Missouri Code of State Regulations › Title 9 - DEPARTMENT OF MENTAL HEALTH › Division 10 - Director, Department of Mental Health › Chapter 7 - Core Rules for Psychiatric and Substance Use Disorder Treatment Programs › Section 9 CSR 10-7.060 - Objections and Hearing

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates requirements for use
				  of restraint, seclusion, and time out.
PURPOSE: This rule establishes requirements for the
				  use of restraint, seclusion and time out in Substance Use Disorder Treatment
				  Programs, Comprehensive Substance Treatment and Rehabilitation Programs
				  (CSTAR), Opioid Treatment Programs, Gambling Disorder Treatment Programs,
				  Substance Awareness Traffic Offender Programs (SATOP), Required Education
				  Assessment and Community Treatment Programs (REACT), Community Psychiatric
				  Rehabilitation Programs (CPR), and Outpatient Mental Health Treatment
				  Programs.
(1) General
				Principles and Practices. The organization shall implement written policies and
				procedures to prevent and respond to disruptive behaviors, behavioral crises,
				and psychiatric crises that may occur with individuals served, staff, visitors,
				and others. All efforts shall be made to minimize retraumatization of persons
				served or others involved in a disruptive situation, including consideration as
				to whether the program is suitable to meet the individual's needs.
(A) Policies and procedures shall indicate
				whether time-out, seclusion, and restraint are used in the organization, by
				whom, and under what circumstances, including protocols for their use with
				children/youth, adults, and individuals with special needs.
(B) Organizations may prohibit by policy and
				practice the use of time-out, seclusion, and restraint and must have policies
				and procedures for addressing disruptive behaviors, behavioral crises, and
				psychiatric crises.
(C) All
				policies and procedures must be-
1. Approved
				by the organization's board of directors;
2. Available to all program staff and service
				providers;
3. Available to
				individuals served and parents/guardians, family members, and other natural
				supports, as appropriate;
4.
				Developed with input from individuals served and, whenever possible,
				parents/guardians, family members, and other natural supports; and
5. Consistent with department regulations
				regarding individual rights.
(D) As applicable to the population served,
				all staff and volunteers having direct contact with individuals served shall
				receive documented initial and ongoing competency-based training on
				evidence-based and best practice interventions to prevent disruptive behaviors
				and behavioral crises and to address them in the least restrictive manner if
				they occur.
(E) All organizations
				shall prohibit by policy and practice-
1.
				Aversive conditioning of any kind-the application of startling, unpleasant, or
				painful stimulus or stimuli that have a potentially harmful effect on an
				individual in an effort to decrease maladaptive behavior;
2. Withholding of food, water, or bathroom
				privileges;
3. Painful
				stimuli;
4. Corporal punishment
				(such as use of pepper spray, mace, Taser, stun gun);
5. Techniques that obstruct the individual's
				airways or impairs breathing;
6.
				Techniques that restrict the individual's ability to communicate;
7. Use of time-out or other disciplinary
				action for staff convenience; and
8. Chemical restraints-use of a medication to
				sedate or limit an individual's ability to participate in treatment rather than
				treat the symptoms of a behavioral health disorder as prescribed and specified
				in the individual treatment plan. Medication used as prescribed and as
				indicated in the individual's treatment plan to treat symptoms of a behavioral
				disorder, including aggressive behavior, is not considered chemical restraint.