63N-1.00952. Secure Observation

(1) When less restrictive means of control are not effective, facilities and programs are authorized to utilize a Secure Observation Room for observation of an At Risk or Potential Suicide Risk youth who manifests behavior which constitutes a strong potential threat to the youth’s safety or to the safety of others For example, the At Risk youth appears extremely restless, agitated, fearful, or his/her behavior appears unpredictable, volatile or highly impulsive.

(a) A Secure Observation Room shall be used for observation of At Risk youths only when other less restrictive means of control are not effective or appropriate.

(b) The Secure Observation Room shall not be used for youth who present an Imminent Threat of Suicide. Such youth shall be transported for emergency mental health services as set forth in Rule 63N-1.011, F.A.C.

(2) If a Potential Suicide Risk youth requires placement in an individual cell, whether locked or unlocked, due to potentially self-injurious behavior or behavior which threatens the safety of others, Secure Observation shall be implemented.

(3) When a youth on Precautionary Observation requires placement in behavioral confinement or controlled observation, the youth must be placed in a Secure Observation Room. When a youth already on Secure Observation requires placement in behavioral confinement due to misbehavior, the youth must remain in the Secure Observation Room during behavioral confinement.

(4) Procedures for Placement in a Secure Observation Room.

(a) The superintendent, program director or designee shall confer with the Designated Mental Health Clinician Authority or other Licensed Mental Health Professional as to whether Secure Observation is appropriate for a specific youth. The superintendent, program director or designee’s consultation with the Licensed Mental Health Professional shall be documented on the Mental Health/Substance Abuse Referral Summary (MHSA 014) or a form developed by the program which contains all the information required in form MHSA 014.

(b) When the decision has been made to place a youth in a Secure Observation Room, the following shall occur:

1. The Secure Observation Room shall be inspected immediately prior to the youth’s placement to ensure that it is safe and secure.

2. A staff member of the same sex will conduct a visual check of the youth to determine if there are any observable injuries that would make placement in the Secure Observation Room inappropriate.

a. The Health Status Checklist (MHSA 008, August 2006) which is incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-03791 shall be completed to document the youth’s physical condition. The form MHSA 008 may be obtained by contacting: DJJ, Office of Health Services, 2737 Centerview Drive, Tallahassee, FL 32399.

b. If a physical injury is observed, the youth complains of injury or illness, or the youth has been observed to have experienced a fall, impact or blow to such an extent that injury would be expected, medical personnel shall be immediately notified for an assessment and treatment prior to placement in a Secure Observation Room.

3. The youth must be searched by a staff member of the same sex.

a. At the time of the search, all jewelry, pocket items, hair ties, and hair pins must be removed.

b. All clothing items which could be used for self-injury such as shoes, shoelaces, socks, and belt must be removed. However, the youth shall not be stripped.

c. The youth shall not to be required to dress in any garment or put on any covering that is sexually revealing.

(5) A youth shall not remain in a Secure Observation Room for more than eight hours unless a Licensed Mental Health Professional has been consulted and agrees to a limited time extension. A Licensed Mental Health Professional must provide written concurrence for a youth to remain in a Secure Observation Room beyond 24 hours for any reason, including behavioral confinement.

(6) Each youth placed in a Secure Observation Room due to At Risk or Suicide Risk Behaviors shall be immediately referred for an Assessment of Suicide Risk. The youth in Secure Observation must receive an Assessment of Suicide Risk or Follow-Up Assessment of Suicide Risk within 8 hours of the youth’s placement in the Secure Observation Room for any reason, or if the youth is placed in the Secure Observation Room during the evening or night shift, the Follow-Up Assessment of Suicide Risk shall be conducted during the following morning shift.

(7) Structural Specifications of a Secure Observation Room. The structure of a Secure Observation Room shall meet the following specifications:

(a) Size: A minimum of 35 square feet of unencumbered space. Unencumbered space is usable space that is not encumbered by any furnishing or fixture. At least one dimension of the unencumbered space is no less than 7 feet.

(b) Doors: Solid core hardwood or metal that has a shatter-resistant observation window or metal frame with wire mesh (holes no larger than 3/16 inch). The door observation window must permit constant visual and sound monitoring of the youth. A door with bars or expanded metal door is acceptable if small wire mesh or lexan shields the bars from the inside.

(c) Floors/Walls: Solid, smooth and high impact resistant without protrusions.

(d) Ceilings: Solid, single piece ceiling which is out of the youth’s reach and has no appendages that can be grasped or tied onto with cloth or other materials.

(e) Vents: Must be covered with small mesh or a metal plate (holes no larger than 3/16 inch). Vents must be unreachable to the youth. Edges of wire mesh or metal covering must not be exposed. Vents should not be immediately accessible from the toilet, sink or bed.

(f) Lighting: Light fixtures should be recessed and covered with shatter-resistant material such as lexan.

(g) Windows: Must be made of shatter-resistant material or glass windows that are not shatter resistant must be covered with security-rated screens or other materials that prevent access to the glass.

(h) Toilet/Sink: Fixtures must be smooth and devoid of handles or parts that cloth or other material could be tied to or hung from. Must be mounted against the wall with water shut off valve outside of room.

(i) Electrical Switches/Outlets: Electrical outlets are not permitted and switches must be located outside the room.

