Definitions, Approved Emergency Procedure Curriculum, Reactive Strategy Policy and Procedures, Initial Assessments, Authorizations for Specific Reactive Strategies, Authorizations for Specific Reactive Strategies, Seclusion and Restraint, Chemical ...
DEPARTMENT OF CHILDREN AND FAMILY SERVICES
Agency for Persons with DisabilitiesRULE NO: RULE TITLE
65G-8.001: Definitions
65G-8.002: Approved Emergency Procedure Curriculum
65G-8.003: Reactive Strategy Policy and Procedures
65G-8.004: Initial Assessments
65G-8.005: Authorizations for Specific Reactive Strategies
65G-8.006: Authorizations for Specific Reactive Strategies
65G-8.007: Seclusion and Restraint
65G-8.008: Chemical Restraint
65G-8.009: Prohibited Procedures
65G-8.010: Documentation and Notification
65G-8.011: Access to Rules
65G-8.012: EnforcementNOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with Section 120.54(3)(d)1., F.S., published in Vol. 34, No. 8, February 22, 2008 issue of the Florida Administrative Weekly.
65G-8.001 Definitions.
[alphabetized and renumbered].
(1) “Approved emergency procedure curriculum” means a course of instruction in procedures and techniques for intervening in behavioral emergency situations, approved by the Agency for Persons with Disabilities (“Agency”), and incorporated into a facility’s or program’s policy for utilizing reactive strategies.
(2)(3) “Authorized staff person” means an employee of a facility or program that has completed training in the approved emergency procedure curriculum and is approved by the authorizing agent to use restraint and seclusion procedures.
(3)(2) “Authorizing agent” means an individual authorized by the facility or program manager to approve use of a reactive strategy.
(4)(5) “Behavioral protective device” means a device used as a means of interfering with or preventing specific results of a targeted behavior as part of a behavior program approved by the Local Review Committee.
(5)(11) “Chemical restraint” means the use of medication to effect immediate control of an individual’s behavior. It does not include the medication administered as treatment for a medical or psychiatric condition.
(6)(15) “Client” means any person with a developmental disability receiving services in the State of Florida.
(7)(17) “Containment” means immobilizing an individual with any technique for the purpose of behavioral control.
(8)(6) “Facility” means a residential operation serving Agency clients funded or licensed under Chapter 393, F.S., and includes separate and secure facilities serving forensics clients pursuant to Chapter 916, Part III, F.S.
(9)(7) “Implementation plan” means an individualized plan utilizing services to assist a client with developmental disabilities in acquiring skills that enable the client to improve his or her physical, mental, and social functioning.
(10)(16) “Licensed medical professional” means a physician licensed under Chapter 458 or 459, F.S.; or registered nurse, licensed practical nurse, or Advanced Registered Nurse Practitioner licensed under Chapter 464, F.S.
(11)(4) “Local Review Committee” means the committee required by subsection 65G-4.008(3), F.A.C., to oversee and review all behavior analysis services provided to clients to ensure that the services are designed and approved in accordance with Florida Statutes and agency rules.
(12) “Manual restraint” means the use of hands or body to immobilize a person’s freedom of movement or normal access to his or her body for more than fifteen continuous seconds. It does not include physically guiding or transporting a client during transport or skill training for up to two minutes. Repeated applications and releases of manual restraint in order to circumvent the fifteen-second and two-minute criteria are prohibited.
(13)(10) “Mechanical restraint” means a physical device used to restrict an individual’s movement or restrict the normal function of the individual’s body. The definition does not include the following:
(a) through (b) No change.
(c) Devices used Restraints necessary to support functional body position or proper balance, or to prevent a person from falling out of bed, falling out of a wheelchair; or
(d) Equipment Restraints used for safety during transportation, such as seatbelts or wheelchair tie-downs.
(14)(8) “Medical protective equipment” means health-related protective devices prescribed by a physician or dentist for use during specific medical or surgical procedures, or for use as client protection in response to an existing medical condition.
(15)(9) “Reactive strategies” means the procedures or physical crisis management techniques of seclusion or manual, mechanical, or chemical restraint utilized for control of behaviors that create an emergency or crisis situation.
(16)(13) “Seclusion” means enforced isolation or confinement of an individual in a room or area. It does not mean “time out” or “time out from positive reinforcement” procedures as defined by this rule, or isolation resulting from medical conditions or symptoms of illness.
