Tracking # 2012-00125
FA/P 4/6/12, eff. 6/1/12

I:/11121401.rtf
(I:/11121401.doc)

(12 CCR 2509-1) 

Instructions: insert before line 1585539.] 
Revisions and repeals of Sections 7.701.2, 7.701.31, 7.701.33, 7.701.4, 7.701.9 through 7.701.91, 7.702.1 through 7.702.2, 7.702.43, 7.702.91, 7.705, 7.705.22, 7.705.33, 7.705.55, 7.705.61 through 7.705.63, 7.705.7 through 7.705.77, 7.705.82, 7.705.84, 7.705.100 through 7.705.104, 7.706 through 7.706.1, 7.706.15, 7.706.16, 7.706.17, 7.706.19, 7.707.1, 7.707.22, 7.707.31, 7.707.32, 7.707.71, 7.707.923, 7.708.11, 7.708.31, 7.708.34, 7.708.35, 7.708.36, 7.708.61, 7.708.65, 7.709.2 through 7.709.21, 7.709.24, 7.710, 7.710.11, 7.710.2, 7.710.21, 7.710.22, 7.710.24, 7.710.25, 7.710.26, 7.710.33, 7.710.34, 7.710.36, 7.710.41, 7.710.42, 7.710.44, 7.710.45, 7.710.52, 7.710.53, 7.710.55, 7.710.56, 7.710.92, 7.710.93, 7.711.1, 7.711.75, 7.712.1, 7.712.33, 7.712.41, 7.712.42, 7.712.74, 7.713 through 7.713.1, 7.713.21, 7.713.23, 7.713.24, 7.713.25, 7.713.31, 7.713.41, 7.713.56, 7.713.65, 7.714 through 7.714.2, 7.714.5, 7.714.52, 7.714.53 through 7.714.537, 7.714.92, 7.714.933, 7.715.11, 7.715.46, 7.715.84, 7.718 through 7.718.4, 7.720.41, and 7.720.73 were final adoption following publication at the 4/6/2012 State Board meeting (Rule-making#’s 11-9-22-1 and 11-12-14-1), with an effective date of 6/1/2012. Statement of Basis and Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, Division of Boards and Commissions, State Board Administration.

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(12 CCR 2509-8)

Instructions: replace line 2252566.] 
7.701.2  DEFINITIONS [Rev. eff. 6/1/12]

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[Instructions: replace lines 2252607 through 2252608.] 
H.  Secure Residential Treatment Center
A "Secure Residential Treatment Center", defined at Section 26-6-102(9), C.R.S., means a facility operated under private ownership that provides twenty-four (24) hour group care and treatment in a secure setting for five (5) or more children or persons from age ten (10) up to the age of twenty-one (21) who are committed by a court pursuant to an adjudication of delinquency or pursuant to a determination of guilt of a delinquent act or having been convicted as an adult and sentenced for an act that would be a crime if committed in Colorado, or in the committing jurisdiction, to be placed in a secure facility. 

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Instructions: replace line(s) 1131001.] 
7.705  RULES REGULATING RESIDENTIAL CHILD CARE FACILITIES [Rev. eff. 6/1/12]
All Residential Child Care Facilities must comply with the “General Rules for Child Care Facilities” found at Section 7.701, et seq., and the 24-Hour Quality Standards at Section 7.714. 

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Instructions: replace line 1131272.] 
7.705.55  Building Safety [Rev. eff. 6/1/12]

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[Instructions: replace line 1131285.] 

[B.] 
5.  In every building or structure, exits shall be so arranged and maintained as to provide free and unobstructed egress from all parts of the building or structure at all times when it is occupied. No lock or fastening to prevent free escape from the inside of any building shall be installed unless specifically authorized pursuant to Section 7.714.53. 

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[Instructions: replace lines 1131323 through 1131375; Sections 7.705.7 - 7.705.77 repealed.] 
7.705.7  (NONE) [Rev. eff. 6/1/12]

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[Instructions: replace lines 1131382 through 1131393.] 
7.705.82  Admission to Shelter Care and Orientation [Rev. eff. 6/1/12]
A.  At the time of emergency shelter care placement of a child, the facility shall obtain at least the following information: name, birth date, if available, physical description of the child, date and time of the admission, name and authority of person bringing child to the facility, and reason for placement.
On the next working day following emergency shelter care placement of the child, the facility shall obtain from the county department of social services or the parent of guardian a signed, written authorization to obtain medical care for the child. The county department is authorized to give this authorization pursuant to this staff manual.
B.  The facility shall ensure that each newly admitted child is checked by facility staff or physician for signs of illness, symptoms of abuse, and the presence of vermin.
The facility shall have a medical plan, including staff training, which includes the screening of the child for child abuse and signs of illness requiring immediate medical attention.
C.  If a child remains in shelter care for longer than thirty days, a medical examination must be completed in compliance with Section 7.705.31, B. 

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[Instructions: replace lines 1131399 through 1131406.] 
7.705.84  Personnel [Rev. eff. 6/1/12]
A.  A shelter care facility shall maintain the staff ratio described at Section 7.705.46.
B.  A shelter care facility must have awake staff during the children's sleeping hours.
C.  A shelter care facility shall make adequate provisions to ensure the immediate availability of additional staff in the event of an emergency or crisis.
D.  Training programs for staff in shelter care facilities shall reflect special emphasis on the following areas:
1.  Physical Management. 
2.  Crisis intervention.
3.  Crisis and emergency procedures. 

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[Instructions: replace lines 1131478 through 1131489.] 
7.706  RULES REGULATING DAY TREATMENT CENTERS [Rev. eff. 6/1/12]
All day treatment centers must comply with the “General Rules for Child Care Facilities” found at Section 7.701, et seq., the restraint and seclusion rules found at Section 7.714.53, et seq., the applicable definitions in Section 7.714.1, and these “Rules Regulating Day Treatment Centers”. 
7.706.1  DEFINITIONS [Rev. eff. 6/1/12]
A “day treatment center” is a facility which provides less than twenty-four (24) hour care for groups of five or more children from five (5) to sixteen (16) years of age and over. The center will provide a structured program of various types of psycho-socio and/or behavioral treatments to prevent or reduce the need for placement of the child out of the home or community. This definition does not preclude the day treatment center from enrolling children sixteen (16) years old to eighteen (18) years old and those persons to twenty one (21) years old who are placed by court order prior to their eighteenth birthday. 
This definition shall not include special education programs operated by a public or private school system or programs which are licensed by other regulations of the Colorado Department of Human Services for less than twenty four (24) hour care of children, such as day care centers or centers for developmentally disabled children.
“De-escalation” is the use of therapeutic interventions with a child during the escalation phase of a crisis. The interventions are designed to allow children to contain their own behavior so that acute physical behavior does not develop that would lead to the need to use a physical management. 
“Reasonable” as used in these rules means appropriate and suitable, or not excessive or extreme.

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Instructions: replace lines 1131516 through 1131527.] 
7.706.15  Child Care Services [Rev. eff. 6/1/12]
A.  Admission of the children to the day treatment center shall be limited to and in keeping with the stated purpose and goals of the center.
1.  Intake policies of the center shall be clearly defined in writing and shall be reviewed and modified as necessary.
2.  At intake the center shall obtain:
a.  Identifying information necessary for the child's record as required at Section 7.706.18, A.
b.  Psycho-social history of the child.
c.  A statement about the health history of the child which includes at least the immunization record; information and instruction for care of each child who has a chronic or handicapping problem such as seizures, asthma, diabetes, allergies, heart or respiratory illness or drug addiction; date of last physical examination. If child has not had a physical examination within the past twelve months, such examination shall be completed within thirty days of admission to the program. Subsequent examinations shall be obtained as required by a physician or nurse practitioner licensed to practice in Colorado. 
d.  The center shall obtain written permission for the following from the person or agency having custody:
1)  Permission to treat the child.
2)  Permission to obtain emergency medical care in the event that the child has an accident or illness requiring medical attention when parent or guardian is unavailable.
3)  Permission to provide transportation to and from the center or for center-sponsored activities if necessary.
4)  Permissions for physical management, restraint and seclusion as required in Section 7.714.53, et seq. 

