subchapter 27e – treatment or habilitation rights
section .0100 – protections regarding interventions procedures
10a ncac 27e .0101 LEAST RESTRICTIVE ALTERNATIVE
(a) Each facility shall provide
services/supports that promote a safe and respectful environment. These
include:
(1) using the least restrictive and most
appropriate settings and methods;
(2) promoting coping and engagement skills that
are alternatives to injurious behavior to self or others;
(3) providing choices of activities meaningful
to the clients served/supported; and
(4) sharing of control over decisions with the
client/legally responsible person and staff.
(b) The use of a restrictive intervention procedure
designed to reduce a behavior shall always be accompanied by actions designed
to insure dignity and respect during and after the intervention. These
include:
(1) using the intervention as a last resort;
and
(2) employing the intervention by people
trained in its use.
History Note: Authority G.S. 122C‑51; 122C‑53;
143B‑147;
Eff. February 1, 1991;
Amended Eff. January 1, 1992;
Temporary Amendment
Eff. January 1, 2001;
Amended Eff. August 1, 2002.
10a NCAC 27e .0102 PROHIBITED
PROCEDURES
In each facility the following types of
procedures shall be prohibited:
(1) those interventions which have been
prohibited by statute or rule which shall include:
(a) any intervention which would
be considered corporal punishment under G.S. 122C‑59;
(b) the contingent use of painful
body contact;
(c) substances administered to
induce painful bodily reactions, exclusive of Antabuse;
(d) electric shock (excluding
medically administered electroconvulsive therapy);
(e) insulin shock;
(f) unpleasant tasting
foodstuffs;
(g) contingent application of any
noxious substances which include but are not limited to noise, bad smells or
splashing with water; and
(h) any potentially physically
painful procedure, excluding prescribed injections, or stimulus which is
administered to the client for the purpose of reducing the frequency or
intensity of a behavior.
(2) those interventions determined by
the governing body to be unacceptable for or prohibited from use in the
facility.
History Note: Authority G.S. 122C‑51; 122C‑57;
122C‑59; 131E‑67; 143B‑147;
Eff. February 1, 1991;
Amended Eff. January 1, 1992.
10a NCAC 27e .0103 GENERAL POLICIES REGARDING INTERVENTION
PROCEDURES
(a) The following procedures shall only be
employed when clinically or medically indicated as a method of therapeutic
treatment:
(1) planned non‑attention
to specific undesirable behaviors when those behaviors are health threatening;
(2) contingent deprivation of
any basic necessity; or
(3) other professionally
acceptable behavior modification procedures that are not prohibited by Rule
.0102 of this Section or covered by Rule .0104 of this Section.
(b) The determination that a procedure is clinically or
medically indicated, and the authorization for the use of such treatment for a
specific client, shall only be made by either a physician or a licensed
practicing psychologist who has been formally trained and
privileged in the use of the procedure.
History Note: Authority G.S. 122C‑51; 122C‑53;
122C‑60; 122C‑62; 131E‑67; 143B‑147;
Eff. February 1, 1991;
Amended Eff. January 1, 1992.
10a ncac 27e .0104 SECLUSION, physical RESTRAINT AND
ISOLATION TIME-OUT and protective devices used for behavioral control
(a) This Rule governs the use of restrictive interventions
which shall include:
(1) seclusion;
(2) physical restraint;
(3) isolation time‑out
(4) any
combination thereof; and
(5) protective
devices used for behavioral control.
(b) The use of restrictive interventions shall be limited
to:
(1) emergency situations, in order to terminate
a behavior or action in which a client is in imminent danger of abuse or injury
to self or other persons or when property damage is occurring that poses
imminent risk of danger of injury or harm to self or others; or
(2) as a planned measure of therapeutic
treatment as specified in Paragraph (f) of this Rule.
(c) Restrictive interventions shall not be employed as a
means of coercion, punishment or retaliation by staff or for the convenience of
staff or due to inadequacy of staffing. Restrictive interventions shall not be
used in a manner that causes harm or abuse.
(d) In accordance with Rule .0101 of Subchapter 27D, the
governing body shall have policy that delineates the permissible use of
restrictive interventions within a facility.
