reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.252 - Application

Current through Reg. 49, No. 28; July 12, 2024
This subchapter applies to the following types of facilities:
(1) a state hospital or a state center operated by the Department of State
											  Health Services;
(2) a psychiatric hospital licensed pursuant to
											  Texas Health and Safety Code, Chapter 577 (relating to Private Mental Hospitals and Other Mental Health
											  Facilities) to the extent and as provided by Chapter 134 of this title (relating to Private Psychiatric
											  Hospitals and Crisis Stabilization Units);
(3) a hospital that is
											  licensed pursuant to Texas Health and Safety Code, Chapter 241 (relating to Hospitals) to the extent and as
											  provided by Chapter 133 of this title (relating to Hospital Licensing), as follows:
(A) an identifiable mental health services unit within the hospital;
											  and
(B) for all other areas within the hospital (including an
											  emergency department), only to the extent that the requirements of this subchapter are consistent with, and
											  not more stringent than, the requirements of the
											  42 CFR
											  §482.13 (relating to Medicare Conditions of Participation);
											  42 CFR
											  §489.20 (relating to Essentials of Provider Agreements); and §
											133.44 of this title (relating
											  to Hospital Patient Transfer Policy).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.253 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this subchapter, shall
													 have the following meanings, unless the context clearly indicates otherwise.
(1) Advanced practice registered nurse or APRN--A registered nurse
											  authorized by the Texas Board of Nursing to practice as an advanced practice registered nurse.
(2) Behavioral emergency--A situation involving an individual who is
											  behaving in a violent or self-destructive manner and in which preventive, de-escalative, or verbal techniques
											  have been determined to be ineffective and it is immediately necessary to restrain or seclude the individual
											  to prevent:
(A) imminent probable death or substantial bodily harm to the
											  individual because the individual is attempting to commit suicide or inflict serious bodily harm;
											  or
(B) imminent physical harm to others because of acts the
											  individual commits.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.254 - General Requirements for Use of Restraint or Seclusion

Current through Reg. 49, No. 28; July 12, 2024
(a) Prohibition. Except as provided by
											  this subchapter, the use of restraint or seclusion is prohibited.
(b) Use of personal or mechanical restraint or seclusion. The use of
											  personal or mechanical restraint or seclusion is permissible on the facility's premises, and personal or
											  mechanical restraint is permissible for transportation of an individual only if implemented:
(1) in accordance with this subchapter;
(2) when less restrictive interventions (such as those listed in the safety
											  plan if there is one) are determined ineffective to protect other individuals, the individual, staff members,
											  or others from harm;
(3) in accordance with, and using only those
											  safe and appropriate techniques as determined by the facility's written policies or procedures and training
											  program as specified in subsection (e) of this section;
(4) by
											  staff members who have been trained in accordance with the applicable requirements specified in §
											415.257 of this title (relating to Staff
											  Member Training);
(5) in connection with the applicable
											  evaluation and monitoring requirements specified in §
											415.266
											  of this title (relating to Observation, Monitoring, and Care of the Individual in Restraint or Seclusion
											  Initiated in Response to a Behavioral Emergency);
(6) in
											  accordance with the applicable initiation and physician order requirements specified in § 415.260 of
											  this title (relating to Initiation of Restraint or Seclusion in a Behavioral Emergency);
(7) in accordance with any alternative strategies and special
											  considerations documented in the treatment plan pursuant to § 415.259(c) of this title (relating to
											  Special Considerations, Responsibilities, and Alternative Strategies);
(8) when the type or technique of restraint or seclusion used is the least
											  restrictive intervention that will be effective to protect the other individuals, the individual, staff
											  members, or others from harm; and
(9) is discontinued at the
											  earliest possible time, regardless of the length of time identified in a physician's order.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.255 - Prohibited and Restricted Practices

