Or. Admin. Code § 419-400-0180 - Licensing Umbrella Rules: Restraints and Involuntary Seclusion
(1) A child-caring
agency may only place child in care in a restraint or involuntary seclusion if
the child in care's behavior poses a reasonable risk of imminent serious bodily
injury to the child in care or others and less restrictive interventions would
not effectively reduce the risk.
(2) A child-caring agency may not place a
child in care in a restraint or involuntary seclusion as a form of discipline,
punishment, or retaliation or for the convenience of staff, contractors or
volunteers of the child-caring agency.
(3) If the child-caring agency utilizes
restraints or involuntary seclusion as part of its practices, its use of
restraints and involuntary seclusion must be in compliance with all applicable
federal and state laws, regulations and rules.
(4) A child in care placed in a restraint or
involuntary seclusion must be continuously monitored by staff of the
child-caring agency for the duration of the restraint or involuntary
seclusion.
(5) Any restraint or
involuntary seclusion used on a child in care must be performed in a manner
that is safe, proportionate and appropriate, taking into consideration the
child in care's chronological and developmental age, size, gender identity,
physical, medical and psychiatric condition and personal history, including any
history of physical or sexual abuse.
(6) The removal or limitation of the use of a
mobility aid or other assistive device in a restraint is prohibited unless
there is a risk of imminent serious bodily injury and less restrictive
interventions would not effectively reduce the risk.
(7) Removing or limiting the use of a
mobility aid or other assistive device for the purpose of controlling a child
in care's behavior is prohibited and
(8) If any restraint or involuntary seclusion
lasts for more than 10 minutes, the child-caring must provide adequate access
to the bathroom and water at least every thirty minutes to the child in
care.
(9) For any restraint or
involuntary seclusion lasting more than 10 minutes a supervisor, trained in the
non-violent crisis intervention system used by the child-caring agency must
provide written authorization for the continuation of the restraint or
involuntary seclusion every five minutes.
(a)
If the supervisor is not on-site at the time the restraint is used, the
supervisor may provide the written authorization electronically.
(b) The written authorization must document
why the restraint or involuntary seclusion continues to be the least
restrictive intervention to reduce the risk of imminent serious bodily injury
in the given circumstances.
(10) Restraint.
(a) The following types of restraint of a
child in care are prohibited:
(A) Chemical
restraint.
(B) Mechanical
restraint.
(C) Prone
restraint.
(D) Supine restraint,
except:
(i) Supine restraint may be used only
when the child in care is currently admitted to a secure children's inpatient
treatment program or secure adolescent inpatient treatment program
and:
(ii) The restraint is
authorized by an order written at the time of and specifically for the current
situation by a licensed medical practitioner as defined by OAR
309-022-0105(54)
or a licensed children's emergency safety
intervention specialist as defined by OAR
309-022-0105(14);
(iii) The restraint is used only as long as
needed to prevent serious physical injury, as defined in ORS
161.015, and while no other
intervention or form of restraint is possible;
(iv) A licensed medical practitioner,
children's emergency safety intervention specialist or qualified mental health
professional, who is certified in the use of the type of restraint used,
continuously monitors the use of the restraint and the physical and
psychological well-being of the child in care at all times while the restraint
is being used;
(v) Each individual
placing the child in care in the restraint is trained, as required by the
Department of Human Services by rule, in the use of the type of restraint used
and the individual's training is current;
(vi) One or more individuals with current
cardiopulmonary resuscitation training are present for the duration of the
restraint;
(vii) The child caring
agency has written policies that require a licensed children's emergency safety
intervention specialist or other licensed practitioner to evaluate and document
the physical, psychological and emotional well-being of the child in care
immediately following the use of the restraint.
(E) Any restraint that includes the
intentional and nonincidental use of a solid object, including the ground, a
wall or the floor, to impede a child in care's movement, except:
(i) This type of restraint may be used if the
restraint is necessary to gain control of a weapon or;
(ii) The child in care is currently admitted
to a secure children's inpatient treatment program or secure adolescent
inpatient treatment program and complies with OAR
419-400-0180
(10)(a)(D) (i through vii).