(e) Within a facility where restrictive interventions may be
used, the policy and procedures shall be in accordance with the following
provisions:
(1) the requirement that positive and less
restrictive alternatives are considered and attempted whenever possible prior
to the use of more restrictive interventions;
(2) consideration is given to the client's
physical and psychological well-being before, during and after utilization of a
restrictive intervention, including:
(A) review of the client's health history or the
client's comprehensive health assessment conducted upon admission to a
facility. The health history or comprehensive health assessment shall include
the identification of pre-existing medical conditions or any disabilities and
limitations that would place the client at greater risk during the use of restrictive
interventions;
(B) continuous assessment and monitoring of the physical
and psychological well- being of the client and the safe use of restraint
throughout the duration of the restrictive intervention by staff who are
physically present and trained in the use of emergency safety interventions;
(C) continuous monitoring by an individual trained in
the use of cardiopulmonary resuscitation of the client's physical and
psychological well-being during the use of manual restraint; and
(D) continued monitoring by an individual trained in the
use of cardiopulmonary resuscitation of the client's physical and psychological
well-being for a minimum of 30 minutes subsequent to the termination of a
restrictive intervention;
(3) the process for identifying, training,
assessing competence of facility employees who may authorize and implement
restrictive interventions;
(4) the duties and responsibilities of
responsible professionals regarding the use of restrictive interventions;
(5) the
person responsible for documentation when restrictive interventions are used;
(6) the person responsible for the notification
of others when restrictive interventions are used; and
(7) the person responsible for checking the
client's physical and psychological well-being and assessing the possible
consequences of the use of a restrictive intervention and, in such cases there
shall be procedures regarding:
(A) documentation if a client has a physical disability
or has had surgery that would make affected nerves and bones sensitive to
injury; and
(B) the identification and documentation of alternative
emergency procedures, if needed;
(8) any room used for seclusion or isolation
time‑out shall meet the following criteria:
(A) the room shall be designed and constructed to ensure
the health, safety and well‑being of the client;
(B) the floor space shall not be less than 50 square
feet, with a ceiling height of not less than eight feet;
(C) the floor and wall coverings, as well as any
contents of the room, shall have a one‑hour fire rating and shall not
produce toxic fumes if burned;
(D) the walls shall be kept completely free of objects;
(E) a lighting fixture, equipped with a minimum of a 75
watt bulb, shall be mounted in the ceiling and be screened to prevent tampering
by the client;
(F) one door of the room shall be equipped with a
window mounted in a manner which allows inspection of the entire room;
(G) glass in any windows shall be impact resistant and
shatterproof;
(H) the room temperature and ventilation shall be
comparable and compatible with the rest of the facility; and
(I) in a lockable room the lock shall be interlocked
with the fire alarm system so that the door automatically unlocks when the fire
alarm is activated if the room is to be used for seclusion.
(9) Whenever a restrictive intervention is
utilized, documentation shall be made in the client record to include, at a
minimum:
(A) notation of the client's physical and psychological
well-being;
(B) notation of the frequency, intensity and duration of
the behavior which led to the intervention, and any precipitating circumstance
contributing to the onset of the behavior;
(C) the rationale for the use of the intervention, the
positive or less restrictive interventions considered and used and the
inadequacy of less restrictive intervention techniques that were used;
(D) a description of the intervention and the date, time
and duration of its use;
(E)
a description of accompanying positive methods of intervention;
(F) a description of the debriefing and planning with
the client and the legally responsible person, if applicable, for the emergency
use of seclusion, physical restraint or isolation time-out to eliminate or
reduce the probability of the future use of restrictive interventions;
(G) a description of the debriefing and planning with
the client and the legally responsible person, if applicable, for the planned
use of seclusion, physical restraint or isolation time-out, if determined to be
clinically necessary; and
(H) signature and title of the facility employee who
initiated, and of the employee who further authorized, the use of the
intervention.
