TABLE OF CONTENTS

CTS 03.01.01: Implementing Identified Needs, Strengths, Preferences, and Goals

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

 

Policy Description:  

The Iris provider will complete an assessment of each patient served in order to create a plan for care, treatment, or service. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

The Iris provider, working in conjunction with clinical partner support staff, will ensure a needs assessment/screening is done for all patients to identify their particular needs, strengths, goals, and preferences, in order to identify and coordinate services best suited to meet the patient’s needs.  While other support staff may gather this information from patients, they will work in conjunction with the Iris providers to make sure all patient’s needs, strengths, goals, and preferences are identified and addressed within the scope of services offered.

All medications the patient is currently taking must be taken into consideration during the assessment and used in the plan for care, treatment, or services. Each plan must be collaborative and interdisciplinary in nature when the patient is working with more than one discipline (e.g. nutrition, cardiology, counseling, etc. Particular attention will be given to patients with opiate use/dependence diagnoses given the high risk of overdose and death in this patient population.  

The planning phase of the patients’ care occurs once the needs assessment is complete in order to identify the necessary goals and objectives that are uniquely tailored to each patient. There should be a well-documented timeline that requires a follow-up or re-assessment of the patient’s identified goals. This is especially true of medication support. The Iris provider will follow-up with patients more regularly when prescribed new medications or when specific issues in the patient’s care plan are identified.  

 

 

CTS 03.01.03: Planning for Identified Needs, Strengths, Preferences, and Goals

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

Every patient will have individual plans and goals, and these will be continually monitored and changed as long as they are being seen. Any changes to this plan must have a valid reason and be documented in the patient’s chart. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

Iris provider’s will work diligently with patients under their care to develop a care plan that reflects the identified needs, strengths, preferences, and goals of the individual patients served. Each plan must have the following:

  • Goals that are expressed in a manner that captures the individual's words or ideas 
  • Goals that build on the individual’s strengths 
  • Factors that support the transition to community integration when identified as a need during assessment 
  • The criteria and process for the individual’s expected successful transfer and/or discharge, which the organization discusses with the individual 
  • The objectives for each plan must meet the following criteria: 
  • They include identified steps to achieve the goal(s) (See also CTS.03.01.01, EP 3)  
  • They are sufficiently specific to assess the progress of the individual served  
  • They are expressed in terms that provide indices of progress

In the course of ongoing care with each patient served, the Iris providers, working in conjunction with clinical staff, re-evaluate and, when necessary, revises the goals and objectives of the plan for care, treatment, or services based on change(s) in the individual's needs, preferences, and goals and his or her response to care, treatment, or services. If no change(s) occurs, the goals and objectives are re-evaluated at a specified time interval established by the Iris provider and clinical staff based on identified clinic policy.

 

If, in the event a goal or objective must be deferred, the reason must be documented in the patient’s chart, as well as plans to assist the patient in achieving identified goals or identifying new goals that may require amendment/update to the patient’s plan of care.

 

 

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

The patient’s plan for care, treatment, or services addresses the family’s involvement. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

Iris providers promote family involvement in the patients' care while maintaining the patient’s right to privacy. Patients are encouraged to include family members in making healthcare discussions and planning ongoing healthcare needs, unless such participation is contraindicated or negatively impacts the patient’s course of care. 

 

While Iris providers are expected to do their best to have family and friends actively involved in patient care, they must always comply with HIPAA privacy laws when coordinating patient care and allow family involvement in treatment only when the patient authorizes it. During the patient appointments, the provider will discuss with the patient who they would like to involve in their course of treatment, and document consent and plan for such involvement in the patient’s chart. The provider and on-site staff will actively seek to obtain any necessary consent from the individual (if an adult) or in accordance with law and regulation (if a minor), unless such participation is contraindicated, all in accordance with HIPAA privacy regulations.

 

The Iris provider will accept any information that a family member feels may be important or helpful for the patient’s ongoing care (if an adult) or in accordance with law and regulation (if a minor), unless such participation is contraindicated. All family participation is documented in the patient’s chart by the Iris provider and included to help develop a plan of care that is in the best interest of the patient.

