Link to law: http://reports.oah.state.nc.us/ncac/title 10a - health and human services/chapter 27 - mental health, community facilities and services/subchapter e/subchapter e rules.html
Published: 2015

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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.