Ohio Administrative Code › Title 5122 - Department of Mental Health and Addiction Services › Chapter 5122-26 - Policies and Procedures for the Operation of Mental Health Services Agencies › Section 5122-26-16 - Seclusion, restraint and time-out

Current through all regulations passed and filed through July 1, 2024
(A)
								This rule is
			 applicable to all certified providers and licensed class one residential
			 providers. The purpose of this rule is to state the general standards
			 applicable to the use of seclusion, mechanical restraint, or physical
			 restraint.
The provisions of this rule and rule
				5122-26-16.1 of the
				Administrative Code are not applicable to forensic restrictions imposed by
				correction and law enforcement authorities for security (non-clinical care)
				purposes. The use of restraint or seclusion by correction, law enforcement or
				other staff for the purposes of clinical care is subject to the provisions of
				this rule.
A provider which prohibits the use of
				seclusion and restraint will develop a policy stating such.
(B)
								The
			 provision of a physically and psychologically safe environment is a basic
			 foundation and requirement for effective mental health and addiction services
			 treatment. Adopting trauma informed treatment practices, creating calm
			 surroundings and establishing positive, trusting relationships are essential to
			 facilitating a person's treatment and recovery.
The goal of reducing and minimizing the
				use of seclusion and restraint is one that will be shared and articulated by
				the provider's leadership. The elevation of oversight by leadership of each use
				of seclusion or restraint in order to investigate causality, ascertain
				relevancy of current policies and procedures, and identify any associated
				workforce development issues, is core to the successful achievement of this
				goal.
Seclusion and restraint are intrusive
				techniques to be used by trained, qualified staff as a last resort in order to
				control dangerous and potentially harmful behaviors and to preserve safety.
				Best practices include careful early assessment of a person's history,
				experiences, preferences, and the effectiveness or ineffectiveness of past
				exposure to these methods. Best practices will be based on understanding and
				consideration of the individual's history of traumatic experiences as a means
				to gain insight into origins and patterns of the individual's
				actions.
Use of seclusion or restraint will be
				subject to performance improvement processes in order to identify ways in which
				the use of these methods can be decreased or avoided and more positive,
				relevant and less potentially dangerous techniques used in their
				place.
When individuals experience repeated or
				sustained use of these methods, leadership should evaluate all causative
				factors and consider alternative treatment interventions and possible transfer
				to or placement in a more structured treatment setting with the capacity to
				meet individual needs with reduced exposure to these intrusive
				interventions.
(C)
								The following definitions apply to rules
			 5122-26-16 to
			 5122-26-16.1 of the
			 Administrative Code and are in addition to those contained in rule
			 5122-24-01 of the Administrative
			 Code:
(1)
									"Advance directives" means a legal document used by an adult
			 to direct in advance the mental or physical health treatment in the event the
			 adult lacks the capacity to make such decisions. Two types of advance
			 directives related to mental health treatment are: a "Declaration for Mental
			 Health Treatment" subject to the requirements of Chapter 2135. of the Revised
			 Code, and a "Durable Power of Attorney for Health Care" subject to the
			 requirements of sections
			 1337.11 to
			 1337.17 of the Revised
			 Code.
(2)
									"Behavior management" means the utilization of
			 interventions that are applied in a systematic and contingent manner in the
			 context of individual or group programs to change or manage behavior or
			 facilitate improved self-control. The goal of behavior management is not to
			 curtail or circumvent an individual's rights or human dignity, but rather to
			 support the individual's recovery and increase the individual's ability to
			 exercise those rights.
(3)
									"Comfort rooms," (formerly known as quiet or time-out
			 rooms), are adapted sensory rooms that provide sanctuary from stress or can be
			 places for persons to experience feelings within acceptable
			 boundaries.
(4)
									"Individual crisis plan" means a written plan that
			 allows the person to identify coping techniques and share with staff what is
			 helpful in assisting to regain control of the person's behavior in the early
			 stages of a crisis situation. It may also be referred to as a "behavior support
			 plan."
(5)
									"Mechanical restraint" means any method of restricting
			 a person's freedom of movement, physical activity, or normal use of his or her
			 body, using an appliance or device manufactured for this
			 purpose.
(6)
									"Physical restraint", also known as "manual restraint,"
			 means any method of physically restricting a person's freedom of movement,
			 physical activity, or normal use of the person's body without the use of
			 mechanical restraint devices. Transitional holds are not physical
			 restraint.
(7)
									"PRN (pro re nata)" means as the situation
			 demands.
(8)
									"Prone Restraint" means all items or measures used to
			 limit or control the movement or normal functioning of any portion, or all, of
			 an individual's body while the individual is in a face-down position. Prone
			 restraint may include either physical (also known as manual) or mechanical
			 restraint.
(9)
									"Qualified person" means an employee or volunteer who
			 carries out the agency's tasks under the agency's administration and/or
			 supervision, and who is qualified to utilize or participate in the utilization
			 of seclusion or restraint by virtue of the following: education, training,
			 experience, competence, registration, certification, or applicable licensure,
			 law, or regulation.
(10)
									"Seclusion" means the involuntary confinement of a
			 person alone in a room where the person is physically prevented from
			 leaving.
(11)
									"Sensory rooms" means appealing physical spaces painted
			 with soft colors with the availability of furnishings and objects that promote
			 relaxation and/or stimulation.
(12)
									"Time-out" means
			 an intervention in which staff compel a person to remove them self from regular
			 programming to a specified place for a specified period of time. Time-outs are
			 allowed in areas away from activity, which may include time out rooms, other
			 identified space in the facility, or the client's bedroom. Time-out is not
			 seclusion or restraint.
(13)
									"Transitional hold" means a brief hold, without undue
			 force, of a person in order to calm or comfort them; or holding a person's hand
			 to safely escort them from one area to another. At no time may a transitional
			 hold be a prone, mechanical, or physical restraint as defined in this rule.
			 Transitional holds are not seclusion or restraint.