or any other, shall not be used on residents who are pregnant or have other medical contraindications.(b) Emergency safety interventions shall not be used on residents who are younger than six (6) years old.(9)Second Chance Home Programs. Emergency safety interventions may be used only by staff trained in the proper use of such interventions when a resident exhibits a dangerous behavior reasonably expected to lead to immediate physical harm to the resident or others and less restrictive means of dealing with the injurious behavior have not proven successful or may subject the resident or others to greater risk of injury.(10)Second Chance Home Programs. Emergency safety interventions shall not include the use of any mechanical or chemical restraint or manual hold that would potentially impair the resident's ability to breathe or has been determined to be inappropriate for use on a particular resident due to a documented medical or behavioral condition. All emergency safety interventions which employ the use of chemical restraints shall be implemented in accordance with the requirements set forth in these rules.(11)Second Chance Home Programs. The home shall have written policies and procedures for the use of emergency safety interventions, a copy of which shall be provided to and discussed with each resident and the resident's parents and/or legal guardians prior to or at the time of admission.(12)Second Chance Home Programs. The home shall document for each resident an assessment that states whether there are medical issues that would be incompatible with the appropriate use of emergency safety interventions on that resident. The assessment shall be performed by a physician, physician's assistant, or advanced practice registered nurse. Such assessment must be reevaluated and documented following any significant change in the resident's medical condition.(13)Second Chance Home Programs. The home shall document for each resident an assessment that states whether there are psychological, emotional, or trauma-related issues that would be incompatible with the appropriate use of emergency safety interventions on that resident. The assessment shall be performed by a psychiatrist, psychologist, or licensed independent practitioner of mental health.(14)Second Chance Home Programs. The home shall document each emergency safety intervention including the following: (a) Date and description of the precipitating incident;(b) Description of the de-escalation techniques used prior to the emergency safety intervention, if applicable;(c) Environmental considerations;(d) Names of staff participating in the emergency safety intervention;(e) Any witnesses to the precipitating incident and subsequent intervention;(f) Exact emergency safety intervention used;(g) Beginning and ending time of the intervention;(h) Outcome of the intervention;(i) Detailed description of any injury arising from the incident or intervention; and(j) Summary of any medical care provided.(15)Second Chance Home Programs. Manual holds shall not be implemented by any employee not trained in prevention and use of emergency safety interventions.(16)Second Chance Home Programs. Emergency safety interventions or the use of physical or chemical restraints may be used to prevent runaways only when the resident presents an imminent threat of physical harm to self or others, or as specified in the individual comprehensive service plan.(17)Second Chance Home Programs. Home staff shall be aware of each resident's medical and behavioral conditions, as evidenced by written acknowledgement of such awareness, to ensure that the emergency safety intervention that is utilized does not pose any undue danger to the health and well-being of the resident.(18)Second Chance Home Programs. Residents shall not be allowed to participate in the emergency safety intervention of another resident.(19)Second Chance Home Programs. Immediately following the conclusion of the emergency safety intervention and hourly thereafter for a period of at least four (4) hours where the resident is with a staff member, the resident's behavior will be assessed, monitored, and documented to ensure that the resident does not appear to be exhibiting symptoms that would be associated with an injury.(20)Second Chance Home Programs. At a minimum, the emergency safety intervention program that is utilized shall include the following: (a) Techniques for de-escalating problem behavior including resident and staff debriefings;(b) Appropriate use of emergency safety interventions;(c) Recognizing aggressive behavior that may be related to a medical condition;(d) Awareness of physiological impact of a restraint on the resident;(e) Recognizing signs and symptoms of positional and compression asphyxia and restraint associated cardiac arrest;(f) Instructions as to how to monitor the breathing, verbal responsiveness, and motor control of a resident who is the subject of an emergency safety intervention;(g) Appropriate self-protection techniques;(h) Policies and procedures relating to using manual holds, including the prohibition of any technique that would potentially impair a resident's ability to breathe;(i) Home policies and reporting requirements;(j) Alternatives to restraint;(k) Avoiding power struggles;(l) Escape and evasion techniques;(m) Time limits for the use of restraint and seclusion;(n) Process for obtaining approval for continual restraints and seclusion;(o) Procedures to address problematic restraints;(q) Investigation of injuries and complaints;(r) Monitoring physical signs of distress and obtaining medical assistance; and(21)Second Chance Home Programs. Emergency safety intervention training shall be in addition to the annual training required in these rules and shall be documented in the staff member's personnel record.(22)Second Chance Home Programs. All actions taken that involve utilizing an emergency safety intervention shall be recorded in the resident's case record showing the cause for the emergency safety intervention, the emergency safety intervention used, and, if needed, approval by the director, the staff member in charge of casework services, and the external physician who has responsibility for the diagnosis and treatment of the resident's behavior.