Section 57.27. Behavior intervention.

 

(1)   Prohibited measures. No licensee, staff member, or volunteer may do any of the following:

(a) Hit, shake, pinch, push, twist or use any other means that the staff member or volunteer knows or should know may inflict mental or physical harm or actions that may be psychologically, emotionally or physically painful to a resident.

(b) Verbally abuse a resident or use profanity, or any language that the staff member or volunteer knows or should know may ridicule a resident.

(c) Lock a resident in a room or any other place.

(d) Use any item to cover a resident's head or face or wrap the resident's body with sheets, blankets, or any other material.

(e) Require a resident to march, stand, kneel, or assume and remain in any fixed position or assign work that is not therapeutic and not a part of the resident's treatment plan.

(f) Release any noxious, toxic or otherwise unpleasant substances near the eyes or face of a resident.

(g) Authorize, direct or ask a resident to discipline another resident.

(h) Discipline one resident for the behavior or action of another resident.

(i) Employ any measure that the staff member or volunteer knows or should know is aversive, cruel, humiliating or that may be psychologically, emotionally, or physically painful, discomforting, dangerous, or potentially injurious to a resident.

(j) Use any mechanical restraint or equipment that restricts the movement of an resident or a portion of the resident's body as behavior intervention.

(k) Use a prone restraint that places a resident in a face down position as behavior intervention.

(2)   Time-outs.

(a) As used in this subsection, "time-out" means a behavior intervention technique that involves brief periods of physical separation of a resident from others.

(b) A time-out may not be used for the convenience of staff members or volunteers, as a substitute for supervision of a resident, or for a child under 3 years old.

(c) Areas used for time-outs shall be free of objects with which a resident could self-inflict bodily harm, shall provide a staff view of the resident at all times and shall be equipped with adequate ventilation and lighting.

(d) The use of time-outs shall be appropriate to the developmental level and the age of the resident and may not be for a period longer than the period of time necessary for the resident to regain control. The maximum length of time that a resident may be in a time-out on each occurrence of a time-out is as follows:

1. For a child 3 through 6 years of age, a time-out may not exceed 10 minutes.

2. For a child 7 through 10 years of age, a time-out may not exceed 15 minutes.

3. For a child over 11 years of age, a time-out may not exceed 30 minutes. The need for continued use of a time-out shall be reviewed at least every 10 minutes and documented in the resident's record.

(e) A resident that is in a time-out shall be permitted use of the toilet if requested.

(f) Any resident that is in a time-out shall be within hearing of a staff member.

(g) Within 12 hours of occurrence, there shall be documentation in the resident's record of each time-out, including the name of each staff member involved, the length of the time-out, and rationale for use.

(3)   Emergency safety intervention.

(a) A staff member may not use any type of physical restraint on a resident unless the resident's behavior presents an imminent danger of harm to self or others and physical restraint is necessary to contain the risk and keep the resident and others safe.

(b) A staff member shall attempt other feasible alternatives to de-escalate a resident and situation before using physical restraint.

(c) A staff member may not use physical restraint as disciplinary action, for the convenience of the staff member, or for therapeutic purposes.

(d) If physical restraint is necessary under par. (a) , a staff member may only use the physical restraint in the following manner:

1. With the least amount of force necessary and in the least restrictive manner to manage the imminent danger of harm to self or others.

2. That lasts only for the duration of time that there is an imminent danger of harm to self or others.

3. That does not include any of the following:

a. Any maneuver or technique that does not give adequate attention and care to protection of the resident's head.

b. Any maneuver that places pressure or weight on the resident's chest, lungs, sternum, diaphragm, back, or abdomen causing chest compression.

c. Any maneuver that places pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the resident's head or neck, or that otherwise obstructs or restricts the circulation or blood or obstructs an airway, such as straddling or sitting on the resident's torso.

d. Any type of choke hold.

e. Any technique that uses pain inducement to obtain compliance or control, including punching, hitting, hyperextension of joints, or extended use of pressure points for pain compliance.

f. Any technique that involves pushing on or into a resident's mouth, nose, or eyes, or covering the resident's face or body with anything, including soft objects, such as pillows, washcloths, blankets, and bedding.

4. Notwithstanding subd. 3. f. , if a resident is biting himself or herself or other persons, a staff member may use a finger in a vibrating motion to stimulate the resident's upper lip and cause the resident's mouth to open and may lean into the bite with the least amount of force necessary to open the resident's jaw.

(e) After an episode of physical restraint, a debriefing shall take place with the resident and staff that were involved in the physical restraint.

(f) Each staff member who uses a physical restraint or who witnesses the use of a physical restraint shall, within 24 hours of each incident, give the group home manager a written description of the incident. The group home manager shall document each incident, including date, time, and a description of the circumstances of the incident, and report the incident to the field office that serves the group home and the placing agency as required under s. DCF 57.13 (1) (c) and (5) . Each description shall include all of the following:

1. The name, age, and sex of each resident involved.

2. The date, time, and location of the incident.

3. The name and job title of each staff member involved in the restraint and each staff member or volunteer who witnessed the use of the restraint.

4. Circumstances leading up to the use of restraint, the behavior that prompted the restraint, efforts made to de-escalate the situation and the alternatives to restraint that were attempted.

5. A description of the administration of the restraint, including the holds used and the reasons the holds were necessary.

6. The beginning and ending time of the restraint and how the restraint ended.

7. Behavior of the resident during and after the use of the restraint.

8. Any injuries sustained by a resident or staff member and any medical care provided, including the name and title of the person providing the care.

9. Any follow-up debriefing provided to residents and staff.

CR 04-067 : cr. Register September 2005 No. 597 , eff. 1-1-06; correction in (3) (c) (intro.) made under s. 13.92 (4) (b) 7. , Stats., Register November 2008 No. 635 ; EmR1106 : emerg. cr. (1) (j), (k), r. and recr. (3), eff. 9-16-11; CR 11-026 : cr. (1) (j), (k), r. and recr. (3) Register December 2011 No. 672 , eff. 1-1-12.