Chapter DCF 52

DCF 52.42(1)(f) (f) “Physical hold restraint” means that a resident is temporarily physically restrained by a staff member.

DCF 52.42(1)(g) (g) “Time-out room” means a designated room used for temporarily holding a resident who is in physically enforced separation from other residents.

DCF 52.42(2) (2) Monitor and review responsibility.

DCF 52.42(2)(a) (a) A center shall assign to a professional staff member the responsibility to monitor and review, on an ongoing basis, the use of all center behavior management measures identified under par. (b) for appropriateness and consistency.

DCF 52.42(2)(b) (b) Monitoring and review shall cover violation of house rules and their resulting consequences, the use of physical hold restraint and physically enforced separation in emergency safety intervention, the use of a locked unit when used to facilitate a resident’s treatment plan under sub. (7) (a) 3., and all related center policies and procedures.

DCF 52.42(3) (3) Conduct of residents. A center shall have written policies and procedures covering the conduct expected of residents. The policies and procedures shall do all of the following:

DCF 52.42(3)(a) (a) Promote the growth, development and independence of residents.

DCF 52.42(3)(b) (b) Address the extent to which a resident’s choice will be accommodated in daily decision making. There shall be an emphasis on self-determination and self-management.

DCF 52.42(3)(c) (c) Specify center behavior management techniques and approaches available to change, eliminate or modify the behaviors or conditions identified in the center’s program statement and operating plan required under s. DCF 52.41 (1).

DCF 52.42(3)(d) (d) Specify criteria for levels of supervision of activities, including off-grounds activities. These criteria shall be directed at protecting the safety and security of residents, center staff, visitors and the community.

DCF 52.42(3)(e) (e) Provide for making a record of a resident’s off-grounds activities. The record shall include where the resident will be, duration of the visit, the name, address and phone number of the person responsible for the resident and expected time of the resident’s return.

DCF 52.42(3)(f) (f) Specify house rules for the residents. The house rules shall include all of the following:

DCF 52.42(3)(f)1. 1. A general description of acceptable and unacceptable conduct.

DCF 52.42(3)(f)2. 2. Curfew requirements.

DCF 52.42(3)(f)3. 3. A resident’s individual freedoms when the resident is involved in recreational or school activities away from the center.

DCF 52.42(3)(f)4. 4. Consequences for a resident who violates a house rule.

DCF 52.42 Note Note: There is a difference between a patient right and a privilege. Deprivation of a privilege such as watching television, playing video games, going to the movies or involvement in some other recreational activity may be used as a disciplinary measure.

DCF 52.42(3)(g) (g) Provide for distribution of the house rules to all staff and to all residents and their parents or guardians.

DCF 52.42(4) (4) Prohibited measures. Center staff may not employ any cruel or humiliating measure such as any of the following:

DCF 52.42(4)(a) (a) Physically hitting or harming a resident.

DCF 52.42(4)(b) (b) Requiring physical exercise such as running laps or doing push-ups or other activities causing physical discomfort such as squatting or bending, or requiring a resident to repeat physical movements or assigning the resident unduly strenuous physical work.

DCF 52.42(4)(c) (c) Verbally abusing, ridiculing or humiliating a resident.

DCF 52.42(4)(d) (d) Denying shelter, clothing, bedding, a meal, or a menu item, center program services, emotional support, sleep or entry to the center.

DCF 52.42(4)(e) (e) Use of a chemical or physical restraint or physically enforced separation or a time-out room as punishment.

DCF 52.42(4)(f) (f) Authorizing or directing another resident to employ behavior management techniques on a resident.

DCF 52.42(4)(g) (g) Penalizing a group for an identified group member’s misbehavior.

DCF 52.42(5) (5) Emergency safety intervention.

DCF 52.42(5)(a) (a) A center staff member may not use any type of physical restraint or physically enforced separation on a resident unless the resident’s behavior presents an imminent danger of harm to self or others and physical restraint is necessary to contain the risk and keep the resident and others safe.

DCF 52.42(5)(ae) (ae) A center staff member shall attempt other feasible alternatives to de-escalate a child and situation before using physical restraint or physically enforced separation.

DCF 52.42(5)(am) (am) A center staff member may not use physical restraint or physically enforced separation as disciplinary action, for the convenience of center staff, or for therapeutic purposes.

DCF 52.42(5)(as) (as) If physical restraint is necessary under par. (a), a center staff member may only use the physical restraint in the following manner:

DCF 52.42(5)(as)1. 1. With the least amount of force necessary and in the least restrictive manner to manage the imminent danger of harm to self or others.

DCF 52.42(5)(as)2. 2. That lasts only for the duration of time that there is an imminent danger of harm to self or others.

DCF 52.42(5)(as)3. 3. That does not include any of the following:

DCF 52.42(5)(as)3.a. a. Any maneuver or technique that does not give adequate attention and care to protection of the resident’s head.

DCF 52.42(5)(as)3.b. b. Any maneuver that places pressure or weight on the resident’s chest, lungs, sternum, diaphragm, back, or abdomen causing chest compression.

