(d) Mechanical restraints may be used in limited secure facilities in accordance with the provisions of this section if such use is part of the facility’s restraint policy which has been approved pursuant to section 441.17 of this Title. Seat belts, shoulder harnesses or wheelchair locks used in vehicular transportation shall not be considered types of mechanical restraint.

1. (1) The permissible uses of mechanical restraints in limited secure facilities shall consist solely of handcuffs and footcuffs and may only be used by staff who have been appropriately trained in the use of such restraints. Handcuffs and footcuffs must be of a size appropriate for the youth on whom they are used.
2. (2) Mechanical restraints may be used on a youth only if there has been a prior individualized assessment that has found that the use of mechanical restraints is permissible for that youth. Any limitations or prohibitions on the use of mechanical restraints for a youth must be followed by staff.
3. (3) Mechanical restraints may be used on a youth inside a limited secure facility only if, after all appropriate pro-active, non-physical behavior management techniques followed by all less restrictive physical behavior management techniques have been tried and failed, the youth continues to be out of control and presents a serious and evident danger to him or herself or others. Mechanical restraints must be removed as soon as the youth is sufficiently under control so that the youth can be managed safely using other less restrictive, approved methods. Mechanical restraints may be used to transport a youth from a limited secure facility to court or other outside activities if an individualized assessment conducted at the time of the transport determines that the youth presents a clear danger to public safety or to him or herself.
4. (4) Staff must provide constant, direct, visual supervision of any youth in mechanical restraints for the protection of the youth’s safety, to evaluate that the youth is properly restrained, and to determine the continued need for the use of mechanical restraints.
5. (5) In no case may a youth be handcuffed or footcuffed to any object.
6. (6) Handcuffs and footcuffs may not be attached to each other.
7. (7) Use of mechanical restraints for a youth must be initially authorized by the director of the facility or a person designated by the director. The authorization must be obtained prior to the use of mechanical restraints and re-authorized throughout the use of the restraints at specified intervals as set forth in the facility’s restraint policy.
8. (8) Staff must be aware of, and follow, all therapeutic and medical restrictions for individual youth as they pertain to the use of mechanical restraints.
9. (9) At least one staff member with a key to the mechanical restraints must be on the scene at all times when mechanical restraints are being used until the restraints are removed.
10. (10) Any injuries or health concerns found or observed by staff and any health concerns expressed by youth after any use of mechanical restraint must be addressed appropriately.

(e) Room isolation, as defined in section 441.17 of this Title, may be used in limited secure facilities in accordance with the provisions of this section, if such use has been approved in writing by the office as part of an authorized agency’s restraint policy. Room isolation means confinement of a youth in a bedroom or other room specifically designed and designated for such use to calm and control acute physical behavior of that youth which presents an immediate risk of physical injury to the youth or others or of escape from the facility or from custody.

1. (1) Room isolation may be used only after less restrictive interventions have been exhausted and found to be ineffective. It may only be used for the least amount of time necessary for the youth to regain self-control.
2. (2) Room isolation shall not be used for youth who are on special supervision status for suicide, have significant intellectual or developmental disabilities, or have a seizure disorder.
3. (3) The approval of the facility director or designee must be obtained prior to placing a youth in room isolation unless the facility staff determines that immediate room isolation is necessary for safety reasons. In such cases, the facility director or designee must be notified as soon as possible, but no later than 15 minutes, after room isolation begins. Absent a showing of necessity, the duration of room isolation shall not be continued beyond two hours. Authorization for continuing room isolation must be obtained at least every two hours.
4. (4) Each isolated youth shall have access to bathroom and toilet facilities.
5. (5) Each isolated youth shall receive meals and fluids on the same schedule as youth in the regular program.
6. (6) As soon as practicable after the commencement of room isolation, each isolated youth must be seen by medical or clinical staff to determine whether the youth has any known injury or medical condition requiring removal from room isolation. If such staff are unavailable, the shift supervisor shall determine whether on-call medical personnel need to be contacted.
7. (7) At least one staff person must be positioned in a manner that enables the staff person to hear the youth should the youth request assistance. Staff must visually observe the youth at least every 15 minutes and shall vary the check-in times so that they are not predictable to the youth. At least every 15 minutes, staff must attempt to engage the youth in a release strategy in a manner consistent with the youth’s behavior services plan.

8. (8) Each room used for isolation shall be heated, lighted and ventilated as any other room in the facility. An isolation room shall have:

   1. (i) a door that locks from the outside and that has an observation window made of unbreakable material that allows a total view of the room;
   2. (ii) no exposed electrical outlets;
   3. (iii) sufficient wall construction to withstand attacks from a violent youth of reasonable height and weight; and
   4. (iv) normal bedroom furnishings unless the facility director or designee has determined that some or all of the furnishings must be removed for safety reasons.
9. (9) Each facility shall maintain daily records regarding youth who are placed in locked isolation rooms including the name and age of each youth, the duration of each isolation, the reasons for using isolation, the individual who approved the isolation, the methods of intervention that were tried and proved unsuccessful, the steps that were taken to reduce the amount of time the youth was in isolation, and attempts to contact the parent/guardian of each youth.