10:42-1.4 General requirements
(a) The Division of Developmental Disabilities recognizes that acceptable behavior in children and adults with developmental disabilities is fostered and maintained by a stimulating environment, participation in activities that encourage development of new skills and support from the people with whom they come into contact. The Division is committed to providing a supportive environment to persons with developmental disabilities individuals it serves. However, the Division also recognizes that, even in a supportive environment, some individuals will exhibit aggressive, destructive or self-injurious behaviors. When such behaviors present a danger to the individual himself or herself or others, action must be taken to help the individual control himself or herself, or, if that is not possible, to control the individual. If the individual exhibits these problem behaviors on a regular basis, a professionally designed program (such as a medical intervention or behavior modification) shall be applied to change these behaviors. When the individual exhibits a dangerous behavior that has not been previously observed or reported, emergency measures must be available to assist them in protecting the individual or others. Among the emergency measures that are used in such situations are mechanical restraints. Some of the devices used as mechanical restraints may also be used to help an individual achieve functional body alignment or to protect the individual from harm. In some instances, only the intended use of the device will determine whether it is a mechanical restraint or a piece of safeguarding equipment.
(b) Devices such as bed rails, mitts, jumpsuits, arm splints, vest, helmets and body harnesses may be used as either a mechanical restraint for control purposes or safeguarding equipment, depending upon circumstances. For example, a helmet used to prevent injury due to seizures is a safeguarding device. Use of a helmet to prevent injury due to self-injurious behavior is for control purposes.
(c) Primary reliance on punishment, physical or mechanical restraints or aversive techniques to decrease undesirable behavior is contrary to Division policy. Mechanical restraints for control purposes are considered to be appropriate only when absolutely necessary and their use shall be minimized in favor of other, more positive interventions.
(d) When highly restrictive mechanical restraints are in use, continual observation by staff is required to recognize obvious signs of physical distress.
(e) All devices shall be applied only by staff trained in their use and applications.
(f) The need for the particular device to be used as safeguarding equipment or for behavioral intervention shall be documented in the Individual Habilitation Plan (IHP) and re-evaluated no less than annually as a part of the IHP review or as specified by the Interdisciplinary Team in the IHP.
(g) Only commercially produced devices shall be employed for control purposes. If a special device must be developed, the need for the device shall be:
1. Documented in the IHP;
2. Approved by the Department's Chief Medical Consultant;
3. Approved by the appropriate Human Rights Committee; and
4. Approved by the Division Director.
(h) All safeguarding equipment shall be prescribed by a licensed physician. With regard to dental matters, the safeguarding equipment shall be prescribed by a dentist.
(i) Restraints may be used on a temporary basis to conduct medical and dental evaluations, examinations or treatments when the individual's behavior prevents the evaluation, examination or treatment.
(j) Mechanical restraints shall be inspected prior to each use to ensure that they remain in good repair and free from tears or protrusions which may cause injury.
(k) The Division of Developmental Disabilities may require a service provider to terminate restraint usage for an individual if any requirements of this chapter are violated