(17)(14) “Time out” or “time out from positive reinforcement” means a procedure designed to interrupt a specific behavior of an individual by temporarily removing that individual to a separate area or room, or by screening him or her from others, or by signaling that the individual is in “time out.” “Time out” is not a reactive strategy regulated by these rules. “Time out” procedures differ from the reactive strategy of seclusion through the following characteristics:
(a) through (c) No change.
(d) The program is implemented either by a Certified Behavior Analyst certified by the Behavior Analyst Certification Board®, Inc.; a behavior analyst certified by the Agency pursuant to Section 393.17, F.S. and Rule 65G-4.003, F.A.C.; a psychologist licensed under Chapter 490, F.S.; or a clinical social worker, mental health counselor, or therapist licensed under Chapter 491, F.S.; or a behavior analyst certified by the Behavior Analyst Certification Board; or a behavior analyst certified under Chapter 65G-4, F.A.C.;
(e) through (h) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.002 Approved Emergency Procedure Curriculum.
(1) All providers and facilities, and programs that use reactive strategies must utilize an emergency procedure training curriculum approved by the Agency, and require all staff utilizing reactive strategies to be trained in that curriculum.
(2) The training curriculum must meet the following minimum requirements for approval:
(a) through (e) No change.
(f) It requires at least twelve sixteen direct training hours;
(g) through (l) No change.
(m) The curriculum includes instruction in reactive strategy precautions and potential hazards; It incorporates transportation procedures that require the cooperation of the person being transported;
(n) No change.
(3) through (5) No change.
(6) The Agency’s Senior Behavior Analyst will refer the proposed curriculum to a multidisciplinary committee or a Peer Review Committee as defined in Rule 65G-4.008, F.A.C., for additional review and comment.
(7) The Senior Behavior Analyst’s rReview of a proposed emergency procedure curriculum must include:
(a) through (b) No change.
(c) Review of available data related to implementation of the curriculum; and
(d) No change.
(8) through (10) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.003 Reactive Strategy Policy and Procedures.
(1) All facilities or providers programs subject to this rule shall develop and implement policies and procedures consistent with the provisions of this rule chapter, including adoption of an approved emergency procedure curriculum, appropriate staff training, record maintenance, reporting and recording the use of any reactive strategy, training in the provisions of this rule chapter, data collection, and maintenance of reactive strategy consent information in client patient records, and any other requirements established in this rule chapter.
(2) Facility or provider program policies and procedures may not include only the reactive strategies not provided in the Agency-approved curriculum or vary from the requirements of these rules. No change to the approved curriculum or variation of a specific reactive strategy may be employed without an Agency-approved variance or waiver obtained in advance through Section 120.542, F.S. A proposed variance to a reactive strategy must demonstrate that it is designed for a specific client and the variance request must include documented evidence of need and benefit. Variance requests will be evaluated by the Local Review Committee and the Agency’s Senior Behavior Analyst.
(3) Providers, and facilities and programs that employ reactive strategies are required to implement procedures to ensure the safety of staff and clients during the use of reactive strategies and to ensure that Agency clients are not placed at risk because of existing medical conditions.
(4) All staff implementing reactive strategies must be certified in advance for all reactive strategy techniques used or approved for use by the facility, program, or provider.
(5) A variation of a specific reactive strategy may be employed only if it is designed for a specific client with documented evidence of need and benefit, and only if evaluated and approved in advance of implementation by the Local Review Committee and the Agency’s Senior Behavior Analyst.
(5)(6) The provider program or facility must conduct an internal review of its emergency procedures at least annually with a written evaluation that addresses the following issues:
(a) through (c) No change.
The facility, program, or provider must maintain this written evaluation for a minimum of five years and make it available to the Agency upon request.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.004 Initial Assessments.
(1) Upon an individual’s admission to a facility or program and at least annually thereafter, the facility or program provider must obtain information and documents relevant to the use of reactive strategies from a variety of sources for the individual’s records. Appropriate sources include the individual, his or her family members, treating medical professionals, and other informants familiar with the individual. The individual’s records must include the following documentation:
(a) A physician’s report of medical release stating that the individual has no medical conditions or physical limitations that would place him or her at risk of physical injury during restraint or seclusion, as permitted by this rule chapter; or otherwise
(b) A physician’s report of any physical limitations that would preclude the use of one or more reactive strategies; and
(b)(c) Documentation of any history of trauma, such as a history of sexual or physical abuse, that the informants, individual, facility, or providers believe to be relevant to the use of reactive strategies; and
(2) through (3) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.005 Authorizations for Specific Reactive Strategies.