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[Instructions: replace lines 1131552 through 1131619.] 
7.706.16  Behavior Management [Rev. eff. 6/1/12]
A.  Each day treatment center will have written documentation of policies and procedures that describe the treatment model upon which the behavior management system is based and who shall be responsible for disciplinary measures.
B.  The behavior management system must be explained to parents/guardians and to children taking into account the child's developmental and cognitive level.
C.  The behavior management system must include, at a minimum:
1.  Positive constructive or educational components including but not limited to diversion, withholding of privileges, talk with the child about the situation, positive reinforcement, skill training, and skill development.
2.  Clear rules and expectations with predictable, consistent consequences or interventions that will be used by staff members to reinforce positive behaviors and to address disruptive, off-task or unsafe behaviors in the program.
3.  A continuum of de-escalation and redirecting techniques to deal with disruptive, escalating or unsafe behaviors.
4.  A review process for addressing chronic behavior problems or serious acute problems in which a child is not responding to the behavior management program as being implemented.
D.  The program will have a monitoring process of the behavior management system to assure both consistency in implementation and for continuous quality improvement as needed to address changing client needs and behaviors.
E.  Physical management will be considered an extreme level of intervention at the day treatment level. The occurrence of restraints for a particular child will require a review as described in Section C, 4 above. The goal of these reviews will be to eliminate restraints for the child by reassessing the identified problem, adjusting the treatment plan, utilizing additional resources or other such interventions including the evaluation of whether day treatment is a level of care at which the child can successfully function. 
F.  The behavior management system will include, but not be limited to, any of the following:
1.  No child shall be punched, shaken, pinched, bitten, roughly handled or struck by an inanimate object by staff members of the day treatment center.
2.  Authority to discipline shall not be delegated to other children.
3.  Separation when used as discipline shall be brief and appropriate to the child's age and circumstances, and the child shall be within hearing and visual observation of an adult in a safe, lighted, well-ventilated room. No child shall be secluded in a locked room or closet.
4.  No child shall be punished for toileting accidents.
5.  Verbal abuse or derogatory remarks about the child, his family, his race, religion or cultural background shall not be used or permitted.
6.  No child shall be force-fed.
7.  Meals may be provided individually, but deprivation of meals shall not be used as punishment.
8.  No child shall be subjected to physical harm or humiliation.
9.  Seclusion. 
G.  Disregard of any of the foregoing disciplinary rules or any disciplinary measure resulting in physical injury or abuse of any child shall be grounds for the denial, revocation, suspension, or making probationary of the license. 
7.706.17  Physical Management [Rev. eff. 6/1/12]
Any physical management, restraint and seclusion shall comply with the rules found at Section 7.714.53, et seq., and the applicable definitions in Section 7.714.1. 

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Instructions: replace lines 2290800 through 2290815.] 
7.708.11  Definitions [Rev. eff. 6/1/12]
“Certifying authority” means licensed child placement agencies and county departments of social/human services that have the authority to certify family foster care homes, including kinship care homes. 
“Child specific foster care” is care where the foster child has a prior relationship to the foster parent(s). 
“County designee” is the representative of a county department designated by the county executive director to make certain key decisions regarding foster children. 
“De-escalation” is the use of therapeutic interventions with a foster child during the escalation phase of a crisis. The interventions are designed to allow foster children to contain their own behavior so that acute physical behavior does not develop which would lead to the need for use of a physical restraint. 
The “Family Service Plan” is a case services plan completed by a county caseworker jointly with the foster child, parents, and foster parents within 60 calendar days of placement for each foster child receiving services from a county department of social/human services. 
“Kinship foster care” is the full time nurturing and protection of foster children by kin. Kin are relatives or persons ascribed by the family as having a family-like relationship. These relationships take into account cultural values and continuity of significant relationships. Certified kinship care is considered a form of out-of-home placement and a type of family foster care home.
“Reasonable”, as used in these rules, means appropriate and suitable, not excessive or extreme. 
“Religion”, where used in these rules, includes traditional religious beliefs and spiritual beliefs such as those of Native Americans. 
“Salaried Foster Parent” means a person who is employed by a child placement agency for the purposes of the demonstration pilot program authorized pursuant to Section 26-6-104(1)(d)(IV), C.R.S., and who is employed for the sole purpose of providing foster care and who serves in no other capacity for the child placement agency.
“Therapeutic Foster Care Services” means a program of foster care that incorporates treatment for the special physical, psychological, or emotional needs of a child placed with specially trained foster parents. 
“Treatment Foster Care” means a clinically effective alternative to residential treatment facilities that combines the treatment technologies typically associated with more restrictive settings with a nurturing and individualized family environment. 
“Whole Family Placement”, also known as “shared family care” , is a situation in which adult parent(s) and foster child(ren) are placed together in the home of a family trained to mentor and support the biological parents as they develop skills and supports necessary to care for their foster child(ren) and move toward living independently. 

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Instructions: replace lines 2290944 through 2290955.] 
7.708.34  The Prohibited Use of Cruel and Aversive Therapy [Rev. eff. 6/1/12]
The family foster care home shall refrain from engaging in all cruel and aversive behavior management, treatment or therapy including, but not limited to, the following: 
A.  Any intervention designed to or likely to cause a foster child physical pain
B.  Releasing noxious, or toxic, sprays, mists, or substances in proximity to the foster child's face.
C.  Any intervention that denies a foster child sleep, food, water, shelter, access to bathroom facilities, adequate bedding, or appropriate physical comfort.
D.  Any intervention or type of treatment that subjects a foster child to verbal abuse, ridicule, humiliation or that can be expected to cause excessive emotional trauma.
E.  Interventions that use a device, material, or object that is designed to simultaneously immobilize all four of the foster child's extremities.
F.  Any treatment intervention that deprives a foster child of the use of his/her senses, including sight, hearing, touch, taste, or smell.
G.  Physical management, restraint and seclusion except as described at Sections 7.708.36 and 7.714.53. 
H.  Use of rebirthing therapy or any therapy technique that may be considered similar to rebirthing therapy as a therapeutic treatment, as defined by Section 12-43-222(1)(t)(IV), C.R.S. 
7.708.35  Discipline [Rev. eff. 6/1/12]

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[Instructions: replace lines 2290979 through 2290982.] 
18.  Physical management, restraint and seclusion. 
7.708.36  Physical Management and Seclusion  Rev. eff. 6/1/12]
A.  Seclusion is prohibited. 
B.  Physical management to attain and maintain control or for behavior management, treatment, or therapy is prohibited and/or seclusion is prohibited, unless the family foster care home is pre-approved by the certifying authority to perform physical management and/or seclusion and the family foster care home is in compliance with Section 7.708.61, K, 2, Section 7.714.53, et seq., and the applicable definitions found in Section 7.714.1. The family foster care home must notify the placing caseworker when a child is subject to physical management and/or seclusion. 

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Instructions: replace lines 2291107 through 2291108.] 
7.708.61  Admission Requirements [Rev. eff. 6/1/12]
A.  Admission of a foster child to a family foster care home shall be in keeping with the stated purpose of the family foster care home and shall be limited to those foster children for whom the foster parent(s) is qualified and by the needs of foster children already in residence to provide the care necessary. Care must be provided in the least restrictive, most appropriate setting in order to meet the foster child's needs. 

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Instructions: replace lines 2291123 through 2291125.] 
K.  The placement agreement shall be developed with the involvement of the foster child, the parent(s) or guardian(s) and the representative of the placing agency. Where the involvement of any of these is not feasible or desirable, the reasons for the exclusion shall be recorded by the certifying authority. The placement agreement shall include by reference or attachment at a minimum the following: 
1.  Discussion of the foster child's and the parent's or guardian's expectations regarding: family contact and involvement: how family contact and involvement are to occur; the nature and goals of care, including any specialized services or specialized treatment to De provided: the religious orientation and practices of the foster child and, or family; and the anticipated planned discharge date and plan for the foster child following discharge.
2.  The policy and procedure to be followed regarding the use of physical management in an emergency pursuant to Section 7.714.53, et seq., and Section 7.708.36. 

