| (F) an opportunity to ask questions concerning the
behavioral support plan; and
(G) the time period, not to exceed one year, for which
the individual's or LAR's consent will be effective.
(4) A LIDDA may implement behavioral support that involves
restrictions or limitations placed on an individual or the use of
intrusive techniques without a behavioral support plan if the support
is in response to a behavioral emergency. If such behavioral support
is implemented more than twice during two consecutive months, the
LIDDA must conduct a functional assessment to determine if a behavioral
support plan is needed to reduce the frequency and severity of the
behaviors exhibited during the behavioral emergency.
(f) Restraint.
(1) A LIDDA must have and implement a curriculum that
ensures staff members are trained in the prevention and management
of aggressive behavior. The curriculum must be consistent with the
requirements of this subsection.
(2) A staff member may use restraint only under the
following circumstances:
(A) in a behavioral emergency;
(B) as part of a behavioral support plan that addresses
inappropriate behavior exhibited voluntarily by an individual; or
(C) in accordance with an order for the restraint from
a physician, dentist, occupational therapist, or physical therapist.
(3) A staff member is prohibited from using restraint:
(A) in a manner that:
(i) obstructs the individual's airway, including the
placement of anything in, on, or over the individual's mouth or nose;
(ii) impairs the individual's breathing by putting
pressure on the individual's torso; or
(iii) places the individual in a prone or supine position;
(B) for disciplinary purposes (that is, for retaliation
or retribution);
(C) for the convenience of a staff member or other
individuals; or
(D) as a substitute for effective treatment or habilitation.
(4) If restraint will be used as part of a behavioral
support plan, the planning team must:
(A) with the involvement of a physician or registered
nurse, identify and document:
(i) the individual's known physical or medical conditions
that might constitute a risk to the individual during the use of restraint;
(ii) the individual's ability to communicate; and
(iii) other factors, such as the individual's:
(I) cognitive functioning level;
(II) height;
(III) weight;
(IV) emotional condition, including whether the individual
has a history of having been physically or sexually abused; and
(V) age; and
(B) review and update with a physician or registered
nurse, at least annually or when a condition or factor documented
in accordance with paragraph (4)(A) of this subsection changes significantly.
(5) If restraint is used in a behavioral emergency
more than twice during two consecutive months, the planning team must
ensure a functional assessment of the individual is conducted to determine
if a behavioral support plan is needed to reduce the frequency and
severity of the behaviors exhibited during the behavioral emergency.
(6) If a staff member restrains an individual in accordance
with paragraph (2) of this subsection, the staff member must:
(A) use the minimal amount of force or pressure that
is reasonable and necessary to ensure the safety of the individual
and others;
(B) safeguard the individual's dignity, privacy, and
well-being; and
(C) not secure the individual to a stationary object
while the individual is in a standing position.
(7) If a staff member restrains an individual in accordance
with paragraph (2)(A) or (B) of this subsection, the staff member
may only use a restraint hold in which the individual's limbs are
held close to the body to limit or prevent movement and that is in
compliance with paragraph (3)(A) of this subsection.
(8) A staff member must release an individual from
restraint:
(A) as soon as the individual no longer poses a risk
of imminent physical harm to the individual or others; or
(B) as soon as possible if the individual in restraint
experiences a medical emergency, as indicated by the medical emergency.
(9) After restraining an individual in a behavioral
emergency, a staff member must:
(A) as soon as possible but no later than one hour
after the use of restraint, notify a registered nurse, licensed vocational
nurse, or a professional identified in subsection (e)(1)(B) of this
section of the restraint;
(B) ensure that medical services are obtained for the
individual as necessary; and
(C) discuss the circumstances of the restraint with
a professional identified in subsection (e)(1)(B) of this section.
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