Current through Reg. 49, No. 28; July 12, 2024
(a) The following practices are prohibited:
(1) a personal or mechanical restraint shall not be used that:
(A) obstructs the individual's airway, including a procedure that places
											  anything in, on, or over the individual's mouth or nose;
(B)
											  impairs the individual's breathing, including applying pressure to the individual's torso or neck;
(C) restricts circulation;
(D)
											  secures an individual to a stationary object while the individual is in a standing position;
(E) causes pain to restrict an individual's movement (pressure points or
											  joint locks); and
(F) inhibits, reduces, or hinders the
											  individual's ability to communicate; and
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.256 - Mechanical Restraint Devices

Current through Reg. 49, No. 28; July 12, 2024
(a) If a facility's policies and procedures
											  permit the use of mechanical restraint, only commercially available or DSHS-approved devices specifically
											  designed for the safe and comfortable restraint of humans shall be used. Any alteration of commercially
											  available devices or independent development of devices must:
(1) be based
											  on the individual's special physical needs, if any (e.g., obesity or physical impairment);
(2) take into consideration any potential medical (including psychiatric)
											  contraindications, including any history of physical or sexual abuse;
(3) be approved by a committee whose membership and functions are specified
											  in the bylaws of medical staff members of the facility; and
(4)
											  be described fully in writing, with a copy of the description and a photograph forwarded to the DSHS medical
											  director for behavioral health for review. Such altered or independently developed device may not be used by
											  the facility unless and until its use is approved, in writing, by the DSHS medical director for behavioral
											  health.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.257 - Staff Member Training

Current through Reg. 49, No. 28; July 12, 2024
(a) The facilities to which this subchapter applies shall ensure that staff
											  members are informed of their roles and responsibilities under this subchapter and are trained and
											  demonstrate competence accordingly.
(b) The training program
											  shall be consistent with the requirements of this subchapter and shall:
(1)
											  target the specific needs of each patient population being served;
(2) be tailored to the competency levels of the staff members being
											  trained;
(3) emphasize the importance of reducing and preventing
											  the use of restraint and seclusion;
(4) be evaluated annually,
											  which shall include evaluation to ensure that the training program, as planned and as implemented, complies
											  with the requirement of this section;
(5) incorporate
											  evidence-based best practices;
(6) provide information about
											  declarations for mental health treatment, including:
(A) the right of
											  individuals to execute declarations for mental health treatment; and
(B) the duty of staff members and other health care providers to act in
											  accordance with declarations for mental health treatment to the fullest extent possible.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.258 - Actions to be Taken to Release from Restraint or Seclusion for an Emergency Medical Condition or Evacuation Emergency

Current through Reg. 49, No. 28; July 12, 2024
(a) Emergency medical condition. If an individual experiences an emergency
											  medical condition while in restraint or seclusion, the staff member providing continuous face-to-face
											  observation of the individual or other staff member must release the individual from restraint or seclusion
											  as soon as possible, as indicated by the emergency medical condition, and the medical condition shall be
											  assessed and treated.
(1) The facility shall ensure that the individual's
											  emergency medical condition is promptly addressed and that aid is rendered to the extent possible in
											  accordance with the facility's policies and procedures for management of emergency medical
											  conditions.
(2) Unlocking the seclusion room door or fully
											  releasing the restraints ends the episode.
(3) If the situation
											  continues to meet the criteria for a behavioral emergency after the individual's emergency medical condition
											  is addressed, a staff member must obtain a new order for restraint or seclusion.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.259 - Special Considerations, Responsibilities, and Alternative Strategies

Current through Reg. 49, No. 28; July 12, 2024
(a) Special considerations.
											  Before ordering restraint or seclusion, the physician shall take the following into consideration:
(1) information about the individual that could contraindicate or otherwise
											  affect the use of restraint or seclusion;
(2) information
											  obtained during the initial assessment of each individual at the time of admission or intake, including, but
											  not limited to:
(A) pre-existing medical conditions or any physical
											  disabilities and limitations, including, without limitation, cognitive functioning, substance use disorders,
											  obesity, or pregnancy, that would place the individual at greater risk during restraint or seclusion;
(B) any history of sexual abuse, physical abuse, neglect,
											  trauma, or previous restraint or seclusion that would place the individual at greater psychological risk
											  during restraint or seclusion;
(C) any history or trauma that
											  would contraindicate seclusion, the type of restraint (personal or mechanical), or a particular type of
											  restraint device for the individual;
(D) cultural factors;
											  and
(E) information contained in a declaration for mental health
											  treatment, if there is one.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.260 - Initiation of Restraint or Seclusion in a Behavioral Emergency

