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RULE §3.603Evaluation and Assessment

(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.

Source Note: The provisions of this §3.603 adopted to be effective May 16, 2013, 38 TexReg 2841

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