(10) The emergency use of restrictive
interventions shall be limited, as follows:
(A) a facility employee approved to administer emergency
interventions may employ such procedures for up to 15 minutes without further
authorization;
(B) the continued use of such interventions shall be
authorized only by the responsible professional or another qualified
professional who is approved to use and to authorize the use of the restrictive
intervention based on experience and training;
(C) the responsible professional shall meet with and
conduct an assessment that includes the physical and psychological well-being
of the client and write a continuation authorization as soon as possible after the
time of initial employment of the intervention. If the responsible
professional or a qualified professional is not immediately available to
conduct an assessment of the client, but concurs that the intervention is
justified after discussion with the facility employee, continuation of the
intervention may be verbally authorized until an on‑site assessment of
the client can be made;
(D) a verbal authorization shall not exceed three hours
after the time of initial employment of the intervention; and
(E) each written order for seclusion, physical
restraint or isolation time-out is limited to four hours for adult clients; two
hours for children and adolescent clients ages nine to 17; or one hour for
clients under the age of nine. The original order shall only be renewed in
accordance with these limits or up to a total of 24 hours.
(11) The following precautions and actions shall
be employed whenever a client is in:
(A) seclusion or physical restraint, including a
protective device when used for the purpose or with the intent of controlling
unacceptable behavior: periodic observation of the client shall occur at least
every 15 minutes, or more often as necessary, to assure the safety of the
client, attention shall be paid to the provision of regular meals, bathing and
the use of the toilet; and such observation and attention shall be documented
in the client record;
(B) isolation time-out: there shall be a facility
employee in attendance with no other immediate responsibility than to monitor
the client who is placed in isolation time‑out; there shall be continuous
observation and verbal interaction with the client when appropriate; and such
observation shall be documented in the client record; and
(C) physical restraint and may be subject to injury: a
facility employee shall remain present with the client continuously.
(12) The use of a restrictive intervention shall
be discontinued immediately at any indication of risk to the client's health or
safety or immediately after the client gains behavioral control. If the client
is unable to gain behavioral control within the time frame specified in the
authorization of the intervention, a new authorization must be obtained.
(13) The written approval of the designee of the
governing body shall be required when the original order for a restrictive
intervention is renewed for up to a total of 24 hours in accordance with the
limits specified in Item (E) of Subparagraph (e)(10) of this Rule.
(14) Standing orders or PRN orders shall not be
used to authorize the use of seclusion, physical restraint or isolation
timeout.
(15) The use of a restrictive intervention shall
be considered a restriction of the client's rights as specified in G.S. 122C‑62(b)
or (d). The documentation requirements in this Rule shall satisfy the requirements
specified in G.S. 122C‑62(e) for rights restrictions.
(16) When any restrictive intervention is
utilized for a client, notification of others shall occur as follows:
(A) those to be notified as soon as possible but within
24 hours of the next working day, to include:
(i) the treatment or habilitation team, or its
designee, after each use of the intervention; and
(ii) a designee of the governing body; and
(B) the legally responsible person of a minor client or
an incompetent adult client shall be notified immediately unless she/he has
requested not to be notified.
(17) The facility shall conduct reviews and
reports on any and all use of restrictive interventions, including:
(A) a regular review by a designee of the governing
body, and review by the Client Rights Committee, in compliance with
confidentiality rules as specified in 10A NCAC 28A;
(B) an investigation of any unusual or possibly
unwarranted patterns of utilization; and
(C) documentation of the following shall be maintained
on a log:
(i) name of the client;
(ii) name of the responsible professional;
(iii) date of each intervention;
(iv) time of each intervention;
(v) type of intervention;
(vi) duration of each intervention;
(vii) reason for use of the intervention;
(viii) positive and less restrictive alternatives that
were used or that were considered but not used and why those alternatives were
not used;
(ix) debriefing and planning conducted with the
client, legally responsible person, if applicable, and staff, as specified in
Parts (e)(9)(F) and (G) of this Rule, to eliminate or reduce the probability of
the future use of restrictive interventions; and
(x) negative effects of the restrictive
intervention, if any, on the physical and psychological well-being of the
client.
(18) The facility shall
collect and analyze data on the use of seclusion and physical restraint. The
data collected and analyzed shall reflect for each incident:
(A) the type of procedure used and the length of time
employed;
(B) alternatives considered or employed; and
(C) the effectiveness of the procedure or alternative
employed.