Current through Reg. 49, No. 28; July 12, 2024
(a) Initiation.
(1) Only staff authorized by the facility's policies and procedures and who
											  have met the training requirements of §
											415.257 of this title (relating to Staff
											  Member Training) and demonstrated competency in the facility's restraint and seclusion training program, may
											  initiate personal restraint in a behavioral emergency.
(2) Only a
											  physician, registered nurse, or physician assistant in accordance with a physician's delegated authority, may
											  initiate mechanical restraint or seclusion.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.261 - Time Limitation on an Order for Restraint or Seclusion Initiated in Response to a Behavioral Emergency

Current through Reg. 49, No. 28; July 12, 2024
(a) Original order. A physician may order restraint or seclusion in
											  response to a behavioral emergency for a period of time not to exceed:
(1)
											  15 minutes for personal restraint;
(2) one hour for mechanical
											  restraint or seclusion for individuals under the age of 9;
(3)
											  two hours for mechanical restraint or seclusion for individuals ages 9 - 17; and
(4) four hours for mechanical restraint or seclusion for individuals age 18
											  and older.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.262 - Family Notification

Current through Reg. 49, No. 28; July 12, 2024
(a) The CEO or CEO's designee shall notify the individual's legally
											  authorized representative if any, or authorized family member of each episode of restraint or seclusion
											  initiated for the management of a behavioral emergency as follows:
(1)
											  except as provided by 42 Code of Federal Regulations, Part 2, and subsection (c) of this section, a staff
											  member shall notify as soon as possible, but no later than 12 hours following the initiation of the restraint
											  or seclusion, the legally authorized representative of a minor under age 18 who is not or has not been
											  married; and
(2) except as provided by subsection (c) of this
											  section, in cases in which the adult individual has consented to have one or more specified family members
											  informed regarding the individual's care, and the family member or members have agreed to be informed, a
											  staff member will inform the family member or members of the restraint or seclusion episode within the time
											  frame determined by prior agreement between the individual and specified family member(s).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.263 - Safekeeping of Personal Possessions During Mechanical Restraint or Seclusion

Current through Reg. 49, No. 28; July 12, 2024
(a) The individual's
											  right to retain personal possessions and personal articles of clothing may be suspended during mechanical
											  restraint or seclusion when necessary to ensure the safety of the individual or others as described in
											  Chapter 404, Subchapter E of this title (relating to Rights of Persons Receiving Mental Health
											  Services).
(b) An inventory of any personal possessions or
											  personal articles of clothing temporarily taken from the individual shall be listed in the individual's
											  medical record. The inventory shall be witnessed by two staff members who shall sign or authenticate this
											  list in individual's medical record. If personal articles of clothing are taken from the individual,
											  appropriate other clothing shall be issued.
(c) The items shall
											  be kept in a locked place.
(d) Upon release of the individual
											  from a restraint, seclusion, or combination of the two, the individual, if willing, and two staff members
											  shall be asked to sign documentation in the individual's medical record indicating the status of items
											  returned and the date and time the items were returned.
(e) If
											  the individual is unwilling or unable to sign the documentation, a staff member shall document the refusal in
											  the individual's medical record and list the items that were returned to the individual, the time they were
											  returned, and the staff member who returned the items.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.264 - Restraint Off Facility Premises or for Transportation

Current through Reg. 49, No. 28; July 12, 2024
(a) All off-premises transport. A registered
											  nurse or physician assistant, as appropriate to the individual's clinical condition and the requirements of
											  this subchapter, shall accompany the staff member(s) transporting an individual off premises when it has been
											  clinically determined that during the time away from the facility the individual may require:
(1) medical attention;
(2)
											  administration of medication; or
(3) restraint.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.265 - Communicating with the Individual During Restraint or Seclusion Initiated in Response to a Behavioral Emergency