 

 

CTS 03.01.07: Patient Referrals

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

When additional care, treatment, or services are required and cannot be found at the patient’s current organization, the patient will be referred out into the community. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

If a patient requires care, treatment, or services not offered at his/her on-site facility, the Iris provider will work with on-site clinical staff to locate, and refer to, the appropriate community organization that has the care, treatment, or service that best meet the patient’s needs. This referral, and the reasons for it, will be documented in the patient’s chart. The Iris provider will work with clinical staff and community referral sources to ensure goals and objectives are being addressed and that the care, treatment, or service is happening concurrently with the Iris provider’s care, treatment, or service. It is the Iris provider’s responsibility to ensure the patient has the appropriate referral, and that all updated note/changes to the patient’s care plan from the outside organization are being received and placed in the patient’s record. If changes to this referral need to take place, the Iris provider will make that recommendation to the patient and on-site staff.  

 

 

CTS 03.01.09: Patient Outcome Assessments

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

Organizations that provide care, treatment, or services continuously strive to improve the quality and safety of their clinical care processes. As part of this improvement process, the organization monitors the progress of the individual served and aggregates data about care, treatment, and service outcomes in order to improve the effectiveness of the care, treatment, or services provided. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

The Iris provider, working in conjunction with on-site clinical staff, will use, and monitor the effectiveness of, pertinent standardized tools (i.e. PHQ-9, GAD-7, ASRS, CSSRS) to monitor a patient’s progress in treatment. Such standardized tools should be used early in the patient’s treatment, care, or services and throughout their course of treatment to monitor response to treatment or identify areas where the treatment plan of care may need to be updated or amended.

Tools used to identity and monitor a patient’s need should be tailored to his/her goals for treatment, whether such tools apply to a population or diagnostic category (such as depression or anxiety), or have a more global focus such as general distress, functional status, quality of life (especially in regard to intellectual/developmental disabilities and other physical and/or sensory disabilities), well-being, or permanency (especially in regard to foster care). By aggregating and analyzing the data gathered from these tools, the patient’s goals and plan of care can be updated. (For more information, refer to Standard PI.02.01.01)

Data gathered from assessment, screening, monitoring tools will be used to assess how the treatment, care, or services is going and if the patient’s goals are being met. These standardized tools should be used as an objective measure of how the patient is doing and should be recorded in the patient’s chart. This data should be used to make changes to the plan of care as needed. 

 

 

CTS 04.01.01: Coordination of Internal and External Resources

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

Care, treatment, or services should be coordinated among providers and between settings, independent of whether they are provided directly by the organization or by an outside source, so that the individual's needs are addressed in a seamless, synchronized, and timely manner. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

(See also Iris Telehealth Medication Management & Treatment Policy, Section 15:A-G)

 

  1. Regardless of where a patient’s information or care, treatment, or services originates (or is referred to), this information should be coordinated by the Iris provider in conjunction with on-site staff and communicated to the patient and/or patient’s guardian. 
    1. It is up to the Iris provider to assist in coordinating the patient’s plan for care, treatment, or services, whether it be within the organization or external to it. 
    2. If the type of care, treatment, or service can be performed internally at the organization the Iris provider is seeing the patient, then this should be the first choice for continued care, treatment or service. 
    3. If the patient must be transferred to an external organization, the Iris provider and on-site staff will communicate what to expect to the patient and document it in the patient’s chart. Type of information to be communicated may include:
      1.  the condition, care, treatment, medications, and services of the individual served
      2.  any recent or anticipated changes to the plan of care. 
    4. The patient or guardian should be afforded the opportunity to ask questions and this should be documented in the patient’s chart.
  2. Hand-off (the communication of important patient information to another source of care, whether internal or external) should be conducted by the referring Iris provider,
    1. This should include any relevant patient information
    2. Such hand-off information should be sent to the external organization to ensure the patient’s plan of care, treatment or services is continued. 
    3. Each on-site facility should have an on-site staff member that helps transfer this information to the relevant external organization. 
    4. All external organizations should transfer relevant patient information back to the Iris provider’s on-site staff as a hand-off to ensure continuity and coordination of care that is in the best interest of the patient.
    5. The on-site staff at the patient’s original clinical location should have a plan in place to receive external organization information about a patient, and every attempt should be made to receive these documents prior to the patient’s next internal appointment. 
  3. When a temporary staff member covers for a permanent staff member, a documented review of any orders issued by the temporary staff member is conducted by the permanent staff member upon his or her return and within the time frame defined by the organization.
  4. When external resources are needed, the organization participates in coordinating care, treatment, or services. The organization will coordinate with Iris providers and on-site staff how best to receive or share relevant information about the individual served to facilitate coordination and continuity when individuals are referred to other care, treatment, or service providers.
    1. Relevant patient information can be shared/communicated via a mutually shared EMR, as applicable.
    2. Information can also be communicated verbally as long as this is clearly documented in the patient’s chart and follows established protocols for ensuring patient safety and privacy.
  5. Coordination of services needed should:
    1. Follow a pre-determined time frame that meets the behavioral health needs of the patient.
    2. Use a” read-back” process/format to convey verbal orders or verbal reports of test results 
  6. In the event that an Iris provider is absent from their clinical placement, the Iris provider will go over each documented order by the temporary provider upon their return to ensure that continuity of care, treatment, or services is up to date and standardized according clinic policy. 
  7. All activities planned for the patient should be given a specific timeline that meets the goals of the individual patient. 

