Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 472 - OFFICE OF CHILD AND FAMILY SERVICES › Chapter 1 - RIGHTS OF RECIPIENTS OF MENTAL HEALTH SERVICES WHO ARE CHILDREN IN NEED OF TREATMENT › Part B - RIGHTS IN INPATIENT AND RESIDENTIAL SETTINGS › Section 472-1-B-VII - FREEDOM FROM UNNECESSARY SECLUSION AND RESTRAINT IN RESIDENTIAL SETTINGS

Current through 2024-29, July 17, 2024
A. SECLUSION.
				  Locked seclusion will be prohibited in residential settings.
B. RESTRAINT
(1) Restraint is the immobilization of a
				  recipient's arms, legs or entire body by the use of an apparatus that is not a
				  protective device as described in sub­section VI.C.
(2) Restraint may be employed only when
				  absolutely necessary to protect the recipient from serious physical injury to
				  self or others and shall impose the least possible restriction consistent with
				  its purpose.
(3) Restraint may be
				  used only after less restrictive measures have proven to be inappropriate or
				  ineffective. The extent to which less restrictive measures are attempted at the
				  time of the incident will be governed by the degree of risk of physical harm to
				  the recipient or others.
(4) The
				  decision to allow restraints to be employed for a particular recipient shall be
				  made by a treatment team and shall be incorporated into the recipient's
				  treatment or service plan.
(5) The
				  decision to place a recipient in restraints shall be made by one of the
				  clinician with one of the following credentials: M.D., Licensed Clinical
				  Psychologist, Licensed Clinical Social Worker, Licensed Clinical Professional
				  Counselor or Clinical Nurse Specialist in mental health or
				  psychiatry.
(6) Within 30 minutes
				  of being placed in restraints, the recipient shall be physically examined by a
				  Registered Nurse.
(7) Documentation
				  of the RN's examination and assessment must be entered in the recipient's
				  file.
(8) As soon as possible,
				  staff should make reasonable efforts to notify the recipient's legally
				  responsible parent, guardian or custodian that the recipient has been placed in
				  restraint and the reasons therefor.
(9) Each decision for initiation or extension
				  of restraint shall be documented, including the time the decision, the number
				  of hours the recipient may be restrained and the conditions under which the
				  recipient may be sooner released.
(10) The need for a recipient's continuation
				  in restraint shall be re-evaluated every two hours by a nurse. The nurse shall
				  examine the recipient in person. This examination may be conducted with the
				  recipient free of restraints. The nurse shall note the clinical reasons for
				  selecting whether the recipient is examined in or free of restraints. The nurse
				  shall assess the recipient to determine whether he or she continues to pose a
				  danger of imminent injury to self or others. If the nurse finds such danger and
				  that the recipient continues to require restraint, restraint use may be
				  continued. If the number of hours contained in the original decision have
				  elapsed, a clinician will be contacted for a decision on an extension of the
				  use of restraint.
(11) A special
				  progress/check sheet shall be maintained for each use of restraint and shall
				  include the following documentation:
a. The
				  indication for the use of restraint.
b. A description of the behaviors that
				  constitute the recipient's danger to self or others.
c. A description of less restrictive
				  alternatives used or considered and a description of why these alternatives
				  proved ineffective or why they were deemed inappropriate upon
				  consideration.
(12)
				  Every recipient placed in restraint shall be frequently monitored and released
				  as necessary to eat, drink; bathe, toilet and to meet any special medical
				  orders. Recipients in restraint shall have each extremity examined and the
				  restraint loosened, sequentially, no less frequently than every 15 minutes. In
				  instances in which blanket wraps are utilized for restraint, the recipient will
				  be released and examined no less frequently than every hour.
(13) Recipients in restraint shall be kept
				  under constant observation.
(14) A
				  description of the recipient's behavior as observed shall be noted on the
				  progress, record/check sheet every 1 5 minutes.
(15) The total amount of time that a
				  recipient spends in restraint may not exceed 24 hours.
(16) Records required by the above provisions
				  shall be made a part of the recipient's permanent record and copies forwarded
				  to the clinical director or his or her designee.
(17) If a recipient communicates via sign
				  language, consideration will be given to restraining the recipient in such a
				  manner as to permit the use of hands for communication purposes.