Guam § 82610 - Seclusion and Restraint Policy.

§ 82610. Seclusion and Restraint Policy.

The Government of Guam’s use of restraint or seclusion shall be strictly

limited to emergencies when there is imminent risk of an individual

physically harming himself or others and nonphysical intervention is not

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effective. This Section applies to all direct care providers within Government

of Guam agencies and agents and employees of the Government of Guam

who provide services to persons with mental difficulties, behavioral

difficulties and developmental disabilities, but not the Department of

Corrections and Guam Police Department. Direct care providers means

personnel working with persons with mental difficulties, behavioral

difficulties and developmental disabilities who are subject to a behavior

plan, individualized educational plan or a similar plan.

(a) Training Program. An agency employing direct care providers

shall provide a minimum of sixteen (16) hours to newly hired providers

and annual follow-up training at a minimum of eight (8) hours. The

training shall instruct providers in the following:

(1) reducing the use of seclusion and restraint through risk

assessment and early intervention, which includes nonphysical

intervention;

(2) needs and behaviors of the population served (e.g. age,

gender, adults, or children);

(3) relationship building;

(4) proper and permissible techniques for seclusion, physical

holds and chemical restraints for the population served, including

risks versus benefits;

(5) preventive techniques for restraint and seclusion,

including a safe and calm physical environment;

(6) positive alternatives to restraint and seclusion;

(7) de-escalation methods;

(8) avoidance of power struggles;

(9) thresholds for restraints and seclusion;

(10) the physiological and psychological impact of restraint

and seclusion;

(11) monitoring physical signs of distress and obtaining

medical assistance;

(12) legal issues;

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(13) positional asphyxia;

(14) escape and evasion techniques;

(15) time limits;

(16) the process for obtaining approval for continued

restraints;

(17) procedures to address problematic restraints;

(18) documentation of restraints and seclusion;

(19) debriefing after the use of restraints and seclusion with

the client or student, the client’s or student’s family member, or

authorized representative, as well as staff members; and

(20) processing with clients or students, and follow-up with

personnel, and investigation of injuries and complaints.

(b) Reporting Requirements. Direct care providers shall document

the use of every restraint defined in §§ 82101(h) and 82101(i), Article

1, Chapter 82, Title 10 GCA on an incident report. Any injury as a

result of restraint or seclusion shall be reported immediately to

professional staff, Guam Behavioral Health and Wellness Center,

Department of Public Health and Social Services, and the territorial

protection and advocacy office or its successor.

Government of Guam agencies and agents and employees of the

government of Guam who provide services to persons with mental

difficulties, behavioral difficulties and developmental disabilities shall

report all deaths and severe injuries to Guam Behavioral Health and

Wellness Center, Department of Integrated Services for Individuals

with Disabilities, and the territorial protection and advocacy office or its

successor. Each agency shall maintain and update a list of all deaths,

severe injuries, and the frequency of its facility’s use of seclusion and

restraint on an annual basis and shall post the same on its website with

a proper regard for client and student confidentiality.

(c) Prohibited Acts.

(1) seclusion is prohibited in school settings;

(2) chemical restraint is prohibited unless prescribed by a

physician who specifies the duration and circumstances under

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which the restraints are to be used, and shall be indicated in a

client or student's individualized treatment plan.

(3) a physical restraint or containment technique that

obstructs a person's respiratory airway or impairs the person's

breathing or respiratory capacity, including techniques in which a

staff member places pressure on a person's back or places his or

her body weight against the person's torso or back is prohibited.

(4) a pillow, blanket, or other item covering the person's face

as part of a physical or mechanical restraint or containment

process is prohibited.

(5) prone restraint on a person at risk for positional

asphyxiation as a result of one of the following risk factors that are

known to the personnel is prohibited:

(A) obesity;

(B) pregnancy;

(C) agitated delirium or excited delirium syndromes;

(D) cocaine, methamphetamine, or alcohol intoxication;

(E) exposure to pepper spray;

(F) preexisting heart disease, including, but not limited

to, an enlarged heart or other cardiovascular disorders; and/or

(G) respiratory conditions, including emphysema,

bronchitis, or asthma.