 

 

CTS 04.01.03: Appropriate Patient Education and Training

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

The Iris provider will provide the appropriate level and type of education and/or training to each individual served. This education and/or training will be documented in each patient’s chart. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

The Iris provider, working in conjunction with on-site clinical staff, will partake in an assessment of each individual served to determine their needs and goals for treatment. The patient wills will be given education and/or training that is appropriate to their goals, meets their individual learning style, and has content that is appropriate to what the patient can understand. The Iris provider, and local on-site staff, will accommodate patient’s learning styles and will ask for assistance when needed (e.g. – using a translator service). The Iris provider will also assess each patient’s comprehension of the provided education. All relevant information will be documented in the patient’s chart. 

 

The assessment and education should take into consideration an individual’s cultural and religious beliefs, emotional barriers, desire and motivation to learn, physical or cognitive limitations, and barriers to communication. Education should include, but is not limited to, the following:

  • The plan for care, treatment, or services
  • Basic health practices and safety
  • The safe and effective use of medications (if applicable)
  • Nutrition interventions, modified diets, and oral health, as needed or as determined by clinical staff or Iris Provider
  • Rehabilitation techniques to help him or her reach the maximum level of independence possible
  • The assessment of learning needs addresses the individual's cultural and religious beliefs, emotional barriers, desire and motivation to learn, physical or cognitive limitations, and barriers to communication.

Information/educational material should be given to patients and included in all patient-provider communication, as follows:

  • This material should be in format/language that is understandable to patients and his/her family or guardian. 
  • The patient’s comprehension of the material should be assessed. If translator services are needed, the on-site clinical staff can assist the Iris provider in procuring such services at the time of initial and/or follow-up care 
  • Teaching methods employed in the care, treatment, or services provided to patients will accommodate various learning styles among patients served to ensure the level of service delivered is understandable, relevant, and meaningful to the patient being served

 

 

CTS 04.02.11: Education Plans for Children and Youth with Significant School Absences

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

If the care, treatment, or services for a child causes a significant absence from school, there will be an educational service plan in place for that youth or child. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

  1. Iris providers, whose plans of care, treatment, and/or service require a child or youth to miss a significant amount of school, will work in conjunction with onsite staff and the patient’s parents or guardian to develop an educational service plan for that child or youth which may include:
    1. Developing an Individualized Education Plan (IEP)
    2. Home schooling 
    3. Online schooling
    4. Bringing student’s work home

 

  1. All educational plans will be documented in the patient’s chart, The Iris provider and on-site staff will periodically confirm that the plan is being implemented successfully, and document this confirmation in the patient’s chart. 
  2. Working in conjunction with on-site staff, Iris provider will ensure a qualified individual is providing the additional educational service to the patient. For example, if the child is going to be home-schooled, there must be a person who has taken the appropriate courses/training/measures to provide a home-based program.
  3. If the child or youth will be part of an inpatient model, the person administering the education at that hospital or organization must be qualified to do so. It is the responsibility of the guardian and staff to ensure this happens. 

