Section 0940-05-25-.11 - REQUIREMENTS FOR THE USE OF RESTRICTIVE BEHAVIOR MANAGEMENT IN BOARDING HOME FACILITIES(1) Corporal punishment must not be used.(2) Behavior-management programs must not employ techniques that may result in denial of a nutritionally adequate diet.(3) Physical restraint, drugs for behavior management, time-out rooms, aversive stimuli, or other techniques with similar degrees of restriction or intrusion must not be employed except as an integral part of an Individual Program Plan that is assigned by the client's Individual Program Plan team to lead to a less restrictive way of managing, and ultimately to the elimination of, the behavior.(4) Restrictive or intrusive behavior-management procedures must not be used until after less-restrictive alternatives for dealing with the problem behavior have been systematically tried or considered and have been determined to be inappropriate or ineffective.(5) Prior to the implementation of a written program incorporating the use of a highly restrictive or intrusive technique, the facility must document that the program has been reviewed and approved by the client or the client's legal guardian and the facility must appoint a Human Rights Committee to review and approve the written program.(6) Emergency procedures used to prevent a client from inflicting bodily harm may not be repeated more than three (3) times within six (6) months without being incorporated into a written behavior-management program that is part of an Individual Program Plan designed by the client's Individual Program Plan team(7) Behavior-management drugs may be used only when authorized in writing by a physician for a specific period of time.(8) Chemical restraint may be used only when authorized and supervised by a physician in attendance.(9) A client placed in chemical restraint must be under continuous staff observation.(10) If the use of chemical restraint is necessary beyond twenty-four (24) hours, the situation must be re-evaluated, authorized and supervised by a physician in attendance.(11) The program for the use of a mechanical restraint must specify the extent and frequency of the monitoring according to the type and design of the device and the condition of the client.(12) A client placed in mechanical restraint must be released for a minimum of ten (10) minutes at least every two (2) hours and provided with an opportunity provided for motion, exercise, liquid intake and toileting.(13) Personal restraint/physical holding may be used only until the client is calm.(14) If the use of personal restraint/physical holding is necessary beyond sixty (60) minutes, the situation must be-revaulated and authorized by a mental retardation specialist.(15) The client placed in a time-out room must be released after a period of not more than sixty (60) minutes.(16) The ability of a client to exit a time-out room must not be prevented by means of keyed or other locks; and time-out rooms must allow for the immediate entry of staff.(17) Aversive stimuli may be used only when the behavior of a client is likely to cause irreparable harm to himself or others, the behavior precludes his or her development and less negative procedures have, in the immediate past, been documented to be ineffective in reducing or eliminating this particular behavior.Tenn. Comp. R. & Regs. 0940-05-25-.11
Original rule filed May 26, 1988; effective July 11, 1988.Authority: T.C.A. § 33-2-504.