Mechanical restraints – plan of treatment, etc.
 21. (1) In this section and in sections 21.1 and 21.2, “health practitioner” means a member of a College under the Regulated Health Professions Act, 1991
or a person designated by the Minister; (“praticien de la santé”) “PASD” means a personal assistance service device, being a device used to assist a child or young person with hygiene, washing, dressing, grooming, eating, drinking, elimination, ambulation or positioning or any other routine activity of living that is a mechanical restraint; (“appareil d’aide personnelle”) “plan of treatment” has the same meaning as in the Health Care Consent Act, 1996. (“plan de traitement”) O. Reg. 155/18, s. 21 (1); O. Reg. 72/22, s. 6 (1-3). (1.1) In this section and in section 21.1, a child or young person’s substitute decision-maker is, (a) their substitute decision-maker within the meaning of the Health Care Consent Act, 1996, in relation to a plan of treatment or the use of a mechanical restraint as authorized by a plan of treatment; or (b) their nearest relative as defined in subsection 21 (1) of the Act, in relation to a plan for the use of a PASD or the use of a PASD as authorized by a plan for the use of a PASD. O. Reg. 72/22, s. 6 (4). (2) A service provider may use or permit the use of a mechanical restraint on a child or young person for whom the service provider is providing a service if, (a) the use is authorized by, (i) a plan of treatment to which the child or young person, or their substitute decision-maker, has consented in accordance with the Health Care Consent Act, 1996, or (ii) a plan for the use of a PASD to which the child or young person, or their substitute decision-maker, has consented; and (b) the plan of treatment or plan for the use of a PASD, (i) includes the content described in subsection (4.1) or (4.2), as the case may be, (ii) has been signed and dated by any health practitioner who participated in its development and by the child or young person to whom it relates, or their substitute decision-maker, in such a manner as to indicate their agreement with the content of the plan, and (iii) if the plan has been amended following its development, (A) it clearly indicates the amendments that were made, and (B) it has been signed and dated by any health practitioner who participated in developing the amendments to the plan and by the child or young person to whom it relates, or their substitute decision-maker, in such a manner as to indicate their agreement with the amendments. O. Reg. 72/22, s. 6 (5). (3) For the purposes of this section and sections 21.1 and 21.2, a plan for the use of a PASD means a plan that is developed by one or more health practitioners and provides for how a PASD will assist a child or young person with hygiene, washing, dressing, grooming, eating, drinking, elimination, ambulation or positioning or any other routine activity of living. O. Reg. 155/18, s. 21 (3); O. Reg. 72/22, s. 6 (6). (4) In circumstances where this section and section 160 of the Act would apply to the use of mechanical restraints on a child in a secure treatment program, section 160 of the Act applies and this section does not apply. O. Reg. 155/18, s. 21 (4). (4.1) A plan of treatment must include the following: 1. A description of, i. any risks the child or young person poses to themselves or others or any other behaviours the child or young person engages in that require the use of mechanical restraints, ii. how the use of mechanical restraints supports the health, safety and well-being of the child or young person, iii. alternative interventions to the use of a mechanical restraint that have been considered or proven to be ineffective in managing the child or young person’s behaviours and the risks posed by those behaviours, iv. clinical or other supports to be provided to the child or young person that are intended to address the behaviours or needs that are being managed through the use of mechanical restraints, and v. alternative interventions that are being used to teach the child or young person skills intended to eliminate the behaviours or meet the needs that are being managed through the use of mechanical restraints. 2. An indication of the length of time during which the mechanical restraint may be used, which shall not exceed 12 hours in any 24-hour period. 3. An indication of the date on which the plan was developed. O. Reg. 72/22, s. 6 (7). (4.2) A plan for the use of a PASD must include the following: 1. A description of alternatives to the use of the PASD that have been considered or proven to be ineffective in assisting the child or young person with a routine activity of daily living. 2. A description of how it was determined that the use of the PASD is reasonable and that the PASD in question is the least restrictive type of PASD that would effectively assist the child or young person with a routine activity of daily living, taking into consideration their physical and mental condition and their personal history. 3. A description of how the child or young person being restrained by the PASD will be repositioned. 