Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65E - Mental Health Program › Chapter 65E-20 - FORENSIC CLIENT SERVICES ACT REGULATION › Section 65E-20.014 - Seclusion and Restraint for Emergency Behavior Management Purposes

Current through Reg. 50, No. 138; July 16, 2024
(1) General Standards.
(a) Each facility will provide a therapeutic
				milieu that supports a culture of recovery, individual empowerment, and
				responsibility. Each individual will have a voice in determining his or her
				treatment options. Treatment will foster trusting relationships and
				partnerships for safety between staff and individuals. Facility staff will be
				particularly sensitive to individuals with a history of trauma and use trauma
				informed care.
(b) The health and
				safety of the individual shall be the primary concern at all times.
(c) Seclusion or restraint shall be employed
				only in emergency situations when necessary to prevent an individual from
				seriously injuring self or others, and less restrictive techniques have been
				tried and failed, or it has been clinically determined that the danger is of
				such immediacy that less restrictive techniques cannot be safely
				applied.
(d) There is a high
				prevalence of past traumatic experience among individuals who receive mental
				health services. The response to trauma can include intense fear and
				helplessness, a reduced ability to cope, and an increased risk to exacerbate or
				develop a range of mental health and other medical conditions. The experience
				of being placed in seclusion or being restrained is potentially traumatizing.
				Seclusion and restraint practices shall be guided by the following principles
				of trauma-informed care: assessing trauma histories and symptoms; recognizing
				culture and practices that are re-traumatizing; processing the impact of a
				seclusion or restraint with the individual; and addressing staff training needs
				to improve knowledge and sensitivity.
(e) When an individual demonstrates a need
				for immediate medical attention in the course of an episode of seclusion or
				restraint, the seclusion or restraint shall be discontinued and immediate
				medical attention shall be obtained.
(f) Individuals will not be restrained in a
				prone position. Prone containment will be used only when required by the
				immediate situation to prevent imminent serious harm to the individual or
				others. To reduce the risk of positional asphyxiation, the individual will be
				repositioned as quickly as possible.
(g) Responders will pay close attention to
				the respiratory function of the individual during containment and restraint.
				All staff involved will observe the individual's respiration, coloring, and
				other possible signs of distress and immediately respond if the individual
				appears to be in distress. Responding to the individual's distress may include
				repositioning the individual, discontinuing the seclusion or restraint, or
				summoning medical attention.
(h)
				Objects shall not be placed over an individual's face. In situations where
				precautions need to be taken to protect staff, staff may wear protective
				gear.
(i) Unless necessary to
				prevent serious injury, an individual's hands shall not be secured behind the
				back during containment or restraint.
(j) The use of walking restraints is
				prohibited except for purposes of off-unit transportation and may only be used
				under direct observation of staff who have been trained for this purpose.
				Direct observation means that staff maintains continual visual contact of the
				individual and remains within close physical proximity to the individual at all
				times.
(k) The individual shall be
				released from seclusion or restraint as soon as he or she is no longer an
				imminent danger to self or others.
(l) Seclusion or restraint use shall not be
				based solely on a history of dangerous behavior or history of seclusion or
				restraint use. Dangerous behaviors include those behaviors that jeopardize the
				physical safety of oneself or others.
(m) Seclusion and restraint may not be used
				simultaneously for children less than 18 years of age. For adults age 18 and
				over, simultaneous seclusion and restraint is only permitted if the individual
				is continually monitored face-to-face by an assigned, trained staff member or
				if the individual is continually monitored by trained staff using both audio
				and video equipment. Staff providing this monitoring must be in close proximity
				to the individual.
(n) An
				individual who is restrained must not be located in areas subject to view by
				individuals other than involved staff or where exposed to potential injury by
				other individuals. This does not apply to individuals in walking
				restraints.
(o) Each facility
				utilizing seclusion or restraint procedures shall establish and utilize a
				Seclusion and Restraint Oversight Committee. Members of the Committee shall
				include, but is not limited to, the facility administrator/designee, medical
				staff, quality assurance staff, and a peer specialist or advocate, if employed
				by the facility or otherwise available. If a peer specialist or advocate is not
				employed by the facility, an external peer specialist or advocate may be
				appointed.