DCF 52.42(5)(as)3.c. c. Any maneuver that places pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the resident’s head or neck, or that otherwise obstructs or restricts the circulation or blood or obstructs an airway, such as straddling or sitting on the resident’s torso.

DCF 52.42(5)(as)3.d. d. Any type of choke hold.

DCF 52.42(5)(as)3.e. e. Any technique that uses pain inducement to obtain compliance or control, including punching, hitting, hyperextension of joints, or extended use of pressure points for pain compliance.

DCF 52.42(5)(as)3.f. f. Any technique that involves pushing on or into a resident’s mouth, nose, or eyes, or covering the resident’s face or body with anything, including soft objects, such as pillows, washcloths, blankets, and bedding.

DCF 52.42(5)(as)4. 4. Notwithstanding subd. 3. f., if a resident is biting himself or herself or other persons, a center staff member may use a finger in a vibrating motion to stimulate the resident’s upper lip and cause the resident’s mouth to open and may lean into the bite with the least amount of force necessary to open the resident’s jaw.

DCF 52.42(5)(b) (b) Use of physically enforced separation shall meet the following additional conditions:

DCF 52.42(5)(b)1. 1. The staff member using physically enforced separation of a resident shall review need for continued use every 10 minutes while the resident is in physically enforced separation and shall log the time of each review and the emotional status of the resident.

DCF 52.42(5)(b)2. 2. Except as otherwise provided for a locked unit under sub. (7) (a) 2. b., initial use of physically enforced separation may not extend for more than one hour without authorization from the center director or a professional staff person designated by the center director.

DCF 52.42(5)(b)3. 3. Except as otherwise provided for a locked unit under sub. (7) (a) 2. b., if a resident is authorized under subd. 2. to be in physically enforced separation for more than one hour and the physically enforced separation lasts for more than 2 hours, or if the resident experiences multiple episodes in a day which prompt use of physically enforced separation for a cumulative period of more than 2 hours during the day, center staff shall consider the need to arrange another more appropriate placement for the resident.

DCF 52.42(5)(b)4. 4. Physical hold restraint on a resident shall not be used to circumvent the requirement of the one hour limit for using a time-out room or a locked unit.

DCF 52.42(5)(b)5. 5. A resident may be kept in physically enforced separation only by means of one of the following:

DCF 52.42(5)(b)5.a. a. A time-out room where the door is latched by positive pressure applied by a staff member’s hand without which the latch would spring back allowing the door to open of its own accord.

DCF 52.42(5)(b)5.b. b. A time-out room where the staff member holds the door to the time-out room shut.

DCF 52.42(5)(b)5.c. c. A time-out room where the staff member is in a position in the doorway to prevent the resident’s leaving.

DCF 52.42(5)(b)5.d. d. A staff member is in a position to prevent a resident from leaving a designated area.

DCF 52.42(5)(b)5.e. e. A time-out room which does not use a key lock, pad lock or other lock of similar design and has a type of lock such as a dead bolt lock, magnetic door lock or lock which only requires the turn of a knob to unlock the door, where a staff member is located next to the time-out room door and has the means to unlock the door immediately, if necessary, and that otherwise meets the requirements of this section and chs. SPS 361 to 366, the Wisconsin Commercial Building Code.

DCF 52.42(5)(b)5.f. f. In a locked unit that otherwise meets the requirements of this section and the provisions for use of locked units for emergency safety intervention under sub. (7) (a) 2.

DCF 52.42(5)(b)6. 6. A resident placed in a time-out room shall be under supervision and shall be free from materials in the room which could represent a hazard to the resident or to others. A time-out room may hold only one resident at a time.

DCF 52.42(5)(b)7. 7. A time-out room shall have adequate ventilation and, if there is a door, a shatter-proof observation window on or adjacent to the door. The window’s location shall allow for observation of all parts of the room. The room’s location shall be within hearing or call to a living area or other area of activity. The time-out room shall have at least 48 square feet of floor space with a ceiling height of not less than 8 feet and a width of at least 6 feet. A time-out room may not include a box or other compartment that represents a stand alone unit within the facility. The time-out room shall be an architectural or permanent part of the building structure.

DCF 52.42(5)(b)8. 8. Physically enforced separation in a time-out room may not be used as a substitute for supervision of a resident who is at risk of running away.

DCF 52.42(6) (6) Emergency safety intervention incident reports.

DCF 52.42(6)(a) (a) For each incident where physical hold restraint or physically enforced separation of a resident was necessary, the staff person on duty shall document in an incident report the following:

DCF 52.42(6)(a)1. 1. The resident’s name, age and sex.

DCF 52.42(6)(a)2. 2. A description of the incident.

DCF 52.42(6)(a)3. 3. The date, time, and location of the incident and methods used to address the resident’s behavior, including duration of each emergency safety intervention episode.

DCF 52.42(6)(a)4. 4. Results achieved from methods used to address resident behavior.

DCF 52.42(6)(a)5. 5. The name of each staff member involved in using the technique or approach with the resident at the time of the incident or when the incident was discovered.

DCF 52.42(6)(a)6. 6. Injuries received by either the resident or a staff member in using physically enforced separation or physical hold restraint, how the injuries happened and any medical care provided.

