TABLE OF CONTENTS

CTS 05.05.11 Using Non-physical techniques as the preferred intervention in managing behaviors of children and 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 nonphysical techniques are the preferred intervention in managing behaviors of children and 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, F)

  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 nonphysical techniques as the preferred intervention in managing behaviors of children and youth, including:
  1. implementing a crisis response plan
  2. redirecting the focus of the child or youth
  3. employing verbal de-escalation and positive behavioral support
  4. using sensory modulation.

 

 

CTS 05.05.13: Limited and Emergency Use of the Physical Holding on a Child 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 use of physical holding on a child or youth is limited to emergencies in which there is an imminent risk of a child or youth physically harming himself or herself, staff, or others, and when nonphysical interventions would not be effective. 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, G)

  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 limit such physical holding to emergencies in which there is an imminent risk of a child or youth physically harming himself or herself, staff, or others, and when nonphysical interventions would not be effective, including:
    1. When nonphysical interventions are ineffective or not viable and when there is an imminent risk of a child or youth physically harming himself or herself, staff, or others.
    2. When a physical hold is used, information learned from the initial assessment of the child or youth is considered.
    3. Not permitting physical holding for any other purpose, such as coercion, discipline, convenience, or retaliation by staff.
    4. Not basing physical holding on the history of past physical holding of the child or youth or solely on a history of dangerous behavior.

 

 

CTS 05.05.15: Discontinuing Physical Holding When a Child or Youth Regains Control of His or Her Behavior

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 discontinues the physical holding of a child or youth when he or she regains control of his or her behavior. 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, H)

  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 discontinue the physical hold when the child or youth regains control of his or her behavior, including:
    1. Making the child or youth aware, as early as feasible in the physical holding process, of the reason(s) for physical holding and reassuring him or her that the physical hold will be discontinued as soon as the child or youth regains control of his or her behavior, as evidenced by examples such as:
      1. the ability of the child or youth to contract for safety
      2. whether the child or youth is oriented to the environment
      3. cessation of verbal threats.
    2. Discontinuing the physical hold as soon as the child or youth regains control of his or her behavior.

 

 

CTS 05.05.17: Debriefing After Physical Hold on a Child 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 how the organization conducts a debriefing with staff and patient after every episode where the physical holding of a child or youth has taken place 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, I)

  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 conduct a debriefing of each episode that includes all staff who participated in the physical hold as well as the child or youth requiring the physical hold. Elements of this debriefing include: 
    1. Conducting the debriefing as soon as possible after the physical hold has ended.
    2. Using the debriefing to accomplish the following goals:
      1. Identify what led to the incident and what could have been handled differently
      2. Ascertain that the physical well-being, psychological comfort, and right to privacy of the child or youth were addressed
      3. Assess the impact of the holding on the child's or youth’s emotional functioning
      4. When indicated, modify the child’s or youth’s plan for care, treatment, or services
    3. Using the information obtained in the debriefings in performance improvement activities.

 

 

CTS 05.05.19: Collecting Data on the Use of Physical Holding of a Child 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 how the organization collects data on the use of physical holding of a child 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, J)

  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 collect data on every episode in which the physical holding of a child or youth has taken place. When gathering this data, particular attention is paid to the following elements:
  • Organizational leaders determine the frequency with which data on the physical holding are aggregated and reported to leadership
  • Individual identifiers are included in data collected on the use of physical holding
  • Data on all physical holding episodes are collected and classified for all settings/locations and include the following:
    1. setting or location
    2. shift
    3. staff who initiated the process of physical holding
    4. number of minutes of each physical hold
    5. date and time each physical hold was initiated
    6. day of the week each physical hold occurred
    7. whether injuries were sustained by the child or youth or staff
    8. age of the child or youth
    9. sex of the child or youth
    10. debriefing data
    11. multiple instances of physical holding of the child or youth within a 12-hour timeframe
    12. number of physical holds per child or youth
    13. use of psychoactive medications to enable discontinuation of physical hold
  • administrative and clinical leaders are made aware when a child or youth experiences a physical hold longer than 30 minutes and when a child or youth experiences multiple episodes of holding within a 12-hour period
  • the organization evaluates the number of physical holding episodes per child or youth served

 

 

CTS 05.05.21: Prevention of the Use of Physical Holding and, when Employed, Guide for its Use

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 works to prevent the use of physical holds on a child or youth and guides their use when they are required. 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, K)