The facility shall analyze the
data on at least a quarterly basis to monitor effectiveness, determine trends
and take corrective action where necessary. The facility shall make the data available
to the Secretary upon request.
(19) Nothing in this Rule shall be interpreted to
prohibit the use of voluntary restrictive interventions at the client's
request; however, the procedures in this Rule shall apply with the exception of
Subparagraph (f)(3) of this Rule.
(f) The restrictive intervention
shall be considered a planned intervention and shall be included in the
client's treatment/habilitation plan whenever it is used:
(1) more than four times, or for more than 40
hours, in a calendar month;
(2) in a single episode in which the original
order is renewed for up to a total of 24 hours in accordance with the limit
specified in Item (E) of Subparagraph (e)(10) of this Rule; or
(3) as a measure of therapeutic treatment
designed to reduce dangerous, aggressive, self-injurious or undesirable
behaviors to a level which will allow the use of less restrictive treatment or
habilitation procedures.
(g) When a restrictive intervention is used as a planned
intervention, facility policy shall specify:
(1) the requirement that a consent or approval
shall be considered valid for no more than six months and that the decision to
continue the specific intervention shall be based on clear and recent
behavioral evidence that the intervention is having a positive impact and
continues to be needed;
(2) prior to the initiation or continued use of
any planned intervention, the following written notifications, consents and
approvals shall be obtained and documented in the client record:
(A) approval of the plan by the responsible professional
and the treatment and habilitation team, if applicable, shall be based on an
assessment of the client and a review of the documentation required by
Subparagraph (e)(9) and (e)(14) of this Rule if applicable;
(B) consent of the client or legally responsible person,
after participation in treatment planning and after the specific intervention
and the reason for it have been explained in accordance with 10A NCAC 27D
.0201;
(C) notification of an advocate/client rights
representative that the specific intervention has been planned for the client
and the rationale for utilization of the intervention; and
(D) physician approval, after an initial medical
examination, when the plan includes a specific intervention with reasonably
foreseeable physical consequences. In such cases, periodic planned monitoring
by a physician shall be incorporated into the plan.
(3) within 30 days of initiation of the use of
a planned intervention, the Intervention Advisory Committee established in
accordance with Rule .0106 of this Section, by majority vote, may recommend
approval or disapproval of the plan or may abstain from making a
recommendation;
(4) within any time during the use of a planned
intervention, if requested, the Intervention Advisory Committee shall be given
the opportunity to review the treatment/habilitation plan;
(5) if any of the persons or committees
specified in Subparagraphs (h)(2) or (h)(3) of this Rule do not approve the
initial use or continued use of a planned intervention, the intervention shall
not be initiated or continued. Appeals regarding the resolution of any
disagreement over the use of the planned intervention shall be handled in
accordance with governing body policy; and
(6) documentation in the client record
regarding the use of a planned intervention shall indicate:
(A) description and frequency of debriefing with the
client, legally responsible person, if applicable, and staff if determined to
be clinically necessary. Debriefing shall be conducted as to the level of
cognitive functioning of the client;
(B) bi-monthly evaluation of the planned by the
responsible professional who approved the planned intervention; and
(C) review, at least monthly, by the
treatment/habilitation team that approved the planned intervention.
History Note: Authority
G.S. 122C‑51; 122C‑53; 122C‑60; 122C‑62; 131E-67; 143B‑147;
Eff. February 1, 1991;
Amended Eff. January 4, 1993; January 1, 1992;
Temporary Amendment
Eff. January 1, 2001;
Temporary Amendment
Expired October 13, 2001;
Amended Eff. April 1, 2003.
