Summary: 

Last Updated: December, 2024

Chapter 68G-8 sets the rules and requirements regarding restraint for all organizations regulated by the Florida Agency for Persons with Disabilities (APD). 65G-8 provides a comprehensive framework for the use of reactive strategies in facilities and programs serving individuals with developmental disabilities. It emphasizes safety, training, accountability, and compliance with state regulations. Below is a more detailed breakdown:

All facilities or providers subject to this rule must create policies and procedures aligned with the provisions of 68G-8 including the adoption of an Agency-approved emergency procedure curriculum, staff training on reactive strategies, proper record-keeping and reporting of any reactive strategy used, and data collection related to reactive strategy use and storing reactive strategy consent information.

Policies and procedures can only include reactive strategies from the Agency-approved curriculum. Any change to this curriculum or variation of a specific reactive strategy requires an Agency-approved variance or waiver in advance (such variance or waivers can be found with APD). Facilities must implement procedures to ensure the safety of both staff and clients when using reactive strategies including the provision of clients’ existing medical conditions that may be worsened by reactive strategies.

All staff implementing reactive strategies must be certified in advance on the specific techniques used by the facility or provider. Any variation of a specific reactive strategy may only be used for a specific client if it has been documented, evaluated, and approved in advance by the Local Review Committee and the Senior Behavior Analyst.

Facilities must conduct an annual internal review of emergency procedures, which should include a written evaluation addressing the methods to reduce the use of reactive strategies, evaluations of policy to ensure compliance with the Agency-approved curriculum and safe practices, and compliance with maintaining appropriate records and reports on the use of reactive strategies. This review must be kept for at least five years and be made available to APD upon request.

Upon admission and at least annually, facilities must gather and document relevant information on the use of reactive strategies for each individual. This information can be sourced from the individual, family members, medical professionals, and others familiar with the client and should include the individual physician reports on medical conditions or physical limitations and documentation of trauma history. Common medical conditions that may pose risks such as obesity, cardiac conditions, asthma, seizures, spinal problems, and others should also be considered. This information must be updated whenever the individual's condition changes or as required by law.

When utilizing a reactive strategy, staff must notify the highest-level direct care supervisor. Continuous staff supervision is required for every reactive strategy employed. Clear rationale for the use of a reactive strategy must be documented and cannot be used as part of a deceleration plan for undesirable behaviors, as punishment, or for staff convenience. Reactive strategies must be the least restrictive necessary to achieve the intended outcome, be terminated immediately once the emergency is over, and allow for comfort and protection of the individual during use. Reactive strategies should be terminated within five minutes after the predetermined behavioral criteria have been met, with reauthorization required for continued use beyond one hour. APD can disapprove any unsafe reactive strategy. If reactive strategies are used frequently, defined as more than twice in 30 days or six times in 12 months, the facility must request behavior analysis services for the individual. APD is authorized to disapprove any unsafe reactive strategy.

Seclusion and restraint as a reactive strategy should be avoided whenever possible. Staff should try to redirect or diffuse problematic behavior before resorting to seclusion or restraint. Certified staff must be available in sufficient numbers to implement seclusion and restraint safely. Clients are to be continuously observed, with a focus on respiration, and restraint exceeding one hour must be approved. Restraint exceeding two house must be authorized by an agent. Environmental standards are to be maintained to ensure client safety.

Chemical restraint is to be used for behavioral control and not as standard treatment for medical or psychiatric conditions. Written orders from a physician are required and a medical professional must evaluate the client in person within one hour. Continuous monitoring of individuals under chemical restraint is required every half-hour.

The following practices are strictly prohibited:

• Use of painful stimuli or untested procedures.
• Techniques that restrict breathing or involve pressure on the head, neck, or back.
• Restraint of hands behind the back.
• Techniques that induce pain or cause physical hyperextension or twisting.
• Movement without physical support for containment purposes.
• Use of any strategy that worsens known medical conditions.
• Use of strategies on a “PRN” (as required) basis.

After using a reactive strategy, staff must document the behavior that led to its use, the reactive strategy employed, the time it was initiated and terminated, and the persons involved in the strategy's initiation, authorization, and termination. Documentation must be signed and reviewed within 24 hours. A Reactive Strategy Report must be submitted within 30 days to the Local Review Committee chairperson, and copies included in the individual’s record. Monthly reports of reactive strategy use must be submitted electronically to the Central Office Senior Behavior Analyst.

How Safety-Care aligns: Numerous organizations throughout the United States and Canada rely upon QBS and our Safety-Care training to provide their staff members with the training they need to help maintain a safe and healthy environment. Safety-Care provides a comprehensive, supportive approach to incident prevention, de-escalation, and management. Your Staff will learn practical strategies for helping students that use evidence-based practices consistent with PBIS (Positive Behavior Interventions and Supports) and ABA (Applied Behavior Analysis).

Safety-Care can meet the requirements of Departmental Requirements in the following ways:

Safety-Care is uniquely designed to provide trainees with the skills to assess potential crises, how de-escalate these situations, and how to respond if the situation is elevated. Our trainings are trauma-informed and focus on modifying behavior to prevent dangerous outcomes. Safety-Care can be taught to all levels of personnel, from administration down to volunteers. Additionally, our core trainings can be supplemented with unique add-on trainings focused on specific needs and professions. Safety-Care uses a Train the Trainer model allowing each district to quickly develop their own core of trainers qualified in the most current behavioral interventions and de-escalation strategies. Our Master Trainers can have up to ten (10) staff ready to train in as little as three days. Safety-Care is geared towards ensuring that all trainees are familiar with a single response system and can respond in-kind to numerous situations regardless of the professional setting.