521 STAFF EDUCATION AND TRAINING

521.1 Each MH provider identified in § 500.7 shall design and implement a training and education program for all MH provider staff aimed at minimizing the use of restraint and seclusion and maximizing safety for consumers and MH provider staff when restraint or seclusion are used.521.2 Each MH provider shall require all staff members to receive effective, ongoing, competency-based education and training on the following:- (a) Understanding and appropriately responding to underlying behaviors of consumers that precipitate the use of restraints or seclusion;

- (b) Techniques to identify staff interactions, consumer medical conditions, and environmental factors that may trigger consumer behavior resulting in the use of restraints or seclusion;

- (c) The use of de-escalation and other non-physical behavior management techniques, such as mediation, conflict resolution, active listening, and verbal and observational methods, to reduce or eliminate the use of restraints and seclusion;

- (d) The safe use of restraints and seclusion, including the ability to recognize and respond to signs and symptoms of physical, mental, medical or emotional distress, or impairments or injury in consumers who are restrained or secluded; and

- (e) Cardiopulmonary resuscitation (CPR), including certification and periodic re-certification in CPR.521.3 Each MH provider identified in § 500.7 shall require all staff members who are authorized to physically apply restraints or seclusion to receive ongoing training and demonstrate competence in the safe use of restraints and seclusion, including:- (a) Acceptable techniques for physically holding a consumer;

- (b) Acceptable take-down procedures; and

- (c) Acceptable means for applying and removing all types of restraints used, including protective measures.521.4 Each MH provider identified in § 500.7 shall require all staff members who are authorized to perform fifteen (15) minute assessments of consumers in restraints or seclusion to receive ongoing training and demonstrate competence in:

1. (a) Taking vital signs and interpreting their relevance;
2. (b) Recognizing nutritional and hydration needs;
3. (c) Checking circulation and range of motion in extremities;
4. (d) Addressing hygiene and elimination needs;
5. (e) Addressing physical and psychological status and comfort;
6. (f) Assisting consumers in meeting behavioral criteria for the discontinuation of restraints or seclusion; and
7. (g) Recognizing when to contact a physician or emergency medical services to evaluate or treat a consumer's physical condition.521.5 Each MH provider identified in § 500.7 shall require all staff members who are authorized to initiate the use of restraints or seclusion, or to perform evaluations of consumers who are in restraints or seclusion to receive education about and demonstrate competence in:- (a) Recognizing how age, developmental considerations, gender issues, cultural issues, ethnicity, traumatology, and history of sexual or physical abuse may affect the way in which a consumer reacts to physical contact; and
8. (b) The use of behavioral criteria for the discontinuation of restraints or seclusion and how to assist a consumer in meeting the criteria.521.6 All staff employed by MH providers shall demonstrate their competencies, as specified in this section, on an annual basis.521.7 Each MH provider shall ensure adequate levels of staffing and appropriate staffing configurations at all times, based on factors such as the physical environment, consumer diagnosis and needs, co-occurring conditions, acuity levels, and the age or developmental status of each consumer.521.8 Each MH provider shall include an annual evaluation of the factors set forth in § 521.2 in its staff performance evaluation or quality improvement program.521.9 Each MH provider shall document in the staff personnel records that necessary training; education and competency have been successfully completed. Documentation shall include the date training was completed, the type of training

completed, and the name of the individual certifying the completion of training.

521.10 All training programs and materials used by each MH provider shall be made available, upon written request, for review by DMH.

SOURCE: Emergency and Proposed Rulemaking published at 51 DCR 8691 (September 3, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 51 DCR 11863 (December 31, 2004)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 52 DCR 5957 (June 24, 2005)[EXPIRED]; as amended by Final Rulemaking published at 52 DCR 7229 (August 5, 2005).