YOUTH CONSULTATION SERVICE
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Site Specific Policy & Procedure Manual
DOCUMENT #: B-1.4 Procedure Date: 7.27.10
Rev.: 11.14.10
TITLE: Emergency Use of Personal Control Techniques
I. PURPOSE: To clarify the requirements of Emergency Physical Controls in the YCS Sawtelle Home Program.
II. INTRODUCTION: It is the policy of YCS that we employ both verbal and physical crisis intervention techniques as a means of de-escalating any consumer who is placed in the YCS Sawtelle Home and who exhibits “out-of-control” behavior in which said consumer’s behavior poses an immediate threat to self or others. At this time, no mechanical or chemical restraints are used within the YCS Sawtelle Home Program.
III. PROCEDURES / IV STAFF RESPONSIBLEV. REPORTING & DOCUMENTATION
A. Upon admission to the YCS Sawtelle Home Program, all consumers will receive the YCS Emergency Physical Control Policy (Attachment A). Per this policy, all uses of Emergency Personal Control Techniques shall be authorized by a Qualified Mental Health Professional.
B. Within 72 hours of admission, the YCS Sawtelle Home completes an assessment of the consumer’s general physical health, including an assessment of conditions which may limit the application of physical control techniques. YCS utilizes all components of Crisis Prevention Institute (CPI) and Handle with Care Crisis Intervention Systems, with the exception of the use of the prone restraints. (A prone restraint means holding an individual facedown on their stomach or chest).
C. The CPI system is utilized because of its strong emphasis on verbal redirection and provision of clear step-by-step prompts throughout the crisis escalation continuum. The Handle with Care Behavior Management System is also utilized to ensure safe, orthopedically-sound, physical management. (See Attachment C- Crisis Prevention Institute (CPI) and Handle with Care (HWC) Training Outlines).
D. Due to the potential danger that could occur when implementing a physical control, YCS Sawtelle Home has incorporated the use of a two-person Supine Position Handle with Care control position restraint (Attachment D). This technique configuration allows for the consumer to be placed in a supine position with two staff persons off at forty-five degree angles to the consumer’s shoulders. All staff are trained in CPI/PRT by the YCS Training Department
E. Should an individual become injured or show signs of distress as a result of Physical Control and / or Defensive Techniques, the following actions will occur:
1. The restraint will immediately be discontinued if the consumer appears to be distressed.
2. The provision of medical treatment consistent with the severity of the injury from on-site first aid to the use of 911 emergency services (particularly if the injury falls under the Danielle’s Law umbrella). Once the consumer has been addressed medically, the YCS staff person must contact the Site Administrator regarding the status of the situation.
3. If a staff person’s role in causing an injury cannot be determined or an injury results from the improper use of an approved technique, Adult Protective Services 1-800-922-7233 may be contacted to report the incident for consumers over 21 and IA- 1-800-NJ Abuse for consumers under the age of 21. Upon the conclusion of any investigation the staff person may be required to be retrained before being permitted to use the technique. The staff person shall not be allowed to work alone until successful retraining occurs.
4. If the misuse of the technique is determined to be deliberate, the employee shall be addressed through the YCS Human Resource process which includes disciplinary action up to and including termination and possible criminal charges if warranted.
F. All instances of personal control or restraint will be documented via the Physical Control (PC) Reporting process. The YCS DD Physical Control Report (Attachment E) Staff Debriefing (Attachment F) and Consumer Debriefing (Attachment G) will be completed upon the termination of the emergency control. These documents will be completed per the YCS DD Emergency Physical Control Policy.
G. All Unusual Incidents (UIR), per the YCS UIR Policy, which are the result of the use of Personal Control or Defensive Techniques, shall be reported to DDD in accordance with Divisional requirements ( DC #14 ).
H. At a minimum, the Inter-disciplinary team (IDT) will meet if the individual requires the use of personal control three or more times in a six month period or more frequently if the IDT deems necessary. The IDT shall meet within five working days of the third use of an emergency physical control technique in any rolling six-month period. The IDT shall conduct a Functional Assessment of the problem behavior and incorporate techniques to address the behavior in the individuals Individualized Service Plan.
I. The Physical Control Reports are aggregated through the YCS reporting process called YCS Monthly Nursing Department Report which is completed by the program nurse and forwarded to the YCS Research Department, and analyzed by the agency-wide YCS Continuous Performance Improvement Committee, which meets 6 times annually. Any recommendations based upon the analysis of the PC Reports are forwarded, in writing, to the YCS Sawtelle Home Site Administrator for review and follow up action(s) by the local CQI Team.
J. A certified trainer in both behavior management systems, (Crisis Prevention Institute & Handle with Care) will provide training and certification in all Defensive and Personal Controls.
K. All employees of the YCS Sawtelle Home will receive the entire Handle With Care and Crisis Prevention Institute training systems at orientation, annually thereafter, and as necessary. Training will include Respiratory Assessment Training – Attachment I.
L. All crisis intervention training is valid for one year only and will be renewed annually. All training participants must demonstrate proficiency in all techniques in order to be certified by the trainer. Retraining will be required if a person fails to achieve adequate proficiency level as determined by the certified trainer or when the staff person fails to properly use a technique. / Attachment A-YCS Emergency Physical Control Policy
Site Administrator
Attachment B- YCS Physical Control Clearance Form
Attachment C- Crisis Prevention Institute (CPI) and Handle with Care (HWC) Training Outlines
YCS Training Department
Attachment D- HWC-Two Person Supine Diagram and Narrative
YCS Training Department
YCS Staff
Attachment E- YCS DD Physical Control Incident Report
Attachment F- YCS Staff Debriefing Form
Attachment G- YCS Consumer Debriefing Form
YCS UIR Policy
Functional Assessment of Behavior
Individual Service Plan
YCS Monthly Nursing Department Report
Attachment H- Trainer Certificate(s)
Attachment I- YCS Physical Control Respiratory Assessment Training
VI. ATTACHMENTS (OR DOCUMENTATION)
A- YCS Physical Control Policy for DD Consumers
A1- YCS Physical Control Acknowledgement
B- YCS Physical Control Clearance Form
C- YCS Crisis Prevention Institute and Handle with Care Training Outlines
D- Diagram and Narrative
E- YCS DD Programs Physical Control Incident Report
F- YCS Staff Debriefing Form
G- YCS Consumer Debriefing Form
H- Trainer Certificate(s)
I- YCS Physical Control Respiratory Assessment Training
VII. REGULATORY REFERENCES: Circular 19; Circular 14
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