Current through Reg. 49, No. 28; July 12, 2024
(a) As soon as feasible after restraint or seclusion has been implemented
											  in response to a behavioral emergency, the staff member shall refer to the individual's declaration for
											  mental health treatment, if any, as a reference in determining and implementing an individual's preferences.
											  The staff member shall communicate reassurance and commitment to the individual's safety on an ongoing basis,
											  including inquiring as to how the staff member can assist the individual to de-escalate.
(b) Communication with the individual shall be conducted in developmentally
											  appropriate language and by a method that is understandable to the individual (e.g., American Sign Language,
											  Spanish, Vietnamese) and that accommodates the individual's method of communication (e.g., releasing a hand
											  of an individual who communicates using American Sign Language).
(c) A staff member shall document in the individual's medical record all
											  attempts to communicate with the individual and the individual's response to these attempts.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.266 - Observation, Monitoring, and Care of the Individual in Restraint or Seclusion Initiated in Response to a Behavioral Emergency

Current through Reg. 49, No. 28; July 12, 2024
(a) Observation.
(1) A staff member of
											  the same gender as the individual shall maintain continuous face-to-face observation of an individual in
											  mechanical restraint, unless the individual's history or other factors indicate this would be contraindicated
											  (e.g., sexual or physical abuse perpetrated by someone of the same gender, in which case a staff member of
											  the opposite gender may be used).
(2) A staff member who is not
											  physically applying personal restraint shall maintain continuous face-to-face observation of an individual in
											  personal restraint.
(3) A staff member shall maintain continuous
											  face-to-face observation of an individual in seclusion for at least one hour. After one hour, the staff
											  member may monitor the individual continuously using simultaneous video and audio equipment in close
											  proximity to the individual.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.267 - Safe and Appropriate Techniques for Restraint or Seclusion

Current through Reg. 49, No. 28; July 12, 2024
(a) A facility shall ensure that:
(1) when personal restraint is used, staff members act to protect the
											  individual's privacy as much as possible without compromising the safety of individuals or staff members
											  during the episode;
(2) if the individual does not calm and
											  mechanical restraint is required, the individual is moved to a protected environment observable by other
											  staff members and away from other individuals as soon as possible;
(3) when a mechanical restraint is used, the individual has a protected
											  environment that is observable by other staff members and is away from other individuals that safeguards the
											  individual's personal dignity and well-being;
(4) the individual
											  is protected (e.g., from assault by others) while in restraint or seclusion; and
(5) the facility uses a seclusion room, as defined in §
											415.253 of this title (relating to Definitions),
											  for any individual placed in seclusion.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.268 - Actions to be Taken when an Individual Falls Asleep in Restraint or Seclusion Initiated in Response to a Behavioral Emergency

Current through Reg. 49, No. 28; July 12, 2024
(a) If the individual appears to fall asleep while in mechanical restraint
											  or seclusion, the registered nurse shall assess the individual to determine if the individual is
											  asleep.
(b) If the individual is determined to be asleep, the
											  registered nurse shall instruct an authorized staff member to immediately release the individual from
											  restraint or unlock the seclusion room door. Authorized staff members shall maintain continuous face-to-face
											  observation until the individual is awake and re-evaluated by the registered nurse.
(c) The registered nurse shall assess the individual upon
											  awakening.
(d) If the individual exhibits behaviors requiring
											  restraint or seclusion upon awakening, the registered nurse shall obtain a new physician's order for any new
											  initiation of restraint or seclusion.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.269 - Transfer of Primary Responsibility for Individual in Restraint or Seclusion