 

 

CTS 04.02.13: Policy on Providing Academic Education to Children and Youth

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

Iris providers, working in conjunction with on-site staff, will ensure that children and youth who are receiving behavioral health care, treatment or services from Iris providers maintain their academic education as part of the child or youth’s educational and intellectual development. When indicated, Iris providers will assist on-site staff by making sure all state and/or local laws are followed, and will assist in specifying requirements for meeting academic needs when children or youth are not able to attend their usual school because they are receiving behavioral health care, treatment, or services. The head of the department will review this policy on a biennial basis.

PROCEDURES:

(See also: Iris Telehealth Medication Management & Treatment Policy, Section 16)

  1. Iris providers, working in conjunction with on-site staff, will ensure that children and youth who are receiving behavioral health care, treatment or services from Iris providers, and their parents or legal guardians, understand what length of stay or absence from their primary educational institution would require providing educational services in accordance with applicable law and regulation.
  2. Since Iris providers may be providing telepsychiatry services from remote sites in other states, on-site staff will assist Iris providers in understanding pertinent local and state regulations pertaining to the child or youth’s educational needs.
  3. Length of absence from school that triggers the need for non-school based education is determined by municipalities and local laws, and Iris providers will be familiar with, and follow, those laws. 

 

  1. Iris providers, working in conjunction with on-site staff, will ensure that children and youth who are receiving behavioral health care, treatment or services from Iris providers maintain their academic education as part of the child or youth’s educational and intellectual development.

 

  1. When indicated, Iris providers will assist on-site staff by making sure all state and/or local laws are followed and will assist in specifying requirements for meeting academic needs when children or youth are not able to attend their usual school because they are receiving behavioral health care, treatment, or services.

 

  1. The Iris provider will complete all school-related correspondence in a timely manner. If the family or school requests a phone call to be made, the Iris provider will complete this task as soon as possible. The Iris provider should work with the on-site staff to communicate between the organization and the patient’s school in a timely manner.  

 

  1. To provide educational support and avoid unwanted consequences that may impede learning for children with substantial (greater than 3 weeks) absence from school, the learning environment should be friendly and safe, and Iris providers will work to promote such an environment as much as possible.

 

  1. Education plays a critical role in reducing poverty, protecting children from crime and delinquency, promoting the well-being of the individual, and maintaining the welfare and stability of the society. To the extent possible, Iris providers will work actively with on-site providers to promote education as a therapeutic activity that is critical to a child or youth’s well-being and development.

 

  1.  When treating children in a hospital or similar facility where children may be confined, quarantined, or unable to attend school related activities, Iris providers will help ensure that a child or youth is not deprived of their right to pursue happiness through education. 

 

  1. Psychoeducation offered by Iris providers helps enhance the understanding of the disease process and may improve a patient’s compliance with treatment and have a positive effect on disease outcome. 

 

  1. The education of a child or youth is of paramount importance for his/her overall growth and development. Iris providers, working in conjunction with on-site providers, will promote the role of education as a therapeutic activity which is protective regarding losing ground academically while receiving care, treatment, or services.

 

  1. On initial evaluations and follow-up appointment, Iris providers will review the EMR for any interim academic reports or progress notes related to the child or youth’s educational activities and performance
  2. When necessary, and with proper consent and privacy, Iris providers will communicate with teachers and educators to ensure the child or youth is advancing in their educational level
  3. When a child or youth is identified as not advancing in his/her educational level, the Iris provider will assist in providing, or helping arrange via referral, educational and learning screening and assessments to identify areas where a child or youth may need additional interventions to maximize educational performance and overall emotional development, such as:
    1. Speech or language comprehension difficulties
    2. Attention impairment (i.e. ADHD assessment)
    3. Reading or learning difficulties
    4. Developmental deficits related to physical or emotional challenges
    5. Worsening mental health difficulties that impair successful learning

 

 