(1) through (2) No change.
(3) The following reactive strategies can be approved only by the following authorizing agents:
(a) No change.
(b) The authorizing agent for behavioral protective devices must be either a Certified Behavior Analyst certified by the Behavior Analyst Certification Board®, Inc.; a behavior analyst certified by the Agency pursuant to Section 393.17, F.S. and by Rule 65G-4.003, F.A.C.; a psychologist licensed under Chapter 490, F.S.; or a clinical social worker, marriage and family therapist, or mental health counselor licensed under Chapter 491, F.S.; or a Certified Behavior Analyst certified by the Behavior Analyst Certification Board; or a behavior analyst certified by the rule Chapter 65G-4, F.A.C.;
(c) The authorizing agent for mechanical restraint must be a Certified Behavior Analyst certified by the Behavior Analyst Certification Board®, Inc.; a behavior analyst certified by the Agency pursuant to Section 393.17, F.S. and by Rule 65G-4.003, F.A.C.; a physician licensed under Chapter 458 or 459, F.S.; a psychologist licensed under Chapter 490, F.S.; or a clinical social worker, marriage and family therapist, or mental health counselor licensed under Chapter 491, F.S.; or a Certified Behavior Analyst certified by the Behavior Analyst Certification Board; or a behavior analyst certified by the Rule Chapter 65G-4, F.A.C.;
(d) through (e) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.006 Limitations on Use and Duration of Reactive Strategies.
(1) through (9) No change.
(10) The facility or provider program must provide written behavioral criteria for termination of a reactive strategy, conforming to the Agency-approved emergency procedure curriculum, to all staff trained in those techniques.
(11) through (12) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.007 Seclusion and Restraint.
(1) No change.
(2) Seclusion and restraint as a reactive strategy may be utilized only if certified adequate staff persons are is available in sufficient number to ensure its for safe implementation.
(3) through (5) No change.
(6) Staff must obtain additional authorization for use of seclusion and restraint for a behavioral episode occurring more than fifteen minutes after termination of a prior restraint procedure, and document the additional use of restraint in the individual’s record.
(7) Before initiating a seclusion or restraint procedure, staff must inspect the environment and the individual to be restrained in order to ensure that any foreign objects that might present a hazard to the individual’s safety are removed.
(8) Any room in which the individual is held must be have sufficient lighting and ventilation to permit the individual to see and breathe normally, and must have enough space to permit him or her to lie down comfortably.
(9) The door to any room in which an individual is secluded without an attending staff person a caregiver must not be locked; however, the door can be held shut by a staff person caregiver using a spring bolt, magnetic hold, or other mechanism that permits the individual in seclusion to leave the room if the caregiver leaves the vicinity. Forensic facilities may seek a waiver or variance from this requirement through Section 120.542, F.S.
(10) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.008 Chemical Restraint.
(1) through (5) No change.
(6) A licensed medical professional must conduct a face-to-face evaluation of the individual within one hour of administration of a chemical restraint, if the restraint was ordered authorized by telephone. The medical professional must record the results of this evaluation in the individual’s records and document whether the administration of medication achieved the expected results.
(7) Staff must monitor an individual who has been chemically restrained at least once every half-hour and record the effects of the restraint in the individual’s records.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.009 Prohibited Procedures.
The following reactive strategies are prohibited:
(1) through (9) No change.
(10) Use of any containment immobilizing technique medically contraindicated for an individual prior to obtaining a medical release that rules out increased risk to the individual by use of this position;
(11) through (12) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.010 Documentation and Notification.
(1) Staff must document the following information in the individual’s records as soon as possible, but no later than the end of the work shift immediately following the use of a reactive strategy:
(a) through (d) No change.
(2) through (4) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.011 Access to Rules.
(1) The provider program or facility employing reactive strategies must maintain on-site a copy of Rule Chapter 65G-8, F.A.C., accessible by these rules and provide access to staff, clients, parents, guardians, and guardian advocates.
(2) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
65G-8.012 Enforcement.
(1) through (2) No change.
Specific Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New ________.