Current through Reg. 49, No. 28; July 12, 2024
(a) At the time of
											  transfer of primary responsibility between staff members for the individual in restraint or seclusion,
											  including transfer of responsibility at the change of shift, the staff member with primary responsibility
											  must meet with the staff member who will assume primary responsibility to review the individual's status. A
											  staff member shall monitor the individual during the transfer process.
(b) The review shall be documented and shall include:
(1) information regarding the time a restraint or seclusion was
											  initiated;
(2) the nature of the circumstances requiring
											  restraint or seclusion;
(3) the current status of the
											  individual's physical, emotional, and behavioral condition;
(4)
											  any medication administered; and
(5) the type of care
											  needed.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.270 - Release of an Individual From Restraint or Seclusion

Current through Reg. 49, No. 28; July 12, 2024
(a) Personal restraint. When a personal restraint
											  has been initiated by a staff member, but the individual has not yet been evaluated by a physician, a
											  physician's assistant, or a registered nurse, and the staff member determines that the individual's behavior
											  has changed sufficiently to no longer require the personal restraint, the staff member must immediately
											  release the individual from the restraint but shall remain with the individual until a physician, physician's
											  assistant, or registered nurse has evaluated the individual for release based on a determination that the
											  individual no longer requires the restraint or seclusion.
(b)
											  Mechanical restraint or seclusion. When a mechanical restraint or seclusion has been initiated, and the
											  unsafe situation ends, a staff member shall contact a physician, a physician's assistant, or a registered
											  nurse. The physician, physician's assistant, or registered nurse must evaluate the individual for release
											  based on a determination as to whether the unsafe situation has resolved. A staff member must immediately
											  release an individual whose behavior has been evaluated by a physician, physician's assistant, or registered
											  nurse and determined to no longer require the restraint or seclusion.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.271 - Actions to be Taken Following Release of an Individual from Restraint or Seclusion Initiated in Response to a Behavioral Emergency

Current through Reg. 49, No. 28; July 12, 2024
(a) Immediately following the release of an individual from restraint or
											  seclusion, a staff member shall:
(1) take action, if appropriate, to
											  facilitate the individual's reentry into the social milieu by providing the individual with transition
											  activities and an opportunity to return to ongoing activities;
(2) observe the individual for at least 15 minutes; and
(3) document in the individual's medical record the steps taken and
											  observations made of the individual's behavior during this transition period.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.272 - Documenting, Reporting, and Analyzing Restraint or Seclusion

Current through Reg. 49, No. 28; July 12, 2024
(a) Facility documentation. The facility
											  shall document the assessment, monitoring, and evaluation of an individual in restraint or seclusion on a
											  facility approved form. Documentation in an individual's medical record shall include:
(1) the date and time the intervention began and ended;
(2) the name, title, and credentials of any staff members present at the
											  initiation of the intervention, with identification of the staff member's role in the intervention, including
											  as an observer, or status as an uninvolved witness, as applicable;
(3) the name of the individual restrained or secluded and the type of
											  restraint or seclusion used;
(4) the time and results of any
											  assessments, observation, monitoring, and evaluations, including those required under this subchapter, and
											  attention given to personal needs;
(5) the physician's
											  documentation of the order authorizing restraint or seclusion in accordance with the requirements of §
											  415.260 of this title (relating to Initiation of Restraint or Seclusion in a Behavioral Emergency);
(6) any specific alternatives and less restrictive interventions, including
											  preventive or de-escalatory interventions that were attempted by any staff member prior to the initiation of
											  restraint or seclusion, and the individual's response to any such intervention;
(7) the individual's response to the use of restraint or seclusion;
											  and
(8) other documentation relating to an episode of restraint
											  or seclusion otherwise required under this subchapter.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.273 - Use of Restraint in Situations Involving Non-Violent, Non-Self-Destructive Behavior

Current through Reg. 49, No. 28; July 12, 2024
(a) If an
											  assessment reveals non-violent, non-self-destructive behavior, as defined in §
										415.253 of this title (relating to Definitions),
											  the facility shall use the least restrictive intervention that effectively protects the individual from harm.
											  If the intervention is a restraint as defined in this subchapter, it shall only be used in the following
											  circumstances:
(1) medically necessary;
(2) ordered by a physician;
(3)
											  needed to ensure the individual's safety; and
(4) used only after
											  less restrictive interventions have been considered, or attempted and determined to be ineffective, or are
											  judged to be unlikely to protect the individual or others from harm.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.274 - Permitted Practices