CTS 04.02.15: Facilitating Educational Continuity for Children or Youth

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

The educational needs of children or youth with long-term psychiatric needs can be easily neglected even in an industrialized country. The establishment of policy and the enrichment of professional education are necessary to eliminate educational inequities and benefit children or youth with long-term psychiatric needs. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

  1. Iris providers will complete all school-related correspondence in a timely manner. If the family or school requests a phone call to be made, the Iris provider will complete this task as soon as possible. 
  2. Iris providers should work with the on-site staff to communicate between the organization and the patient’s school in a timely manner, especially regarding the child or youth’s past academic functioning and achievement.
  3. Iris providers should promote regular communication among teachers, clinical and child-care staff, and parent or guardian regarding the ongoing educational needs of the child or youth. 
  4. Working in conjunction with on-site providers, Iris providers will encourage and promote consistent intervention and communication between teachers and clinical and child-care staff, as defined in the plan for care, treatment, or services.

(For additional details, see the Iris Telehealth Medication Management & Treatment Policy, Section 16)

 

 

CTS 05.05.01: Physical Holding of Children or Youth

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

This policy outlines the minimum standard for how Iris leaders establish and communicate our organization’s philosophy on physical holding of children or youth. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

(See also: Iris Telehealth Medication Management & Treatment Policy, Section 17, A)

 

  1. While recognizing that there are rare cases where the use of physical holding on a child or youth is medically and ethically necessary due to imminent risk of danger to self or others, it is our organization’s policy to:
    1. communicate to the children or youth served, as well as their parent(s) or guardian, and staff, our organizations philosophy on the use of physical holding of children and youth, and our commitment to use all non-physical interventions as preferred interventions to help children and youth during moments of crisis
    2. use all means necessary to avoid the use of such physical holding of children or youth and to view such physical holding as an option of last resort only to avoid severe and imminent physical harm
    3. assess for and, where possible, prevent emergencies and other situations that have the potential to lead to the use of physical holding of children or youth
    4. employ all possible non-physical interventions as preferred interventions prior to considering the use of physical holding of children or youth, including the use of input from the child or youth and his or her parent or guardian in this process
    5. limiting the use of physical holding of children and youth to those emergencies in which there is an imminent risk that the child or youth would physically harm himself or herself or imminently harm staff or others
    6. facilitate the discontinuation of any physical holding of children or youth as soon as possible and resort to non-physical interventions as preferred interventions once the imminent risk of danger to self or others has been mitigated
    7. consistently raise awareness among all clinical and support staff on how the physical holding of children and youth is experienced by the child or youth in numerous ways including emotionally, physically and socially
    8. maintain and preserve the safety and dignity of the child or youth when the physical holding of children or youth is used

 

 

CTS 05.05.03: Minimizing Use of Restraints

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

This policy is a written description outlining that the organization’s staffing standards are set to minimize circumstances that give rise to physical holding of children or youth and maximize safety when physical holding of children and youth is used. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

(See also Iris Telehealth Medication Management & Treatment Policy, Section 17, B)

  1. While recognizing that there are rare cases where the use of physical holding on a child or youth is medically and ethically necessary due to imminent risk of danger to self or others, it is our organization’s policy to work with on-site clinical staff to help set staffing ratios to minimize the occasions and circumstances that may give rise to physical holding of children or youth, and to maximize the safety of children and youth when physical holding is used.
    1. Organizational staff is required to follow all applicable regulations related to physical holds of children and youths and safety management during such physical holes. 
    2. Organizational staff is required to participate in ongoing education, continuous assessment and competency related to physical holding of children and youths (see HRM.01.06.05 for additional details.)
       

