Seclusion in Statewide Inpatient Psychiatric Programs (SIPP)

Initial Assessments

When a youth is admitted to a Statewide Inpatient Psychiatric Program (SIPP), the program must obtain information about the individual that relates to the use of “reactive strategies” (seclusion and restraint). This information should come from a variety of sources, be documented in the person’s records, and be updated at least annually. Information should include:

• medical conditions or physical limitations that would place the youth at risk during seclusion or restraint;
• history of trauma, including sexual or physical abuse and past trauma from seclusion or restraint; and
• the Youth’s “Safety Plan” for slowing down. (A Safety Plan is developed by the youth at a calm time. The plan sets the guidelines for how the youth wants to calm down and tools or people he/she wants to help him/her stay in control. This reduces trauma for the youth and allows him/her to learn his/her trigger behavior.)

Seclusion Process

Requirements for Use of Seclusion When using Seclusion, authorization must be obtained by a supervisor. Seclusion lasting more than one hour requires approval of a staff person called an “authorizing agent”. The authorizing agent must meet certain qualifications outlined by the State. People in Statewide Inpatient Psychiatric Program (SIPP) facilities cannot be secluded automatically or as part of a slow-down plan for undesirable behaviors, as punishment, as a substitute for an achievement plan, or for the convenience of staff. Limitations and Conditions for Use of Seclusion Upon initiating seclusion, staff must immediately notify the highest–level of direct care supervisor on duty. Authorization of seclusion must include a clear reason for its use. At the onset of seclusion, staff will notify the appropriate authorizing agent of the conditions requiring seclusion.

• Staff will provide continuous monitoring of the youth implemented in a manner that permits the greatest possible amount of comfort and protection from injury to the youth.
• Seclusion must be terminated within five minutes after desired behavior criteria have been met. Providers and facilities may seek an exemption from this requirement through the variance and waiver process.
• Seclusion exceeding one hour requires additional consent from an authorizing agent.
• Seclusion may not exceed two hours without visual review and approval of the procedure by an authorizing agent or an onsite designee.
• Before seclusion begins the environment must be inspected for foreign objects that might present dangerous conditions.
• Sufficient lighting and ventilation must be ensured.
• Doors must be unlocked, if not attended by staff;
  
  • The door can be held by a staff person. A spring bolt, magnetic hold or other mechanism that permits the youth in seclusion to leave the room if the staff providing observation leaves the vicinity, must be used.

If you want to know the policy of a facility or provider, ask for a copy of their policy. Program and Staff Requirements for Use of Seclusion All facilities or providers must develop and implement policies and procedures consistent with the provisions of the Florida Administrative Code. All policies and procedures must be approved by the Agency for Persons with Disabilities (APD). All staff must be certified before performing reactive (restraint and seclusion) strategies. SIPP programs must conduct internal reviews of their seclusion policies to ensure that application of seclusion occurs in accordance with the APD standards and is administered in a safe manner.

Prohibited Procedures

Seclusion cannot be used as a “PRN” or “as required” basis.  Seclusion cannot be used if it may worsen a known medical or physical condition.
Seclusion must not be used automatically or as part of a slow-down plan for undesirable behavior, as punishment, as a substitute for an achievement plan, or for the convenience of staff.

“Time Out” and “Seclusion”

Seclusion does not mean “time out”. Time out from positive reinforcement means a procedure designed to interrupt a specific behavior of an individual by temporarily removing that individual to a separate area or room or by screening him or her from others, or by signaling that the individual is in “time out”. “Time out” is:

• of short duration, as brief as one minute, and never longer than twenty (20) uninterrupted minutes;
• only done in response to a specific behavior;
• part of a written program that includes a functional assessment and is approved by a local Review Committee;
• a program implemented by either by a Certified Behavior Analyst or a clinical social worker, mental health counselor or therapist licensed under Chapter 491, Florida Statute.;
• not used for threat, disciplinary acts, or as a tool for staff convenience; and
• stopped after one minute of calm behavior, then the youth can return to activities. During each use of seclusion, information must be collected for review, evaluation and analysis.

Complaints

Every facility or program should have a complaint process in place to investigate complaints made by a youth in the facility or by a parent, guardian, family member, friend or other interested individual. Sometimes this is called a “grievance” or “complaint” process. If you believe that a person has been unjustly restrained, or secluded in a manner that violated the person’s rights you may also contact:

• Florida Abuse Hotline 1-800-962-2873,
• Florida Statewide Advocacy Council (SAC) 1-800-342-0825, or
• Advocacy Center for Persons with Disabilities, Inc. 1-800-342-0823

Links

• Agency for Persons with Disabilities (APD) Rules on Seclusion (a.k.a. Reactive Strategies)
• Mental Health Patients’ Bill of Rights
• The Florida Abuse Hotline
• Local Advocacy Council