Mains’l promotes the rights of the people we serve and protects their health and safety during the emergency use of manual restraints. “Emergency use of manual restraint” means using a manual restraint when a person poses an imminent risk of physical harm to self or others and it is the least restrictive intervention that would achieve safety. Property damage, verbal aggression, or a person’s refusal to receive or participate in treatment or programming on their own, do not constitute an emergency.
Mains’l employees will not perform an emergency use of manual restraint unless they have:
In addition to the behavior intervention policy and procedure, the following procedures are followed if and when it is necessary to perform the emergency use of a manual restraint.
Responding to Escalating Disruptive Behavior
When a person begins to engage in escalating disruptive behavior and it becomes apparent that they may likely engage in continuous aggression, self-injury, or high level disruptive behaviors that also threaten the safety and well-being of others if not redirected, implement the following steps:
8. If the person begins to engage in behavior that is continuous aggression, continuous self-injury, or high magnitude disruption that threatens the safety of themselves or others, emergency manual restraint may be implemented, as trained. When implementing an emergency use of manual restraint start with the least restrictive procedure necessary to keep the individual and others safe.
9. After implementing the manual restraint, attempt to release the person at the moment staff believe the person’s conduct no longer poses an imminent risk of physical harm to self or others and less restrictive strategies can be implemented to maintain safety.
Mains’l will not allow the use of a manual restraint procedure with a person when it has been determined by the person’s physician or mental health provider to be medically or psychologically contraindicated. Mains’l will complete an assessment of whether the allowed procedures are contraindicated for each person receiving services as part of the service planning required under section 245D.070, subdivision 2, for recipients of basic support services; or the assessment and initial service planning required under section 245D.071, subdivision 3, for recipients of intensive support services.
Manual Restraints Allowed in Emergencies
Below is a list of each of the manual restraints trained staff are allowed to use on an emergency basis when a person’s actions pose an imminent (it is about to happen) risk of physical harm to self or others and less restrictive strategies have not achieved safety. The list includes instructions for the safe and correct implementation of those procedures.
They are listed in order of least to most restrictive:
Conditions for Emergency Use of Manual Restraint
Emergency use of manual restraint must meet the following conditions:
Restrictions When Implementing Emergency Use of Manual Restraint
Emergency use of manual restraint must not:
1. be implemented with a child in a manner that constitutes sexual abuse, neglect, physical abuse, or mental injury;
2. be implemented with an adult in a manner that constitutes sexual abuse, neglect, physical abuse or mental injury;
3. be implemented in a manner that violates a person’s rights and protection;
4. be implemented in a manner that is medically or psychologically contraindicated for a person;
5. restrict a person’s normal access to a nutritious diet, drinking water, adequate ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping conditions, or necessary clothing;
6. restrict a person’s normal access to any protection required by state licensing standards and federal regulations governing this program;
7. deny a person visitation or ordinary contact with legal counsel, a legal representative, or next of kin;
8. be used as a substitute for adequate staffing, for the convenience of staff, as punishment, or as a consequence if the person refuses to participate in the treatment or services provided by this program;
9. use prone restraint. “Prone restraint” means use of manual restraint that places a person in a face-down position. It does not include brief physical holding of a person who, during an emergency use of manual restraint, rolls into a prone position, and the person is restored to a standing, sitting, or side-lying position as quickly as possible; or
10. apply back or chest pressure while a person is in a prone position, supine (meaning a face-up) position, or side-lying position,
11. be implemented in a manner that is contraindicated for any of the person’s known medical or psychological limitations.
Monitoring Emergency Use of Manual Restraint
Mains’l must monitor a person’s health and safety during an emergency use of a manual restraint. When possible, a staff person who is not implementing the emergency use of a manual restraint must monitor the procedure. The purpose of the monitoring is to ensure the following:
1. only manual restraints allowed in this policy are implemented;
2. manual restraints that have been determined to be contraindicated for a person are not implemented with that person;
3. allowed manual restraints are implemented only by staff trained in their use;
4. the restraint is being implemented properly as required; and
5. the mental, physical, and emotional condition of the person who is being manually restrained is being assessed and intervention is provided when necessary to maintain the person’s health and safety and prevent injury to the person, staff involved, or others involved.
Reporting Emergency Use of Manual Restraint
The staff who implemented any form of manual restraint procedure:
The manager/designated coordinator:
b. Within (5) working days of the behavior intervention, reviews and finalizes the Behavior Intervention Internal Review form.
Expanded Support Team Review of Emergency Use of Manual Restraint
Within 5 business days after the completion of the internal review, the manage or senior manager must consult with the expanded support team to:
1. Discuss the incident to:
a. define the antecedent or event that gave rise to the behavior resulting in the manual restraint; and
b. identify the perceived function the behavior served.
2. Determine whether the person’s service and support plan needs to be revised to:
a. positively and effectively help the person maintain stability; and
b. reduce or eliminate future occurrences of manual restraint.
3. Make the revisions to the person’s service and support plan when it is determined necessary.
The written summary of the expanded support team’ discussion and decisions will be documented on the Expanded Support Team Review Form and saved in the person’s plan file.
Internal Review of Emergency Use of Manual Restraint
a. Within 5 business days after the date of the emergency use of a manual restraint, the senior manager must complete and document an internal review of the report prepared by the staff member who implemented the emergency procedure. The internal review must include an evaluation of whether:
1. the person’s service and support strategies need to be revised;
2. related policies and procedures were followed;
3. the policies and procedures were adequate;
4. there is need for additional staff training;
5. the reported event is similar to past events with the persons, staff, or the services involved; and
6. there is a need for corrective action by the program to protect the health and safety of persons.
b. Based on the results of the internal review, the senior manager must develop, document, and implement a corrective action plan designed to correct current lapses and prevent future lapses in performance by individuals or Mains’l.
c. The corrective action plan, if any, must be implemented within 30 days of the internal review being completed
d. The original is filed in the person’s plan file and a copy is submitted to the director.
External Review and Reporting of Emergency Use of Manual Restraint
Within 5 business days after the completion of the expanded support team review, the senior manager must submit the following to DHS using the online behavior intervention reporting form which automatically routes the report to the Office of the Ombudsman for Mental Health and Developmental Disabilities:
1. report of the emergency use of a manual restraint;
2. the internal review and corrective action plan; and
3. the expanded support team review written summary.
Positive Support Transition Plan
If an individual uses a positive support transition plan, the plan will be written by a Board Certified Behavior Analyst. The plan will be written and phased out within 11 months form the date of plan implementation. The BCBA will use the DHS created and approved plan.
Behavior Intervention Policy and Procedure
Minnesota Statute 245D.06, subd. 5 to subd, 8; 245D.061 and Minnesota Positive Support Rule
PRN Use Protocol
Behavior Intervention Report Form (BIRF) and Incident Report Form
Behavior Intervention Report Form – Internal Review Form and External Review Form
Corrective Action Plan and Positive Support Transition Plan