(I) The restraint is authorized by an order
written at the time of and specifically for the current situation by a licensed
medical practitioner or a licensed children's emergency safety intervention
specialist;
(II) The restraint is
used only as long as needed to prevent serious physical injury, as defined in
ORS 161.015, and while no other
intervention or form of restraint is possible;
(III) A licensed medical practitioner,
children's emergency safety intervention specialist or qualified mental health
professional, who is certified in the use of the type of restraint used,
continuously monitors the use of the restraint and the physical and
psychological well-being of the child in care at all times while the restraint
is being used;
(IV) Each individual
placing the child in care in the restraint is trained, as required by the
Department of Human Services by rule, in the use of the type of restraint used
and the individual's training is current;
(V) One or more individuals with current
cardiopulmonary resuscitation training are present for the duration of the
restraint;
(VI) The child caring
agency has written policies that require a licensed children's emergency safety
intervention specialist or other licensed practitioner to evaluate and document
the physical, psychological and emotional well-being of the child in care
immediately following the use of the restraint;
(F) Any restraint that places or creates a
risk of placing pressure on a child in care's neck or throat.
(G) Any restraint that places or creates a
risk of placing, pressure on a child in care's mouth. This type of restraint
may be used if the restraint is necessary for the purpose of extracting a body
part from a bite.
(H) Any restraint
that impedes, or creates a risk of impeding, a child in care's
breathing.
(I) Any restraint that
involves the intentional placement of any object or a hand, knee, foot or elbow
on a child in care's neck, throat, genitals or other intimate parts.
(J) Any restraint that causes pressure to be
placed or creates a risk of causing pressure to be placed, on a child in care's
stomach, chest, joints, throat or back by a knee, foot or elbow.
(K) Any other action, of which the primary
purpose is to inflict pain.
(b) Permissible use of restraint. A restraint
may be used on a child in care in the following situations:
(A) Holding a child in care's hand or arm to
escort the child in care safely and without the use of force from one area to
another;
(B) Assisting the child in
care to complete a task if the child in care does not resist the physical
contact; or
(C) Using a physical
intervention if:
(i) The intervention is
necessary to break up a physical fight or to effectively protect a person from
an assault, serious bodily injury or sexual contact;
(ii) The intervention uses the least amount
of physical force and contact possible: and
(iii) The intervention is not a prohibited
restraint identified in OAR
419-400-0180(10)(a).
(c) Only child-caring
agency staff and proctor foster parents who have been trained in a nationally
recognized nonviolent crisis-intervention system may use restraint and only
when necessary as a last resort to prevent a child in care from inflicting harm
to self or others. The restraint must be conducted within the parameters of the
nationally recognized system in which the staff or proctor foster parent is
trained.
(d) Any use of restraint
by a staff member or proctor foster parent of the child-caring agency, if the
member is not trained in a nationally recognized nonviolent crisis intervention
system, must also be reported to a Department licensing coordinator within one
business day of occurrence.
(e)
Limitations. The child-caring agency must have a policy that prohibits the
application of a nonviolent restraint to a child in care who has a documented
physical condition that would contraindicate the use of that particular
restraint, unless a qualified medical professional has previously and
specifically authorized its use in writing for the child in care. Documentation
of the authorization must be maintained in the child of care's
record.
(11) Involuntary
Seclusion.
(a) Rooms used for seclusion must
have adequate space, temperature, light, and ventilation.
(b) Episodes of involuntary seclusion are
limited to two hours for children in care age nine and older and one hour for
children in care under the age of nine.
(c) If incidents of involuntary seclusion
used with an individual child in care cumulatively exceed five hours in five
days, or a single episode of more than two hours for children in care age nine
and older or more than one hour for children in care under age nine, the
executive director or designee must review the case with those with clinical
leadership responsibilities to evaluate the child in care's plan of care and
make necessary adjustments.
(12) Records
(a) A program shall maintain a record of each
incident in which a reportable injury arises from the use of a restraint or
involuntary seclusion. The record must include any photographs, audio recording
or video recording immediately preceding, during and following the incident.
The record may not be destroyed, edited, concealed, or altered in any
way.
(b) For each record created as
required by OAR 419-400-0180(12)(a),
the program shall immediately provide written notification of the incident and
true copies of the record to the department.
(c) If a program places a child in care in
involuntary seclusion or arestraint, except as described in OAR
419-400-0180(10)(b)(A)
or 419-400-0180(10)(b)(B),
the program shall provide the child in care's case manager, attorney, court
appointed special advocate and parent or guardian with:
(A) Verbal or electronic notice that the
restraint or involuntary seclusion was used as soon as practicable following
the incident but not later than the end of the next business day; and
(B) Written notice in compliance with OAR
419-400-0180(12)(d)
that the restraint or involuntary seclusion was used as soon as practicable
following the incident but not later than the end of the next business
day.
