Wednesday, October 1, 2014 - 10:33am Search:  
 







Our Mission

To support County Boards of Developmental Disabilities in providing services and supports to people with developmental disabilities.



Our Address

73 East Wilson Bridge Rd
Suite B1
Worthington, Ohio 43085
614-431-0616

Restraint and Seclusion Survey

Introduction

In order to assist you in completing this survey, we have included the following definitions for each concept discussed.  These definitions are established in Ohio Revised Code Section 5123:2-1-02 (for restraint and time-out) and by the Centers for Medicare and Medicaid Services/CMS (for seclusion).

 

  Seclusion means confining an individual in a room and preventing the individual from leaving the room by applying physical force or closing a door or other barrier, including placement in such a room when a staff person does not remain in the room with the individual.

  Time-out means confining an individual in a room and preventing the individual from leaving the room by applying physical force or by closing a door or other barrier, including placement in such a room when a staff person remains in the room with the individual.

  Restraint means any of the following:
(a) "Chemical restraint," which means a prescribed medication for the purpose of modifying, diminishing, controlling, or altering a specific behavior.
(b) "Manual restraint," which means a hands-on method that is used to control an identified behavior by restricting the movement or function of the individual's head, neck, torso, one or more limbs or entire body, using sufficient force to cause the possibility of injury.
(c) "Mechanical restraint," which means a device that restricts an individual's movement or function applied for purposes of behavior support, including a device used in any vehicle, except a seat belt of a type found in an ordinary passenger vehicle or an age-appropriate child safety seat.


Please answer the questions below with as many details as possible.

- If you have any questions about the purpose of this survey or how the results will be used, please contact Adam Herman at aherman@oacbdd.org or 330-904-0930. 

- If you have specific questions about concepts, definitions, techniques, or practices associated with the terms discussed in this survey, please contact Willie Jones at wjones@oacbdd.org or 740-310-2651.


AGENCY INFORMATION
(1) Please select your agency
 

SECTION 1:  Existence of Board Policy on Seclusion

(2) Does your board have a written policy prohibiting the use of seclusion for adults? (This question applies to all settings, including: workshops, day habilitation, residential and/or community living settings).
 Yes  No  
(3) If yes, is it a comprehensive policy or are there exceptions?
 Comprehensive  Exceptions  
(4) If there are exceptions, please list them in the space provided. If no, leave blank.
 

SECTION 2:  Board use of Seclusion

(Only for boards that do not have written policies prohibiting seclusion or have policies with exceptions.  If the question does not apply to your board, leave blank and move to the next question.)

(5) Does your board permit seclusion to be written into a person's ISP or behavior support plan in non-emergency situations?
 Yes  No  
(6) If the answer to the previous question is yes, how many individuals would you estimate have seclusion written into their ISP/behavior support plan for non-emergency situations at this time?
(7) Does your board permit seclusion to be written into a person's ISP or behavior support plan in emergency situations (i.e., situations outside that which is considered "normal" behavior)?
 Yes  No  
(8) If the answer to the previous question is yes, how many individuals would you estimate have seclusion written into their ISP/behavior support plan for non-emergency situations at this time?
(9) Does your board keep records or logs of how many times seclusion is used?
 Yes  No  
(10) How many times has seclusion been used for adults since January of this year? If exact records are not kept, an estimate would be acceptable.
 

SECTION 3: Existence of Board Policy on "Time-out"

(11) Does your board have a written policy prohibiting the use of "time-out" for adults? (This question applies to all settings, including: workshops, day habilitation, residential and/or community living settings).
 Yes  No  
(12) If yes, is it a comprehensive policy or are there are exceptions? Does your board have a written policy prohibiting the use of "time-out" for adults? (This question applies to all settings, including: workshops, day habilitation, residential and/or community living settings).
 Comprehensive  Exceptions  
(13) If there are exceptions, please list them in the space provided. If no, leave blank.
 

SECTION 4: Existence of Board Policy on "Time-out"

(Only for boards that do not have written policies prohibiting "time-out" or have policies with exceptions.  If the question does not apply to your board, leave blank and move to the next question.)

(14) Does your board permit "time-out" to be written into a person's ISP or behavior support plan in non-emergency situations?
 Yes  No  
(15) If yes, how many individuals would you estimate have "time-out" written into their ISP/behavior support plan for non-emergency situations at this time?
(16) Does your board permit "time-out" to be written into a person's ISP or behavior support plan in emergency situations (i.e., situations outside that which is considered "normal" behavior)?
 Yes  No  
(17) If yes, how many individuals would you estimate have "time-out" written into their ISP/behavior support plan for emergency situations at this time?
(18) Does your board keep records or logs of how many times a seclusion or "time-out" room is used?
(19) How many times have seclusion or "time-out" rooms been used for adults since January of this year? If exact records are not kept, an estimate would be acceptable.
 

SECTION 5:  Existence of Board Policy on Restraint

(20) Does your board have a written policy prohibiting the use of restraint for adults? (This question applies to all settings, including: workshops, day habilitation, residential and/or community living settings).
 Yes  No  
(21) If yes, is it a comprehensive policy or are there exceptions?
 Comprehensive  Exceptions  
(22) If there are exceptions, please list them in the space provided. If no, leave blank.
 

SECTION 6:  Board use of Restraint 

(Only for boards that do not have written policies prohibiting restraint or have policies with exceptions.  If the question does not apply to your board, leave blank and click "SUBMIT" below.)

(23) Does your board permit restraint to be written into a person's ISP or behavior support plan in non-emergency situations?
 Yes  No  
(24) If yes, how many individuals would you estimate have restraint written into their ISP/behavior support plan for non-emergency situations at this time?
(25) Does your board permit restraint to be written into a person's ISP or behavior support plan in emergency situations (i.e., situations outside that which is considered "normal" behavior)?
 Yes  No  
(26) If yes, how many individuals would you estimate have restraint written into their ISP/behavior support plan for emergency situations at this time?
(27) Does your board keep records or logs of how many times restraint is used?
 Yes  No  
(28) How many times restraint has been used for adults since January of this year? If exact records are not kept, an estimate would be acceptable.
Home | About Us | Contact Us | Webmaster | Facebook | Twitter