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Instructions: replace lines 2291148 through 2291170.] 
7.708.65  Orientation, Training, and Certification [Rev. eff. 6/1/12]
A.  The certifying authority shall have a comprehensive written plan for the orientation, pre-certification training, certification, and ongoing training of foster parents.   Eff  08/01/2007
1.  The certifying authority shall have an introductory training and orientation program for all foster parents. This program shall include, at a minimum, twenty-seven hours of initial core training consisting of at least twelve (12) hours prior to placement of a child and the remaining hours to be completed within 3 months after placement, including orientation to emergency and safety procedures and the general and specific duties and responsibilities of being a foster parent. 
2.  If a child is placed with a foster care family on an emergency basis, twelve (12) hours of core training must be completed and the remaining hours of training competed within 4 months from the date of placement. An emergency means that a child’s safety is subject to actual or likely harm, immediate or emerging, serious or sever, which requires control. 
3.  The certifying authority shall maintain written documentation of specific in-service training held, foster parents participating, the hours involved, and/or other on-going training activities in which foster parents were involved.   Eff  08/01/2007
B.  The certifying authority shall create a training development plan for each foster parent(s) to document the strengths and competencies of the foster parent(s) and to identify those areas in which additional training is needed.   Eff  08/01/2007
C.  The certifying authority shall document that foster parents receive quality, appropriate, competency-based training in the following areas that builds on basic competencies of the foster parent(s) established through life experiences and pre-certification training.   Eff  08/01/2007
1.  The family foster care home’s emergency and safety procedures, including but not limited to fire evacuation drills, tornado drills, where appropriate, and flood evacuation drills, where appropriate, on at least a semiannual basis.   Eff  08/01/2007
2.  The principles and practices of child care, including developmentally appropriate practices.   Eff  08/01/2007
3.  The certifying authority’s administrative procedures and overall program goals. 
4.  Acceptable behavior management techniques that comply with these rules and, if applicable, Section 7.708.36 and Section 7.714.53, et seq. 
5.  Acceptable discipline techniques that comply with these rules. 
6.  Appropriate boundaries (both physical and emotional) between foster parents and foster children while in placement at the family foster care home and after discharge. 
7.  Positive and constructive methods of dealing with the foster child, including but not limited to, physical structuring of the environment and de-escalation of crisis situations. 
8.  Annual review of these regulations by foster parents. 
D.  Training requirements for the initial year of certification are as follows: 
1.  Twenty-Seven (27) hours of Core training, as identified in Section 7.708.65, A; and, 
2.  CPR and First Aid training; and, 
3.  Twenty (20) hours of ongoing specialized training. 
E.  Annually, each foster parent, except therapeutic foster parents or treatment foster parents, must complete twenty hours of on-going specific training as required in his/her training development plan. Training must include at least the areas listed above. Therapeutic or treatment foster parents providing therapeutic services must complete an additional twelve hours of on-going training annually for a total of thirty-two hours of training in such areas as dynamics of victimization issues, with emphasis on appropriate age and developmental levels; and the individual needs of the foster children in care. All providers serving children funded by the Children's Habilitation Residential Program (CHRP) must complete thirty-two (32) hours of ongoing specific training as identified in their training development plan. 

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Instructions: replace lines 1134294 through 1134304.] 
7.713  MINIMUM RULES AND REGULATIONS FOR SECURE RESIDENTIAL TREATMENT CENTERS [Rev. eff. 6/1/12]
All secure residential treatment centers must comply with the "General Rules for Child Care Facilities” found at Section 7.701, et seq., Section 7.714.53, et seq., and the applicable definitions in Section 7.714.1, and these "Rules Regulating Secure Residential Treatment Centers." 
7.713.1  DEFINITIONS [Rev. eff. 6/1/12] 
The definition of a secure residential treatment center facility is found at Section 26-6-102(9) of the Colorado Revised Statutes. 

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Instructions: replace line 1134341.] 
7.713.21  Admission Policy and Procedures [Rev. eff. 6/1/12]

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Instructions: replace lines 1134364 through 1134369.] 

[I.] 
7.  The youth shall be given an orientation. If the youth does not understand English, the orientation is to be in the youth's own language. Completion of orientation is documented by a statement signed and dated by the youth. Orientation shall include but is not limited to the following:
a.  A tour of the facility including fire escape routes and exits.
b.  A copy of written rules and regulations of the facility which include but are not limited to daily schedule, medical services, discipline, mail, visitation, grievance, and communication procedures.
c.  A discussion about the procedures to assure the youth's understanding. 
d.  Assistance in notifying family members as to his/her arrival at the center and procedure for mail and visiting. 
e.  Notifying the individual, legal custodian, and if appropriate, the individual’s family and obtaining authorizations from the legal custodian to perform physical management, restraint and seclusion as delineated in Section 7.714.53. 
J.  The total number of residents admitted to the Secure Residential Treatment Center shall not exceed the licensed capacity.

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Instructions: replace lines 1134411 through 1134417.] 
7.713.23  Program Description and Individual Treatment Plan [Rev. eff. 6/1/12]
A.  A secure residential treatment center shall have a written overall program description which is submitted to the Colorado Department of Human Services for review prior to original licensing. Any significant change in this description shall be submitted to the licensing authority for review prior to implementation. The written description shall include the following: 
1.  The position title and qualifications of the person who has overall responsibility for the treatment program.
2.  Staff responsibility for planning and implementation of the treatment procedures and techniques.
3.  Staff competencies and qualifications.
4.  The range of services and techniques which shall include at least modes of therapy, behavior management, physical management, restraint and seclusion, education, medical and recreation. 
B.  Within thirty (30) days of admitting a youth into care, a secure residential treatment center shall conduct a comprehensive assessment of the youth. 

