Utah Admin. Code R539-4-6 - Intrusive Behavior Intervention

(1) If a provider or the developmental center uses an intrusive behavior intervention, the intrusive behavior intervention must be:

(a) identified in the behavior support plan; and

(b) used immediately after the person engages in an unwanted target behavior identified in the behavior support plan.

(2) An intrusive behavior intervention includes:

(a) aversive stimulus;

(b) contingent rights restriction;

(c) deprivation;

(d) emergency rights restriction;

(e) enforced compliance;

(f) seclusion;

(g) manual restraint;

(h) mechanical restraint;

(i) physical guidance;

(j) response-cost;

(k) restitutional overcorrection;

(l) satiation; and

(m) seclusion room.

(3) To include an intrusive behavior intervention in the behavior support plan, describe the:

(a) method of intervention;

(b) safety and efficacy monitoring procedure; and

(c) time limitation or individualized release criteria.

(4) Individualized release criteria for manual restraint, mechanical restraint, seclusion, and seclusion room shall be based on:

(a) a predetermined behavior that must be achieved; or

(b) a predetermined amount of time spent in restraint or seclusion.

(5) Aversive stimulus shall be free from any procedure or action that is degrading, humiliating, harsh, punitive, painful, or abusive. A provider and the developmental center may not use:

(a) a device that transmits an electric shock to the person;

(b) heat and cold exposure; or

(c) any procedure or action likely to result in psychological or physical trauma.

(6) Except when approved by a provider administrator or a qualified behavior professional as described in Subsection R539-4-6(6)(a), use of a manual restraint, mechanical restraint, or seclusion may not exceed one hour.

(a) If the predetermined behavior release criteria in the person's behavior support plan is not met within one hour of beginning the restraint or seclusion, one additional hour may be approved.

(b) Use of restraint or seclusion that exceeds one hour requires review by the team and the Provider Peer Review Committee.

(c) Any time that the person spends asleep must count toward the predetermined amount of time in the release criteria.

(d) Total time spent in restraint or seclusion may not exceed two hours in a 24-hour period.

(7) Staff shall complete detailed documentation of each use of a manual restraint, mechanical restraint, or seclusion; and any observation requirement included in the behavior support plan.

(8) A provider or the developmental center shall submit each mechanical restraint, seclusion, or seclusion room included in the behavior support plan to the State Behavior Review Committee for review. The State Behavior Review Committee must approve the intervention before it may be used

(9) A manual restraint shall be used as described in Rule R501-1 and Section R539-4-6.

(a) A manual restraint program or procedure may be used after approval by the State Behavior Review Committee and Division Human Rights Council.

(b) Intervention training programs currently approved by the State Behavior Review Committee include:

(i) the Mandt System;

(ii) the Professional Assault Response Training (PART);

(iii) Supports Options and Actions for Respect (SOAR);

(iv) Crisis Prevention Intervention (CPI); and

(v) Safety Care.

(10) A mechanical restraint shall be used as follows:

(a) Safety and efficacy monitoring procedure shall ensure a person's health and safety.

(i) Each procedure must be individualized.

(ii) Procedure must include a method to monitor the person before, during, and after use of a mechanical restraint.

(iii) Procedure must include observation and documentation of the person's status at a minimum of 15-minute intervals.

(b) A mechanical restraint device includes gloves, mitts, helmet, splints, and wrist or ankle binding.

(c) A mechanical restraint device does not include:

(i) a device commonly used to ensure a person's safety such as seatbelts or protective sporting equipment;

(ii) medically necessary equipment related to a health condition used to promote healing or to prevent injury; and

(iii) a protective helmet used to limit injury to a person during a seizure or other medical reason.

(11) Seclusion shall be used as described in Rule R501-1 and Subsection R539-4-6(11).

(a) A seclusion room may be used as follows:

(i) A provider licensed through the Office of Licensing may use a seclusion room as described in Rule R501-1.

(ii) A provider not licensed through the Office of Licensing and the developmental center may use a seclusion room as described in Rule R501-1 and use the seclusion room for an adult or child.

(iii) The developmental center may not use a seclusion room as an emergency behavior intervention as described in 42 CFR 483.450(c)(1)(i).

(b) To include seclusion or a seclusion room in a behavior support plan, describe the individualized release criteria for each intervention as described in Subsection R539-4-6(3).

(c) Staff shall maintain constant visual and auditory observation of the person during each seclusion and use of a seclusion room.

(12) Use of a seclusion room must be approved by the division director before the intervention may be used.

(a) A provider or the developmental center must request that the State Behavioral Review Committee review the use of a seclusion room in a behavior support plan. The behavior support plan must include a procedure for ensuring:

(i) the person's health and safety;

(ii) that staff must maintain constant visual and auditory observation of the person;

(iii) observation and documentation of the person's status at a minimum of 15-minute intervals; and

(iv) that staff shall open the door if the person falls asleep before release from the seclusion room.

(b) The State Behavior Review Committee may recommend that a provider be allowed to shut a door or hold a door shut during use of the seclusion room included in a behavior support plan.

(i) The recommendation must be based upon adequate justification and documentation.

(ii) The intervention must help the person be more safely served within the division support system.

(c) The State Behavioral Review Committee sends the behavior support plan and committee recommendation to the Division Human Rights Council for review.

(d) The division director may approve use of a seclusion room on a case-by-case basis after reviewing the recommendation of the State Behavioral Review Committee and Division Human Rights Council.

Notes

Utah Admin. Code R539-4-6

Amended by Utah State Bulletin Number 2022-11, effective 5/23/2022