N.J. Admin. Code § 3A:56-6.13

Current through Register Vol. 56, No. 21, November 4, 2024

Section 3A:56-6.13 - Restrictive behavior management practices

(a) Homes that choose to utilize restrictive behavior management practices shall develop policies and procedures that assist children in gaining control of their behavior, protect the children from self-harm, protect other children or staff members, and prevent the destruction of property.

(b) The home shall:

1. Obtain written approval from the Office of Licensing for restrictive behavior management practices that are not identified in (i) and (j) below, that the home plans to utilize, prior to their implementation with children; and

2. Not utilize restrictive behavior management practices as a means of punishment, for the convenience of staff members, or as a substitute for a treatment program.

(c) Prior to the child's admission, the home shall:

1. Explain to the parents, the child, the Division's worker, or other placing agency any restrictive behavior management practice that is used, the circumstances under which it will be employed, and the possible risks involved; and

2. Obtain written consent for the use of each restrictive behavior management practice the home uses from the child's parents or legal guardian.

(d) The home shall ensure that the consent form is written in plain language and is explained to the parents.

(e) Whenever the parents refuse to consent to a restrictive behavior management practice, revoke their consent for the practice, or cannot be located to give consent, the home shall:

1. Refrain from utilizing the practice unless the child presents an imminent danger to self or others, and apply other, non-restrictive interventions until such consent is obtained and continue to make reasonable efforts to obtain informed consent; and

2. Request that the Division's worker and the placing agency obtain the necessary consent, either through administrative action pursuant to an agreement between the parent, the Division, and other placing agency or through legal action, if necessary to protect the best interests of the child.

(f) The home shall maintain a copy of all signed consent forms in the child's records.

(g) At least 10 working days before each staffing or treatment planning meeting for a child for whom the home uses a restrictive behavior management practice, the home shall send a letter to the child's parents and the Division's worker and other placing agency, which shall:

1. Inform them of the frequency and duration of any restrictive behavior management practice that was used with the child;

2. Describe how the child responded to the treatment; and

3. Invite them to the treatment planning meeting to discuss the child's program and progress.

(h) The home shall develop and maintain on file in the home or home's administrative office a policy indicating which restrictive behavior management practices the home uses.

(i) Homes that utilize physical restraint with children shall:

1. Ensure that physical restraint is used only to protect a child from self-harm, or to protect other children or staff members, or to prevent the destruction of property when the child fails to respond to non-restrictive behavior management interventions;

2. Ensure that staff members only use physical restraint techniques and holds, such as escort holds approved by the Office of Licensing, which staff members may implement to move a child from one place to another, the basket hold or restraining the child in the prone position and only when the child:

i. Has received a medical examination that documents that the child is in good health; and

ii. Does not have a documented respiratory ailment such as asthma, a spinal condition, fractures, seizure disorder or other physical condition that would preclude the child from being restrained, unless the physician authorizes such techniques;

3. Ensure that a minimum of two staff members are involved in the physical restraint and at least one staff member monitors the child's breathing by maintaining constant visual face-to-face contact with the child during the restraint;

4. Ensure that a child is released from restraint as soon as he or she has gained control;

5. Document each physical restraint incident in an incident report that reflects the following:

i. The name of the child;

ii. The date and time of day the restraint occurred;

iii. The name(s) of all staff members involved in the restraint;

iv. Precipitating factors that led to the restraint;

v. Other non-restraint interventions attempted;

vi. The time the restraint ended;

vii. The condition of the child upon release; and

viii. A medical review by the nurse or physician if injury to the child is suspected;

6. Ensure that all restraint incidents are:

i. Reviewed by a supervisory staff member within one working day after the incident; and

ii. If needed, discussed with the staff member involved in the restraint incident within one working day after the incident.

7. Ensure that staff members who are involved in the restraint of a child receive training in safe techniques for physical restraint and that such training is updated at least annually;

8. Prohibit staff members from utilizing the following practices during a physical restraint:

i. Pulling a child's hair;

ii. Pinching a child's skin;

iii. Twisting a child's arm or leg in such a manner that would cause the child pain;

iv. Kneeling, straddling or sitting on the chest or back of a child in such a manner as to inhibit the child's breathing;

v. Placing a choke hold on a child;

vi. Bending back a child's fingers;

vii. Intentionally shoving a child into walls and objects; and

viii. Allowing other children to assist in the restraint; and

9. Ensure that staff members are trained in escape, release and defensive blocking techniques approved by the Office of Licensing, to be used when staff members are placed at risk of physical injury during the implementation of a physical restraint.

(j) Homes that utilize exclusion shall:

1. Inform staff members through written policy of the circumstances when exclusion may be utilized as a behavior management intervention, such as:

i. Disruptive behavior, including fighting, name calling and pushing;

ii. Increased agitation on the part of the child;

iii. Non-compliant behavior or failure to participate in the program; and

iv. Uncontrollable emotional outbursts such as crying, screaming and inappropriate laughter;

2. Ensure that the child being excluded has no record of suicidal behavior;

3. Prohibit more than one child from being excluded in a room or area at a time;

4. Ensure that at least one staff member is responsible to make visual contact with the child every 10 minutes and is within hearing distance of a child when the child is removed from the group;

5. Ensure that the home does not utilize a closet, bathroom, unfinished basement, unfinished attic, stairway, locked room or other unapproved area when excluding a child from the group;

6. Ensure that the exclusion of a child from the other children does not exceed 30 consecutive minutes, unless there is direct verbal contact by a staff member to assess if the child is ready to return to the other children prior to the end of the 30 minutes and a child is not excluded from the group for more than a total of two hours in a 24-hour period, unless there are circumstances documented in the child's treatment plan by a physician's written order, or a physician's verbal order to the nurse documented in the child's record extending the exclusion time;

7. Document each exclusion of a child in an incident report that reflects the following:

i. The name of the child;

ii. The date and time of day the exclusion occurred;

iii. The name(s) of all staff members observing the child;

iv. Precipitating factors that led to the exclusion;

v. Other intervention attempted;

vi. The time the exclusion ended; and

vii. The condition of the child upon release; and

8. Ensure that the child is reintroduced to the group in a sensitive and non-punitive manner as soon as he or she has gained control.

(k) The home shall not utilize mechanical restraint on any child, such as:

1. A straight jacket;

2. Leg irons;

3. A papoose board;

4. A rope;

5. Metal handcuffs;

6. Body wraps;

7. Body tubes;

8. Teflon handcuffs;

9. Blanketing; and

10. Four and five point restraint.

(l) The home shall not have a behavior management room, which is a room specifically designed and constructed for the isolation of children.

N.J. Admin. Code § 3A:56-6.13

Amended by R.1996 d.118, effective 3/4/1996.
See: 27 N.J.R. 4266(a), 28 N.J.R. 1379(c).
Amended by R.2006 d.433, effective 12/18/2006.
See: 38 N.J.R. 2610(a), 38 N.J.R. 5362(b).
In (b)1, substituted "Office of Licensing" for "Bureau" and "their" for "its"; in (i)2, deleted "Bureau-approved" preceding "escort" and substituted "approved by the Office of Licensing, which" for "that"; and in (i)9, deleted "Bureau-approved" preceding "escape" and inserted "approved by the Office of Licensing".
Amended by R.2014 d.103, effective 6/16/2014.
See: 46 N.J.R. 7(a), 46 N.J.R. 1473(b).
In (c)1, substituted "worker," for "case manager"; in (e)2 and the introductory paragraph of (g), substituted "worker" for "case manager"; and in (e)2, inserted a comma following "Division".