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Instructions: replace lines 1134449 through 1134487.] 
E.  If an individual treatment plan requires the individual to be placed in seclusion for more than twenty-four (24) hours, the individual: 
1.  Shall be afforded living conditions and rights approximating those available to the general population, such as one hour of large muscle activity every twenty-four hours, the use of toilet and shower, the receipt and sending of mail, and the same meals as the general population. 
2.  Shall receive a counseling visit as soon as possible and a visit at least once every twenty-four hours, and an administrative review of the use of seclusion by the facility director or designee, who was not involved in the incident every twenty-four hours. 
A record shall be kept pursuant to Section 7.714.53 and include documenting the actions taken while operating under this provision. 
7.713.24  Discipline, Physical Management, Restraint, and Seclusion [Rev. eff. 6/1/12]
A.  Discipline shall be constructive or educational in nature and may include diversion, withholding of privileges, separation from problem situation, talk with the youth about the situation, praise for appropriate behavior, physical management, and seclusion. Youth shall not be subjected to physical harm or humiliation. 
B.  A secure residential treatment center shall have written policies and procedures regarding discipline and control, and pursuant to Section 7.714.53, written policies and procedures regarding physical management, restraint and seclusion, which shall be explained to all youth, families, staff, and placing agencies. These policies shall include measures for positive responses to appropriate behavior. 
C.  A secure treatment center shall prohibit all cruel and unusual punishments including, but not limited to, the following:
1.  Punishments including any type of physical hitting or any type of physical punishment inflicted in any manner upon the body such as punching, shaking, biting, or roughly handling a child.
2.  Physical exercises such as running laps or push-ups, when used solely as a means of punishment, and when such activities are not approved in the treatment plan.
3.  Requiring or forcing the youth to take an uncomfortable position, such as squatting or bending, or requiring or forcing the youth to repeat physical movements when used solely as a means of punishment.
4.  Group punishments for misbehaviors of individuals except in accordance with the center's written policy.
5.  Verbal abuse or derogatory remarks about the youth, his family, his race, religion or cultural background.
6.  Excessive denial of on-grounds program services or denial of any essential program service solely for disciplinary purposes.
7.  Deprivation of meals, although scheduled meals may be provid2d individually.
8.  Denial of visiting or communication privileges with family solely as a means of punishment.
9.  Denial of sufficient sleep.
10.  Requiring the youth to remain silent for long periods of time.
11.  Denial of shelter, clothing or bedding.
12.  Extensive withholding of emotional response or stimulation.
13.  Physical management, restraint and seclusion used as sanctions. 
14.  Assignment of physically strenuous or harsh work which could result in harm to the youth.
D.  The secure residential treatment center shall have written rules for resident conduct which specify prohibited acts and the sanctions which may be imposed. The written rules are given to each resident and are to be fully understood by all staff.
E.  The secure residential treatment center shall have written guidelines for the informal resolution of minor behavior infractions. These guidelines shall include the opportunity for youths to have input into the problem solving and decision making that relate to their participation in the program and to the consequences for their minor behavior infractions.
F.  Minor Rule Violations 
1.  Prior to privilege suspension or a room restriction sanction, the reasons for the sanction shall be explained and the youth shall have the opportunity to explain the behavior leading to the sanction.
a.  Whenever possible, the discussion should take place in a private setting. When a private setting is not available, the youth shall be afforded as much privacy as is possible.
b.  Staff shall advise the youth of the expectations of the program and of the youth's responsibilities in the situation.
c.  Staff shall assist the youth in developing solutions and/or strategies for correcting the problematic behavior.
2.  Room restriction or time-out in an unlocked room or area away from the group for minor misbehaviors shall not exceed sixty (60) minutes, to be continuously reviewed in fifteen (15) minute intervals. At the time that the restriction is imposed, the youth shall be informed that the restriction period will last between fifteen and sixty minutes, depending on his/her interaction with staff and participation in the counseling process during the restriction period. 
3.  Reports are prepared on each incident of a youth's behavior infractions resulting in room restriction or loss of privileges.
4.  During room restriction or time-out in or out of an unlocked room, direct staff communication shall occur at least every fifteen minutes or more frequently, depending on the youth's emotional state. During this interaction with the staff, the youth should participate with staff in determining the end of the restriction or time-out period. 
G.  Major Rule Violations
1.  When a youth is charged with violating a major rule of the facility which could result in a disciplinary action, the youth shall be insured the right to due process prior to any disciplinary sanction being imposed.
2.  In an emergency, an individual may be placed in seclusion if less restrictive alternatives have failed. Seclusion shall occur in compliance with Section 7.714.53, et seq. 
3.  A youth charged with a major rule violation shall be given a written notice of charge(s) of the alleged violation as soon as possible, but at least within twenty-four (24) hours of the time that the infraction is discovered. 
a.  A written notice of the scheduled disciplinary hearing shall be provided to the youth at least twenty-four hours in advance of the hearing. 
b.  Although notice of the time and place of the hearing must be provided to the youth at least twenty-four hours in advance, the youth may consent in writing to waive the twenty-four hour notice and to proceed with an earlier hearing time. 
4.  A disciplinary hearing shall be conducted within seventy-two (72) hours of the discovery of an alleged violation. 

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[Instructions: delete lines 1134500 through 1134502; Section G, items 15-17 repealed.] 

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Instructions: replace lines 1134506 through 1134584.] 
7.713.25  Security, Control, and Supervision [Rev. eff. 6/1/12]
A.  Youth shall be under the supervision of qualified and trained staff members or volunteers at all times.
B.  The door of the bedroom may be locked during sleeping hours for the safety of youth and/or staff and the security of the center.
C.  Staff shall conduct visual checks of youth at least every five minutes when youth are in their bedrooms and the door is locked.
D.  The center's perimeter shall be controlled by an appropriate means to ensure that youth remain within the facility and to prevent access by the general public without authorization.
E.  Residents of the secure residential treatment center shall be physically counted according to a system established by the facility. Any changes in the number of residents shall be reported to the appropriate staff member on a shift by shift basis.
F.  Staff shall inspect the center's security system and devices on a weekly basis and shall take appropriate corrective actions.
G.  Except in emergency situations, firearms are not permitted in the secure residential treatment center.
H.  The use of physical management and restraint shall comply with Section 7.714.53, et seq. 
I.  The use of mechanical restraints made of metal, soft leather, rubber, plastic or cloth is limited to cases of emergency and prevention of escape and after the failure of less restrictive alternatives. Only the facility director or designee may authorize the use of mechanical restraints. Any mechanical restraint will comply with Section 7.714.53, et seq. The facility shall establish written policy and shall train all staff in the established written policy. The written policy shall include the following elements, at the minimum: 
1.  Handcuffs shall be applied wrist to wrist in the front or back, or may be attached to a waist belt in the front only. Soft elbow restraints may also be utilized when necessary and shall be applied in the rear only. Thin, hard, portable plastic wrist restraints shall not be used on youth, except under emergency conditions identified in the facility’s written policy. 
2.  Shackles shall be applied on one person's ankles only and shall not be used to connect two persons' ankles together. 
3.  Handcuffs and shackles shall never be intertwined directly together in such a manner as to interfere with a person's ability to maintain his or her spinal column in an erect or straight position. 
4.  Youth shall never be handcuffed or otherwise attached to a vehicle. 
5.  Youth placed in restraints shall not be undressed or intentionally made uncomfortable. 
6.  Youth shall be immediately removed from restraints and evacuated into a safer area or separate smoke compartment whenever a fire alarm, set off because of concern of a fire, results in the evacuation of other youth from the building or smoke compartment where the restrained youth is located. In the event that a fire alarm sounds which does not result in evacuation, the restrained youth shall not be left unattended during the alarm/emergency/drill. 
7.  Appropriate allowances shall be made to assure the safety, comfort, and dignity of the youth. Normal bodily functions shall be attended to, including elimination and respiration. The room shall be maintained at a normal room temperature and shall meet all state and local safety, sanitation, and health standards. 
8.  Because of the vulnerability of the youth during a physical management, precautions shall be taken to assure that the youth is protected from mistreatment, antagonism, and harm from another person. 
9.  Hard metal restraint may be used for transporting youth from one location to another. 
10.  When the only equipment immediately available to a staff member is hard restraint equipment and the equipment must be used to restrain a youth who poses a serious, probable, imminent threat of bodily harm to self or others, the equipment shall be exchanged for soft restraint equipment as soon as it is safely possible. 
11.  Following application, all restraint equipment shall be checked by the supervisor on duty to assure that the equipment has been property applied, is of the proper type to assure the youth's safety, and is not likely to cause injury or undue discomfort. 
J.  All special incidents and emergency situations shall be reported to the director of the center. 
K.  The secure residential treatment center shall maintain a control center to provide order and security. A manual of all the written procedures for the center's security and control with detailed instructions for the implementation of the procedures shall be maintained at the control center. At least the following procedures shall be written and maintained: 
1.  A procedure for dealing with escapes.
2.  A procedure to govern the supervision of all youth outside the facility and movement of youth within the facility.
3.  A procedure regarding searches for control of contraband. The procedure shall be explained to both youth and staff.
4.  A procedure to govern the control and use of keys, tools, culinary, and medical equipment.
5.  A procedure for the use of physical management, and necessary reporting of their use pursuant to Section 7.714.53, et seq. and Section 7.713.25, et seq. 

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[Instructions: replace line 1134620.] 
7.713.31  Medical and Health Services [Rev. eff. 6/1/12]

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Instructions: replace line 1134667.] 
N.  Under no circumstances is a stimulant, tranquilizer or psychotropic drug administered for purposes of behavior management and control, or for purposes of experimentation and research. 

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Instructions: replace line 1134704.] 
7.713.41  Personnel Policy, Orientation and Training [Rev. eff. 6/1/12]

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Instructions: replace lines 1134720 through 1134723.] 

[C.]
5.  All new youth care/supervisory staff shall receive an additional 120 hours of training during the first year of employment and 40 hours of training each subsequent year of employment. At a minimum this training covers the following areas: 
a.  Security Procedures,
b.  Supervision of Youth,
c.   The use of physical management, restraint and seclusion pursuant to the requirements of Section 7.714.53, et seq. 