(j) Beds: Must provide a security-rated plastic mattress suitable for floor use or suicide resistant bed. The bed must be anchored to the floor or secured to the wall, be of one piece construction (no springs) must be no higher than 18 inches from the floor and have a plastic fire retardant mattress.

(8) Mental Health Supportive Services shall be provided to the youth being maintained on Secure Observation, based upon the individualized needs of the youth as determined by Mental Health Clinical Staff.

(9) Youths placed in a Secure Observation Room shall be maintained on One-to-One Supervision while in the Secure Observation Room.

(a) The staff person assigned to observe the youth in Secure Observation must record observations of the youth’s behavior in the Secure Observation Room on the Suicide Precautions Observation Log (MHSA 006). The Suicide Precautions Observation Log (MHSA 006) is reviewed and signed by the shift supervisor each shift and by a Mental Health Clinical Staff Person daily.

(b) The shift supervisor shall be responsible for ensuring that a listing of youths currently placed on Secure Observation is passed on to the next shift, and that any concerns or observations regarding youths on Secure Observation have been documented and communicated to the next shift.

(c) When it is necessary to temporarily remove the youth from the Secure Observation Room for any reason, the youth shall be searched again before being placed back into the Secure Observation Room.

(10) Discontinuation/Termination of Secure Observation.

(a) The At Risk youth shall be maintained on Secure Observation until he or she has received an Assessment of Suicide Risk or Follow-Up Assessment of Suicide Risk by, or under the direct supervision of, a Licensed Mental Health Professional.

(b) The Assessment of Suicide Risk or Follow-Up Assessment of Suicide Risk findings and recommendations shall be reviewed by the superintendent/program director or designee. Based upon the Assessment of Suicide Risk findings, the Licensed Mental Health Professional and facility superintendent/program director or designee will determine whether Secure Observation is to be continued.

(c) When Assessment of Suicide Risk findings/recommendations indicate the need for continued Suicide Precautions, the following shall occur:

1. Documentation that the Licensed Mental Health Professional concurs with the Assessment of Suicide Risk findings/recommendations and that continued Suicide Precautions through either a limited time extension of placement in Secure Observation or placement of the youth on Precautionary Observation is required.

2. Unless there is a specific recommendation in the Assessment of Suicide Risk that the youth shall remain in Secure Observation, the youth shall be removed from the Secure Observation Room and Suicide Precautions continued by placing the youth on Precautionary Observation.

3. The youth shall remain on Secure Observation or Precautionary Observation until subsequent Follow-Up Assessment of Suicide risk conducted by, or under the direct supervision of a Licensed Mental Health Professional, indicates Suicide Precautions may be discontinued.

(d) The discontinuation of Secure Observation and initiation of Precautionary Observation shall be documented by the superintendent or program director or designee on the Suicide Precautions Observation Log (MHSA 006) and in the facility log, and must be documented in the youth’s Active Mental Health/Substance Abuse File by the Mental Health Clinical Staff.

(e) If an At Risk youth in Secure Observation due to behavioral confinement receives a Follow-Up Assessment of Suicide Risk which indicates that the youth is no longer a suicide risk, he/she may be removed from the Secure Observation Room and transitioned to a normal routine. However, if the youth cannot be transitioned to a normal routine because he/she must continue behavioral confinement, then the youth must remain in Secure Observation and on Suicide Precautions until behavioral confinement is concluded.

1. A Licensed Mental Health Professional shall provide written concurrence for a youth to remain in a Secure Observation Room beyond 24 hours for any reason, including behavioral confinement.

2. If the youth is in Secure Observation due to behavioral confinement and the Licensed Mental Health Professional does not concur with a youth’s continued placement in Secure Observation due to his/her deteriorating mental health status, the Licensed Mental Health Professional shall immediately notify the facility superintendent or designee of his/her recommendation that Secure Observation and behavioral confinement be discontinued, and the youth must either be placed on Precautionary Observation with One-to-One Supervision or transported for emergency mental health services.

(f) When deemed appropriate by the Licensed Mental Health Professional and superintendent/program director or designee, the youth shall be removed from Suicide Precautions (Secure Observation and/or Precautionary Observation).

1. Documentation of the Assessment of Suicide Risk or Follow-Up Assessment of Suicide Risk findings which indicate Suicide Precautions may be discontinued shall be reviewed by a Licensed Mental Health Professional prior to the youth’s removal from Suicide Precautions.

2. Documentation that the Licensed Mental Health Professional concurs with the removal of Suicide Precautions (Secure Observation or Precautionary Observation) and the superintendent/program director or designee’s written authorization is required for removal of a youth from Suicide Precautions.

(g) Discontinuation of Secure Observation and step-down to Close Supervision must be documented on the Assessment of Suicide Risk Form (MHSA 004) or Follow-Up Assessment of Suicide Risk Form (MHSA 005).

(11) The youth being removed from Secure Observation shall be placed on Close Supervision during transition back into the facility/program’s normal routine, until deemed stable by the Designated Mental Health Clinician Authority or a Licensed Mental Health Professional. The procedures set forth in Rule 63N-1.00953, F.A.C., shall be followed.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.601(3)(a), 985.14(3)(a), 985.145(1), 985.18, 985.48(4), 985.64(2) FS. History–New 3-16-14.