Seclusion in Developmental Disability Facilities

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

In Florida, an individual who has a developmental disability (DD) can only be secluded to control behaviors that create an emergency or crisis situation. Seclusion is forced isolation or confinement of a person in a room or area away from other people. Seclusion, however, does not mean “time out”, “time out from positive reinforcement”, or isolation for medical reasons. People in DD facilities cannot be secluded automatically or as part of a slow-down plan for undesirable behaviors, as punishment, as a substitute for an implementation plan, or for the convenience of staff. It’s important to remember that every effort should be made by staff to avoid unnecessary use of seclusion, and should therefore try to redirect and lessen problematic behavior before it creates a crisis situation.

Each facility or provider must have policies and procedures related to the use of seclusion that follow the state standards. If you want to know what they are, ask the facility or provider for a copy.

Seclusion Process

Requirements for Use of Seclusion

Seclusion lasting longer than one hour requires approval by a designated staff person, or “authorizing agent”.  This person must meet certain qualifications that are outlined by the State of Florida.  A person cannot be secluded for more than two hours without the authorizing agent performing a visual review and approval of the procedure.  Each use of seclusion, however, requires continuous staff monitoring.

Staff Qualifications for Use of Seclusion

Each facility or provider must have policies and procedures related to the use of seclusion that follow the standards outlined in Florida Administrative Code (F.A.C.) 65G-8.  Seclusion can only be used if a sufficient number of trained and certified staff are available to ensure it is safe.   Staff must be trained in an emergency procedure course that has been approved by the Agency for Persons with Disabilities (APD).

Conditions for Seclusion

  • Any room used for seclusion 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. 
  • Foreign objects that might be a hazardous/dangerous to the safety of the individual must be removed. 
  • The door to the room must not be locked, however, it can be held shut by a staff person using a spring bolt, magnetic hold, or other mechanism. 
  • Forensic facilities may seek a waiver or variance from this requirement from APD.

Limitations on Use of Seclusion

If a person with a developmental disability or disabilities is secluded 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 (restraint and seclusion) strategy use.  This means that a behavioral assessment must be conducted to determine why the individual is engaging in the dangerous behavior, and for an individualized behavior intervention plan to be put in place.

Release from Seclusion

Seclusion must be ended when the emergency ends.  Facilities and providers must establish desired behavioral criteria for ending seclusion, and the person must be released within five (5) minutes of meeting those criteria.  However, providers and facilities can seek an exemption from this requirement through a process outlined in Florida Statute.

Seclusion should be limited to one (1) 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
  • History of trauma, including sexual or physical abuse and past trauma through seclusion or restraint

Prohibited Procedures

Seclusion cannot be used on a “PRN” or “as required” basis. Seclusion cannot be used if it may worsen a known medical or physical condition. In addition, a person’s hands may not be restrained behind his or her back, whether they are in seclusion or not.

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 secluded, 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

“Time Out” and “Seclusion”

Seclusion does not mean “time out”. Time out from positive reinforcement means a procedure designed to interrupt a specific behavior of an individual by temporarily removing that individual to a separate area or room or by screening him or her from others, or by signaling that the individual is in “time out”. “Time out” is:

  • of short duration, as brief as one minute, and never longer than twenty (20) uninterrupted minutes;
  • only done in response to a specific behavior;
  • part of a written program that includes a functional assessment and is approved by a local Review Committee;
  • a program implemented by either by a Certified Behavior Analyst or a clinical social worker, mental health counselor or therapist licensed under Chapter 491, Florida Statute.;
  • not used for threat, disciplinary acts, or as a tool for staff convenience; and
  • stopped after one minute of calm behavior, then the youth can return to activities. During each use of seclusion, information must be collected for review, evaluation and analysis.