  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 try and prevent the use of such physical holds and to guide their use when they are required. The organization follows its written policies and procedures regarding physical holding that include details about the following: 
    1. Staffing
    2. Staff competence and training
    3. Initial assessment of the child or youth
    4. The role of non-physical techniques
    5. Limiting physical holding to emergencies
    6. Notification of the parent(s) or guardian of the child or youth (See also CTS.05.05.07, EP 5)
    7. Initiation of physical holding by an authorized staff member
    8. Monitoring of the child or youth
    9. Discontinuation of the physical hold
    10. Debriefing
    11. Reporting injuries and deaths to the organization’s leadership and appropriate external agencies consistent with applicable law and regulation
    12. Documentation of physical holding
    13. Data collection and the integration of physical holding into performance improvement activity

 

 

CTS 05.06.13: Using a Licensed Independent Practitioner to Order Restraints and Seclusions

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 a licensed independent practitioner to order restraints and seclusions while noting that this does not limit the authority of a doctor of medicine or osteopathy to delegate tasks to physician assistants and advanced practice nurses to the extent recognized under state law or a state’s regulatory mechanism and allowed by the organization. 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, L)

  1. While recognizing that there are rare cases when using restraint or seclusion is medically and ethically necessary due to imminent risk of danger to self or others, it is our organization’s policy to have a licensed independent practitioner order the use of restraint or seclusion, while noting that this does not  limit the authority of a doctor of medicine or osteopathy to delegate tasks to physician assistants and advanced practice nurses to the extent recognized under state law or a state’s regulatory mechanism and allowed by the organization. Specific items related to ordering restraints and seclusions include: 
    1. All restraint and seclusion are applied and continued pursuant to an order by the licensed independent practitioner who is primarily responsible for the ongoing care of the individual served, or his or her licensed independent practitioner designee, or other licensed independent practitioner. 
    2. Because restraint and seclusion use is limited to emergencies (in which a licensed independent practitioner may not be immediately available), the organization may authorize qualified, trained staff members who are not licensed independent practitioners to initiate restraint or seclusion before an order is obtained from the licensed independent practitioner. In addition, restraint and seclusion may be ordered by licensed practitioners (for example, registered nurses, licensed social workers) if permitted by state law and by the organization.
    3. As soon as possible, but no longer than one hour after the initiation of restraint or seclusion, qualified staff do the following:
      1. notify, and obtain a written or verbal order from, the licensed independent practitioner
      2. consult with the license independent practitioner about the physical and psychological condition of the individual served
    4. The licensed independent practitioner does the following:
      1. reviews with staff of physical and psychological status of the individual served
      2. determines whether restraint or seclusion should be continued
      3. supplies staff with guidance in identifying ways to help the individual regain control so that restraint or seclusion can be discontinued
      4. supplies an order for restraint or seclusion

 

 

CTS 05.06.17: A Licensed Independent Practitioner Sees and Evaluates, In Person, Individuals in Restraint or Seclusion

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 a licensed independent practitioner to see and evaluate, in person, individuals in restraint or seclusion. 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, M)

  1. While recognizing that there are rare cases when using restraint or seclusion is medically and ethically necessary due to imminent risk of danger to self or others, it is our organization’s policy to have a licensed independent practitioner see and evaluate, in person, any individual who is restrained or secluded. Specific items related to these in-person evaluations include: 
    1. The licensed independent practitioner primarily responsible for the ongoing care, treatment, or services of the individual served, or his or her licensed independent practitioner designee, or other licensed independent practitioner, evaluates the individual in restraint or seclusion in person within the following time constraints: 
      1. four hours of the initiation of restraint or seclusion for individuals ages 18 or older
      2. two hours of initiation of restraint or seclusion for children and youth ages 17 and under.
    2. At the time of the in-person evaluation of the individual in restraint or seclusion, the licensed independent practitioner does the following:
      1. works with the individual and staff to identify ways to help individual regain control
      2. revises the individual’s plan for care, treatment, or services as needed
      3. if necessary, provides a new written order
    3. The licensed independent practitioner evaluates the individual in restraint or seclusion in person within 24 hours of the initiation of restraint or seclusion if the individual is no longer in restraint or seclusion when an original verbal order expires.