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Instructions: replace lines 1135006 through 1135008.] 
7.713.65  Incident Reports and Logs [Rev. eff. 6/1/12]
A.  There shall be maintained a permanent log in which is reported a summary of situations involving individual or groups of youth for use by supervisory and treatment staff. Each shift of staff members shall prepare shift reports that record routine and emergency situations.
B.  All special incidents such as emergency situations, injuries, physical management or major rule violations shall be recorded and reported as required in these rules, Section 7.714.53, et seq., and reported to the director of the facility or his/her designee. A copy of the record shall be maintained in the youth's case record. 

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Instructions: replace lines 2252705 through 2252722. Editor’s note: second paragraph deleted in Tracking# 2012-00136 (#11-9-22-1) and incorporated into this submittal.] 
7.714  QUALITY STANDARDS FOR TWENTY–FOUR (24)-HOUR CHILD CARE [Rev. eff. 6/1/12]
All rules in Section 7.714 will be known and hereinafter referred to as the Quality Standards for Twenty-Four (24)-Hour Child Care and will apply to all child care applicants and licensees subject to licensing as a specialized group facility, residential child care facility, shelter residential child care facility, or psychiatric residential treatment facility. However, Section 7.714.53, et seq., and the applicable definitions in Section 7.714.1 also apply to approved family foster care homes, see Section 7.708.36, et seq., and day treatment centers, see Section 7.706, et seq. 
7.714.1  DEFINITIONS [Rev. eff. 6/1/12]
"Client Representative" means a person designated by the facility to process grievances.
"Chemical restraint" means giving an individual medication involuntarily for the purpose of restraining that individual; except that chemical restraint does not include the involuntary administration of medication pursuant to Section 27-65-111(5), C.R.S., or administration of medication for voluntary or life-saving medical procedures. A chemical restraint does not include a drug or medication that is a usual and customary part of a medical diagnostic or treatment procedure to treat the individual’s medical condition or symptoms or to promote the individual’s independent functioning. 
"De-escalation" is the use of therapeutic interventions with a child during the escalation phase of a crisis. The interventions are designed to allow children to contain their own behavior so that acute physical behavior does not develop that would lead to the need to use a physical management. 
"Emergency" means a serious, probable, imminent threat of bodily harm to self or others where there is the present ability to effect such bodily harm. 
"Escalation" is an increase in intensity of a child's out-of-control behavior. 
The "Family Service Plan" is a case services plan completed by a county caseworker jointly with the child, parents, and providers within sixty (60) calendar days of placement for each child receiving services from a county department of social/human services. 
The "Individual Child's Plan" ("the Plan") is based upon an assessment of the child immediately following placement at the facility. It is developed by the facility for each child and must be consistent with the Family Service Plan for the child. 
"Mechanical Restraint" means a physical device used to involuntarily restrict the movement of an individual or the movement or normal function of a portion of his or her body. Mechanical restraints include, but are not limited to: the use of handcuffs, shackles, straight jackets, posey vests, ankle and wrist restraints, craig beds, vail beds, and chest restraints. Mechanical restraint does not include the use of protective devices used for the purpose of providing physical support or prevention of accidental injury. 
“Nationally Recognized Criteria” means a set of standards, nationally acknowledged as acceptable and appropriate for use with at-risk populations, that are incorporated into the model of physical management utilized by the facility. The Nationally Recognized Criteria shall include, at a minimum the following: 
A.  Annual staff training and/or certification, to include training upon hire, and ongoing (at least every six months) refresher training or practice exercises for each staff member trained or certified in restraint, to review and refresh skills involved in positive behavior intervention, prevention, de-escalation, and physical management, in accordance with the model. 
B.  A restraint prevention and de-escalation component, to include identifying antecedents that may cause an individual to escalate, and/or development of behavior management plans that are in alignment with individual treatment plans if necessary. 
C.  A physical management process that prohibits or provides alternatives to a prone position, and includes identifying primary control techniques that emphasize utilizing only the minimum amount of force necessary to gain control and keep the individual safe. 
D.  A debriefing process which includes a review of physical management, to determine the appropriateness and effectiveness of preventive/de-escalation techniques used, the appropriateness of physical management, and how, or if, physical managements are preventable.
“Physical Management” means the physical action of placing one’s hands on an individual. Physical management may be used to gain physical control in order to protect the individual or others from harm after all attempts to verbally direct or deescalate the individual have failed. Physical management may be utilized when an emergency situation exists. The physical management continuum may include: 
A.  Utilizing transitional measures. 
B.  Placing one’s hands on an individual to physically guide and/or physically control the individual. 
C.  Use of an approved restraint method to control or contain the individual. 
D.  Placing of an individual into an approved prolonged restraint method. 
E.  Physical management may be used to move or escort an individual into seclusion. Seclusion, in itself, is not a form of physical management. 
"Physical Restraint" means the use of bodily, physical force to involuntarily limit an individual's freedom of movement. 
“Prone Position” means placing an individual in a face down position. 
“Prone Restraint” means a restraint in which the individual being restrained is secured for a period of time in a prone position for a period of time exceeding five (5) minutes. 
"Reasonable" as used in these rules means appropriate and suitable, or not excessive or extreme. 
"Religion" where used in these regulations includes traditional religious beliefs and spiritual beliefs such as those of Native Americans. 
"Restraint" means any method or device used to involuntarily limit freedom of movement, including, but not limited to, bodily physical force, mechanical devices, or chemicals. Restraint includes a chemical restraint, a mechanical restraint, a physical restraint, and seclusion. Restraint does not include: 
A.  The use of any form of restraint in a licensed or certified hospital when such use is in the context of providing medical or dental services that are provided with the consent of the individual or the individual's guardian; 
B.  The use of protective devices or adaptive devices for providing physical support, prevention of injury, or voluntary or life-saving medical procedures; 
C.  The initial temporary holding or positioning of an individual, for less than five minutes, by a staff person appropriately trained and/or certified for protection of the individual or other persons; 
D.  The holding of a child by one adult for the purpose of calming or comforting the child; 
E.  Placement of an individual in his or her sleeping room for the night; or, 
F.  The use of time-out, in an unlocked setting where voluntary egress is not prevented, and as may be defined by written policies, rules, or procedures. 
A "Residential Facility" ("the facility") provides 24-hour child care and includes residential child care facilities and specialized group facilities.
A "staff member" of the facility as used in these rules includes a specialized group home parent or a specialized group center or residential child care facility.
“Seclusion" means the placement of an individual, six (6) years old or older, alone in a room from which egress is involuntarily prevented. 
“Transitional measure” means physical guidance, prompting techniques of short duration, or an initial temporary approved physical positioning of an individual at the onset or in response to a re-escalation during a physical management, for the purpose of quickly and effectively gaining physical control of that individual in order to prevent harm to self or others. Momentary utilization of a short term (as quickly as possible, but not to exceed five (5) minutes) prone position is only permissible during a transitional measure. 
7.714.2  ADMISSION POLICY AND PROCEDURES [Rev. eff. 6/1/12]