(d) The written
notice must include:
(A) A description of the
restraint or involuntary seclusion, the date of the restraint or involuntary
seclusion, the times when the restraint or involuntary seclusion began and
ended and the location of the restraint or involuntary seclusion;
(B) A description of the child in care's
activity that necessitated the use of restraint or involuntary
seclusion;
(C) The efforts the
program used to de-escalate the situation and the alternatives to restraint or
involuntary seclusion the program attempted before placing the child in care in
the restraint or involuntary seclusion;
(D) The names of each of individual who
placed the child in care in the restraint or involuntary seclusion or who
monitored or approved the placement of the child in care in the restraint or
involuntary seclusion;
(i) For each individual
identified whether the individual was trained, as required by the Oregon
Department of Human Services by rule, in the use of the type of restraint or
involuntary seclusion used, the date of the individual's most recent training
and a description of the types of restraint the individual is trained to use,
if any.
(ii) If an individual
identified was not trained in the type of restraint or involuntary seclusion
used, or if the individual's training was not current, a description of the
individual's training deficiency and the reason an individual without the
proper training was involved in the restraint or involuntary
seclusion.
(E) If the
child in care suffered a reportable injury arising from being placed in
involuntary seclusion or a restraint, a description of any photographs, audio
or video recordings related to the incident that are maintained by the program
as required by OAR 419-400-0180(12)(a).
(e) If an incident requires notice
under 419-400-0180(12)(c),
not later than two business days following the date of the restraint or
involuntary seclusion, the program shall hold a debriefing meeting with each
individual who was involved in the incident and with any other appropriate
program staff, shall take written notes of the debriefing meeting and shall
provide copies of the written notes to the child in care's case manager,
attorney, court appointed special advocate and parents or guardians.
(f) If serious bodily injury or the death of
staff occurs in connection to the use of the restraint or involuntary
seclusion, the program shall provide the department with written notification
of the incident not later than 24 hours following the incident.
(13) Reporting Requirements
(a) A child caring agency must submit a
report to the Department on a quarterly basis that includes at a minimum:
(A) The total number of incidents involving
restraint.
(B) The total number of
incidents involving involuntary seclusion.
(C) The total number of involuntary
seclusions in a locked room.
(D)
The total number of rooms available for use by the program for involuntary
seclusion and a description of the dimensions and design of the
rooms.
(E) The total number of
children in care placed in restraint.
(F) The total number of children in care
placed in involuntary seclusion.
(G) The total number of children who
experienced both restraint and involuntary seclusion.
(H) The total number of incidents under
paragraph (A) or (B) of this subsection that resulted in reportable
injuries.
(I) The number of
children in care who were placed in restraint or involuntary seclusion more
than three times during the preceding three-month period and a description of
the steps the program has taken to decrease the use of restraint and
involuntary seclusion.
(J) The
number of incidents in which an individual who placed a child in care in a
restraint or involuntary seclusion was not trained, as required by the
department by rule, in the use of the type of restraint or involuntary
seclusion used.
(K) The demographic
characteristics of the children in care who the program placed in a restraint
or involuntary seclusion, including race, ethnicity, gender, disability status,
migrant status, English proficiency and status as economically disadvantaged,
unless the demographic information would reveal personally identifiable
information about an individual child in care.
(L) The total number of children in care
served by the program during the reporting period, including race, ethnicity,
gender, disability status, English proficiency and status as economically
disadvantaged, unless the demographic information would reveal personally
identifiable information about an individual child in care.
(b) If a child caring agency
provides services in more than one location, the reports required under
subsection 419-400-0180(13)(a)
must separate the data for each location that serves five or more children in
care.
(c) If a child caring agency
provides services to four or fewer children in care at a location, the location
specific data must include a notation indicating the aggregate number of
children in care served by the child caring agency across all of its locations
and the reporting requirements continue to apply to any of the child care
agency's other locations serving five or more children in care.
(d) Each child caring agency that submits a
report under this section shall make its quarterly report available to the
public upon request at the Child Caring Agency's main office and on the child
caring agency's website if applicable.
(e) Each child caring agency shall provide
notice regarding how to access the quarterly reports to the parents or
guardians of children in care in the program. The child caring agency shall
provide the notice upon the child in care's admission and at least two times
each year thereafter.
(14) The reporting requirements described in
OAR 419-400-0180
(13) do not apply to a program that is
licensed as an Adoption Agency (as defined by OAR
419-400-0005(2))
and does not provide care or services to children other than those described in
the definition.
Notes
Statutory/Other Authority: ORS 409.050, ORS 418.240, ORS 418.005 & 418.526
Statutes/Other Implemented: ORS 418.205 - 418.327, ORS 418.521, ORS 418.528, 418.526 & 418.519
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