10a ncac 27e .0105 PROTECTIVE DEVICES
(a) Whenever a protective device is utilized for a client,
the governing body shall develop and implement policy to ensure that:
(1) the necessity for the protective device has
been assessed and the device is applied by a facility employee who has been
trained and has demonstrated competence in the utilization of protective
devices;
(2) the use of positive and less restrictive
alternatives have been reviewed and documented and the protective device
selected is the appropriate measure;
(3) the client is frequently observed and
provided opportunities for toileting, exercise, etc. as needed. When a
protective device limits the client's freedom of movement, the client shall be
observed at least every hour. Whenever the client is restrained and subject to
injury by another client, a facility employee shall remain present with the
client continuously. Observations and interventions shall be documented in the
client record;
(4) protective devices are cleaned at regular
intervals; and
(5) for facilities operated by or under
contract with an area program, the utilization of protective devices in the
treatment/habilitation plan shall be subject to review by the Client Rights
Committee, as required in 10A NCAC 27G .0504. Copies of this Rule and other
pertinent rules are published as Division publication RULES FOR MENTAL HEALTH,
DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES, APSM 30-1,and may be
purchased at a cost of five dollars and seventy-five cents ($5.75) per copy.
(b) The use of any protective device for the purpose or
with the intent of controlling unacceptable behavior shall comply with the
requirements of Rule .0104 of this Section.
History Note: Authority G.S. 122C‑51; 122C‑53;
122C‑60; 143B‑147;
Eff. February 1, 1991;
Amended Eff. January 4, 1993; January 1, 1992;
Temporary Amendment Eff. January 1, 2001;
Amended Eff. August 1, 2002.
10A NCAC 27e .0106 INTERVENTION ADVISORY COMMITTEES
(a) An Intervention Advisory Committee shall
be established to provide additional safeguards in a facility that utilizes
restrictive interventions as planned interventions as specified in Rule
.0104(g) of this Section.
(b) The membership of the Intervention
Advisory Committee shall include at least one person who is or has been a
consumer of direct services provided by the governing body or who is a close
relative of a consumer and:
(1) for a facility operated by
an area program, the Intervention Advisory Committee shall be the Client Rights
Committee or a subcommittee of it, which may include other members;
(2) for a facility that is not
operated by an area program, but for which a voluntary client rights or human
rights committee has been appointed by the governing body, the Intervention
Advisory Committee shall be that committee or a subcommittee of it, which may
include other members; or
(3) for a facility that does not
meet the conditions of Subparagraph (b)(1) or (2), the committee shall include
at least three citizens who are not employees of, or members of the governing
body.
(c) The Intervention Advisory Committee
specified in Subparagraphs (b)(2) or (3) shall have a member or a regular
independent consultant who is a professional with training and expertise in the
use of the type of interventions being utilized, and who is not directly
involved in the treatment or habilitation of the client.
(d) The Intervention Advisory Committee
shall:
(1) have policy that governs its
operation and requirements that:
(A) access to client information shall be
given only when necessary for committee members to perform their duties;
(B) committee members shall have access
to client records on a need to know basis only upon the written consent of the
client or his legally responsible person as specified in G.S. 122C‑53(a);
and
(C) information in the client record
shall be treated as confidential information in accordance with G.S. 122C‑52
through 122C‑56;
(2) receive specific training
and orientation as to the charge of the committee;
(3) be provided with copies of
appropriate statutes and rules governing client rights and related issues;
(4) be provided, when available,
with copies of literature about the use of a proposed intervention and any
alternatives;
(5) maintain minutes of each
meeting; and
(6) make an annual written
report to the governing body on the activities of the committee.
History Note: Authority G.S. 122C‑51 through 122C‑56;
143B‑147;
Eff. February 1, 1991;
Amended Eff. January 1, 1992.
10A ncac 27E .0107 Training ON ALTERNATIVES TO Restrictive
iNTERVEntions
(a) Facilities shall implement policies and practices that
emphasize the use of alternatives to restrictive interventions.
(b) Prior to providing services to people with disabilities,
staff including service providers, employees, students or volunteers, shall
demonstrate competence by successfully completing training in communication
skills and other strategies for creating an environment in which the likelihood
of imminent danger of abuse or injury to a person with disabilities or others
or property damage is prevented.
(c) Provider agencies shall establish training based on
state competencies, monitor for internal compliance and demonstrate they acted
on data gathered.
(d) The training shall be competency-based, include
measurable learning objectives, measurable testing (written and by observation
of behavior) on those objectives and measurable methods to determine passing or
failing the course.
(e) Formal refresher training
must be completed by each service provider periodically (minimum annually).
(f) Content of the training that
the service provider wishes to employ must be approved by the Division of
MH/DD/SAS pursuant to Paragraph (g) of this Rule.