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Instructions: replace lines 2252735 through 2252751.] 
E.  The facility shall obtain a current comprehensive intake evaluation, including a social, health, and family history, developmental assessment or mental health evaluation, and a psychological evaluation, if determined to be necessary by the facility. Educational records shall be obtained it appropriate. As much of this information as possible shall be obtained prior to admission, but the total evaluation shall be completed within fourteen (14) calendar days after admission. If the facility is unable to obtain this information within these time periods or is totally unable to obtain the information, the facility must document its attempts to obtain the information and reasons for not obtaining the information. 
If a child is placed at the facility as an emergency placement, the facility shall obtain at least the following information: name, birth date, if available, and physical description of the child; date and time of the admission; name, address, telephone number and authority of person bringing the child to the facility, and the reason for placement. Any other information that may be available should be recorded at the time of placement or as it becomes available. The date that placement terminates shall also be recorded.
F.  Preparation of the child for admission shall be in a manner consistent with the child's age and ability to participate in the plan and to understand the reason for the placement.
G.  The placement agreement shall be developed with the involvement of the child, the parent(s) or guardian(s) and the representative of the placing agency. Where the involvement of any of these is not feasible or desirable, the reasons for the exclusion shall be recorded by the facility. The placement agreement shall address by reference or attachment at a minimum the following:
1.  Discussion of the child's and the parent's or guardian's expectations regarding: family contact and involvement; how family contact and involvement are to occur; the nature and goals of care, including any specialized services or specialized treatment to be provided, the religious orientation and practices of the child and/or family; the anticipated length of stay, planned discharge date, criteria for discharge, and plan for the child following discharge.
2.  The policy and procedure to be followed regarding the use of physical management, restraint and seclusion in an emergency situation pursuant to 7.714.53, et seq. 
3.  A delineation of the respective roles and responsibilities of all agencies and persons involved with the child and his/her family.
4.  Written authorization for care and treatment of the child.
5.  Written authorization to obtain routine medical and dental care for the child and to obtain emergency medical and dental care.
6.  The legal status or custody of the child. 
7.  If a child is placed by a Colorado county department of social/human services, the appropriate State form or contract shall be completed. This form or contract may provide some of the required authorizations. 
H.  Within twenty-four (24) hours of arrival at the facility, a child shall be given an orientation to the facility, consistent with the child's age and ability to participate, which includes at least the following: 
1.  Tour of the facility and instruction on fire alarm and fire evacuation procedures, escape routes and exits.
2.  The rules/regulations of the facility.
3.  Procedures that will affect the child's behavior, including limiting or restricting a child's rights where allowed, the type of discipline used in the facility, the consequences for certain behaviors, and the orientation, notification and consents required by Section 7.714.53, et seq. 
4.  The complete children's rights and children's grievance procedures as developed by the facility and the name of the client representative.
5.  A form signed by the staff member and the child, if applicable, verifying that the orientation occurred.
6.  Introduction to staff. 

7.  Discussion of tasks and behaviors the child is expected to perform.

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Instructions: replace lines 2252804 through 2252847.] 
7.714.4  PROGRAM DESCRIPTION AND INDIVIDUAL CHILD'S PLAN [Rev. eff. 6/1/12]
A.  The facility shall have a written overall program description for the facility. The written description shall include the following:
1.  The title of the person who has overall responsibility for the development, implementation, and coordination of the treatment program.
2.  Staff responsibility for planning and implementation of the treatment procedures and techniques.
3.  The range of procedures and techniques to be used and the anticipated range or types of behavior or conditions for which such procedures and techniques are to be used, including philosophy of treatment, modes of therapy, treatment modalities, positive behavior intervention, problem management, discipline, physical management, restraint, and seclusion where allowed and approved by the department. 
4.  The facility's responsibility for monitoring the safety of children during treatment.
5.  Review procedures for ensuring the appropriateness of the ongoing treatment and placement for each child.
6.  Policies and procedures encouraging termination of the treatment procedures at the earliest opportunity in the event of achievement of goals, or when the procedures are proving to be ineffective or detrimental for a particular child.
7.  Policies and procedures on how the facility involves the child and the parent(s) or guardian(s) in the plan for care and treatment of the child and obtains their consent of the plan and any subsequent revisions to the plan.
8.  Policies and procedures on how the facility monitors the ongoing physical safety of a child during treatment or therapy which involves face to face interaction with the child. 
9.  Requirements, where appropriate, for medical examination of a child prior to implementation of a treatment strategy on a regular basis.
10.  Provisions for regular and thorough review and analysis of the individualized treatment strategies and the overall treatment orientation of the facility, including provisions for making appropriate adjustments in the treatment strategies and orientation, the recording practices and procedures, and the program activities in accordance with the results of the reviews.
11.  Each facility shall adopt and implement a written policy for continuity of resident care which shall include, at a minimum, the following: 
a.  Ease of resident movement from one element of service to another within the facility.
b.  Aftercare planning, to be completed ninety (90) calendar days prior to a scheduled discharge, and included with the resident’s discharge summary which describes any recommendations for the resident to follow after discharge from the facility. 
c.  Referrals to other agencies.
12.  The placement alternative selected shall be conducive to the optimum restoration of the resident’s mental and physical functioning, with due regard for the safety of the resident and those around him/her and the availability of placement alternatives.
B.  A facility shall prohibit all cruel and aversive treatment or therapy including, but not limited to, the following:
1.  Any intervention designed to or likely to cause a child physical pain.
2.  Releasing noxious, toxic or unpleasant sprays, mists, or substances in proximity to the child's face.
3.  Any intervention that denies a child sleep, food, water, shelter, access to bathroom facilities, adequate bedding, or appropriate physical comfort.
4.   Any intervention or type of treatment that subjects a child to verbal abuse, ridicule, humiliation, or that can be expected to cause excessive emotional trauma.
5.  Interventions that use a device, material, or object that is designed to simultaneously immobilize ail four of the child's extremities.
6.  Any treatment intervention that deprives a child of the use of his/her senses, including sight, hearing, touch, taste, or smell.
7.  Physical management, restraint, and seclusion except as described at Section 7.714.53. 
8.  Use of rebirthing therapy or any therapy technique that may be considered similar to rebirthing therapy as a therapeutic treatment, as defined by Section 12-43-222(1)(t)(IV), C.R.S. 
C.  Within seven (7) calendar days of admitting a child in care, a facility shall begin a comprehensive assessment/evaluation of the child.
1.  The assessment/evaluation shall be conducted by a planning team This team shall include persons responsible for implementing the plan on a daily basis and persons who have had direct interaction with and observation of the child.
2.  The planning team shall assess and evaluate the needs and strengths of the child in at least the following areas where information is available:
a.  Medical, health and dental care, including a health history of the child and family, and if appropriate health information regarding speech therapy, occupational therapy, and physical therapy needs of the child;
b.  Mental and psychological health, including treatment history;
c.  Education/vocation;
d.  Personal/social development;
e.  Family and community relationships;
f.  Vocational training, if appropriate;
g.  Recreation;
h.  Life skills development;
i.  Emancipation skills, if appropriate;
j.  Legal status and history;
k.  Treatment/placement history;
l.  Alcohol/substance abuse history.
3.  All direct assessments/evaluations of the child shall be conducted in the child's dominant language or mode of communication, including augmented or facilitated communication, if necessary, and shall take into consideration the child's age, disability, and cultural and religious background.
D.  On the basis of this assessment/evaluation, and within fourteen (14) calendar days of admission, a facility shall develop an individual child's plan that is written, time-limited, strength-focused, outcome based, and goal-oriented. The plan must support the Family Services Plan. 

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[Instructions: insert after line 2252884.] 
G.  The facility shall have a written plan for each individual in residence. Prior to the placement of the child in seclusion, the conditions for use of the seclusion shall be detailed and justified in the written plan, and the child shall be oriented to the room, the purpose of its use and type of behavior which might result in its use. 

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Instructions: replace line 2252885.] 
7.714.5  SAFETY, DISCIPLINE, PHYSICAL MANAGEMENT, RESTRAINT, AND SECLUSION [Rev. eff. 6/1/12]

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Instructions: replace line 2252936.] 
7.714.52  Discipline [Rev. eff. 6/1/12]

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Instructions: replace lines 2252961 through 2253011.] 

