Restraint in Developmental Disability Facilities

Including group homes, Developmental Disability Centers (DDC), and the Comprehensive Transitional Education Program (CTEP or “Carlton Palms”)

In Florida, an individual who has a developmental disability (DD) can only be restrained to control behaviors that create an emergency or crisis situation. Restraint means the immobilization of a person’s body in order to restrict movement by physically holding or by the use of mechanical devices or medications. Restraint does not include health related protective medical devices, orthopedic equipment, or other restraints used for medical treatment, devices used to support functional body position, or equipment used for safety during transportation. Chemical restraint requires a doctor’s order, and other forms of restraint require the authorization of a Certified Behavior Analyst or other qualified individual as outlined in the state rules. All forms of restraint require specific documentation. Restraint is not to be used as punishment, to compensate for inadequate staffing or for the convenience of staff.

It’s important to remember that every effort should be made by staff to avoid unnecessary use of restraints, and should therefore try to redirect and diffuse problem behavior before it reaches crisis proportions.

Each facility or provider has developed its own policies and procedures related to the use of restraint. If you want to know what they are, ask the facility administrator for a copy.

Restraint Process

Requirements for Use of Restraint

Restraint must not be implemented automatically or as part of a slow-down plan for undesirable behavior. Each facility or provider must have policies and procedures related to the use of restraints (physical, including four point restraint, mat wrap, range of motion, and chemical restraint) that follow the standards outlined in the Florida Administrative Code (F.A.C.) 65G-8.  Upon initiating a restraint procedure on a person with developmental disabilities (DD), staff must immediately notify the highest-level direct care supervisor. Restraints must be terminated immediately when the emergency ends.

Staff Requirements for Use of Restraint

Restraints can only be used if a sufficient number of trained and certified staff is available to ensure its safe implementation.  Staff must meet certain qualifications that are outlined by the State of Florida.  Staff must be trained using an emergency procedure curriculum that has been approved by the Agency for Persons with Disabilities (APD).

Length of Time for Use of Restraint

Restraints lasting longer than one hour require approval by a designated staff person, or “authorizing agent”.  A person cannot be restrained for more than two hours without the authorizing agent performing a visual review and approval of the procedure.  Each use of restraints, however, requires continuous staff monitoring.

Conditions for Use of Restraint

  • Any room used for restraint must have sufficient lighting and ventilation to permit a person to see and breathe normally. 
  • The room must have enough space so that the person can lie down comfortably. 
  • Before initiating a restraint procedure, staff must inspect the environment and the individual and remove any objects that might present a hazard to the individual’s safety. 
  • A person mechanically restrained for more than one hour must be given an opportunity for motion and exercise for at least ten minutes of each hour that the individual is restrained.

Limitations on Use of Restraint

If a person with a developmental disability is restrained more than two times in any thirty-day period or six times in any twelve-month period, then the facility or provider should submit a request for behavioral analysis services for that person, including documentation of the frequency of “reactive strategies” (seclusion and restraint) use.  This means that a behavioral assessment must be conducted to determine why the individual is engaging in the dangerous behavior, and that an individualized behavior intervention plan must be put in place.

Release While in Restraint

  • Restraint must be ended when the emergency ends.  Facilities and providers must have pre-determined behavioral criteria for ending restraint, plus release the individual within five minutes of meeting those criteria, unless an exemption applies.  Facilities and providers may request an exemption by Florida Law (Section 120.542, Florida Statute.) if they believe strict adherence to the rules governing restraint and seclusion can lead to undesirable negative outcomes.
  • Restraint should be limited to one hour in duration, but additional time may be added by the authorizing agent if that person determines an emergency situation still exists. 

Initial Assessments

When a person is admitted to a facility or program, the facility or program must obtain information about the individual that relates to the use of “reactive strategies” (seclusion and restraint). This information should come from a variety of sources, be documented in the person’s records, and be updated at least annually. Information should include:

  • Medical conditions or physical limitations that would place him or her at risk during seclusion or restraint; and
  • History of trauma, including sexual or physical abuse and past trauma through seclusion or restraint

Prohibited Procedures

Restraint cannot be used on a “PRN” or “as required” basis. Restraint cannot be used if it may worsen a known medical or physical condition. Any procedure that might restrict or obstruct an individual’s airway or impair breathing, including techniques where staff applies pressure to the head, neck, back, chest, abdomen, or joints may not be used. In addition, a person’s hands may not be restrained behind his or her back.

Complaints

Every facility or program should have a complaint process in place to investigate complaints made by a person in the facility or by a guardian, family member, friend or other interested individual. Sometimes this is called a “grievance” process. If you believe that a person has been unjustly restrained, or secluded in a manner that violated the person’s rights you may also contact:

  • Florida Abuse Hotline 1-800-962-2873, or
  • Disability Rights Florida 1-800-342-0823