Standards for public agencies

2020 Edition

Behavior Support and Management (PA-BSM) 4: Restrictive Behavior Management Interventions

Restrictive behavior management interventions are used in a manner that protects the safety and well-being of service recipients and personnel in crisis situations when less-restrictive measures have proven ineffective.
2020 Edition

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Purpose

The agency’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.
Note: The use of mechanical restraints is prohibited for public or private non-medical, community-based facilities that serve children and youth according to the Public Health Service Act, as amended by the Children's Health Act of 2000. As referenced in PA-BSM 1.01, agencies serving youth involved with the juvenile justice system may be subject to different laws and regulations, and should familiarize themselves with any laws and regulations addressing the behavior management interventions they are permitted to employ. 
1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed administration and management infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
  • BSM procedures including procedures for:
    1. authorization and reauthorization of restrictive interventions  
    2. continuous monitoring during a restrictive intervention
    3. safely escorting service recipients
    4. provision of food and water and use of bathrooms
    5. time limits on use of restrictive interventions
    6. evacuating individuals in seclusion or mechanical restraint during an emergency
  • A list of authorized personnel and their qualifications (counties provide an agency-wide list, and state central offices provide a list of personnel in the central office)
State Administered Agency (Regional Office)
  • A list of authorized personnel in the region and their qualifications
All Agencies
  • Restrictive behavior management intervention logs that include documentation of continuous monitoring
All Agencies
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Observe seclusion room(s)

PA-BSM 4.01

Personnel qualified through annual training and evaluation authorize each restrictive behavior management intervention and reauthorize interventions that exceed maximum time limits, in accordance with any applicable federal or state requirements.
Note: See PA-BSM 4.07 for additional requirements related to reauthorizing restrictive interventions. 

Fundamental Practice

PA-BSM 4.02

Individuals are monitored continuously, face-to-face, and:
  1. assessed at least every 15 minutes for any harmful health or psychological reactions; and 
  2. interventions are discontinued immediately if they produce adverse side effects such as illness, severe emotional or physical stress, or physical injury.

Fundamental Practice

PA-BSM 4.03

Procedures address safe methods for involuntarily escorting individuals.
NA The agency does not escort individuals or use seclusion.
 
Examples: This includes methods such as the backwards escort.

Fundamental Practice

PA-BSM 4.04

Seclusion rooms:
  1. conform to existing licensing and/or fire safety requirements;
  2. are outfitted with a door that easily opens in case of emergency (e.g. spring lock door); and
  3. are limited to one person at a time.
NA The agency does not use seclusion.
Note: Please see the Facility Observation Checklist for additional guidance on this standard.

Fundamental Practice

PA-BSM 4.05

During a restrictive behavior management intervention staff assess the service recipient’s need for food, water, and use of bathroom facilities and provide access when safe and appropriate. 

Fundamental Practice

PA-BSM 4.06

Restrictive behavior management interventions are discontinued as soon as possible, and are limited to the following maximum time periods per episode:
  1. 15 minutes for children aged nine and younger, for all restrictive behavior management interventions; 
  2. 30 minutes for individuals aged ten and older, undergoing manual or mechanical restraint; 
  3. 30 minutes for individuals aged ten to thirteen in seclusion; and 
  4. one hour for individuals aged fourteen and older in seclusion. 
Juvenile Justice

Interpretation

Although agencies serving youth involved with the juvenile justice system may be authorized to use time limits that exceed those listed in the standard, COA expects these agencies to meet the timeframes outlined in the standard whenever possible. When it is necessary to extend timeframes in order to maintain safety, security, and order (for example, when youth must be transported greater than 30 minutes in mechanical restraints in order to prevent escape), qualified personnel must approve the extension, and the intervention should be discontinued as soon as possible.
 

Fundamental Practice

PA-BSM 4.07

Reauthorization is required for each instance of restrictive intervention that exceeds the maximum time limit, and qualified personnel must evaluate the patient every 24 hours before writing a new order for a restrictive intervention.

PA-BSM 4.08

The agency has procedures to address the safe removal of individuals in seclusion or mechanical restraint in the event of an emergency evacuation.