Title 7 . Health and Social Services

Chapter 50 . (Reserved)

Section 435. Behavior guidance

7 AAC 50.435. Behavior guidance

(a) A facility shall help a child to develop age appropriate patterns of behavior that foster constructive relationships and increasing ability to deal with everyday life.

(b) A facility shall provide for positive reinforcement, redirection, and the setting of realistic expectations and clear and consistent limits.

(c) A facility may not use discipline or a behavior management technique that is cruel, humiliating, or otherwise damaging to the child.

(d) A child in care may not be

(1) removed from the other children for more than 10 minutes if the child is a young child, except as provided in (e) of this section;

(2) disciplined in association with food or rest;

(3) punished for bedwetting or actions in regard to toileting or toilet training;

(4) subjected to discipline administered by another child;

(5) deprived of family contacts, mail, clothing, medical care, therapeutic activities designated in the child's plan of care, or contact with the child's placement worker or legal representative;

(6) subjected to verbal abuse, to derogatory remarks about the child or members of the child's family, or to threats to expel the child from the facility;

(7) placed in a locked room;

(8) physically restrained, except when necessary to protect a young child from accident, to protect persons on the premises from physical injury, or to protect property from serious damage; and then only passive physical restraint may be used;

(9) mechanically restrained, except for a protective device such as a seatbelt; or

(10) chemically restrained, except on the order of a physician and subject to the provisions of 7 AAC 50.440.

(e) Deleted 7/1/2000.

(f) Corporal punishment may not be used on a child in care.

(g) A residential child care facility shall set out rules to help children develop self control and conform to acceptable patterns of behavior, and give a copy of the rules to a child upon the child's admission.

(h) A residential child care facility may not isolate a child for more than one hour unless the facility has established an isolation procedure as part of the facility's behavior guidance policy required by 7 AAC 50.425(a) that

(1) includes the provisions under (i) of this section;

(2) addresses the provision of (j) of this section, if applicable;

(3) describes the circumstances under which a child may be isolated for more than one hour; and

(4) includes other less restrictive responses to be used before isolation for more than one hour.

(i) A residential child care facility shall document in the child's file the circumstances leading to each incident of physical restraint of a child or isolation of a child exceeding one hour.

(j) A residential child care facility may not isolate a child in a locked room except that, with prior approval of the division, a locked behavior-management room may be used under the following conditions:

(1) the locked behavior-management room must meet the approval of the appropriate municipal or state fire safety authority, must be suicide-resistant, must have break-resistant glass and security screening on its windows, and may not have less space than 50 square feet; and

(2) the facility's policies and procedures regarding the use of its locked behavior-management room must incorporate the following requirements:

(A) the locked behavior-management room may be used only if a child is out of control and is in danger of harming the child's self or others, and the facility staff has exhausted all less restrictive alternatives;

(B) the locked behavior-management room may be used only for the time necessary to change the behavior compelling its use;

(C) the locked behavior-management room may be used only on the order of a professional mental health clinician; the clinician must set out in the order a maximum time limit for initial use of the room for isolation of a particular resident, not to exceed two hours for a child 10 years of age or older, and not to exceed one hour for a child less than 10 years of age; after that initial period the clinician may not continue the isolation of the resident in the locked behavior-management room unless

(i) the clinician executes a separate order for each period of continued isolation, and sets out in that order a maximum time limit not to exceed the applicable initial time limit set out in this subparagraph;

(ii) the clinician makes a face-to-face assessment of the child before executing an order described in (i) of this subparagraph; and

(iii) within any 24-hour period, the resident is kept in isolation, whether continuous or intermittent, for no more than eight hours, if the child is 10 years of age or older, and for no more than four hours, if the child is less than 10 years of age;

(D) no more than one child may be placed in the locked behavior-management room at a time;

(E) a staff member of the facility shall observe the child at intervals of 15 minutes or less and record the observation in a behavior management log;

(F) the behavior management log must include the name of the child, the time of the child's placement in the locked behavior-management room, the name of the staff member responsible for the placement, a description of the specific behavior requiring the use of the locked behavior-management room, and the time of the child's removal from the locked behavior-management room; the behavior management log must be signed by the professional mental health clinician who recommended its use;

(G) for each use in which a child remains in the locked behavior-management room for longer than one hour, the behavior management log must contain hourly supervisory approval and the reasons for the continued use of the locked behavior-management room beyond the first hour;

(H) use of the locked behavior-management room may not exceed the time limit established by the mental health professional;

(I) when a child less than 10 years of age is placed in the locked behavior-management room, a staff member shall be physically present in the room; however, the staff member may move to an area outside and immediately adjacent to the room if

(i) the child's behavior and affect indicate that the removal of the staff member from the room will allow the child to better gain self-control;

(ii) before leaving the room, the staff member ensures that the child is safe; and

(iii) by personal observation, including both sight and sound, the staff member continuously monitors the child from immediately outside the window in the door or outside another window that looks into the room; for purposes of this subparagraph, personal observation does not include staff observation of the child over a video monitor; and

(J) the facility shall ensure that the personal needs of the child placed in the locked behavior-management room are met and that the child has prompt access to washroom and toilet facilities.

History: Eff. 1/1/96, Register 136; am 3/1/98, Register 145; am 6/21/2001, Register 158

Authority: AS 44.29.020

AS 47.35.010