Summary: 

Filed: 01-27-2023 

Effective Date: 02-01-23 

Below is a summary of the restraint and seclusion requirements set forth by the Oregon Health Authority for facilities serving children and adolescents. Also included is information on how Safety-Care can be used as a training tool to ensure the safety of all involved parties.

How Safety-Care aligns: Numerous health care 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 these requirements in the following ways: 

Restraint and seclusion are only be used in emergency safety situations where there is an imminent risk of harm to the individual or others, such as violence, personal injury, or attempted suicide. Any use of an intervention (restraint or seclusion) must respect the dignity and civil rights of the individual and are not to be utilized as a form of punishment, discipline, or for the convenience of staff. 

• Duration and Limitations: The use of restraint or seclusion should be limited to the time necessary for the individual to regain self-control and prevent harm, with specific time limits based on age:
  • Ages 18 to 21: not to exceed four hours
  • Ages 9 to 17: not to exceed two hours
  • Age 9: not to exceed one hour 
  
  Orders for restraint or seclusion cannot be pre-written or used as needed and cannot be applied simultaneously. 
  
  
• Notification and Documentation: Providers must notify the individual's parent or guardian within 24 hours of any incident involving restraint or seclusion, providing both verbal and written notification. Detailed documentation of the intervention is required, including details of the restraint or seclusion used, the date, times when the intervention began and ended, location, the circumstances leading to its use, efforts made to de-escalate the situation, name of staff involved, and the outcome. If the individual sustains a reportable injury during the intervention, notification must include any available photographs, audio, or video recordings of the incident.
  • If the number of incidents requiring restraint or seclusion exceeds five interventions in five days or more than one incident in a 24 hour period, the psychiatrist or designee shall conduct a meeting with program staff, either in person or electronically, to discuss precipitating factors, alternative strategies for prevention, possible procedures, outcomes, and possible changes to the individual’s service plan.
  
  How Safety-Care aligns: Part of Safety-Care training is reporting of physical incidents. This information can be collected and reported in our “Trainer Connect” system, which all persons certified in Safety-Care have access. Information gathered in Trainer Connect can be used to supplement investigations. Additionally, Safety-Care is frequently updated with the latest practices in PBIS, ABA, and with input from practitioners to ensure that those trained in the program are as up to date as possible in improving behavior and safety. 
  

Physical Restraint 

• Authorization and Documentation:
  • A documented order by a physician, licensed practitioner, or licensed CESIS is required for each personal restraint, including details such as the authorized individual's name, date and time of the order, and duration of the intervention.
    

• Training and Staffing:
  • Personal restraints must be conducted by program staff trained in Division-approved crisis intervention techniques.
  • At least one staff member trained in emergency safety interventions must be physically present throughout the restraint, continuously monitoring the individual's well-being. If a non approved technique is used, a review process begins requiring an administrator report on the incident to the Division within 24 hours
    

How Safety-Care aligns: Safety-Care can be taught to all levels of staff, 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 organization 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. 

• Assessment and Review:
  • Within one hour of initiating a personal restraint, a face-to-face assessment by a psychiatrist, licensed practitioner, or CESIS must be conducted to evaluate the individual's physical and psychological condition.
  • A designated program staff with clinical leadership responsibilities must review all documentation of personal restraint before the end of the shift. 
    
  • Each incident of personal restraint must be thoroughly documented in the service record, detailing factors like attempted less restrictive interventions, authorization, events leading to the restraint, duration, assessment of appropriateness and physical injury, and the individual's response to the intervention.
  • Additional requirements are set for PRTF, Sub-Acute, SCIP and SAIP programs.
    

• Discussion and Debriefing:
  • Within 24 hours of a restraint, staff involved, along with supervisory and administrative staff, must conduct a face-to-face discussion with the individual and their parent(s) or legal guardian(s), if appropriate, to review the circumstances, prevention strategies, and outcome.
  • A debriefing session must also occur within 24 hours, covering the emergency situation, alternative techniques, preventive procedures, and intervention outcomes. Documentation of both discussions must be included in the resident's record, noting attendees and any resulting changes to the treatment plan. 

• Adequate size to accommodate three adults and allow for one adult to lie down, with a minimum size of 64 square feet for newly constructed rooms.
• Equipped with locking devices on all doors and windows, with outward-opening doors containing a port for viewing from outside.
• Free of protruding, sharp objects and furniture, with a fireproof mattress or mat provided for comfort. 
  
• Windows made of unbreakable or shatterproof material, protected by climb-proof screening if necessary.
• No exposed pipes or wiring, with electrical outlets securely covered and lights recessed and covered with safety glass or plastic.
• Compliance with State Fire Marshal fire, safety, and health standards, including proper ventilation and temperature control.
• Design preventing children from climbing off the floor, with walls, floor, and ceiling constructed for easy cleaning and no rough or jagged portions.
• Availability of adequate and safe bathrooms.