4. An indication of the date on which the plan was developed. O. Reg. 72/22, s. 6 (7). (5) A service provider shall ensure that the use of mechanical restraints under this section is carried out in accordance with the following rules: 1. Mechanical restraints shall not be used on a child or young person for the purposes of punishment or solely for the convenience of the service provider, foster parent or staff member who is providing the service. 1.1 Only the least intrusive type of mechanical restraint that is necessary in the circumstances shall be used. 2. Mechanical restraints must be applied using the least amount of force that is necessary in the circumstances. 2.1 A child or young person must not be secured by a mechanical restraint to a fixed object or another person. 3. The service provider shall ensure that the child or young person being restrained by the use of mechanical restraints is monitored continuously and in accordance with any instructions or recommendations provided in the child or young person’s plan of treatment or plan for the use of a PASD. 4. Mechanical restraints must be removed immediately upon the earliest of the following: i. When there is a risk that their use will endanger the health or safety of the child or young person. ii. When the continued use of the mechanical restraints would no longer be authorized by the plan of treatment or plan for the use of a PASD, including when the length of time set out in the plan has expired and no approval under subsection (7.1) has been given. iii. If the child or young person, or their substitute decision-maker, withdraws consent to the use of the mechanical restraint. O. Reg. 155/18, s. 21 (5); O. Reg. 72/22, s. 6 (8-11). (6) A service provider shall ensure that mechanical restraints used under this section, (a) are applied in accordance with the manufacturer’s instructions, if any; (b) are maintained in good condition in accordance with the manufacturer’s instructions, if any; and (c) are not altered except for adjustments made in accordance with the manufacturer’s instructions, if any. O. Reg. 155/18, s. 21 (6). (7) A service provider shall ensure that a staff member or foster parent who is permitted to use a mechanical restraint on a child or young person under this section has received the necessary training, instruction or education to allow the staff member or foster parent to use the mechanical restraint in accordance with the child or young person’s plan of treatment or plan for the use of a PASD. O. Reg. 155/18, s. 21 (7). (7.1) If the use of a mechanical restraint is authorized by a plan of treatment, a service provider shall ensure that any use of the mechanical restraint does not exceed 12 hours, or such other shorter amount of time set out in the plan of treatment, in any 24-hour period, unless the use of the mechanical restraint for a longer amount of time is approved by, (a) a legally qualified medical practitioner; (b) a registered nurse or a registered practical nurse; (c) a member of the College of Occupational Therapists of Ontario; or (d) a member of the College of Physiotherapists of Ontario. O. Reg. 72/22, s. 6 (12). (7.2) A service provider shall ensure that any approval given under subsection (7.1) is documented in the plan of treatment. O. Reg. 72/22, s. 6 (12). (8) A service provider shall maintain written records regarding the use of a mechanical restraint on a child or young person under this section and those records shall include, (a) information that is necessary to demonstrate that use of the mechanical restraint was in conformity with the child or young person’s plan of treatment or plan for the use of a PASD; and (b) the names of every staff member or foster parent who was permitted to use mechanical restraints on the child or young person and a description of the training, instruction or education that the staff member or foster parent received. O. Reg. 155/18, s. 21 (8). (8.1) A service provider shall, for every month, maintain a written record that summarizes every instance of the use of a mechanical restraint that is not a PASD on a child or young person at any premises at which the service provider provides a service during that month, and the record shall include the following in respect of each instance: 1. The name and age of each child or young person who was restrained. 2. The dates and time periods during which the mechanical restraint was used in respect of each child or young person. 3. A description of the circumstances and the risk that existed before the mechanical restraint was used. O. Reg. 72/22, s. 6 (13). (8.2) A service provider shall, on or before the fifth day of every month, provide a copy of the record required under subsection (8.1) in respect of the previous month to, (a) in the case of a child who is not a young person, a Director; or (b) in the case of a young person, a provincial director. O. Reg. 72/22, s. 6 (13). (9) A service provider that uses or permits the use of a mechanical restraint under this section shall develop and maintain policies regarding the following: 1. Protocols that must be followed in monitoring and assessing a child or young person’s condition while a mechanical restraint is being used. 2. Protocols for developing and maintaining records required under subsection (8). 3. Protocols for ensuring that the mechanical restraints are only used for the amount of time permitted by this section. O. Reg. 155/18, s. 21 (9); O. Reg. 72/22, s. 6 (14). (10) Revoked: O. Reg. 72/22, s. 6 (15).