Crisis Prevention, Response, and Restraint

(1) Crisis Prevention, Response, and Restraint (CPRR). (a) Restrictive Procedures: Restraint. 1. Requirements For Use. The use of restraints must conform to the requirements set forth in 115 CMR 5.11. a. Use Permitted Only in Emergency. Restraint of an individual with intellectual or developmental disability may be used only in cases of emergency as defined in 115 CMR 5.02. b. Acceptable Restraint Techniques. Restraint techniques are limited to those contained in the Department approved CPRR curricula and administered by persons trained in the specific restraint(s) that is utilized. c. Restraint Debriefing. Debriefings are required following a restraint for: i. Persons administering a restraint shall debrief with a staff person identified by the PBS Leadership Team. The debriefing shall include: (i) review of the technique utilized; (ii) antecedents to the restraint; (iii) duration of the restraint; and (iv) alternative de-escalation strategies that may be employed in the future. ii. Individuals who are subject to a restraint shall participate in a separate debriefing with trained staff persons who did not participate in administering the restraint in order to support the individual and to mitigate distress that may result after experiencing a restraint. In the event the debriefing is clinically contraindicated, the PBS qualified clinician shall document the reason why the debriefing cannot take place in the restraint form. iii. Restraint debriefings described in 115 CMR 5.11(1)(a)1.c.i. shall be completed within threee business days after the time the restraint occurred. The restraint debriefing described in 115 CMR 5.11(1)(a)1.c.ii shall be completed within 24 hours after the time the restraint occurred. 2. Least Restrictive Alternative. In an emergency, restraint may be used only after the failure of less restrictive alternatives or there is not sufficient time to de-escalate the individual and maintain a safe environment. 3. Duration of Restraint. Restraint may be used only for the period of time necessary for the individual to regain control, but in no event may the duration of a restraint exceed 60 minutes. (b) Staff Training. 1. Restraint Curriculum. Providers utilizing CPRR shall ensure all direct care staff providing supports to an individual who has a Behavior Safety Plan are trained in the Department approved CPRR curriculum adopted for use by the Provider's PBS Leadership Team described at 115 CMR 5.14(5). 2. Monitoring and Examination of Individuals in Restraint. a. Staff persons shall observe and monitor an individual in a restraint in accordance with the CPRR curriculum adopted by the provider's PBS Leadership Team. The staff person(s) observing an individual in a restraint shall be situated so the staff person is able to communicate with and see the individual at all times. b. In the event an individual in restraint is observed to be in distress or injured, the restraint shall be terminated and staff persons shall seek medical attention for the individual. c. One staff person may be in attendance for more than one individual at the same time provided that the monitoring, examination, release, and documentation requirements of the CPRR curriculum are met for each individual who is in a restraint. (c) Frequent Restraints. An individual subject to a restraint more than one time within a week or more than two times within a month shall be referred to a PBS Qualified Clinician for the development of a Behavior Safety Plan and an Intensive PBSP. 1. A Behavior Safety Plan is only available with an Intensive PBSP: 115 CMR 5.14(5)(c) and (8). 2. The Behavior Safety Plan should specify: a. observable criteria for severe, unsafe behavior (circumstances under which restraints may be used to ensure safety); b. termination criteria; c. maximum duration; d. the type of restraint as contained in the Department approved CPRR curriculum used by the organization; e. data collection; and f. additional safeguards. 3. The PBS Qualified Clinician shall notify the PBS Leadership Team of the development of a Behavior Safety Plan and Intensive PBSP. (d) Documentation Requirements. 1. Restraint Form. Each provider shall ensure a restraint form is completed on each occasion when an individual is placed in a restraint. Restraint forms shall be completed on the Department's electronic incident tracking database, Home and Community Services Information System (HCSIS), if available. a. The restraint form must be in a form approved by the Commissioner; b. The restraint form shall be retained in the Department electronic tracking database (HCSIS); c. Restraint forms shall be reviewed by the: i. head of provider or designee; ii. Commissioner's designee; iii. the area office director or designee; and iv. the provider's human rights committee. d. All fields contained in the restraint form must be completed. e. Individual's Comments. Individual participation in a restraint debriefing, including the individual's comments, shall be documented by the provider in the restraint form. (e) Commissioner's Review. The commissioner or designee shall review restraint forms in accordance with M.G.L. c. 123B, § 8. All restraints will be reviewed by a provider's human rights committee in accordance with 115 CMR 3.09: Protection of Human Rights/Human Rights Committees. (2) Statistical Records. Statistical records of restraints shall be made available to the general public in accordance with M.G.L. c. 123B, § 8.