(1) Notwithstanding the provisions of section 26-20-103, an agency that uses restraint shall ensure that:
(a) At least every fifteen minutes, staff shall monitor any individual held in mechanical restraints to assure that the individual is properly positioned, that the individual's blood circulation is not restricted, that the individual's airway is not obstructed, and that the individual's other physical needs are met;
(b) No physical or mechanical restraint of an individual shall place excess pressure on the chest or back of that individual or inhibit or impede the individual's ability to breathe;
(c) During physical restraint of an individual, an agent or employee of the agency shall check to ensure that the breathing of the individual in such physical restraint is not compromised;
(d) A chemical restraint shall be given only on the order of a physician or an advanced practice registered nurse with prescriptive authority who has determined, either while present during the course of the emergency justifying the use of the chemical restraint or after telephone consultation with a registered nurse, licensed physician assistant, or other authorized staff person who is present at the time and site of the emergency and who has participated in the evaluation of the individual, that such form of restraint is the least restrictive, most appropriate alternative available. Nothing in this subsection (1) shall modify the requirements of section 26-20-102 (2) or 26-20-103 (3).
(e) An order for a chemical restraint, along with the reasons for its issuance, shall be recorded in writing at the time of its issuance;
(f) An order for a chemical restraint shall be signed at the time of its issuance by such physician if present at the time of the emergency;
(g) An order for a chemical restraint, if authorized by telephone, shall be transcribed and signed at the time of its issuance by an individual with the authority to accept telephone medication orders who is present at the time of the emergency;
(h) Staff trained in the administration of medication shall make notations in the record of the individual as to the effect of the chemical restraint and the individual's response to the chemical restraint.
(2) For individuals in mechanical restraints, agency staff shall provide relief periods, except when the individual is sleeping, of at least ten minutes as often as every two hours, so long as relief from the mechanical restraint is determined to be safe. During such relief periods, the staff shall ensure proper positioning of the individual and provide movement of limbs, as necessary. In addition, during such relief periods, staff shall provide assistance for use of appropriate toiletting methods, as necessary. The individual's dignity and safety shall be maintained during relief periods. Staff shall note in the record of the individual being restrained the relief periods granted.
(3) Relief periods from seclusion shall be provided for reasonable access to toilet facilities.
(4) An individual in physical restraint shall be released from such restraint within fifteen minutes after the initiation of physical restraint, except when precluded for safety reasons.
Source: L. 99: Entire article added, p. 380, � 1, effective April 22. L. 2001: (1)(d) amended, p. 185, � 18, effective August 8. L. 2008: (1)(d) amended, p. 135, � 26, effective January 1, 2009.
26-20-104.5. Duties relating to use of seclusion by division of youth services. (1) Notwithstanding the provisions of section 26-20-103 to the contrary, if the division of youth services holds a youth in seclusion in any secure state-operated or state-owned facility:
(a) A staff member shall check the youth's safety at varying intervals, but at least every fifteen minutes;
(b) Within one hour after the beginning of the youth's seclusion period, and every hour thereafter, a staff member shall notify the facility director or his or her designee of the seclusion and receive his or her written approval of the seclusion; and
(c) Within twelve hours after the beginning of the youth's seclusion period, the division of youth services shall notify the youth's parent, guardian, or legal custodian and inform that person that the youth is or was in seclusion and the reason for his or her seclusion.
(2) (a) A youth placed in seclusion because of an ongoing emergency must not be held in seclusion beyond four consecutive hours, unless the requirements of paragraph (b) of this subsection (2) are satisfied.
(b) If an emergency situation occurs that continues beyond four consecutive hours, the division of youth services may not continue the use of seclusion for that youth unless the following criteria are met and documented:
(I) A qualified mental health professional, or, if such professional is not available, the facility director or his or her designee, determines that referral of the youth in seclusion to a mental health facility is not warranted; and
(II) The director of the division of youth services, or his or her designee, approves at or before the conclusion of four hours, and every hour thereafter, the continued use of seclusion.
(c) A youth may not be held in seclusion under any circumstances for more than eight total hours in two consecutive calendar days without a written court order.
(3) Notwithstanding any other provision of this section, the division of youth services may place a youth alone in a room or area from which egress is involuntarily prevented if such confinement is part of a routine practice that is applicable to substantial portions of the population. Such confinement must be imposed only for the completion of administrative tasks and should last no longer than necessary to achieve the task safely and effectively.
Source: L. 2016: Entire section added, (HB 16-1328), ch. 345, p. 1403, � 4, effective June 10. L. 2017: IP(1), (1)(c), IP(2)(b), (2)(b)(II), and (3) amended, (HB 17-1329), ch. 381, p. 1983, � 62, effective June 6.
26-20-105. Staff training concerning the use of restraint and seclusion - adults and youth. (1) An agency that utilizes restraint or seclusion shall ensure that all staff involved in utilizing restraint or seclusion in its facilities or programs are trained in the appropriate use of restraint and seclusion.
(1.5) The division of youth services shall ensure that all staff involved in utilizing restraint and seclusion are trained in:
(a) The health and behavioral effects of restraint and seclusion on youth, including those with behavioral or mental health disorders or intellectual and developmental disabilities;
(b) Effective de-escalation techniques for youth in crisis, including those with behavioral or mental health disorders or intellectual and developmental disabilities;
(c) The value of positive over negative reinforcement in dealing with youth; and
(d) Methods for implementing positive behavior incentives.
