Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 564 - CHEMICAL DEPENDENCY TREATMENT FACILITIES › Subchapter G - CLIENT RIGHTS › Section 564.706 - Restraint and Seclusion

Current through Reg. 49, No. 28; July 12, 2024
(a) A small
				  residential facility is defined as a treatment facility with less than eight
				  licensed beds.
(b) The governing
				  body shall adopt a policy to either authorize or prohibit the use of personal
				  restraint, mechanical restraint, and seclusion. Any facility authorizing use of
				  restraint or seclusion shall comply with and have a written procedure that
				  ensures compliance with Health and Safety Code, Chapter 322, including its
				  definition of seclusion; the rules adopted under that chapter; and this
				  section. Outpatient programs shall prohibit the use of restraint or seclusion,
				  except as it relates to court commitment clients.
(c) In programs authorizing use of restraint
				  or seclusion, direct care staff shall be trained as described in the applicable
				  provisions of §
										448.603 of
				  this title (relating to Training). Staff sufficient in number and who have the
				  training required by §
										448.603 of
				  this title to safely implement any permitted restraint or seclusion shall be on
				  duty at all times.
(d) Staff shall
				  not use restraint or seclusion unless it is necessary to intervene to prevent
				  imminent probable death or substantial bodily harm to the client or imminent
				  physical harm to another and less restrictive methods have been tried and
				  failed.
(e) Staff shall not use
				  more force than is necessary to prevent imminent harm and shall ensure the
				  safety, well-being, and dignity of clients who are restrained or secluded,
				  including attention for personal needs. Staff shall not deny bathroom
				  privileges, water, sleep, or regularly scheduled meals and snacks.
(f) Staff shall obtain authorization from the
				  supervising Qualified Credentialed Counselor (QCC) before starting restraint or
				  seclusion or as soon as possible after initiation or implementation.
(1) The facility shall not use standing
				  authorizations for restraint or seclusion.
(2) Authorization for mechanical restraint or
				  seclusion shall be based on a face-to-face evaluation by the authorizing QCC,
				  if on site or reasonably available, or by the direct care staff initiating or
				  implementing the procedure.
(3)
				  Each authorization shall include a specific time limit, not to exceed 12
				  hours.
(4) The QCC must take into
				  consideration information that could contraindicate or otherwise affect the use
				  of restraint or seclusion, including information obtained during the initial
				  assessment of each client at the time of admission or intake. This information
				  includes, but is not limited to:
(A)
				  techniques, methods, or tools that would help the client effectively cope with
				  his or her environment;
(B)
				  pre-existing medical conditions or any physical disabilities and limitations,
				  including substance use disorders, that would place the client at greater risk
				  during restraint or seclusion;
(C)
				  any history of sexual or physical abuse that would place the client at greater
				  psychological risk during restraint or seclusion; and
(D) any history that would contraindicate
				  seclusion, the type of restraint (personal or mechanical), or a particular type
				  of restraint devise.