(23)Second Chance Home Programs. Homes shall submit to the Department electronically or by facsimile a report, in a format acceptable to the Department, within 24 hours whenever an unusual incident occurs regarding emergency safety interventions, including: (a) Any injury requiring medical treatment beyond first aid that is received by a resident as a result of any emergency safety intervention;(b) Whenever a home utilizes emergency safety interventions three (3) or more times in one (1) month with the same resident and/or whenever the home utilizes more than 10 emergency safety interventions for all residents in care within a 30-day period.(24)Second Chance Home Programs. Homes shall submit a written report to the program's director on the use of any emergency safety intervention immediately after the conclusion of the intervention and shall further notify the resident's parents or legal guardians regarding the use of the intervention. A copy of such report shall be maintained in the resident's file.(25)Second Chance Home Programs. At least once per quarter, the home, utilizing a master emergency safety intervention log, including all incidents of physical restraint, chemical restraint, and seclusion, and the residents' case records, shall review the use of all emergency safety interventions for each resident and staff member. The review shall include the type of intervention used and the length of time of each use, to determine whether there was an appropriate basis for the intervention, whether the use of the emergency safety intervention was warranted, whether any alternatives were considered or employed, the effectiveness of the intervention or alternative, and the need for additional training. Written documentation of all such reviews shall be maintained. Where the home identifies opportunities for improvement as a result of such reviews or otherwise, the home shall implement these changes through an effective quality improvement plan.(26)Second Chance Home Programs. All direct care staff who may be involved in the use of emergency safety interventions, shall have evidence of having satisfactorily completed a training program for emergency safety alternative, and the need for additional training. Written documentation of all such reviews shall be maintained. Where the home identifies opportunities for improvement as a result of such reviews or otherwise, the home shall implement these changes through an effective quality improvement plan.(27)Second Chance Home Programs. All direct care staff who may be involved in the use of emergency safety interventions, shall have evidence of having satisfactorily completed a training program for emergency safety interventions to protect residents and others from injury, which has been approved by the Department and taught by an appropriately certified trainer in such program. Homes shall check the Department's website for a list of approved training programs.(28)Second Chance Home Programs. Manual Holds. Emergency safety interventions utilizing manual holds require at least one (1) trained staff member to carry out the hold. Emergency safety interventions utilizing prone restraints require at least two (2) trained staff members to carry out the hold.(29)Second Chance Home Programs. Manual Holds. Emergency safety interventions shall not include the use of any chemical or mechanical restraint or manual hold that would potentially impair a resident's ability to breathe or has been determined to be inappropriate for use on a particular resident due to a documented medical or behavioral condition.(30)Second Chance Home Programs. Manual Holds. When a manual hold is used upon any resident whose primary mode of communication is sign language, the resident shall be permitted to have his or her hands free from restraint for brief periods during the intervention, except when such freedom may result in physical harm to the resident or others.(31)Second Chance Home Programs. Manual Holds. If the use of a manual hold exceeds 15 consecutive minutes, the home's director or his or her designee, who possesses at least the qualifications of the director and has been fully trained in the home's emergency safety intervention plan, shall be contacted by a two-way communications device or in person and determine that the continuation of the manual hold is appropriate under the circumstances. Documentation of any consultations and outcomes shall be maintained for each application of a manual hold that exceeds 15 minutes. Manual holds shall not be permitted to continue if the restraint is determined to pose an undue risk to the resident's health given the resident's physical or mental condition.(32)Second Chance Home Programs. Manual Holds. A manual hold may not continue for more than 30 minutes at any one (1) time without the consultation as specified in subparagraph (31), and under no circumstances may a manual hold be used for more than one (1) hour total within a 24-hour period.(33)Second Chance Home Programs. Manual Holds. If the use of a manual hold on a resident reaches a total of one (1) hour within a 24-hour period, the staff shall reconsider alternative strategies, document same, and consider notifying the authorities or transporting the resident to a hospital or other appropriate facility for evaluation.(34)Second Chance Home Programs. Manual Holds. The resident's breathing, verbal responsiveness, and motor control shall be continuously monitored during any manual hold. Written summaries of the monitoring by a trained staff member not currently directly involved in the manual hold shall be recorded every 15 minutes during the duration of the restraint. If only one (1) trained staff member is involved in the restraint and no other staff member is available, written summaries of the monitoring of the manual hold shall be recorded as soon as is practicable, but no later than one (1) hour after the conclusion of the restraint.(35)Second Chance Home Programs. Manual Holds. A positioning or securing device used to maintain the position, limit mobility, or temporarily immobilize a resident during medical, dental, diagnostic, or surgical procedures is not considered a manual hold.(36)Second Chance Home Programs. Seclusion. Homes shall not utilize seclusion as an emergency safety intervention.(37)Second Chance Home Programs. Mechanical restraint. Homes shall not utilize mechanical restraint as an emergency safety intervention.(38)Second Chance Home Programs. Chemical restraint. Homes shall not utilize chemical restraint as an emergency safety intervention.Ga. Comp. R. & Regs. R. 290-2-29-.20
O.C.G.A. Secs. 49-5-3, 49-5-8.
Original Rule entitled "Second Chance Home Programs-Behavior Management and Emergency Safety Interventions" adopted. F. Dec. 15, 2011; eff. Jan. 4, 2012.