This regulation establishes special requirements for the use of restraints or seclusion with vulnerable populations in DC behavioral health settings. Operators must conduct trauma and risk assessments within 24 hours of admission for children and youth in inpatient hospitals and residential treatment centers, and must prohibit restraint or seclusion for children with recent abuse histories (with limited exceptions). Additional protections apply to frail consumers (soft restraints only), consumers with intellectual/developmental disabilities (medical assessment required before restraint), and consumers who are deaf or nonverbal (constant one-to-one observation and documented communication attempts).
View official source515 USE OF RESTRAINTS OR SECLUSION WITH SPECIAL POPULATIONS 515.1 Consideration should be given to removing dentures or other dental devices either prior to the use of restraints or seclusion, or at the earliest opportunity after initiation of restraints or seclusion. 515.2 Only soft restraints may be used with frail consumers. Leather restraints should never be used with frail consumers as these may cause lesions or fractures, especially in cases of osteoporosis. 515.3 Consumers affected by mental retardation or developmental disability who become agitated or violent should be carefully assessed for an underlying medical condition that may be causing the behavioral change. 515.4 Children and youth residing in inpatient hospital settings or residential treatment centers shall receive an assessment to identify those who have experienced physical, psychological, or sexual trauma, including abuse, and those at high risk for seclusion and restraint events for any reason. The assessment shall include a review of the child or youth's medical condition and any disability. 515.5 The assessment referenced in § 515.4 shall be completed within twenty-four (24) hours of admission. 515.6 With the exception of physical holds as defined in this chapter, the use of restraint or seclusion with children or youth who have been sexually or physically abused within the past two years is strictly prohibited. 515.7 For children and youth residing in hospitals or RTCs, initial service plans shall include positive interventions to avoid the use of seclusion and restraints, especially for children most likely to lose self-control. 515.8 For consumers who are deaf or unable to speak, any use of restraint or seclusion must include constant one-to-one observation. Efforts to communicate with the person using sign language or in writing, must be made and documented in the clinical record. SOURCE: Emergency and Proposed Rulemaking published at 51 DCR 8691 (September 3, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 51 DCR 11863 (December 31, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 52 DCR 5957 (June 24, 2005)[EXPIRED]; as amended by Final Rulemaking published at 52 DCR 7229 (August 5, 2005). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 515