Current through Reg. 49, No. 28; July 12, 2024
(a) Escort or brief physical prompt. An individual may be assisted to move
											  from one location to another when guidance is needed if the individual agrees verbally or with gestures and
											  is able to cooperate with the staff member who is attempting to assist the individual to move.
(b) Activities of daily living. A staff member may assist an individual who
											  is willing and able to cooperate with toileting, bathing, dressing, eating, or other personal hygiene
											  activities that normally involve the use of touch.
(c) Immediate
											  danger of harm. A staff member may escort, prompt, or move an individual who is unable to respond in the
											  affirmative or negative or is unable to move due to his or her psychiatric or medical condition if there is
											  an imminent danger of harm to the individual because of a circumstance in the individual's immediate
											  environment.
(d) Immobilization during medical, dental,
											  diagnostic, or surgical procedure. A positioning or securing device used to maintain the position of, limit
											  mobility of, or temporarily immobilize an individual, with the individual's consent, during medical, dental,
											  diagnostic, or surgical procedures and that is a standard part of the procedure is not considered a
											  restraint. The care of the individual shall be based on a rationale that reflects consideration of the
											  individual's medical needs and health status.
(1) Facility policies and
											  procedures on the use of immobilization during medical, dental, diagnostic and surgical procedures shall
											  address:
(A) the frequency of assessment of the individual during
											  immobilization; and
(B) how the individual's circulation,
											  hydration, elimination needs, level of distress and agitation, mental status, cognitive functioning, cardiac
											  functioning, skin integrity, nutrition, exercise, and range of motion of extremities are to be assessed
											  during immobilization.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.275 - Clinical Timeout and Quiet Time

Current through Reg. 49, No. 28; July 12, 2024
(a) The facility shall develop, implement, and
											  enforce policies and procedures that address the use of clinical timeout and quiet time as preventive and
											  de-escalating interventions to prevent a behavioral emergency from occurring and to alleviate or otherwise
											  reduce the necessity for any use of restraint or seclusion.
(b)
											  The policies and procedures shall include the following requirements.
(1)
											  Clinical timeout. A staff member may suggest that an individual initiate clinical timeout.
(A) Prior to clinical timeout, the staff member suggesting that an
											  individual initiate clinical timeout shall explain to the individual that clinical timeout is
											  voluntary.
(B) Each time an individual uses clinical timeout, a
											  staff member shall document that use in the individual's medical record.
(C) The facility's documentation of any use of clinical timeout shall
											  include a description of the conditions under which the clinical timeout was suggested and the individual's
											  response to the suggestion.
(D) A decision by the individual to
											  decline to begin, or remain in, clinical timeout or similar interventions may not result in the staff
											  member's use of restraint or seclusion of the individual, unless the initiation and use of the restraint or
											  seclusion is permitted under, and otherwise meets the requirements of, this subchapter. To physically force
											  or use personal restraint or coercion to direct the individual to a clinical timeout areas or to prevent an
											  individual from leaving an area separated from other individuals receiving services, constitutes a restraint
											  and/or seclusion and renders the procedure subject to the requirements for restraint or seclusion, as
											  applicable, described in this subchapter.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter F - INTERVENTIONS IN MENTAL HEALTH SERVICES › Section 415.276 - Protective and Supportive Devices