(g) Staff shall demonstrate
competence in the following core areas:
(1) knowledge and understanding of the people
being served;
(2) recognizing and interpreting human
behavior;
(3) recognizing the effect of internal and
external stressors that may affect people with disabilities;
(4) strategies for building positive
relationships with persons with disabilities;
(5) recognizing cultural, environmental and
organizational factors that may affect people with disabilities;
(6) recognizing the importance of and assisting
in the person's involvement in making decisions about their life;
(7) skills in assessing individual risk for
escalating behavior;
(8) communication strategies for defusing and
de-escalating potentially dangerous behavior; and
(9) positive behavioral supports (providing
means for people with disabilities to choose activities which directly oppose
or replace behaviors which are unsafe).
(h) Service providers shall
maintain documentation of initial and refresher training for at least three
years.
(1) Documentation shall include:
(A) who participated
in the training and the outcomes (pass/fail);
(B) when and where they attended; and
(C) instructor's name;
(2) The Division of MH/DD/SAS may
review/request this documentation at any time.
(i) Instructor Qualifications and Training Requirements:
(1) Trainers shall demonstrate competence by
scoring 100% on testing in a training program aimed at preventing, reducing and
eliminating the need for restrictive interventions.
(2) Trainers shall demonstrate competence by
scoring a passing grade on testing in an instructor training program.
(3) The training shall be
competency-based, include measurable learning objectives, measurable testing
(written and by observation of behavior) on those objectives and measurable
methods to determine passing or failing the course.
(4) The content of the
instructor training the service provider plans to employ shall be approved by
the Division of MH/DD/SAS pursuant to Subparagraph (i)(5) of this Rule.
(5) Acceptable instructor
training programs shall include but are not limited to presentation of:
(A) understanding
the adult learner;
(B) methods
for teaching content of the course;
(C) methods
for evaluating trainee performance; and
(D) documentation
procedures.
(6) Trainers shall have coached experience
teaching a training program aimed at preventing, reducing and eliminating the
need for restrictive interventions at least one time, with positive review by
the coach.
(7) Trainers shall teach a training program
aimed at preventing, reducing and eliminating the need for restrictive
interventions at least once annually.
(8) Trainers shall complete a refresher
instructor training at least every two years.
(j) Service providers shall maintain documentation of initial and
refresher instructor training for at least three years.
(1)
Documentation shall include:
(A) who participated in the training and the outcomes
(pass/fail);
(B) when and where attended; and
(C) instructor's name.
(2) The
Division of MH/DD/SAS may request and review this documentation any time.
(k) Qualifications of Coaches:
(1) Coaches shall meet all preparation
requirements as a trainer.
(2) Coaches shall teach at least three times
the course which is being coached.
(3) Coaches shall demonstrate competence by
completion of coaching or train-the-trainer instruction.
(l) Documentation shall be the same preparation as for trainers.
History Note: Authority G.S. 143B‑147;
Temporary Adoption Eff. February 1, 2001;
Temporary Adoption Expired October 13, 2001;
Eff. April 1, 2003.
10a ncac 27e .0108 TRAINING in SECLUSION, PHYSICAL
RESTRAINT and isolation time-out
(a) Seclusion, physical restraint and isolation time-out
may be employed only by staff who have been trained and have demonstrated
competence in the proper use of and alternatives to these procedures.
Facilities shall ensure that staff authorized to employ and terminate these
procedures are retrained and have demonstrated competence at least annually.
(b) Prior to providing direct care to people with
disabilities whose treatment/habilitation plan includes restrictive
interventions, staff including service providers, employees, students or
volunteers shall complete training in the use of seclusion, physical
restraint and isolation time-out and shall not use these interventions until
the training is completed and competence is demonstrated.
(c) A pre-requisite for taking this training is
demonstrating competence by completion of training in preventing, reducing and
eliminating the need for restrictive interventions.
(d) The training shall be competency-based, include
measurable learning objectives, measurable testing (written and by observation
of behavior) on those objectives and measurable methods to determine passing or
failing the course.
(e) Formal refresher training must be completed by each
service provider periodically (minimum annually).
