RESTRICTIVE MEASURES OVERVIEWPresented by :

CCCW Behavior Support Oversight Committee (BSOC)

WHAT WILL WE BE COVERING TODAY ?

Proactive and Behavior Support Plan overview.

Definitions of Restrictive Measures per DHS 94.

Emergency Restrictive Measures Plan. Roles of CCCW Interdisciplinary Teams, CCCW

Behavior Support Oversight Committee (BSOC), and DHS/DLTS

Restrictive Measures Approval Process (what needs to be included).

DISCLAIMER

We are putting the cart before the horse. Prior to even thinking about restrictive

measures, we need to have a behavior support plan in place.

Data documenting effectiveness or ineffectiveness.

Restrictive measures are the last resort option.

PROACTIVE SUPPORT PLANS

Designed to prevent the likelihood of negative, maladaptive behaviors from emerging, and places focus on positive behaviors, one’s strengths, and abilities.

Create an environment that is conducive of safe learning and expression, residents feel more comfortable and are more likely to respond favorably to staff support.

Evolve with the individual and are updated routinely as we learn more about each person’s abilities, improvement in certain life areas, and effective interventions and interactions.

PROACTIVE SUPPORT PLANS

Is the big picture plan. How do we support the individual throughout

the day - not just during crisis? More importantly, how do we assist the

individual in being more independent, by assisting in modifying behaviors?

Very clear step-by-step for consistency.

BEHAVIOR SUPPORT PLANS

Specific to each individual behavior. Define the behavior (what does it look like). Precursors, onset, severity, how often it occurs,

how long will it last - conclusion of the behaviors. Identified function of the behavior. Proactive prevention of behavior. Management of the behavior.

EFFECTIVENESS OF A PLAN

Data collection, Data collection, Data collection.

Review, Review, Review, Review. Team approach and input.

RELATIONSHIP OF INDIVIDUAL RIGHTS ANDRESTRICTIVE MEASURES

Mail

Access to Phone

Prompt Treatment

Visitors

Storage

Access to Funds

Religion

Voting

Medications and Treatment

RestraintIsolationSeclusionLeast Restrictive Treatment and Conditions

WHAT IS A RESTRICTIVE MEASURE?

The definition of Restrictive Measures applies to the forms of restraint, isolation, and protective equipment identified below: Manual Restraints Mechanical Restraint Medical Restraint Isolation/Seclusion Protective Equipment Mechanical Support

WHAT IS A RESTRAINT?

Any device, garment or physical hold that

Restricts the voluntary movement of a person’s body or access to any part of the body

And cannot be easily removed by the individual

MANUAL RESTRAINTS

“Hands on,” holding limbs or body contingent upon behavior

Restricting or preventing movement Not longer than 15 continuous minutes

Examples:

MANUAL RESTRAINT DOES NOT INCLUDE:

Medical restraints. Holding limbs or body to provide functional

movement and positioning. Holding limbs or body to prevent falling. Self-protective blocking or passive redirecting

aggressive behavior. Graduated guidance as part of an approved

intervention.

MECHANICAL RESTRAINT

A device applied to any part of a person’s body contingent upon behavior

Restricts or prevents movement or normal use/functioning of the body part

Cannot be easily removed by the individual Cannot impair hearing, vision, or speech

(DHS)

Examples:

MEDICAL RESTRAINT

Apparatus or procedure that restricts voluntary free movement

Cannot be easily removed by the individual Used prior to, during, or subsequent to a medical

procedure Or to protect during the time a medical condition

exists

Examples:

MEDICAL RESTRAINT CONT. – SHORT-TERM USE

MD writes an order for use during the first 10 days. Guardian is notified.

If restraint continues past the initial 10 days, then guardian consent is required.

If this occurs regularly or becomes long-term, then application for use is required.

ISOLATION/SECLUSION

Involuntary physical or social separation from others by actions of staff

Contingent upon behavior

Examples:

PROTECTIVE EQUIPMENT

Device that does not restrict movement but does prevent access

Applied to any part of a person’s body to prevent tissue damage as a result of behavior

Cannot be easily removed by the individual

Examples:

MECHANICAL SUPPORT

An apparatus Properly aligns a person’s body or helps

maintain balance Designed by a qualified professional in

accordance with principles of good body mechanics, concern for circulation, and allow for change in position.

Generally not a restraint, but could be if it meets the definition.

Examples:

EXCEPTIONAL MEASURES

Specific forms of restraint that are considered highly restrictive and present a higher level of risk

Requires an additional level of review - Oversight Committee

Waiving or modifying any process requirement is considered an exceptional measure, as well

EXCEPTIONAL FORMS OF …MANUAL RESTRAINT

Any form of horizontal restraint Physically forcing a person to lay in a

horizontal position

Takedowns Physically forcing a person to a prone

position on the ground, floor, or mat

EXCEPTIONAL FORMS OF …MECHANICAL RESTRAINT

Restraint vests, jackets, body wraps Seclusion Wrist or ankle restraints Removal of mobility aids Restraint chairs Bed enclosures

EXCEPTIONAL FORM OF …ISOLATION

Seclusion Person is physically set apart from others Use of locked doors