Current through Reg. 49, No. 28; July 12, 2024
(a) Voluntary use of protective and supportive
											  devices. A protective or supportive device that is easily removable by the individual without a staff
											  member's assistance is not restraint.
(1) A protective or supportive device
											  may only be used with the consent of the individual.
(2) A
											  supportive device must allow greater freedom of mobility than would be possible without the use of the
											  device.
(3) Use of a protective or supportive device shall be
											  based upon a prior order of a physician, physician's assistant, or advanced practice registered
											  nurse.
(4) If an individual uses a protective or supportive
											  device, the individual's treatment team shall include an occupational or physical therapist and the
											  individualized treatment plan shall specify that a protective or supportive device is to be used and shall:
(A) include any special considerations for the use of the device based on
											  the findings of the comprehensive initial assessment performed at admission or intake;
(B) include an outcome oriented goal;
(C) describe the specific type of device to be used;
(D) specify who is responsible for applying the device;
(E) describe the plan for monitoring the individual; and
(F) reflect periodic assessment, intervention, and evaluation by the
											  treatment team, including the physical therapist, on an ongoing basis.
(5) The facility shall have written policies and procedures that address
											  the proper implementation of this subsection and monitoring requirements with reference to individuals with
											  particular types of protective and supportive devices.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter G - DETERMINATION OF MANIFEST DANGEROUSNESS › Section 415.301 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter:
(1) establishes the two types of review boards that conduct hearings to
											  determine whether an individual is manifestly dangerous;
(2)
											  defines the elements to be considered in the determination of manifest dangerousness by review
											  boards;
(3) describes which persons may and may not be subject to
											  a hearing to determine manifest dangerousness;
(4) enumerates the
											  rights of an individual who is subject to a hearing to determine manifest dangerousness;
(5) provides due process for individuals who have been determined
											  manifestly dangerous; and
(6) provides procedures governing the
											  transfer of an individual to the maximum security unit/secure adolescent unit (MSU/SAU) and from the
											  MSU/SAU.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter G - DETERMINATION OF MANIFEST DANGEROUSNESS › Section 415.302 - Application

Current through Reg. 49, No. 28; July 12, 2024
This subchapter applies to facilities, as defined in §
										415.303(8) of this title (relating
													 to Definitions).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter G - DETERMINATION OF MANIFEST DANGEROUSNESS › Section 415.304 - Persons Who May and May Not Be Subject to a Hearing to Determine Manifest Dangerousness

Current through Reg. 49, No. 28; July 12, 2024
(a) Only an
											  adult or adolescent who is committed by a court of law to a facility (as defined) may be subject to a hearing
											  to determine manifest dangerousness.
(b) The following persons
											  may not be subject to a hearing to determine manifest dangerousness:
(1) an
											  adult, adolescent, or child who is voluntarily admitted to a facility (as defined) or who is under an order
											  of protective custody in accordance with the Texas Health and Safety Code, §
											574.022; and
(2) a child who is committed by a court of law to a facility (as
											  defined).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter G - DETERMINATION OF MANIFEST DANGEROUSNESS › Section 415.305 - Procedures and Requirements for All Review Boards

Current through Reg. 49, No. 28; July 12, 2024
(a) Pool of mental health professionals.
(1) Facility review board. Each facility CEO is responsible for having
											  access to a pool of mental health professionals who will be available to be impaneled as members on the
											  facility review board. A CEO may appoint a pool of professionals or may arrange to have access to a pool of
											  professionals appointed by another facility CEO.
(2) DSHS
											  Dangerousness Review Board. The commissioner will appoint a pool of at least 16 mental health professionals
											  who will be available to be impaneled as members on the DSHS Dangerousness Review Board.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter G - DETERMINATION OF MANIFEST DANGEROUSNESS › Section 415.306 - Rights of the Individual

Current through Reg. 49, No. 28; July 12, 2024
(a) The individual and LAR have the right to represent themselves at the
											  hearing or to be represented by a spokesperson of their choice.
(b) The individual and LAR and their spokesperson(s) have the right to:
(1) be present at the hearing; and
(2) examine before the date of the hearing:
(A) the hearing documentation referenced as §
												415.307(3)(A)
											  of this title (relating to Procedures and Requirements Specific to a Facility Review Board) unless an
											  exception exists as provided by §
												415.307(3)(B)
											  of this title; or
(B) the hearing documentation referenced as
											  §
												415.310(4)(A)
											  of this title (relating to Procedures and Requirements Specific to the DSHS Dangerousness Review
											  Board).
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter G - DETERMINATION OF MANIFEST DANGEROUSNESS › Section 415.307 - Procedures and Requirements Specific to a Facility Review Board

