Code of Massachusetts Regulations › 104 CMR - DEPARTMENT OF MENTAL HEALTH › Title 104 CMR 28.00 - Licensing and Operational Standards for Community Services › Subpart A - STANDARDS FOR COMMUNITY SERVICES › Section 28.05 - Prohibition of Medication Restraint and Mechanical Restraint or Seclusion; Prevention of Physical Restraint; and Requirements for Emergency Physical Restraint When Necessary

Current through Register 1525, July 5, 2024
(1) Medication
				restraint, mechanical restraint or seclusion shall not be used. Physical
				restraint may only be used in an emergency and if the requirements of 104 CMR
				28.05(4) are met.
(2) Physical
				restraint occurs when a manual method is used to restrain a person by
				restricting the person's freedom of movement or normal access to his or her
				body. Physical restraint does not include taking reasonable steps to prevent a
				person at imminent risk of entering a dangerous situation from doing so with a
				limited response to avert injury, such as blocking a blow, breaking up a fight,
				or preventing a fall, a jump, or a run into traffic.
(3)
Prevention of the Use of
				Physical Restraint
. Each provider shall develop and implement a
				strategic plan to prevent, reduce, and wherever possible eliminate, the use of
				physical restraint in its service. A provider's plan shall include, at a
				minimum, the following:
(a) policies and
				procedures supporting the prevention, reduction and, wherever possible,
				elimination of physical restraint;
(b) staff training focusing on:
1. crisis prevention and de-escalation;
				and
2. the safe and appropriate use
				of physical restraint in the event of imminent danger.
(c) the development of a supportive
				environment that incorporates the teaching of and use of coping skills and
				strategies, including sensory integration/modulation approaches to prevent,
				reduce, and wherever possible eliminate the use of physical
				restraints;
(d) the development and
				use of individual crisis prevention plans for all persons;
(e) the development and use of debriefing
				procedures following an episode of restraint to address, at a minimum, what led
				to the incident, what might have prevented or curtailed the incident, and how
				to prevent future incidents. Debriefing activities shall at a minimum include:
1. identification of what led to the
				episode;
2. determination of
				whether the individual crisis prevention plan was used;
3. assessment of alternative interventions
				that may have avoided the use of restraint;
4. determination of whether the person's
				physical and psychological needs were appropriately addressed and that the
				person's right to privacy was maintained;
5. whether the restraint resulted in any
				injuries and the results of such injuries;
6. consideration of counseling or medical
				evaluation and treatment for the involved person and/or staff for any emotional
				or physical trauma that may have resulted from the incident;
7. consideration of whether other persons and
				staff who may have witnessed or otherwise been affected by the incident should
				be involved in debriefing activities or offered counseling;
8. determination of whether the legally
				authorized representative, if any, family members, or others should be notified
				of and/or involved in debriefing activities;
9. consideration of whether additional
				supervision or training should be provided to staff involved in the
				incident;
(f)
				documentation requirements that will ensure an adequate record of the
				authorization, the less restrictive means attempted, if any, and the reason for
				their failure and all debriefing activities. These requirements must, at a
				minimum, meet the documentation requirements set forth in 104 CMR
				28.05(4);
(g) requirement that
				debriefings documentation be reviewed by appropriate staff for the purpose of
				identifying and addressing opportunities to prevent, reduce, or eliminate
				future occurrences of restraint;
(h) appropriate review of the use of physical
				restraint by senior administrative and clinical staff;
(i) the process for understanding and
				addressing any person's concern or complaint about the use of physical
				restraint;
(j) the use of data to
				monitor and improve quality and prevent, reduce, and wherever possible
				eliminate the use of restraint, such as identifying times or shifts with a high
				incidence of restraint, and to modify the plan as indicated;
(k) the identification and utilization of
				support measures after a restraint, including debriefing activities which may
				include peer support, advocacy, Human Rights Officer participation and
				inclusion of family and friends designated by the person; and
(l) the provider's strategic plan to prevent,
				reduce, and wherever possible eliminate, the use of physical restraint in its
				service must be reviewed and updated in the event there are repeated instances
				of restraint at the site, but no less frequently than on an annual
				basis.