Pa. Code 5240.6

Restrictive procedures

This section governs restrictive procedures used by Intensive Behavioral Health Services (IBHS) agencies serving children, youth, and young adults in Pennsylvania. It prohibits specific restrictive procedures (e.g., seclusion, chemical restraint, mechanical restraint) and sets strict conditions for when manual restraints may be used, including de-escalation requirements, positional safety rules, and 10-minute monitoring intervals. IBHS agencies must maintain written policies, document each restraint use, notify the treatment team within 24 hours, and ensure staff complete Department-approved annual training on restrictive procedures.

55 Pa. Code § 5240.6 - Restrictive procedures 

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(a)
 The
 following restrictive procedures are prohibited: 
 
(1)
 Seclusion.

(2)
 Aversive conditioning.

(3)
 Pressure-point technique.

(4)
 Chemical restraint.

(5)
 Mechanical restraint.

(6)
 A restrictive procedure that is not the
 least restrictive procedure.

(7)
 A
 restrictive procedure that does not maintain a child's, youth's or young
 adult's welfare and dignity.

(8)
 A
 restrictive procedure that limits a child's, youth's or young adult's access to
 food, drink or toilet.

(b)
 An IBHS agency that uses restrictive
 procedures shall have written policies and procedures that identify the
 specific restrictive procedures that may be used and when such restrictive
 procedures may be used.

(c)
 A manual
 restraint shall only be used in an emergency situation to prevent self-injury
 or injury to others by a child, youth or young adult and only after: 
 
(1)
 Every attempt has been made to anticipate
 and de-escalate the behavior.

(2)

 Less intrusive techniques and resources appropriate to the behavior have been
 tried and failed.

(d)
 A
 manual restraint may not: 
(1)
 Apply pressure
 or weight on a child's, youth's or young adult's respiratory system.

(2)
 Use a prone position.

(e)
 The position of the manual
 restraint or the staff person applying a manual restraint shall be changed at
 least every 10 minutes during the application of the manual
 restraint.

(f)
 A trained individual
 who is not applying the manual restraint shall observe and document the
 physical and emotional condition of the child, youth or young adult at least
 every 10 minutes during the application of the manual restraint.

(g)
 A manual restraint shall be discontinued
 when the child, youth or young adult is no longer an imminent danger to self or
 others.

(h)
 Within 24 hours of using
 a manual restraint on a child, youth or young adult, an IBHS agency shall
 notify the treatment team.

(i)
 An
 IBHS agency shall document the use of a manual restraint in the child's,
 youth's or young adult's individual record in accordance with §
 
5240.41
(a)(12) 

 (relating to individual records).

(j)
 An IBHS agency that uses manual
 restraints shall have policies and procedures for the use of manual restraints
 that shall include the following:
(1)

 Appropriate use of the manual restraint, including prohibitions on the use of a
 manual restraint.

(2)
 Required use
 of less intrusive techniques and resources appropriate to the behavior prior to
 the use of a manual restraint.

(3)

 Immediate discontinuation of the manual restraint when the child, youth or
 young adult is no longer an imminent danger to self or others.

(4)
 The staff who may authorize the use of a
 manual restraint.

(5)
 How the use
 of a manual restraint will be monitored.

(k)
 An IBHS agency shall require yearly
 training that is approved by the Department for staff who administer a
 restrictive procedure that includes the following: 
 
(1)
 De-escalation techniques and
 strategies.

(2)
 Proper use of the
 restrictive procedure, including what is appropriate for the age and weight of
 a child, youth or young adult.

(3)

 Demonstrated experience in the proper use of the restrictive procedure,
 including practice on other staff.

(4)
 A testing process to demonstrate the
 ability to properly apply the restrictive procedure.

(l)
 An IBHS agency shall keep a record of
 each staff person's training in the use of restrictive procedures in each staff
 person's personnel file in accordance with §
 
5240.42
(b)(2) 

 (relating to agency records).

(m)
 An
 IBHS agency that provides training to parents, legal guardians or caregivers on
 the use of restrictive procedures that are included in the child's, youth's or
 young adult's ITP shall use trainings approved by the Department and have
 policies and procedures that address training parents, legal guardians or
 caregivers on the use of restrictive procedures.

Notes

55

 Pa. Code §
 
5240.6

This section cited in 55 Pa. Code §
 
5240.41
 (relating to individual
 records); and 55 Pa. Code §
 
5240.73
 (relating to training
 requirements for staff who provide individual
 services).

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