ARM 37.98.8

ARM 37.98.8 Program Policy Requirements

This regulation establishes program policy requirements for residential outdoor/wilderness youth programs licensed under Montana DPHHS, covering behavior management, nonviolent crisis intervention, physical restraint, time out, animals, weapons, contraband, and searches. Operators must maintain written policies prohibiting abusive discipline practices, train staff in de-escalation and restraint techniques, document all restraint and time-out incidents, and follow strict protocols for searches of youth and their property. These requirements apply to programs serving youth in outdoor/expedition-based residential settings as defined by the chapter context (ARM 37.98).

37.98.801
 BEHAVIOR MANAGEMENT POLICIES 

(1)
 
A program shall have and follow written behavior management policies and procedures including a description of the model, program or techniques to be used with youth. The program shall have policies addressing discipline, therapeutic de-escalation of crisis situations, nonviolent crisis intervention, and time out. Behavior management must be based on an individual assessment of each youth's needs, stage of development and behavior. It must be designed with the goal of teaching youth to manage their own behavior and be based on the concept of providing effective treatment by the least restrictive means. 

(2)
 
The program shall document that a copy of the written policies has been provided and explained to each youth. A copy of the policies must also be provided to parents, guardians and referral sources upon request. 

(3)
 
The behavior management policies must prohibit: 

(a)
 
the use of physical force, mechanical, chemical, or physical restraint as discipline; 

(b)
 
pain compliance, aversive conditioning, and use of pressure point techniques; 

(c)
 
the placing of anything in or on a youth's mouth; 

(d)
 
cruel or excessive physical exercise, prolonged positions or work assignments that produce unreasonable discomfort; 

(e)
 
verbal abuse, ridicule, humiliation, profanity and other forms of degradation directed at a youth or a youth's family; 

(f)
 
locked confinement or seclusion; 

(g)
 
withholding of necessary food, water, clothing, shelter, bedding, rest, medical care or toilet use; 

(h)
 
denial of visits or communication with the youth's family as punishment or discipline. Visits or communication with the youth's family may be limited as specified in the program's design and planned activities, in accordance with the youth's service plan, or by court order; 

(i)
 
isolation as punishment, except as provided for in the time out provisions of ARM 
37.98.803
; and 

(j)
 
any other form of punishment or discipline which subjects a youth to pain, humiliation, or unnecessary isolation or restraint. 

(4)
 
If program policies allow for disciplining a group of youth for actions of one youth, the organization's policies and procedures for behavior management or discipline must clearly prescribe the circumstances and safeguards under which disciplining the group is allowed. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.802
 USE OF NONVIOLENT CRISIS INTERVENTION STRATEGIES 

(1)
 
The program shall have written policies and procedures governing the appropriate use of nonviolent crisis intervention strategies, including: 

(a)
 
the use of de-escalation techniques; 

(b)
 
physical assists; and 

(c)
 
physical restraints. 

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

(a)
 
Crisis prevention and verbal and non-verbal 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)
 
Appropriate use of physical assists occurs when staff members physically aid, support or redirect youth who are not physically resisting. Physical assists include staff leading youth along the trail or moving youth to his or her campsite by gently pulling on a backpack strap, guiding him or her by the hand or elbow, or placing a hand on the youth's back. If a youth resists reasonable staff direction, staff must assess whether the use of physical restraint is warranted based on the program's written physical restraint policy. 

(c)
 
Physical restraint must be used to safely control a youth until he or she can regain control of his or her 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/or physical assists; 

(ii)
 
when necessary to prevent harm to the youth or others, or to prevent the substantial destruction of property; or 

(iii)
 
when a youth's behavior puts himself/herself or others at substantial risk of harm and he/she must be forcibly moved. 

(d)
 
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 record must include written documentation of attempts made to release the youth from the restraint and the reasons that continuation of restraint is necessary. 

(e)
 
Physical restraint may be used only by employees documented to have been specifically trained in nonviolent crisis intervention techniques. 

(f)
 
Program policies must prohibit the application of a nonviolent physical restraint if a youth has a documented physical condition that would contraindicate 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. 

(g)
 
Program policies must require 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)
 
the debriefing completed with the staff and youth involved in the physical restraint. 

(h)
 
Program policies must require that whenever a physical restraint has been used on a youth more than two times in one week, there is a review by lead clinical staff members to determine the suitability of the youth remaining in the program, whether modification to the youth's plan are warranted, or whether staff need additional training in alternative therapeutic behavior management techniques. The program shall take appropriate action as a result of the review. 

