|(a) Immediately following the release of an individual
from restraint or seclusion, a staff member shall:
(1) take action, if appropriate, to facilitate the
individual's reentry into the social milieu by providing the individual
with transition activities and an opportunity to return to ongoing
(2) observe the individual for at least 15 minutes;
(3) document in the individual's medical record the
steps taken and observations made of the individual's behavior during
this transition period.
(b) The facility shall conduct or attempt to conduct
debriefings based on the following:
(1) identify what led to the episode and what could
have been handled differently;
(2) identify strategies to prevent future restraint
or seclusion of the individual, taking into consideration suggestions
from the individual and the individual's declaration for mental health
treatment, if any;
(3) ascertain whether the individual's physical well-being,
psychological comfort, including trauma, and right to privacy were
protected or otherwise addressed, as applicable;
(4) counsel the individual(s) in relation to any trauma
that may have resulted from the episode; and
(5) when indicated, make appropriate modifications
to the individual's treatment plan and/or the treatment plans of other
(c) Following an episode of restraint or seclusion,
the facility shall conduct, or attempt to conduct, the following debriefings.
(1) Staff members who were involved in the episode,
other staff members who the facility determine are appropriate, and
supervisors shall debrief together as a support mechanism and to identify
successes, problems, or necessary modifications as soon after the
episode as is practicable in light of facility operations.
(2) When clinically indicated and at a time when the
individual has cognitive capacity to understand what could have been
done differently to avoid restraint or seclusion, a staff member or
members shall conduct a private discussion with the individual, the
individual's LAR, if practicable, and family members, if clinically
appropriate and available, with the consent of the individual.
(3) If the episode was a restraint, when clinically
indicated or upon request of individuals who witnessed the restraint,
a staff member or members shall have a private discussion with individuals
who witnessed the restraint.
(d) If an individual has been discharged from the facility,
does not have the cognitive capacity to understand what he or she
could have done differently to avoid restraint or seclusion, where
clinically inappropriate, or where not requested pursuant to subsection
(c)(3) of this section, the facility does not need to attempt the
debriefings described in subsection (c)(2) and (3) of this section.
The facility shall document in the individual's medical record the
reason for not conducting the debriefing described in subsection (c)(2)
of this section.
(e) Any debriefings conducted under subsection (c)(2)
or (3) of this section shall be documented in the individual's medical
record in a timely manner. Any debriefing conducted pursuant to subsection
(c)(1) of this section shall be documented in accordance with facility
policy. If debriefing is not conducted, the reasons for not completing
the debriefing shall be documented in the individual's medical record.