	Behavior Support and Management

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

BSM 5: Restrictive Behavior Management Interventions*

Restrictive behavior management interventions are used in a manner that protects the safety and well-being of service recipients and personnel in emergency or crisis situations when less-restrictive measures have proven ineffective.

Interpretation: This standard prohibits the use of isolation, locked seclusion, and manual or mechanical restraint for the purposes of routine discipline, compliance, or convenience.

Note: COA accreditation standards prohibit the use of isolation, locked seclusion, and mechanical restraint by foster parents. Only those standards that address manual restraint apply to foster parents.

The use of mechanical restraints is prohibited for public or private non-medical, community-based facilities that serve children and youth according to the Public Health Service Act, as amended by the Children's Health Act of 2000. As referenced in BSM 1.01, organizations serving youth involved with the juvenile justice system may be subject to different laws and regulations, and should familiarize themselves with any laws and regulations addressing the behavior management interventions they are permitted to employ.

NA The organization does not use restrictive behavior management interventions.

BSM 5.01

Qualified personnel authorize each restrictive behavior management intervention, in accordance with any applicable federal or state requirements.

Interpretation: The organization should develop protocols for foster parents that use manual restraint to address compliance with federal or state requirements.

BSM 5.02

Service recipients are monitored continuously, face-to-face, and assessed at least every 15 minutes for any harmful health or psychological reactions.

BSM 5.03

Procedures address safe methods for escorting individuals to seclusion rooms and placing them in seclusion.

NA The organization does not escort individuals or use locked seclusion.

BSM 5.04

Isolation and seclusion rooms conform to existing licensing and/or fire safety requirements and are limited to one person at a time.

Note: Unlike seclusion rooms, isolation rooms do not have a lock or locking device.

Note: Please see Checklist: Facility Observation in the Tools Index for additional assistance with this standard.

NA The organization does not use isolation or locked seclusion.

BSM 5.05

During a restrictive behavior management intervention staff assess the service recipient’s need for food, water, and use of bathroom facilities and provide access when safe and appropriate.

BSM 5.06

Restrictive behavior management interventions are used only in emergency or crisis situations, when less-restrictive measures have proven ineffective, are discontinued as soon as possible, and are limited to the following maximum time periods per episode:

15 minutes for children aged nine and younger, for all restrictive behavior management interventions;
30 minutes for individuals aged ten and older, undergoing manual or mechanical restraint;
30 minutes for individuals aged ten to thirteen in isolation or locked seclusion; and
one hour for individuals aged fourteen and older in isolation or locked seclusion.

Interpretation: Restrictive behavior management interventions are discontinued immediately if they produce adverse side effects such as illness, severe emotional or physical stress, or physical injury. Timeframes may be extended on a case-by-case basis, but qualified personnel with the authority to make such decisions must approve all extensions, as referenced in BSM 5.07.

Interpretation: As referenced in BSM 1.02, organizations serving youth involved with the juvenile justice system may be authorized to use restrictive interventions to prevent escapes or protect property, but should only do so when absolutely necessary, as referenced throughout these standards.

Further, although organizations serving youth involved with the juvenile justice system may be authorized to use time limits that exceed those listed in the standard, COA expects these organizations to meet the timeframes outlined in the standard whenever possible. When it is necessary to extend timeframes in order to maintain safety, security, and order (for example, when youth must be transported in mechanical restraints in order to prevent escape, and travel time is greater than 30 minutes), qualified personnel must approve the extension, and the intervention should be discontinued as soon as possible.

BSM 5.07

Reauthorization by a physician or another qualified clinician is required for each instance of locked seclusion, manual restraint, or mechanical restraint that exceeds the maximum time limit.

NA The organization does not use locked seclusion, manual restraint, or mechanical restraint.

QUICK JUMP TO


	PURPOSE: The organization’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.

RELATED FILES


	BEHAVIOR SUPPORT AND MANAGEMENT The use of specialized interventions to guide, control, and redirect client behaviors. Examples of behavior management approaches used in residential treatment settings include mediation, time out, locked seclusion, and physical restraint.


	PRACTICE Established actions or ways of proceeding in the regular performance of organizational duties. Policies and procedures often guide practice.


	SERVICE RECIPIENT The individuals, groups, organizations, or communities that use, receive, or benefit from programs and services. Service recipients can include consumers, patients, family members, legal guardians, advocates, public/private organizations, employers, and purchasers. All are regarded as significant stakeholders served in a variety of agencies and practice settings.


	RESTRICTIVE BEHAVIOR MANAGEMENT Interventions that restrict, limit, or curtail a person's freedom of movement to prevent harm to self or others. These interventions include isolation, manual or mechanical restraint, and locked isolation.


	PERSONNEL The body of employees and/or volunteers that carries out the organization's tasks under the organization's administration and/or supervision. This definition does not include foster parents who are specifically referenced in relevant standards


	ISOLATION The practice of separating a person from others and placing him/her in a monitored, non-locked or "quiet" room in order to calm the person. A person in isolation is physically prevented from leaving the designated space or room where s/he is placed. For purposes of COA accreditation, isolation is distinguished from TIME-OUT.


	LOCKED SECLUSION The practice of placing a person in a locked room to prevent harm to self and others.


	MECHANICAL RESTRAINT The use of any physical device to limit movement and prevent harm to self or others, not including devises such as prescribed orthopedic devices, surgical dressings or bandages, protective helmets, or any other methods that involve physical holding of an individual for the purpose of conducting routine physical examinations, conducting tests, protecting the child from falling out of bed, or to permit the child to participate in activities without the risk of physical harm.


	ACCREDITATION The formal evaluation of an organization against accepted criteria or standards. A professional society, non-governmental organization, or a governmental agency may conduct accreditation activities. A COA-accredited organization has undergone a period of rigorous self-study and is capable of providing programs and services that meet or exceed COA standards.


	FOSTER PARENTS State- or county-licensed adults who provide a temporary home for children whose birth parents are unable to care for them. Foster parents are not considered employees or personnel and are specifically referenced in all relevant standards.


	PARENTS Parents can include: birth, foster, kinship, and adoptive parents. Please see service standards for more specific information about use of this term.


	COMMUNITY A specific group of people living in the same locality and who may share a common culture, values, and norms. Communities can also be defined by race, religion, ethnicity, age, occupation, political status, tribal affiliation, interest in particular problems or outcomes, or other common bonds. The term "community" encompasses worksites, schools, tribes, residential neighborhoods, business districts, recreational areas, and health and human service sites.


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	MANAGEMENT See ADMINISTRATION


	MANUAL RESTRAINT The practice of physically holding a person's arms, legs, or head to prevent harm to self and others.


	PROTOCOLS Instruments and procedures used to accomplish a particular goal, activity, or purpose.


	CASE A general term used to designate clients (including individuals, families, and groups) served by an organization for purposes of monitoring the provision of services. A foster care case is generally based on the placement of an individual child, although casework for the child may include services to the child's family. A child protective services case is based on an entire family household if a family assessment model is used; otherwise a case is defined as a child.