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(1) The YCF shall have written policies and procedures governing the appropriate use of crisis intervention and physical restraint strategies, including but not limited to the use of de-escalation techniques and physical restraint methods if used by provider.

(2) The crisis intervention and physical restraint strategies policies and procedures must comply with the following:

(a) Crisis prevention and verbal and nonverbal de-escalation techniques are the preferred methods and must be used first to manage behavior. All staff working directly with youth must be trained in de-escalation techniques. This training must be documented in each staff member's personnel file.

(b) Physical restraint may only be used to safely control a youth until the youth can regain control of the youth's own behavior. Physical restraint must only be used in the following circumstances:

(i) when the youth has failed to respond to de-escalation techniques and it is necessary to prevent harm to the youth or others; or

(ii) when a youth's behavior puts themselves or others at substantial risk of harm and the youth must be forcibly moved.

(c) Physical restraint must be used only until the youth has regained control and must not exceed 15 consecutive minutes. If the youth remains a danger to self or others after 15 minutes, the youth's record must include written documentation of attempts made to release the youth from the restraint and the reasons that continuation of restraint is necessary.

(d) Physical restraint may be used only by employees who are documented to be specifically trained in crisis intervention and physical restraint techniques.

(e) YCF policies and procedures must prohibit the application of a physical restraint if a youth has a documented physical condition that would contradict its use, unless a health care professional has previously and specifically authorized its use in writing. Documentation must be maintained in the youth's record.

(f) YCF policies and procedures must require the documentation of:

(i) the behavior which required the physical restraint;

(ii) the specific attempts to de-escalate the situation before using physical restraint;

(iii) the length of time the physical restraint was applied including documentation of the time started and completed;

(iv) the identity of the specific staff member(s) involved in administering the physical restraint;

(v) the type of physical restraint used;

(vi) any injuries to the youth resulting from the physical restraint; and

(vii) debriefing completed with the staff and youth involved in the physical restraint.

(g) YCF policies and procedures must require that whenever a physical restraint has been used on a youth more than four times within a seven-day period, lead clinical staff members or treatment team members will review the youth's situation to determine the suitability of the youth remaining in the YCF, whether modification to the youth's plan is warranted, or whether staff need additional training in alternative therapeutic behavior management techniques. The YCF shall take appropriate action as a result of the review.

(3) All TGHs must provide physical restraint training and comply with this rule.

History: 52-2-111, 52-2-603, 52-2-622, MCA; IMP, 52-2-113, 52-2-603, 52-2-622, MCA; NEW, 2011 MAR p. 387, Eff. 3/25/11.

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