| (a) Only staff who have successfully completed competency-based
training on the use of restraints may implement restraint procedures.
Staff who implement restraint procedures must also complete training
on person-specific instructions and other measures regarding restraints
contained in an individual's crisis intervention plan or other plan.
(b) The following conditions must be met before a PCP
may order a restraint in response to a behavioral crisis:
(1) the individual's behavior constitutes a behavioral
crisis;
(2) if no PBSP, desensitization plan, or other preventive
measures are in place, staff have considered the level of imminent
risk of violence or injury and have applied a graduated range of
less-restrictive approved procedures as safety permits and the measures
have not reduced the risk of imminent physical harm to the individual
or others;
(3) if a PBSP, desensitization plan, or other preventive
measures are in place, the individualized procedures for prevention,
de-escalation and a graduated range of less restrictive measures have
been followed, as safety permits, but have not reduced the risk of
imminent physical harm to the individual or others; and
(4) if a helmet, mittens with ties, wristlets, or other
mechanical restraints will be used to prevent self-injury in a behavioral
crisis:
(A) an approved crisis intervention plan allowing the
use of the mechanical restraint must be in place; or
(B) the use of the mechanical restraint must be approved
by the individual's psychologist or board certified behavior analyst
(BCBA) or the psychologist or BCBA on call, the administrator on duty,
and the director of psychology or behavioral services.
(c) If a mechanical restraint is used in accordance
with subsection (b)(4)(B) of this section, its use must be reviewed
by the chairperson of the facility's human rights committee as soon
as possible but within 24 hours after initiation of the restraint.
(d) A psychotropic medication may be ordered as a chemical
restraint in response to a behavioral crisis, but only if immediate
use of the medication is essential to prevent or mitigate the danger
of the individual's harmful behavior and the following conditions
have been met:
(1) the individual is experiencing a behavioral crisis;
(2) a graduated range of less restrictive alternatives
to stop the behavior and protect the individual and others has been
attempted, as safety permits, but has not reduced the risk of imminent
physical harm to the individual or others;
(3) the requirements of any component of the ISP have
been followed but have not reduced the risk of imminent harm to the
individual or others;
(4) a psychiatrist or PCP has determined that early
administration of a regularly prescribed psychotropic medication instead
of chemical restraint is not a reasonable option; and
(5) a psychiatrist or PCP approves and orders the use
of the chemical restraint.
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| Source Note: The provisions of this §967.33 adopted to be effective May 16, 2013, 38 TexReg 2841; transferred effective July 31, 2024, as published in the July 5, 2024, issue of the Texas Register, 49 TexReg 4927 |