Current through Reg. 49, No. 28; July 12, 2024
If the facility CEO has reason to believe that a person receiving
													 services in the facility may be manifestly dangerous and in need of transfer to the MSU/SAU, then the
													 facility CEO may convene the facility review board to conduct a hearing to determine whether the person is
													 manifestly dangerous in accordance with this section.
(1) Convening
											  the board. The facility CEO will inform the chair of the facility review board of the need to convene the
											  board. The chair will impanel a review board in accordance with §
										415.305(e)
											  of this title (relating to Procedures and Requirements for All Review Boards) and identify the time and
											  location of the hearing. The chair will serve as one of the five members unless the chair is disqualified as
											  described in §
										415.305(d)
											  of this title. If the chair is disqualified, then the chair will appoint one of the five impaneled members to
											  act as chair for the hearing.
(2) Notice and statement(s). The
											  facility CEO will provide notice of the hearing and receive statement(s) in accordance with this paragraph.
(A) Notice. At least three days before the hearing, the facility CEO will
											  complete the Notice of Hearing by Facility Review Board, referenced in §
											415.314 of this title (relating to
											  Notice of Hearing Forms), and deliver it to the individual and LAR, if any, for signature.
(i) The facility CEO must ensure that the content of the notice is
											  communicated in a language and format likely to be understandable to the recipient(s) and initiating a
											  discussion with the individual and LAR regarding the right to be represented by a spokesperson. If the
											  individual or LAR requests a spokesperson, then the CEO will assist him/her with identifying and securing a
											  spokesperson. If an individual who lacks capacity does not request a spokesperson, then the CEO will make a
											  reasonable effort to identify and secure a spokesperson. If the CEO is unable to secure a spokesperson, then
											  the facility rights protection officer will serve as the individual's spokesperson to ensure the individual's
											  rights are protected during the hearing.
(ii) The facility CEO
											  will provide a copy of the signed notice to the individual, LAR, and spokesperson(s) and will file a copy of
											  the signed notice in the individual's medical record.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter G - DETERMINATION OF MANIFEST DANGEROUSNESS › Section 415.308 - Transfer of an Individual to the MSU/SAU

Current through Reg. 49, No. 28; July 12, 2024
(a) Prior to the transfer of an individual who
											  has been determined manifestly dangerous by a facility review board, the facility CEO will ensure:
(1) the hearing documentation described in §
											415.307(3)(A)
											  of this title (relating to Procedures and Requirements Specific to a Facility Review Board) is submitted to
											  the MSU/SAU CEO; and
(2) the individual's treating physician
											  communicates with the MSU/SAU physician who will treat the individual regarding the characteristics of the
											  individual. The individual's treating physician may communicate with another physician at the MSU/SAU if the
											  other physician at the MSU/SAU is the designee of MSU/SAU physician who will treat the individual.
Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 415 - PROVIDER CLINICAL RESPONSIBILITIES-MENTAL HEALTH SERVICES › Subchapter G - DETERMINATION OF MANIFEST DANGEROUSNESS › Section 415.309 - Appealing a Facility Review Board's Determination of Manifest Dangerousness

Current through Reg. 49, No. 28; July 12, 2024
The individual, LAR, or facility CEO may appeal a facility review
													 board's determination that the individual is manifestly dangerous on the grounds that the determination was
													 substantively flawed or on the grounds that the determination was affected by an error in a procedure
													 specified in this subchapter. Transfer of the individual to the MSU/SAU is not stayed pending appeal.
(1) A request for an appeal from the individual or LAR must be in writing
											  and received by the facility CEO within 10 days after receipt of the written report as described in §
										415.305(j)
											  of this title (relating to Procedures and Requirements for All Review Boards). The request must include:
(A) the reason(s) why the requestor believes the review board's
											  determination was substantively flawed; or
(B) the reason(s) why
											  the requestor believes the review board's determination was affected by an alleged procedural error,
											  including a description of the procedure specified in this subchapter and the alleged error.