November 25, 2011
USE OF RESTRAINTS ON CHILDREN IN DCF GROUP HOMES
By: Robin K. Cohen, Principal Analyst
You asked (1) for background information on the use of restraints in Department of Children and Families (DCF)-licensed therapeutic group homes and (2) when they were outlawed.
Both the law (CGS §§ 46a-152 to -154) and regulations adopted under CGS § 17a-16 contain requirements governing the use of restraints on children in DCF care and custody. But in practice, DCF applies the more restrictive provisions in CGS § 46a-152. This law was enacted in 1999. To comport with the law, DCF has adopted policy that largely follows the law but that is tailored to its clients and programs.
Since 1999, Connecticut has limited the circumstances in which state schools and certain institutions and facilities may use restraints on the people they care for. Specifically, it prohibits individuals who provide direct care, education, or supervision to a “person at risk” in these settings from using involuntary physical restraints on such people. Persons at risk include children who receive care, education, or supervision in an institution or facility operated by, licensed or authorized to operate by, or operating under a contract with, DCF or other specified agencies or operating under a contract with a local school board.
The law establishes a general exception to this prohibition. It permits restraints as an emergency intervention to prevent immediate or imminent injury to the person at risk or others, provided they are not used for discipline or convenience or as a substitute for a less restrictive alternative. DCF policy mirrors this. (Another exception exists for the Whiting Forensic Division within the Department of Mental Health and Addiction Services.)
DCF regulations contain an additional exception, allowing the use of restraints when a possibility exists that a child could run away while being transported from one location to another.
Contracts between DCF and therapeutic group homes contain language that recognizes that there may occasionally be the need for restraints, but encourage the homes to employ other strategies; they do not reference the law. Presumably, when the homes use restraints, this is done according to CGS § 46a-152, et. seq. and agency policy.
DCF—USE OF RESTRAINTS IN GROUP HOMES
In 1999, the legislature severely restricted the use of physical restraints by individuals providing care to “persons at risk.” These include people receiving care, education, or supervision in an institution or facility operated by, licensed, or authorized to operate by or operating under a contract with, the departments of Public Health, Developmental Services (Mental Retardation at the time), Children and Families, Mental Health and Addiction Services, as well as certain educational facilities and institutions.
Documentation and Reporting. Under the law, facilities must document the use of restraints in a person's medical or educational record. The documentation must include (1) in the case of emergency use, the nature of the emergency and what other steps, including attempts at verbal de-escalation, were taken to prevent the emergency from arising if there were indications that it was likely to arise and (2) a detailed description of the nature of the restraint, its duration, and its effect on the person's established medical or behavioral support or education plan. The provider must continually monitor a restrained person for physical distress and record these observations in the person's medical or education record (CGS § 46a-152).
The law also requires the facilities to compile an annual report on their use of restraints and requires the state agency under whose jurisdiction it operates (in this case, DCF) to review these compilations before renewing a license for, or a contract with, the facility.
When the use of restraints results in an injury to a child in a DCF facility, the facility must report this to DCF. The DCF commissioner must report any incidence of serious injury or death to the Office of the Child Advocate (CGS § 46a-153).
Monitoring and Training. The law also requires each facility to develop policies and procedures that (1) establish monitoring and internal reporting of the use of physical restraint and (2) require training of all of their caregivers. These policies and procedures must be available upon request to the DCF commissioner (CGS § 46a-154).
DCF policy, adopted in 2009, largely mirrors the law, but contains provisions that are specific to agency clients and contractors. For example, it requires the staff person applying the restraint to take into account a child-specific risk assessment, including factors like developmental level, age, and existing health conditions.
The policy also requires any program or facility DCF runs or with which it has a contract to have a statement of purpose that includes the law's elements. It requires risk assessment and crisis management plans to be developed for each client, and requires monitoring and assessement whenever physical restraints are used to ensure safety, with very detailed requirements for how the monitoring and assessment must be done. They also require debriefings with the staff and client after every use of a restraint, staff training, and data collection and reporting when a serious injury or death occurs during a restraint. Finally, the policy lists prohibited practices, including restraining or holding the client if the client experiences chest or back compression or using pressure to, or gripping of, the client's throat or neck.
CGS § 17a-16 requires the DCF commissioner to adopt regulations specifying when facilities or institutions under her jurisdiction may place children or youth in restraints or use force against them. The regulations, which DCF adopted in 1994, allow children or youth to be put in mechanical restraints if there is reasonable cause to believe they
may (1) hurt themselves or anyone else or (2) run away while being transported from one location to another (Conn. Agency Regs., § 17a-16-10).
According to DCF legislative liaison, Josh Howroyd, DCF follows the rules for restraints set out in CGS § 46a-152, et. seq., and the above policy, not these regulations. But it is in the process of updating these regulations to reflect both.
DCF Contracts with Therapeutic Group Homes
DCF contracts with 52 therapeutic group homes to serve children (primarily those between ages 13 and 17) in the department's care or custody, according to DCF's Howroyd. The contracts state that DCF recognizes that there may occasionally be the need for restraints but DCF encourages the home to employ “therapeutic models which provide high-level, targeted, individualized psycho-educational/therapeutic interventions, including, but not limited to, the development and maintenance of daily living skills, anger management, social skills, family living skills, communication skills, stress management, relational support, intensive or near crisis management, and de-escalation.”
DCF Policy on Restraints