 

 

CTS 06.02.01: Plan following Discharge or Transfer

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

When a patient is discharged or transferred, it is the responsibility of the Iris provider to make sure the continuity of care is not broken and reasons for any type of change are well documented. 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 18:A)

  1. The Iris provider, in conjunction with on-site discharge planners and staff, must have a plan in place for any patients that are discharged or transferred. The plan must be documented in the patient’s chart and should include each of the following: 
    1. The transfer of responsibility for care, treatment, or services for the individual served from one staff, organization, organizational program, or service to another  
    2. The reason(s) for transfer or discharge when moving from one staff, organization, organizational program, or service to another 
    3. Mechanisms for internal and external transfer  
    4. Identification of the person who has accountability and responsibility for the safety of the individual served during an external transfer

 

 

CTS 06.02.03: Individualized Discharge or Transfer Plans

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

There must be a well-documented reason for a patient being transferred or discharged. The decision should be based on each patient’s assessment(s) and needs. The head of the department will review this policy on a biennial basis.

PROCEDURES:

(See also: Iris Telehealth Medication Management & Treatment Policy, Section 18:B)

  1. When an individual served is discharged or transferred, the Iris provider, working in conjunction with the on-site staff, bases the discharge or transfer on the assessed needs of the individual and the organization's capabilities including:
    1. Identifying the physical and psychosocial needs for continuing care of the individual served.
    2. Telling the individual in a timely manner of the need to plan for discharge or transfer to another organization or level of care, treatment, or services.
    3. Involving the individual served, his or her family if applicable, and staff in discharge or transfer planning (Note: Family includes legal guardian and surrogate decision-maker)
    4. When the individual served is transferred, information provided to the individual includes the following: 
      1. The reason he or she is being transferred
      2. Alternatives to transfer, if any
    5. Discussing discharge and transfer plans, or changes in these plans, with the individual served and, with the individual's consent, his or her family or legal guardian. If the individual is a child or youth, the organization acts in accordance with law and regulation.
    6. When the individual served is discharged, information provided to the individual and his or her family, if applicable, includes the following: 
      1. The reason he or she is being discharged 
      2. The anticipated need for continued care, treatment, or services after discharged
      3. Note: Continued care, treatment, or services includes, as needed, special education, adult day care, case management, home health services, hospice, long term care, outpatient care, support groups, rehabilitation services, and community mental health services.
    7. Educating the individual about how to obtain further care, treatment, or services to meet his or her identified needs.
    8. Before discharge, arranging for or helping the family arrange for care, treatment, or services needed to meet the needs of the individual served after discharge. 
    9. Providing the individual served and his or her family, if applicable, discharge instructions in a form the individual can understand. (See also RI.01.01.03, EP 1)

 

 

CTS 06.02.05: Communication of Patient Information when Discharged or Transferred

Revision Date: November 12, 2020 

Written/Revised By: Marie DiDario, DO

Approved By: Thomas Milam, MD

Policy Description:  

It is the responsibility of the Iris provider and the on-site staff to share pertinent patient information about the patient’s care, treatment, and services with the appropriate external providers and organizations when a patient is being transferred or discharged. 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 18:C)

  1. Any time a patient is discharged or transferred, the Iris provider or on-site staff must communicate pertinent information to the relevant provider(s) or organization that the patient will be seeing. This information includes, at a minimum, the following:
    1. The reason for transfer or discharge
    2. Relevant biopsychosocial status at transfer or discharge
    3. A summary of care, treatment, or services provided and progress made toward goals
    4. Community resources or referrals provided to the individual served
    5. Documentation of above information in the patient’s chart. 

 

 

CTS 06.03.01: Assisting Young Adults with Life Transition Needs

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 the minimum standards for providing care, treatment, or services to young adults with life transition needs. This policy shall be applicable to Iris providers. The head of the department will review this policy on a biennial basis.

 

PROCEDURES:

Iris Telehealth staff and providers recognize the unique challenges faced by young adults in today’s complex societal and cultural milieu. Helping young adults navigate through those unique challenges and process biopsychosocial and physical stressors is central to the work of Iris clinicians. 

Utilizing evidence-based psychopharmacology interventions, as well as developmentally appropriate and evidence-based psychotherapeutic interventions--including cognitive behavioral therapy, supportive therapy, interpersonal therapy, dialectical behavioral therapy, mindfulness meditation, relaxation training, coping skills training, and additional therapeutic techniques--are some of the key tools used by Iris clinicians to assist young adults with life transition needs. 

Iris clinicians, and the staff with whom they closely work, utilize a diverse referral base to address patients’ needs for specific transitional skill development for areas such as personal financial management, employment searching and resume design, general and vocational educational training and completion, housing management, healthcare management, accessing social and community services, and addressing other personal, social, and family needs as may be pertinent to the transitional needs of young adults under the clinician’s care. 

All efforts are made to connect young adults with specific needs to the community, regional, state, and federal resources that are most suited to help meet that young adult’s needs so that he or she can function in a meaningful and life-sustaining way.