/ Tennessee Department of Children’s Services
Notification of Restrictive Behavior Management Practices

This form needs to be mailed to the parent within 24 hours of a youth’s admission to a YDC. A separate copy will be signed by the youth and placed in the youth’s file.

Youth Name / TFACTS ID

DCS seeks to use a variety of methods to provide a safe and structured environment for youth in the Youth Development Center. Through appropriate supervision, individual and group therapy, and the use of verbal de-escalation techniques, staff work to help youth feel in control of their behavior and emotions. There are times, however, when the youths’ emotions or behaviors are out of control and they pose a danger to themselves or others. In these situations, staff will try all methods possible to help the youth regain control. If all other methods have failed, restrictive behavior interventions may be used to protect the youth from himself or others.

These methods include the use of mechanical restraint, physical restraint, and confinement. All staff members are trained in these techniques prior to using them. There are strict time limits on the use of these techniques, and permission from a qualified clinician is required to extend the timeframes. Staff attempt to minimize how often and for how long these techniques are used. Use of all three of these techniques is carefully monitored and they are discontinued as soon as the youth has regained control.

  • Mechanical restraintsare handcuffs and/or leg shackles. Mechanical restraints may be used in emergency situations such as those described above. They are also used for routine purposes when there is not an emergency but youth are being transported off-campus. Youth are placed in handcuffs and shackles whenever they are transported, and this letter serves as the only notification you will receive of those situations.
  • Physical restraints consist of body contact by staff with a youth to restrict the youth’s movement. Physical restraints will not be used more than 30 minutes without permission from a qualified clinician.
  • Confinementconsists of placing a youth alone in a room or area where the youth is physically prevented from leaving. A youth may be placed in a locked confinement room under visual observation by staff until he regains self-control. Confinement will not be used more than 60 minutes without permission from a qualified clinician.

If restrictive behavior interventions are used in an emergency situation, someone from the facility will notify the parent or guardian by phone within 24 hours using the most current contact information.

If you have any questions regarding this procedure or would like a copy of DCS Policy 19.11 regarding these practices, please contact the YDC Case Manager.

Date Mailed to Parent: / Staff Mailing Form:
Youth signature: / Date:

Check the “Forms” Webpage for the current version and disregard previous versions. This form may not be altered without prior approval.

Distribution: RDA2982

CS-1046,Rev. 10/15Page 1