Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 384 - BEHAVIOR TREATMENT IN RESIDENTIAL CHILD CARE FACILITIES › Section 384.50 - Behavior Management Requirements for the Use of Manual Restraints

Current through Register Vol. 48, No. 28, July 12, 2024
Each application of manual restraint may be used only as a
				therapeutic measure when a child presents a threat of physical harm to self or
				others. Such threat shall include any dangerous behavior reasonably expected to
				lead to physical harm to self or others. Manual restraint shall not be used
				until after other less restrictive procedures or measures have been explored
				and found to be inappropriate. Manual restraint shall not be used for a child
				whose medical condition, mental illness, or developmental or psychological
				status contraindicates the use of this technique, as documented in the child's
				individual treatment plan.
a) Manual
			 restraint may be used to prevent runaway only when the child presents a threat
			 of physical harm to self or others, or as specified in the individual treatment
			 plan.
b) Manual restraint shall not
			 be used as discipline for rule infractions or as a convenience for
			 staff.
c) A child may not be
			 restrained for more than 15 minutes beyond the point at which the child ceases
			 presenting the specific behavior for which the restraint was ordered or any
			 other behavior for which restraint is an appropriate intervention, unless
			 specific clinical justification to the contrary is documented in the child's
			 treatment plan.
d) For every
			 restraint episode that exceeds 30 consecutive minutes, a registered nurse or a
			 licensed physician must be notified and consulted by telephone or in person
			 concerning the restraint. The licensed physician or registered nurse must
			 confirm, in writing, the content of the consultation and document that the
			 restraint does not pose an undue risk to the child's health given the child's
			 physical or medical condition. At the same time, the treatment team must
			 explore alternative treatment strategies, such as an emergency SASS assessment
			 or transporting the child to a hospital or mental health facility.
e) No child may be restrained for more than
			 two hours within a 24 hour period. However, within the two hours of restraint,
			 there may be no period of continuous restraint that exceeds one hour.
f) If a child has been in and out of manual
			 restraint for a total of two hours, the treatment team must explore alternative
			 treatment strategies, such as an emergency SASS assessment or transporting the
			 child to a hospital or mental health facility.
g) Manual restraint shall be administered in
			 such a manner as to avoid provoking further and escalating incidents of the
			 behavior in the child.
h) Manual
			 restraint shall not consist of, or be accompanied by, the use of mechanical
			 restraints, the use of excessive or unnecessary force, or any other action that
			 produces pain, covers the head or any part of the face, or in any way restricts
			 normal circulation and respiration of the child. Manual restraints that include
			 neck holds or a staff member lying across the torso of a client are
			 prohibited.
i) When manual
			 restraint is imposed upon any child whose primary mode of communication is sign
			 language, the child shall be permitted to have his or her hands free from
			 restraint for brief periods during the restraint, except when such freedom may
			 result in physical harm to the child or others.
j) Manual restraint shall be employed only by
			 persons who are certified as having successfully completed a competency based
			 training program presenting the specific procedures to be used. This
			 certification must be renewed through a competency based assessment at least
			 every 12 months. Current certification of competency shall be documented in the
			 individual's permanent personnel record. If an organized self-governance
			 program, as defined in Section
			 384.20, approved by
			 the governing body and the Department allows for peer participation, only peers
			 having completed such training may assist with the technique. This training
			 shall include demonstrated competency in the humane and efficient
			 implementation of the restraint program as demonstrated in applications of the
			 procedures on participants in the training.
k) Application of manual restraint requires
			 direct authorization, supervision and management by the mental health
			 professional, as defined in Section 384.20, designated as responsible for
			 making clinical decisions at the time restraint is applied. If this person is
			 not present when restraint is first applied, he or she must be summoned
			 immediately and maintain supervision and management of the restraint until the
			 restraint episode is concluded or he or she is relieved by a similarly
			 qualified and clinically responsible person. Supervision of a restraint episode
			 does not require in person supervision throughout the duration of the restraint
			 provided that the mental health professional has viewed the restraint in
			 person, has confirmed that the restraint is being applied according to the
			 agency's selected model and is confident that the restraint will continue to be
			 so applied. The mental health professional must review the restraint episode
			 immediately upon conclusion of the restraint to ensure that the restraint
			 continued and concluded in a manner that is consistent with the model and the
			 child's interest. Each use of manual restraint shall be reported as soon as
			 practicable and a written record forwarded within 24 hours to the administrator
			 of the facility or designee, the assigned caseworker in the facility, and the
			 social work supervisor. If the use of manual restraint results in an injury
			 requiring emergency medical treatment by medical personnel or exceeds 60
			 consecutive minutes, the senior agency administrator shall be contacted
			 immediately.
l) The written record
			 of manual restraint shall include: the date of the occurrence; the
			 precipitating incidents; the age, height, weight, sex and race of the
			 restrained child; the persons (including other residents) who participated in
			 restraining the child; any witnesses to the precipitating incident and
			 subsequent restraint; the exact methods of restraint used; the beginning and
			 ending time of the restraint; a detailed description of any injury arising from
			 the incident or restraint; and a summary of any medical care provided. The
			 supervisor in charge at the time of the incident and restraint shall review the
			 report submitted by staff, inquire into any irregularities, and sign and date
			 the written report indicating the date it was reviewed and approved or
			 disapproved.
m) The administrator
			 of the facility or designee shall review all written records of manual
			 restraint the next business day. The administrator or designee shall approve or
			 disapprove of the use of restraint under the circumstances described and shall
			 indicate review and approval/disapproval by signing and dating the report of
			 behavior treatment. If the administrator or designee disapproves of this
			 instance of manual restraint, the administrator or designee shall state the
			 reasons for disapproval and shall correct the improper use of manual restraint.
			 The decision concerning the need for further action, if any, should be
			 documented whenever any of the following occurs:
1) restraint is used repeatedly excessively
			 by any staff person;
2) restraint
			 is used repeatedly excessively on any child;
3) the duration of the restraint exceeds 30
			 minutes;
4) any provision in this
			 Part is violated; or
5) the
			 restraint results in any injury requiring emergency medical treatment by
			 medical personnel.