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.
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 PA-BSM 1.01, agencies 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 agency does not use restrictive behavior management interventions.
Qualified personnel authorize each restrictive behavior management intervention in accordance with any applicable federal or state requirements.
Interpretation: The agency should develop protocols for foster parents that use manual restraint to address compliance with federal or state requirements.
Service recipients are monitored continuously, face-to-face, and assessed at least every 15 minutes for any harmful health or psychological reactions.
Procedures address safe methods for escorting individuals to seclusion rooms and placing them in seclusion.
NA The agency does not escort individuals or use locked seclusion.
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 agency does not use isolation or locked seclusion.
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.
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:
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, agencies serving youth involved in the juvenile justice system, may also 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 agencies 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 agencies 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.
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 agency does not use seclusion, manual restraint, or mechanical restraint.