(3)
 
The program shall train staff in the therapeutic de-escalation of crisis situations provided through a nationally recognized training system to ensure the protection and safety of the youth and staff. The training must include the use of physical and non-physical methods of managing youth, and must be updated at least annually to ensure the maintenance of necessary skills. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.803
 TIME OUT 

(1)
 
Time out must only be used when a youth's behavior is disruptive to the youth's ability to learn, to participate appropriately, or to function appropriately with other youth or the activity and when other de-escalation techniques have failed. Restraint, seclusion, or confinement may not be used as part of time out procedures. 

(2)
 
A staff member must be designated to be responsible for visually observing the youth at random intervals at least every 15 minutes. 

(3)
 
For each time out, a report must be written and placed in the client's file in sufficient detail to provide a clear understanding of the occurrence or behavior which resulted in the youth being placed in time out, and staff's attempts to help the youth avoid time out. 

(4)
 
Youth placed in time out must be re-introduced to the group in a sensitive and non-punitive manner as soon as control is regained. 

(5)
 
If there are more than 10 one hour time outs for a youth in a 24-hour period, or the separation lasts for 24 hours, appropriate lead clinical staff members must conduct a review to determine the suitability of the youth remaining in the program, whether modifications to the youth's plan are warranted, and whether staff need additional training in alternative therapeutic behavior management techniques. The results of the review must be documented and placed in the youth's file. The program shall take appropriate action as a result of the review. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.806
 ANIMALS AND PETS 

(1)
 
A program may make use of domesticated animals or pets as part of a youth's treatment plan, provided that animals and pets are vaccinated, free from disease, not a danger to the youth, and cared for in a safe and clean manner. The program shall have documentation of current vaccinations, including rabies, as appropriate for all animals and pets. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.811
 POTENTIAL WEAPONS 

(1)
 
A program shall have and follow written policy and procedures on management of weapons and potential weapons. 

(2)
 
Firearms must not be allowed in programs. 

(3)
 
Program staff shall inventory knives, hatchets, other edged tools or any item which might pose a danger to youth and complete a daily count of these items against the inventory. Program staff shall supervise youth possession and use of knives, hatchets, other edged tools or any item which might pose a danger to self or others. 

(4)
 
Large animal repellants must be stored under lock and key when not being carried by program staff, and be safeguarded from youth. Youth shall only use large animal repellants under the supervision of staff. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.812
 CONTRABAND 

(1)
 
A program shall define prohibited contraband in a written policy. 

(2)
 
Law enforcement must be notified as appropriate when illegal contraband is discovered. 

(3)
 
All contraband that is not illegal must be returned to the youth's parent or guardian, or must be destroyed in accordance with the program's contraband policy. When contraband is disposed of, the disposal must be witnessed by at least two other staff members and must be documented in the youth's case record. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.813
 PROGRAM REQUIREMENTS: SEARCHES 

(1)
 
The provisions of this rule apply to all searches by program staff of youth and their personal property, including searches of personal correspondence. 

(2)
 
Youth may not be subjected to a search of the youth's person, personal property or correspondence unless there is reasonable cause to believe that the search will result in discovery of contraband, or unless there is reasonable cause to believe that the search is necessary to alleviate a threat of harm to the youth, other youths, or staff. The facts and circumstances supporting a determination of reasonable cause for the search must be documented in the youth's file. 

(3)
 
Any correspondence search must be conducted in the presence of the youth. 

(4)
 
The program shall adopt policies relating to searches, including pat down searches, personal property searches and correspondence searches. The policies must include the following: 

(a)
 
a protocol for conducting personal property searches when the youth is not available to be present for the search; and 

(b)
 
a procedure for documenting all searches, reasons for the search, who conducted the search and the results of the search. 

(5)
 
Youth may not be subjected to any of the following intrusive acts: 

(a)
 
strip searches; 

(b)
 
body cavity searches; or 

(c)
 
video surveillance. 

(6)
 
Youth may be not subjected to urinalysis testing unless the testing has been ordered by a court, is required pursuant to a case plan for monitoring drug or alcohol use, as approved by the parent or legal guardian, or requested by the youth's parent or legal guardian. The following requirements must be met by the program utilizing urinalysis testing: 

(a)
 
Prior to any testing, the program shall adopt policies which address, at a minimum, procedures for obtaining samples for urinalysis testing. 

(b)
 
Staff shall document compliance with program policies in connection with each testing. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.