1. (1) General requirements.

   1. (a) A CCF may use seclusion and restraint as an emergency intervention only.
   2. (b) Seclusion and restraint shall only be administered by staff who have completed orientation and training described in s. DHS 31.10 (1) (b) 7., and shall comply with all of the requirements for emergency safety interventions under s. 51.61 (1) (i) 1., Stats., s. DHS 94.10, and this chapter.
2. (2) Prohibited interventions. Chemical restraints intended to control behavior or for prolonged sedation or incapacitation are prohibited. This does not include emergency medication used to treat symptoms.

3. (3) Seclusion and restraint administration requirements.

   1. (a) Seclusion and restraint may only be administered when all other less restrictive methods have been exhausted.
   2. (b) Seclusion and restraint shall be administered for the shortest time possible and only until the client is no longer a danger to self or others.
   3. (c) Seclusion and restraint shall be administered in a manner that is attentive to, and respectful of the trauma history, dignity, and civil rights of the client.
   4. (d) Seclusion and restraint shall be administered in a manner that avoids or causes the least possible physical or emotional discomfort, harm, and pain to the client.
   5. (e) Regular access to bathroom facilities, drinking water, and necessary medication shall be provided according to the client’s needs during the administration of seclusion or physical restraint. Temperature and lights shall be maintained at levels which are comfortable to the client.

4. (4) Specific requirements for seclusion.

   1. (a) A client may only be kept in the seclusion area by means of one of the following:

      1. 1. A staff member is in a position, such as in a doorway, to prevent a client from leaving the seclusion area.
      2. 2. A door to a seclusion room is latched by positive pressure applied by staff’s hand without which the latch would spring back allowing the door to open on its own accord, or a program may use a magnet door lock or a lock which requires the turn of a knob to unlock a door. Other designs of door locks shall not be used, including pad lock, key lock, or other locks of similar design.
   2. (b) Staff shall provide uninterrupted supervision and monitoring of the client and the seclusion area during seclusion by being in the room with the client or by observation through a window to the room.
   3. (c) Seclusion rooms shall be free of objects or fixtures with which the client could inflict bodily harm.
   4. (d) Only one client at a time may be placed in a seclusion room.

5. (5) Specific requirements for physical restraint.

   1. (a) Physical restraint shall only be administered during an emergency, when there is a serious threat of violence to other clients or a staff member, personal injury, or attempted suicide.
   2. (b) At a minimum, 2 staff trained in the use of emergency safety interventions shall be physically present during the administration of restraint and shall continually monitor the condition of the client and the safe use of restraint throughout the duration of the intervention.

   3. (c) All of the following are prohibited forms of physical restraint:

      1. 1. Pressure or weight on the chest, lungs, sternum, diaphragm, back, or abdomen, such as straddling or sitting on the torso.
      2. 2. Pressure, weight, or leverage on the neck or throat, on any artery, or on the back of the head or neck, or that otherwise obstructs or restricts the circulation of blood or obstructs an airway, such as chokeholds or sleeper holds.
      3. 3. Wrestling holds or martial arts techniques.
      4. 4. Covering the face with any object.
      5. 5. Pain or pressure points.
      6. 6. Hyperextension of limbs, fingers, or neck.
      7. 7. Forcible take downs from a standing position to the floor.
      8. 8. Any other physical restraint that is not administered during an emergency, that is administered for longer than necessary to prevent immediate injury to a client or others, or that is administered for a purpose other than to prevent immediate injury to a youth or others.
   4. (d) Immediately, upon the termination of a physical restraint, a medical staff member, such as a physician, advanced practice nurse prescriber, physician assistant, or registered nurse shall conduct a follow-up assessment of the condition of the client to ensure that the client was not injured and shall document the finding of the assessment in the client’s clinical record.
   5. (e) If any injury is noted following a physical restraint, a staff member shall make a referral for any medical care needed and inform a client’s guardian, if applicable.

6. (6) Specific requirements for mechanical restraint. Mechanical restraints shall only be used as a last resort when all other interventions are unsuccessful. A CCF that intends to utilize mechanical restraints shall meet all the following requirements:

   1. (a) Mechanical restraints may only be used under a medical order made by the treatment or medical director or their designee, and that order shall be reviewed by a physician within 8 hours.
   2. (b) Mechanical restraints must be observed every 15 minutes, and a record kept of observations.
   3. (c) Mechanical restraints may only be used for clients admitted involuntarily.
   4. (d) Mechanical restraints shall not be used with minors.

7. (7) Debriefing.

   1. (a) Unless clinically contraindicated, within a reasonable time following the administration of a seclusion or restraint, staff shall talk with the client about each of the following:

      1. 1. The circumstances that contributed to the seclusion or restraint.
      2. 2. The client’s psychological well-being and impact of the intervention.
      3. 3. Any modifications that can be made in the client’s services or plan for care to prevent seclusion or restraint in the future.
   2. (b) A CCF shall notify a guardian of any seclusion or restraint within 12 hours of being administered. The CCF shall document in the client’s record any situation in which notification has been attempted and the CCF has been unable to contact a guardian.

   3. (c) Each administration of seclusion or restraint shall be documented in the client’s clinical record and shall specify all of the following:

      1. 1. Events precipitating the seclusion or restraint.
      2. 2. Less restrictive interventions attempted prior to the seclusion or restraint.
      3. 3. Length of time the seclusion or restraint was used.
      4. 4. Assessment of the appropriateness of the seclusion or restraint based on threat of harm to self or others.
      5. 5. Assessment of any physical injury to the client, other clients, or staff.
      6. 6. The client’s response to the use of seclusion or restraint.
   4. (d) The treatment director, clinical director, or nursing administrator or their designee shall review all seclusion and restraint documentation within 24 hours of intervention, and in consultation with others determine whether changes in services are necessary, including whether a different level of care is necessary. These findings and recommendations shall be documented in the client’s clinical record.

8. (8) Reporting.

   1. (a) A CCF shall report to the department all incidences of seclusion, restraint, injury, or elopement to the department within 24 hours of the incident occurring. Reporting shall be completed through the department’s online reporting system.
   2. (b) The department will evaluate the circumstances of each incident, conduct any appropriate follow-up, and identify programs in need of technical assistance, training, policy development, or other quality improvement.

History

History: EmR2507: emerg. cr., eff. 6-16-25; CR 25-051: cr. Register February 2026 No. 842, eff. 3-1-26.