| (a) The IDT must develop and implement person-centered
proactive supports, training, and treatment with the goal of making
the use of restraints unnecessary.
(b) When evidence indicates that the individual's behaviors
result in a behavioral crisis or sustained self-injury or make it
difficult to provide needed medical or dental care, the IDT, including
the individual and LAR, with the involvement of a PCP and other relevant
professional staff, must assess and identify any issues or contraindications
for the use of restraint, including:
(1) any physical, behavioral, psychiatric, or medical
conditions that constitute a risk; and
(2) any considerations in the use of restraint due
to the individual's communication level, cognitive functioning level,
height, weight, emotional condition (including whether the individual
has a history of having been physically or sexually abused), and age.
(c) The IDT must ensure that a PCP reviews and updates,
as necessary in response to changes in condition and at IDT meetings,
but at least annually, any conditions, factors, or limitations on
specific physical techniques, drugs, or mechanical devices used for
restraint.
(d) For individuals participating in a program outside
the facility, the IDT must coordinate with staff from the outside
program to assess and develop interventions consistent with the ISP
and any action plans and invite staff from the outside program to
participate in IDT meetings at which interventions are discussed.
(e) An ISP action plan must:
(1) be developed to decrease and ultimately eliminate
the use of restraint for the individual, with consideration of protection
from harm and safety issues;
(2) include an interdisciplinary analysis that identifies
the circumstances that contribute to causing the dangerous behaviors
that result in the use of restraint;
(3) identify actions, data collection, and the responsible
persons for implementing the actions;
(4) address a broad range of changes, which may include
changing living arrangements, implementing calming procedures, and
incorporating preferences in programs;
(5) include a PBSP and other therapeutic plans, as
applicable; and
(6) contain individualized instructions to direct support
professionals in the safe and effective use of restraint procedures.
(f) A facility must develop or revise an interdisciplinary
ISP action plan in response to significant events, including but not
limited to, the following:
(1) more than three behavioral crises in a 30-day rolling
period have required the use of restraints;
(2) restraint use has not decreased over time and may
be likely to continue at a stable rate unless an action plan is developed;
(3) the individual's characteristics require that
standard restraint procedures be adapted to meet his or her needs;
(4) a pattern of injuries to the individual or others
is observed as restraint procedures are carried out;
(5) an individual has sustained, self-injurious behavior,
and supervision and treatment have not been successful in reducing
harm; or
(6) an individual's behavior is presenting a risk to
medical or dental treatment or to healing.
(g) A facility must develop and implement an ISP action
plan by:
(1) reviewing the individual's relevant adaptive skills
and biological, medical, and psychosocial factors;
(2) reviewing possible contributing environmental
conditions;
(3) completing or revising structural and functional
assessments of the behavior leading to use of restraint;
(4) developing or revising a PBSP based on the structural
and functional assessments of the behavior leading to the use of restraint
that identifies the individual's particular strengths, specifies the
behavior to be addressed, prescribes alternative, positive adaptive
behaviors to be taught or strengthened to replace the dangerous behavior
that requires the use of restraint, and describes prevention procedures
to be followed as the individual's behavior indicates an escalation
of behaviors that are dangerous and likely to result in restraint;
(5) as applicable, developing or revising other programs
to reduce or eliminate the use of restraint that are not part of the
PBSP, such as treatment or strategies to minimize or eliminate the
need for medical restraints;
(6) as applicable, developing or revising a crisis
intervention plan or medical restraint plan, including staff instructions
on how to safely and appropriately use a recommended restraint procedure
with a specific individual, any changes in the type of restraint used,
the maximum duration of the restraint, and the criteria for terminating
the restraint;
(7) as applicable, developing or revising a protective
mechanical restraint plan for self-injurious behavior, including procedures
for gradually increasing the time the individual is able to stay
safe but not be in restraints and any changes in the type of restraint
used; and
(8) specifying the persons responsible for activities,
including obtaining legally adequate consent from the individual or
LAR before implementing the plan, providing required staff training,
monitoring activities, evaluating effectiveness, and ensuring any
necessary reviews by the Human Rights Committee.
(h) The IDT must review, assess, and revise an ISP
action plan at least annually and more frequently as necessary. The
IDT must review, at least quarterly and more frequently as necessary,
an individual who was restrained for a behavioral crisis or for whom
medical restraint was used. The IDT must review a protective mechanical
restraint plan for self-injurious behavior at least monthly and more
frequently as necessary.
(i) The IDT may consult with a facility discipline
director, state office discipline coordinator, or outside consultant
to explore alternative treatment strategies.
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