Virginia Administrative Code › Title 12 - HEALTH › Agency 35 - DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES › Chapter 115 - REGULATIONS TO ASSURE THE RIGHTS OF INDIVIDUALS RECEIVING SERVICES FROM PROVIDERS LICENSED, FUNDED, OR OPERATED BY THE DEPARTMENT OF BEHAVIORAL › Part III - Explanation of Individual Rights and Provider Duties › Section 12VAC35-115-110 - Use of seclusion, restraint, and time out

Current through Register Vol. 40, No. 24, July 15, 2024
A. Each
				  individual is entitled to be completely free from any unnecessary use of
				  seclusion, restraint, or time out.
B. The voluntary use of mechanical supports
				  to achieve proper body position, balance, or alignment so as to allow greater
				  freedom of movement or to improve normal body functioning in a way that would
				  not be possible without the use of such a mechanical support, and the voluntary
				  use of protective equipment are not considered restraints.
C. The provider's duties.
1. Providers shall meet with the individual
				  or the individual's authorized representative upon admission to the service to
				  discuss and document in the individual's services record his preferred
				  interventions in the event his behaviors or symptoms become a danger to himself
				  or others and under what circumstances, if any, the intervention may include
				  seclusion, restraint, or time out.
2. Providers shall document in the
				  individual's services record all known contraindications to the use of
				  seclusion, time out, or any form of physical or mechanical restraint, including
				  medical contraindications and a history of trauma, and shall flag the record to
				  alert and communicate this information to staff.
3. Seclusion may be used only in an emergency
				  and only in facilities operated by the department; residential facilities for
				  children that are licensed under the Regulations for Children's Residential
				  Facilities (12VAC35-46); inpatient hospitals; and crisis receiving centers or
				  crisis stabilization units that are licensed under Part VIII (12VAC35-105-1830 et seq.) of
				  12VAC35-105.
4. Providers shall not
				  use seclusion, restraint, or time out as a punishment or reprisal or for the
				  convenience of staff.
5. Providers
				  shall not use seclusion or restraint solely because criminal charges are
				  pending against the individual.
6.
				  Providers shall not use a restraint that places the individual's body in a
				  prone (face down) position.
7.
				  Providers shall not use seclusion or restraint for any behavioral, medical, or
				  protective purpose unless other less restrictive techniques have been
				  considered and documentation is placed in the individual's safety plan, the
				  crisis ISP, or the ISP that these less restrictive techniques did not or would
				  not succeed in reducing or eliminating behaviors that are self-injurious or
				  dangerous to other people or that no less restrictive measure was possible in
				  the event of a sudden emergency.
8.
				  Providers that use seclusion, restraint, or time out shall develop written
				  policies and procedures that comply with applicable federal and state laws and
				  regulations, accreditation and certification standards, third party payer
				  requirements, and sound therapeutic practice. These policies and procedures
				  shall include at least the following requirements:
a. Individuals shall be given the opportunity
				  for motion and exercise, to eat at normal meal times and take fluids, to use
				  the restroom, and to bathe as needed.
b. Trained, qualified staff shall monitor the
				  individual's medical and mental condition continuously while the restriction is
				  being used.
c. Each use of
				  seclusion, restraint, or time out shall end immediately when criteria for
				  removal are met.
d. Incidents of
				  seclusion and restraint, including the rationale for and the type and duration
				  of the restraint, shall be reported to the department as provided in
				  12VAC35-115-230 C.
9. Providers shall comply with all
				  applicable state and federal laws and regulations, certification and
				  accreditation standards, and third party requirements as they relate to
				  seclusion and restraint.
a. Whenever an
				  inconsistency exists between this chapter and federal laws or regulations,
				  accreditation or certification standards, or the requirements of third party
				  payers, the provider shall comply with the higher standard.
b. Providers shall notify the department
				  whenever a regulatory, accreditation, or certification agency or third party
				  payer identifies problems in the provider's compliance with any applicable
				  seclusion and restraint standard.
10. Providers shall ensure that only staff
				  who have been trained in the proper and safe use of seclusion, restraint, and
				  time out techniques may initiate, monitor, and discontinue their use.
11. Providers shall ensure that a qualified
				  professional who is involved in providing services to the individual reviews
				  every use of physical restraint as soon as possible after it is carried out and
				  documents the results of his review in the individual's services
				  record.
12. Providers shall ensure
				  that review and approval by a qualified professional for the use or
				  continuation of restraint for medical or protective purposes is documented in
				  the individual's services record. Documentation includes:
a. Justification for any restraint;
b. Time-limited approval for the use or
				  continuation of restraint; and
c.
				  Any physical or psychological conditions that would place the individual at
				  greater risk during restraint.
13. Providers may use seclusion or mechanical
				  restraint for behavioral purposes in an emergency only if a qualified
				  professional involved in providing services to the individual has, within one
				  hour of the initiation of the procedure:
a.
				  Conducted a face-to-face assessment of the individual placed in seclusion or
				  mechanical restraint and documented that alternatives to the proposed use of
				  seclusion or mechanical restraint have not been successful in changing the
				  behavior or were not attempted, taking into account the individual's medical
				  and mental condition, behavior, preferences, nursing and medication needs, and
				  ability to function independently;
b. Determined that the proposed seclusion or
				  mechanical restraint is necessary to protect the individual or others from
				  harm, injury, or death;
c.
				  Documented in the individual's services record the specific reason for the
				  seclusion or mechanical restraint;
d. Documented in the individual's services
				  record the behavioral criteria that the individual must meet for release from
				  seclusion or mechanical restraint; and
e. Explained to the individual, in a way that
				  he can understand, the reason for using mechanical restraint or seclusion, the
				  criteria for its removal, and the individual's right to a fair review of
				  whether the mechanical restraint or seclusion was permissible.
14. Providers shall limit each
				  approval for restraint for behavioral purposes or seclusion to four hours for
				  individuals age 18 and older, two hours for children and adolescents ages nine
				  through 17, and one hour for children under age nine.
15. Providers shall not issue standing orders
				  for the use of seclusion or restraint for behavioral purposes.
16. Providers shall ensure that no individual
				  is in time out for more than 30 minutes per episode.
17. Providers shall monitor the use of
				  restraint for behavioral purposes or seclusion through continuous face-to-face
				  observation, rather than by an electronic surveillance device.