(2) All agencies that utilize restraint or seclusion shall ensure that staff are trained to explain, where possible, the use of restraint or seclusion to the individual who is to be restrained or secluded and to the individual's family if appropriate.
Source: L. 99: Entire article added, p. 381, � 1, effective April 22. L. 2016: Entire section amended, (HB 16-1328), ch. 345, p. 1404, � 5, effective June 10. L. 2017: (1.5)(a) and (1.5)(b) amended, (SB 17-242), ch. 263, p. 1335, � 225, effective May 25; IP(1.5) amended, (HB 17-1329), ch. 381, p. 1984, � 63, effective June 6.
Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
26-20-106. Documentation requirements for restraint and seclusion - adults and youth. (1) Each agency shall ensure that the use of restraint or seclusion is documented in the record of the individual who was restrained or secluded. Each agency that is authorized to promulgate rules or adopt ordinances shall promulgate rules or adopt ordinances applicable to the agencies within their respective jurisdictions specifying the documentation requirements for purposes of this section.
(2) The division of youth services shall maintain the following documentation each time a youth is placed in seclusion as a result of an emergency in any secure state-operated or state-owned facility:
(a) The date of the occurrence;
(b) The race, age, and gender of the individual;
(c) The reason or reasons for seclusion, including a description of the emergency and the specific facts that demonstrate that the youth posed a serious, probable, and imminent threat of bodily harm to himself, herself, or others, and that there was a present ability to effect such bodily harm;
(d) A description of de-escalation measures taken by staff and the response, if any, of the youth in seclusion to those measures;
(e) An explanation of why less restrictive alternatives were unsuccessful;
(f) The total time in seclusion;
(g) Any incidents of self-harm or suicide that occurred while the youth was in seclusion;
(h) With respect to the interactions required by section 26-20-104.5, documentation of the justification for keeping the youth in seclusion and specific facts to demonstrate that the emergency was ongoing;
(i) The facility director or his or her designee's approval of continued seclusion at intervals as required by section 26-20-104.5;
(j) Documentation of notification within twelve hours to the parent, guardian, or legal custodian of the youth in seclusion as required by section 26-20-104.5; and
(k) The written approval by the director of the division of youth services for any seclusion that results from an emergency that extends beyond four consecutive hours, as required by section 26-20-104.5. This written approval must include documentation of specific facts to demonstrate that the emergency was ongoing and specific reasons why a referral to a mental health facility was not warranted.
(3) The division of youth services shall maintain the following documentation each time one or more youths are placed in confinement for administrative reasons pursuant to section 26-20-104.5 (3) in a secure state-operated or state-owned facility:
(a) The number of youth confined;
(b) The length of time the youth or youths were confined; and
(c) The reason or reasons for the confinement.
(4) On or before January 1, 2017, and on or before July 1, 2017, and every January 1 and July 1 thereafter, the division of youth services shall report on its use of restraint or seclusion in any secure state-operated or state-owned facility to the youth restraint and seclusion working group established in section 26-20-110. The January report must include information from March 1 through August 31, and the July report must include information from September 1 through the last day of February. The reports must include the following:
(a) An incident report on any use of seclusion on a youth due to an emergency for more than four consecutive hours, or for more than eight total hours in two consecutive calendar days. Each incident report must include length of seclusion, specific facts that demonstrate that the emergency was ongoing, any incidents of self-harm while in seclusion, the reasons why attempts to process the youth out of seclusion were unsuccessful, and any corrective measures taken to prevent lengthy or repeat periods of seclusion in the future. To protect the privacy of the youth, the division of youth services shall redact all private medical or mental health information and personal identifying information, including, if necessary, the facility at which the seclusion occurred.
(b) A report that lists the following aggregate information, both as combined totals and totals by facility for all secure state-operated or state-owned facilities:
(I) The total number of youths held in seclusion or restraint due to an emergency;
(II) The total number of incidents of seclusion or restraint due to an emergency;
(III) The average time in seclusion or restraint per incident;
(IV) An aggregate summary of race, age, and gender of youths held in seclusion or restraint; and
(V) The type of restraint or restraints used in each incident; and
(c) An incident report for any youth whom the division isolates from his or her peers for more than eight hours in two consecutive calendar days. Each incident report must include the age, race, and gender of the youth; the name of the facility; the length of time that the youth was isolated from his or her peers; and the justification for the isolation on an hour-by-hour basis. To protect the privacy of the youth, the division shall redact all private medical or mental health information and personal identifying information, including, if necessary, the facility at which the seclusion occurred. If the division has prepared an incident report of an incident involving seclusion pursuant to subsection (4)(a) of this section, the division is not required to include a report of the same incident pursuant to this subsection (4)(c).
(5) Reports prepared pursuant to this section must maintain the confidentiality of all youth. The reports made pursuant to this section are available to the public upon request.
(6) Prior to January 1, 2018, the division of youth services shall meet the requirements of this section to the extent that it is able using its current reporting mechanisms. The division of youth services shall fully comply with all requirements of this section on or before January 1, 2018.
Source: L. 99: Entire article added, p. 382, � 1, effective April 22. L. 2016: Entire section amended, (HB 16-1328), ch. 345, p. 1404, � 6, effective June 10. L. 2017: IP(2), (2)(k), IP(3), (4), and (6) amended, (HB 17-1329), ch. 381, p. 1962, � 4, effective June 6.