CTS 05.05.05: Staff Training in Physical Holding of Children or Youth

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

This policy is a written description outlining that the organization’s staff are trained and are competent in the organization’s efforts to minimize the use of the physical holding of children or youth, and, when use is indicated as medically necessary due to imminent danger to self or others, physical holding of children or youth is performed in such a way as to maximize safety when physical holding of children and youth is used. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

 (See also: Iris Telehealth Medication Management & Treatment Policy, Section 17, C)

  1. While recognizing that there are rare cases where the use of physical holding on a child or youth is medically and ethically necessary due to imminent risk of danger to self or others, it is our organization’s policy to do significant education around the eventuality of such physical holds on children and youth when medically necessary when there is a clear and imminent danger to self or others. To that end, the Iris providers work with onsite providers to:
    1. educate staff about minimizing the use of physical holding of children and youth and, before staff participate in any use of physical holding of children or youth, assesses the competence of staff to use this procedure safely.
    2. minimize the use of physical holding of children and youth by:
      • having staff involved in the use of physical holding receive ongoing training in and demonstrate an understanding of the following:
      • addressing underlying causes of threatening behaviors exhibited by children and youth
      • understanding that sometimes children or youth may exhibit aggressive behavior related to his or her medical conditions rather than related to his or her emotional conditions (i.e. metabolic delirium, medication reactions)
      • Educating staff on how behavior can affect the behavior of children or youth
      • use of de-escalation, mediation, self-protection, and other techniques such as time-out
      • helping children or youth regain self-control
      • recognizing readiness for discontinuing physical holding of a child or youth
      • recognizing signs of physical distress in a child or youth who is being physically held
      • recognizing how age, developmental considerations, gender issues, ethnicity, and history of sexual or physical abuse really affect the way in which a child or youth reacts to physical contact
    3. have staff involved in physical holding of children or youth receive ongoing training and demonstrate competence in the safe use of physical holding techniques
    4. have staff assigned to monitor the physical well-being of the child or youth being physically held demonstrate competence in the following areas:
      • recognizing signs and symptoms of breathing difficulties
      • providing hydration as needed and as deemed medically necessary
      • checking circulation and appropriate extremities
      • recognizing signs of any inappropriate or incorrect application of physical holding
      • recognizing when to contact a medically trained practitioner or emergency medical services to evaluate and/or treat the physical status of the child or youth
      •  (See also CTS.05.05.09, EP 4)
    5. always have staff available who are competent to initiate and perform first aid and CPR

 

 

CTS 05.05.07: Using Initial Assessments and Reassessments during the physical holding of children or youth to obtain information that could help minimize the use and impact of physical holding

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

 

POLICY DESCRIPTION:  

This policy is a written description outlining how the organization uses initial assessments and reassessments during the physical holding of children or youth to obtain information that could help minimize the use and impact of physical holding. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

 (See also: Iris Telehealth Medication Management & Treatment Policy, Section 17, D)

 

  1. While recognizing that there are rare cases where the use of physical holding on a child or youth is medically and ethically necessary due to imminent risk of danger to self or others, it is our organization’s policy to use initial assessments and reassessments during the physical holding of children or youth to obtain information that could help minimize the use and impact of physical holding, including identifying the following:
    1. Techniques that would help the child or youth control his or her behavior.
    2. Preexisting medical conditions or any physical disabilities and limitations that would place the child or youth at greater risk during a physical hold.
    3. Any history of sexual or physical abuse or other traumas that would place the child or youth at greater psychological risk during physical holding
    4. When indicated, the child or youth served and/or his or her family helps in identifying techniques that would help minimize the use of physical holding.
    5. The parent(s) or guardian of the child or youth is notified of a physical hold episode. (See also CTS.05.05.21, EP 1)

 

 

CTS 05.05.09: Safe Physical Holding of Children and Youth, When Necessary

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

This policy is a written description outlining how the organization uses the physical holding of children and youth in a safe manner when the physical holding of a child or youth is necessary. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

(See also: Iris Telehealth Medication Management & Treatment Policy, Section 17, E)

  1. While recognizing that there are rare cases where the use of physical holding on a child or youth is medically and ethically necessary due to imminent risk of danger to self or others, it is our organization’s policy to use the physical holding of children and youth in a safe manner, including:
    1. Making sure that the physical holding is initiated by an authorized staff member in accordance with law and regulation and organization policy
    2. Prohibiting the use of physical holding techniques that restrict the flow of air to the child’s or youth’s lungs
    3. Following the organization’s written process on physical holding of children and youth that identifies the techniques approved for use (may vary among clinic settings)
    4. Having a staff member who is not physically holding the child or youth assigned to observe the child's or youth’s physical well-being. (See also CTS.05.05.05, EP 4)