DCF 52.42(6)(b) (b) In each building housing residents, center staff shall maintain a log of written reports of incidents involving residents. The report of an incident shall include at least the information under par. (a) 1. to 3.

DCF 52.42(6)(c) (c) Resident care staff at the beginning of each shift shall be informed of or review incident reports occurring since their last shift. A copy of each incident report concerning a resident shall be placed in the resident’s treatment record.

DCF 52.42(7) (7) Use of locked units.

DCF 52.42(7)(a) (a) Conditions for use. No resident may be placed in a locked unit unless the center has first obtained department approval to operate a locked unit, the locked unit meets the requirements of this subsection and one of the following applies:

DCF 52.42(7)(a)1. 1. Use of a locked unit is ordered by a physician, to protect the health of the resident or other residents.

DCF 52.42(7)(a)2. 2. Use of a locked unit is for purposes of ensuring physically enforced separation when intervening in an emergency safety situation involving the resident. Use of a locked unit to deal with an emergency safety situation may take place provided that the following conditions are met:

DCF 52.42(7)(a)2.a. a. Use is as a emergency safety intervention physically enforced separation under sub. (5).

DCF 52.42(7)(a)2.b. b. Use of a locked unit for emergency safety intervention physically enforced separation may not extend beyond one hour except with written authorization from a physician, a psychologist licensed under ch. 455, Stats., or an independent clinical social worker certified under s. 457.08 (4), Stats. After review of the resident’s condition, new written orders, where necessary, may be issued for up to 24 hours. The resident shall be released from the physically enforced separation as quickly as possible. In this subdivision paragraph, “as quickly as possible” means as soon as the resident is calm and no longer a danger to self or others.

DCF 52.42(7)(a)2.c. c. Use is followed by a review of the need for development of goals and objectives in the resident’s treatment plan to govern the use of locked unit physically enforced separation or to minimize or eliminate its need.

DCF 52.42(7)(a)3. 3. Use of a locked unit is part of a behavior management and control program described in the resident’s treatment plan provided that the following conditions are met:

DCF 52.42(7)(a)3.a. a. The resident exhibits or recently has exhibited severely aggressive or destructive behaviors that place the resident or others in real or imminent danger and the lack of the locked unit prevents treatment staff from being able to treat the resident.

DCF 52.42(7)(a)3.b. b. A physician, a psychologist licensed under ch. 455, Stats., or an independent clinical social worker certified under s. 457.08 (4), Stats., who is knowledgeable about contemporary use of locked unit treatment intervention gives written approval included in the resident’s treatment record for its use.

DCF 52.42(7)(a)3.c. c. The goals, objectives and approaches in the resident’s treatment plan support its use. Goals and objectives shall be directed at reducing or eliminating the need for use of a locked unit.

DCF 52.42(7)(a)3.d. d. The parent or guardian and legal custodian of the resident if a minor, gives informed consent in writing to the use of a locked unit or the locked unit intervention is ordered by a court or other lawful authority.

DCF 52.42(7)(a)3.e. e. The resident has no known medical or mental health condition which would place the resident at risk of harm from being placed in a locked unit as evidenced by a statement from a physician.

DCF 52.42(7)(b) (b) Record. The center shall maintain a written record of the following information on locked unit use under par. (a) 3, in the resident’s treatment record:

DCF 52.42(7)(b)1. 1. The name and age of the resident.

DCF 52.42(7)(b)2. 2. The date or dates the resident is in a locked unit and the length of time each day.

DCF 52.42(7)(b)3. 3. At least weekly assessment for continued need for locked unit use.

DCF 52.42(7)(c) (c) Supervision. Appropriately trained staff shall directly supervise use of a locked unit. Appropriately trained staff are staff who have received the training under s. DCF 52.12 (5) (b) 4. and (c).

DCF 52.42(7)(d) (d) Center locked unit policies and procedures. A center with a locked unit shall have written policies and procedures that include all of the following:

DCF 52.42(7)(d)1. 1. Except as provided in this subsection, no resident may be housed in a locked unit.

DCF 52.42(7)(d)2. 2. A resident may be in a locked unit only if there is a written informed consent document signed by the resident’s parent or guardian and legal custodian or by an order of a court or other lawful authority or as provided under subd. 5. A copy of the informed consent document, court order or document from another lawful authority shall be filed in the resident’s treatment record.

DCF 52.42(7)(d)3. 3. Parent or guardian and legal custodian written informed consent to placement of a resident in a locked unit shall be effective for no more than 45 days from the date of the consent and may be withdrawn sooner unless otherwise specified in a court order or by another lawful authority. Parent or guardian and legal custodian written informed consent for continued use of a locked unit may be renewed for 30 day periods except as otherwise specified in a court order or by another lawful authority. Each renewal of informed consent shall be through a separate written informed consent document.

DCF 52.42(7)(d)4. 4. The resident’s parent or guardian or the legal custodian may withdraw the written informed consent to the resident being placed in a locked unit at any time, orally or in writing. Except as otherwise specified in a court order or by another lawful authority, the resident shall be transferred to an unlocked unit promptly following withdrawal of informed consent.