[F.]
19.  Use of physical management, restraint or seclusion as discipline for a child. 
7.714.53  PHYSICAL MANAGEMENT, RESTRAINT AND SECLUSION [Rev. eff. 6/1/12]
If a facility is authorized to use physical management, restraint or seclusion at the facility, the facility shall use physical management, restraint or seclusion only in accordance with the following rules unless the specific rules prohibit, limit or modify the requirements placed upon the facility.
7.714.531  Authorization [Ref. eff. 6/1/12]
At the time of admission to the facility, the legal custodian of the individual shall be notified that physical management or seclusion may performed in certain circumstances. For a facility to perform physical management or seclusion, the legal custodian must give written consent for physical management and/or seclusion to be performed on the individual. No physical management or seclusion shall be performed on an individual without the specific written permission of the individual’s legal custodian. 
7.714.532  Uses Of Physical Management, Restraint and Seclusion [Rev. eff. 6/1/12]
Facility staff, including pre-approved family foster care home providers, may only use: 
A.  Restraint or seclusion in an emergency after the failure of less restrictive alternatives or after a determination that such alternatives would be inappropriate or ineffective under the circumstances; and, 
B.  Restraint if prior to the use of restraint: 
1.  Staff have been appropriately trained or certified in accordance with a model that includes nationally recognized criteria; and, 
2.   The facility tried all positive and constructive methods of dealing with the individual, including, but not limited to, implementation of a structured and consistent behavior management program, physical structuring of the environment, talking with the individual, praise for appropriate behavior, skill training and development, assisting the individual with the expression of feelings, and de-escalation of the situation. 
In addition to the circumstances delineated in these rules, Seclusion may be used pursuant to a valid court order that the individual is kept separate from the general population. 
7.714.533  Facility Policies And/Or Procedures [Rev. eff. 6/1/12]
Facility policies and/or procedures shall, at a minimum, include and comply with the following: 
A.  The use of prone restraint is prohibited. Momentary (as quickly as possible, but not to exceed five (5) minutes) utilization of a prone position is permissible only during the transitional measure portion of a physical management. 
B.  When using a physical or mechanical restraint method, in the course of a physical management, trained or certified staff shall be positioned within arm’s length of the individual and continuously monitor the person 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. Staff shall not place excessive pressure on the chest, abdomen or back of an individual or inhibit or impede the individual’s ability to breathe. Staff shall continuously monitor to ensure that the breathing of the individual in such restraint is not compromised. If the individual is exceedingly agitated, staff may move further from the individual, but must still be able to effectively assess, and respond as necessary, to the individual’s physical condition. If breathing is compromised in any way, the restraint shall be discontinued immediately and a physical assessment shall occur to determine if medical attention is needed. 
1.  A transitional measure may be used during an episode of physical management to effectively gain initial physical control of an individual in order to prevent harm to self or others. A transitional measure may result in a restraint to maintain prolonged physical control or containment of an individual. 
2.  When mechanical restraints are used, 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 with toileting, as necessary. The individual's dignity and safety shall be maintained during relief periods. Staff shall note the relief periods granted in the record of the individual being restrained. 
3.  An individual in physical restraint shall be released from such restraint within fifteen minutes after physical control of the individual is gained, except when precluded for safety reasons and documented accordingly. 
C.  Chemical restraint is prohibited. 
D.  When seclusion is utilized: 
1.  Relief periods shall be provided for reasonable access to toilet facilities. While in seclusion, staff shall be physically present and individuals shall be visually observed no less than every fifteen (15) minutes. 
2.  When a facility utilizes seclusion, there shall be a seclusion room supervisor who is a full-time facility staff member, is a Colorado Licensed Clinical Social Worker (LCSW), a Licensed Professional Counselor (LPC), a Licensed Marriage and Family Therapist (LMFT), a Colorado licensed psychologist or a board-eligible psychiatrist licensed to practice medicine in Colorado, and is designated and trained to be responsible for the use of seclusion and the seclusion room. If the seclusion room supervisor is not a psychiatrist or a licensed psychologist, there shall be such a person contracted to provide consultation with the seclusion room supervisor and staff. Staff will obtain authorization from the seclusion room supervisor prior to utilizing the seclusion room. 
E.  Each program choosing to use physical management, restraint and/or seclusion is to have a written policy, and practices consistent with these rules and the written policy. The program’s written policy must include at a minimum the following information: 
1.  Documentation of the physical management model used. The physical management model shall comport with the requirements provided in section 7.714.53, et seq. 
2.  Documentation of the type of behavior management system utilized by the program. 
3.  The training, which satisfies the requirements of section 7.714.53, et seq., provided to staff members approved to use physical management and seclusion, and the type and number of hours of training each staff member is required to take as required by the model. 
4.  Which staff members will be approved by the program to use physical management and seclusion. Staff members authorized to perform seclusion shall be from one or more of the following positions: administrator, assistant administrator, child care staff, social worker, teacher, psychologist, psychiatrist, or nurse. 
5.  The preventive and de-escalation techniques and positive behavioral intervention that must be attempted by staff prior to the use of physical management and seclusion. 
6.  How the facility continuously monitors physical management, how the facility will be physically present, such that the staff member is able to immediately respond to the needs of the individual in seclusion, and how the individual in seclusion shall be visually observed no less than every fifteen (15) minutes. 
7.  The philosophy and use of the seclusion room, the intake process, the evaluation of an individual while in the room, emergency procedure while an individual is in seclusion and method for a resident's grievance regarding the use of the room. 
8.  The type of written documentation the facility maintains of each physical management or seclusion. The record shall be prepared by each staff member involved in the physical management and/or seclusion and shall contain all of the following: 
a.  A description of the incident including the name of the individual, date and time of day, the name of any witnesses to the incident, staff members involved, their position at the facility and their involvement in the physical management, and how long the physical management or seclusion lasted, the person who authorized the seclusion, those that visited the individual during the seclusion, the exact time of each seclusion fifteen (15)-minute monitoring check and the behavior of the individual at each monitoring check, time and date of each seclusion counseling visit, the person who authorized the release from seclusion, and the time and date of the release. 
b.  The precipitating incident(s) and the individual's behavior before the restraint or seclusion. 
c.  What specific actions were attempted and/or taken to de-escalate the situation and control, calm, or contain the individual and the effect of these de-escalating actions upon the individual. 
d.  The staff's decision-making process to perform a physical management and/or seclusion, A description of the physical management and/or seclusion including the individual's physical, emotional and behavioral condition prior to, during and after the physical management, including, but not limited to, breathing, pulse, color, and signs of choking or respiratory distress, and in the case of seclusion, the time the individual was last given access to restroom facilities, the time the individual had opportunity for exercise if exercise is required under the individual child plan, when and what type of medications were given and by whom, when the individual's last staff contact occurred, and the stated reasons and/or authorization to continue any seclusion. 
e.  A description of the debriefing and evaluation with the individual and with the staff following the physical management to address other options that may have been successful in de-escalating the individual. 
f.  An indication of review by the neutral reviewer as to the appropriateness of the physical management or seclusion. 
g.  Verification that notification of the use of physical management or seclusion was made to the legal custodian. 
9.  Evaluation by an objective, internal professional of the documentation of each physical management to determine appropriateness and effectiveness of the preventive and de-escalation techniques used and the physical management performed, as well as assessing carefully any injuries, bruising, or death. 
10.  The requirement that staff not restrain an individual in physical areas that may pose a threat to the health and safety of the individual including, but not limited to, soft, pliable surfaces, concrete, asphalt or areas including broken glass. 
11.  All facilities shall ensure that staff are trained to explain, at time of admission, the use of physical management, restraint and/or seclusion to the individual, legal custodian, and if appropriate, to the individual's family. The explanation provided to the legal custodian and individual will occur in a language or communication understandable to him/her and will include the purpose of physical management, the physical management model used, and the circumstances when a physical management may occur. 
12.  Notification to the legal custodian of each use of physical management, restraint and/or seclusion, no later than the end of the day that the physical management, restraint or seclusion occurred with a written report completed and given to the legal custodian by the next business day. 
13.  Emergency procedures, including First Aid, that will be used if an individual or staff member is seriously injured during a physical management. 
