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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-23. [RESERVED] |
Section 29-2366. SPECIALITY SERVICES -- STANDARDS FOR BEHAVIORAL MANAGEMENT
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2366.1 A substance abuse treatment facility or program shall develop written policies and procedures that define the use of behavior management, including time-out, physical, mechanical and chemical restraint, seclusion, and the use of positive and negative reinforcement.
(a) The facility or program shall prohibit by policy and practice the following practices:
(1) Aversive conditioning of any kind;
(2) Withholding of food, water or bathroom privileges;
(3) Painful stimuli; or
(4) Corporal punishment.
(b) Required behavior management policies and procedures shall be:
(1) Approved by the facility’s or program’s executive director or if a governmental entity, approved by the governing Department;
(2) Made available to all program employees and providers;
(3) Made available to individuals, their families and others upon request;
(4) Developed with the participation of the persons served and, whenever possible, family members or advocates, or both; and
(5) Be consistent with rules developed by the Department regarding patient rights.
(c) Time-out does not preclude the use of behavior-modifying techniques such as ignoring undesirable behaviors or withdrawing attention due to behavior.
2366.2 All substance abuse treatment facility or program staff involved in person to-person contact and behavior management shall receive training in the safe and effective use of all behavior management methods permitted by facility or program policy.
2366.3 Training shall be documented in the employee’s personnel file and shall be updated as needed but at least annually. The facility or program manual shall specify which staff are included or excluded from this requirement.
2366.4 If a substance abuse treatment facility or program utilizes chemical, physical and mechanical restraints, such restraints shall be used only if ordered by a practitioner in emergency situations where the potential exists for self-harm or harm to others.
2366.5 A substance abuse treatment facility or program shall use emergency restraint only when less restrictive alternatives have failed and only to reduce or eliminate a substantial risk of serious physical harm to the patient, staff or others. Any use of restraint shall conform to the facility or program’s policies and procedures regarding restraint.
2366.6 The staff of a substance abuse treatment facility or program shall evaluate patients who required emergency restraint on more than one (1) occasion during any thirty (30) day periods for appropriateness of continued participation in the facility or program.
2366.7 A director of a substance abuse treatment facility or program shall review each use of emergency restraint within two (2) business days of its occurrence. The quality improvement committee shall review monthly incidents and appropriateness of corrective actions taken and make recommendations regarding any further process improvements needed to reduce the use of restraints.
2366.8 The staff of a substance abuse treatment facility or program shall document the use of any restraint in the patient’s record and shall include the rationale for the order of emergency restraint, the type of restraint and the signature of the practitioner ordering the restraint.
2366.9 Immediately after use of a restraint, the facility or program staff shall take appropriate steps to ensure the patient’s safety including, but not limited to:
(a) Arranging for a more restrictive treatment setting;
(b) Contacting the Department, police, patient’s family and physician, as appropriate; and
(c) Arranging for an ambulance or hospitalization.
2366.10 The facility or program staff shall document any harmful effects to a patient due to the use of emergency restraint and shall bring those effects to the immediate attention of the substance abuse treatment facility or program director.