« Back to all Disability Topics

Restraint in Statewide Inpatient Psychiatric Program (SIPP)

In Florida, an individual who is in a Statewide Inpatient Psychiatric Program (SIPP) 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 or chemical restraints. This does not include protective medical devices used for the protection of injury. Any form of restraint requires a doctor’s order and 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 does not mean “time out”, “time out from positive reinforcement”, or isolation for medical reasons. Restraint must not be implemented automatically or as part of a slow-down plan for undesirable behavior. Upon initiating a restraint on a youth with a mental health diagnosis, staff must immediately notify the highest-level direct care supervisor. This person must meet certain qualifications outlined by the State. Restraints must be terminated immediately when the emergency situation ends.

Program and Staff Requirements for Use of Restraint

Each Statewide Inpatient Psychiatric Program (SIPP) must have policies and procedures related to the use of restraints (physical, including four point restraint, mat wrap, range of motion, as well as chemical restraint) that follow the standards outlined in the Florida Administrative Code. Restraints can only be used if a sufficient number of trained and certified staff is available to ensure its safe implementation. 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 additional 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. Foreign objects that might be a hazard to safety of the youth must be removed prior to the youth entering the room. If a youth exhibits behavior that requires the use of restraints more than two times in any thirty-day period or six times in any twelve-month period; then the facility or provider must submit a request for behavioral analysis services for that youth, including documentation of the frequency of reactive (seclusion and restraint) strategy use.

Limitations on Use of Restraint

Restraint must be ended when the emergency ends. Facilities and providers must have pre-determined behavioral criteria for ending each use of seclusion, and the youth must be released within five minutes of meeting those criteria. Restraint should be limited to up to one hour in duration, but additional time may be added by the authorizing agent if that person determines that the emergency situation continues to exist. Each facility and provider has its own policies and procedures related to the use of restraint. If you want to know what they are, ask the facility administration or the provider for a copy.

Initial Assessments

When a person is admitted to a Statewide Inpatient Psychiatric Program (SIPP), the 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 the youth at risk during seclusion or restraint
  • History of trauma, including sexual or physical abuse and past trauma from seclusion or restraint
  • A Youth Safety Plan must be developed and followed (A Youth Safety Plan is developed by the youth at a calm time. The plan sets the guidelines for how the youth wants to calm down and tools or people he/she wants to help him/her stay in control. This reduces trauma for the youth and allows the youth to learn his/her trigger behavior.)

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. Restraints cannot be used with staff putting pressure on the back or abdomen area that could cause the youth to stop breathing.  The youth’s nose and mouth must not be covered or impeded.  In addition, a youth’s hands may not be restrained behind his or her back for any reason or in any situation. 

Complaints

Every Statewide Inpatient Psychiatric Program (SIPP) should have a complaint process in place to investigate complaints made by a youth in the facility or by a guardian, family member, friend or other interested individual. Sometimes, this is called a “grievance” or “complaint” procedure.

If you believe that a youth has been unjustly restrained in a manner that violated the youth’s rights, you may also contact:

  • Florida Abuse Hotline 1-800-962-2873,
  • Florida Statewide Advocacy Council (SAC) 1-800-342-0825, or
  • The Advocacy Center for Persons with Disabilities, Inc. 1-800-342-0823

Links