(f) Content of the training that the service provider plans
to employ must be approved by the Division of MH/DD/SAS pursuant to Paragraph
(g) of this Rule.
(g) Acceptable training programs shall include, but are not
limited to, presentation of:
(1) refresher information on alternatives to
the use of restrictive interventions;
(2) guidelines on when to intervene
(understanding imminent danger to self and others);
(3) emphasis on safety and respect for the
rights and dignity of all persons involved (using concepts of least restrictive
interventions and incremental steps in an intervention);
(4) strategies for the safe implementation of
restrictive interventions;
(5) the use of emergency safety interventions
which include continuous assessment and monitoring of the physical and
psychological well-being of the client and the safe use of restraint throughout
the duration of the restrictive intervention;
(6) prohibited procedures;
(7) debriefing strategies, including their
importance and purpose; and
(8) documentation methods/procedures.
(h) Service providers shall maintain documentation of
initial and refresher training for at least three years.
(1) Documentation shall include:
(A) who participated
in the training and the outcomes (pass/fail);
(B) when and where
they attended; and
(C) instructor's
name.
(2) The
Division of MH/DD/SAS may review/request this documentation at any time.
(i) Instructor Qualification and Training Requirements:
(1) Trainers shall demonstrate competence by
scoring 100% on testing in a training program aimed at preventing, reducing and
eliminating the need for restrictive interventions.
(2) Trainers shall demonstrate competence by
scoring 100% on testing in a training program teaching the use of seclusion,
physical restraint and isolation time-out.
(3) Trainers shall demonstrate competence by
scoring a passing grade on testing in an instructor training program.
(4) The training shall be competency-based,
include measurable learning objectives, measurable testing (written and by
observation of behavior) on those objectives and measurable methods to
determine passing or failing the course.
(5) The content of the instructor training the
service provider plans to employ shall be approved by the Division of MH/DD/SAS
pursuant to Subparagraph (j)(6) of this Rule.
(6) Acceptable
instructor training programs shall include, but not be limited to, presentation
of:
(A) understanding the adult learner;
(B) methods for teaching content of the course;
(C) evaluation of trainee performance; and
(D) documentation procedures.
(7) Trainers shall be retrained at least
annually and demonstrate competence in the use of seclusion, physical restraint
and isolation time-out, as specified in Paragraph (a) of this Rule.
(8) Trainers shall be currently trained in CPR.
(9) Trainers shall have coached experience in
teaching the use of restrictive interventions at least two times with a
positive review by the coach.
(10) Trainers shall teach a program on the use of
restrictive interventions at least once annually.
(11) Trainers shall complete a refresher
instructor training at least every two years.
(k) Service providers shall maintain documentation of
initial and refresher instructor training for at least three years.
(1) Documentation shall include:
(A) who participated in the training and the outcome
(pass/fail);
(B) when and where they attended; and
(C) instructor's name.
(2) The Division of
MH/DD/SAS may review/request this documentation at any time.
(l) Qualifications of Coaches:
(1) Coaches shall meet all preparation
requirements as a trainer.
(2) Coaches shall teach at least three times,
the course which is being coached.
(3) Coaches shall demonstrate competence by
completion of coaching or train-the-trainer instruction.
(m)
Documentation shall be the same preparation as for trainers.
History Note: Authority G.S. 143B‑147;
Temporary Adoption Eff. February 1, 2001;
Temporary Adoption Expired October 13, 2001;
Eff. April 1, 2003.
SECTION .0200 ‑ PROTECTIONS REGARDING MEDICATIONS
10a NCAC 27e .0201 SAFEGUARDS REGARDING MEDICATIONS
(a) The use of experimental drugs or
medication shall be considered research and shall be governed by G.S. 122C‑57(f),
applicable federal law, licensure requirements codified in 10A NCAC 27G .0209,
or any other applicable licensure requirements not inconsistent with state or
federal law.
(b) The use of other drugs or medications as
a treatment measure shall be governed by G.S. 122C‑57, and G.S. 90,
Articles 1, 4A and 9A.
History Note: Authority G.S. 122C‑51; 122C‑57;
131E‑67; 143B‑147;
Eff. February 1, 1991;
Amended Eff. January 1, 1992.