14.  The requirement of staff to report any critical incident, or child abuse or neglect pursuant to Colorado state law and Sections 7.701.52 and 7.701.53. 
15.  If seclusion is performed, the purpose of the seclusion room, evaluation of the individual while in the room, the emergency procedures for an individual in seclusion, and the method for the resident's right to grieve the use of the room. 
7.714.534  SECLUSION [Rev. eff. 6/1/12]
A.  Seclusion may only occur for the period of time necessary to accomplish its purpose. The individual shall be released from seclusion when state of emergency has ceased. Seclusion shall not exceed two (2) hours per incident unless required by the individual’s treatment plan or individual child plan. 
B.  At the time of placement of the individual in seclusion, the neutral reviewer shall be notified in person or by telephone. Leaving a message is not notification, and if the neutral reviewer cannot be contacted in person or by telephone, the individual may not be placed in a seclusion room. 
C.  There must be notification of another staff member, who is currently on duty, that an individual has been placed in seclusion. 
D.  A staff member must be physically present, at all times when an individual is locked inside the room. 
E.  Physical Requirements for a Seclusion Room 
1.  The seclusion room shall be located in reasonable proximity to the living unit or other areas of activity. 
2.  The seclusion room shall be a minimum of eighty (80) square feet in size. 
3.  The seclusion room shall be kept in a clean and sanitary condition. 
4.  All switches for light, heat, and ventilation, as well as other electrical outlets, shall be outside the room. All switches shall be available only to the staff. 
5.  There shall be no features by which an individual might injure him or her self within the seclusion room such as utility pipes, cleaning equipment and materials, or mirrors. 
6.  Exterior windows are not recommended, but if there are window panes they shall be of shatter-resistant material and have psychiatric screening. 
7.  There shall be an observation window on the door from which all parts of the room are visible for purposes of supervision. The window shall be made of shatter-resistant materials. 
8.  The seclusion room shall have a lighted, soothing environment. The individual shall not be subjected to glaring lights. All lights shall be recessed into the ceiling and shall be covered with a shatter-resistant guard which is flush with the ceiling. 
9.  There shall be no more than one locked door between the individual and the staff member. 
10.  If the seclusion room is soundproof, there must be an intercom system which is activated when an individual is in the room. 
F.  Approvals Necessary to Operate a Seclusion Room 
1.  The written approval of the local fire department and the Colorado Department of Human Services must be received prior to the initial use of the seclusion room. 
2.  The licensee shall request such an inspection and there shall be an inspection by the fire department at least annually. The licensee shall retain a copy of the inspection report in the facility file. 
3.  If it is found, at the time of inspection by the State Department of Human Services, that the facility does not meet all the regulations for operation of the room, the department staff member shall give written notice of specific deficiencies which shall be corrected. The facility shall cease secluding any individual in the locked room until corrections are completed and authorization is given by the Colorado Department of Human Services.
7.714.535  STAFF TRAINING [Rev. eff. 6/1/12]
A.  Staff utilizing any physical management in facilities or programs shall be trained in the appropriate use and implementation of a model that includes nationally recognized criteria prior to any staff being approved to use physical management. The model shall include, at a minimum, the following: 
1.  Annual staff training and/or certification, to include training upon hire, and ongoing (at least every six months) refresher training or practice exercises for each staff member trained or certified in restraint, to review and refresh skills involved in positive behavior intervention, prevention, de-escalation, and physical management, in accordance with the model. 
a.  Staff will be periodically observed when performing a physical management by a supervisor of the facility who has been training in physical management. If a supervisor of the facility determines a staff member did not correctly perform a physical management, the staff member must be immediately retrained or be restricted from performing further physical management until retraining can occur, and; 
b.  If available, the staff person shall complete any competency tests offered as part of the training prior to being approved to use physical management. 
2.  How to assess the signs of physical distress in a person in restraint. 
3.  A restraint prevention and de-escalation component, to include identifying antecedents that may cause an individual to escalate, and/or development of behavior management plans that are in alignment with individual treatment plans if necessary. 
4.  A physical management process that prohibits or provides alternatives to a prone position, and includes identifying primary control techniques that emphasize utilizing only the minimum amount of force necessary to gain control and keep the individual safe. 
5.  A debriefing process which includes a review of physical management, to determine the appropriateness and effectiveness of preventive/de-escalation techniques used, the appropriateness of physical management, and how, or if, physical managements are preventable. 
B.  Persons specified to place an individual in the seclusion shall have ongoing training and supervision which shall include at least the following: 
1.  The safety of the individual and staff and emergency procedures including First Aid and fire protection; 
2.  The purpose and policy, legal ramifications of placing the individual in seclusion; 
3.  The role of the neutral reviewer; 
4.  The dynamics of the behavior of individuals when in seclusion; 
5.  Safe methods of getting the individual to the seclusion room; 
6.  Methods of searching an individual when placing the individual in the seclusion room; and, 
7.  The protection of keys for the seclusion room. 
7.714.536  DOCUMENTATION [Rev. eff. 6/1/12]
Each facility shall have processes in place to document the reason for the physical management and/or seclusion, alternative methods attempted, and the type and duration of physical management and/or seclusion in the record of the individual. Each physical management or seclusion shall be recorded as required by section 7.714.533, E, 7. 
7.714.537  REVIEW [Eff. 6/1/12]
A.  Each facility shall include physical management, restraint and/or seclusion in its critical incident review process and/or quality management program. 
1.  Review the Use of Physical Management 
a.  Records of each physical management shall be reviewed by a supervisor of the facility within forty-eight (48) hours of each restraint. 
b.  According to the policies and procedures of the facility, the entire individual's behavior management or treatment plan must be reviewed if it appears that the individual is being physically managed an excessive number of times, frequently in a short period of time, or frequently by the same staff member. 
c.  If any particular de-escalation technique appears to be causing an escalation in the behavior of an individual or a group of individuals, the use of the technique shall be evaluated for its effectiveness. De-escalation techniques that are not effective or are counter-productive must be terminated at the earliest opportunity. 
d.  If either the individual or a staff member was seriously injured or died during a physical management, a thorough review of the physical management and injuries must be instituted immediately. Based on the findings of the review, the staff members involved in the physical management must be retrained, be restricted from performing further physical management, and/ or corrective personnel action must be taken. 
e.  If a staff member appears to be involved in a larger number of physical managements than other staff members and is not a part of a specially trained team, or is unsuccessful at using de-escalation effectively, the facility must conduct a thorough review of the staff member's interactions with individuals in care, prior physical management training, and need for further training or corrective personnel action as required by program's policies. 
2.  Review the Use of Seclusion 
a.  The record of use of the seclusion room shall be reviewed daily by the seclusion room supervisor and weekly by the facility administrator.  If one individual is placed in the seclusion room more than three times in 72 hours or a maximum of 5 hours in 72 hours, the entire plan for the individual shall be reviewed, and a person, who meets the requirements of consultant to the seclusion room supervisor, and staff shall authorize any further use of the seclusion room or other treatment for the individual. 
b.  If the same staff member places an individual in the seclusion room repeatedly, this shall be investigated by the seclusion room supervisor. 
c.  The facility which operates a seclusion room shall appoint a neutral reviewer. The neutral reviewer shall not be the seclusion room supervisor or the person who placed the individual in the seclusion room. The reviewer shall determine if the situation resulting in the seclusion of an individual in a seclusion room merits such a decision. The reviewer may be a staff member of the facility or a professional contracted by the facility in one of the following positions: administrator, assistant administrator, social worker, psychologist, psychiatrist, nurse, lawyer. 
B.  All agencies shall have an administrative oversight component, to include, at a minimum, tracking and reviewing episodes of seclusion, physical management and restraint data such as through a quality assurance or performance improvement process. 
C.  Pursuant to Section 26-6-106(2)(k) of the Colorado Revised Statutes, a license can be suspended or revoked for failure to comply with the rules governing seclusion. 

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[Instructions: replace line 2253113.] 
7.714.92  Personnel Policy, Orientation, and Training [Rev. eff. 6/1/12]

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Instructions: replace lines 2253117 through 2253131.] 
B.  The facility shall document that staff receive appropriate training in the following areas: 
1.  The facility's emergency and safety procedures, including but not limited to fire evacuation drills and disaster drills, on at least a semiannual basis.
2.  The principles and practices of child care, including developmentally appropriate practices.
3.  The facility's and, where appropriate, certifying authority's administrative procedures and overall program goals.
4.  Acceptable behavior management techniques, appropriate discipline and physical management, restraint and seclusion of children in accordance with facility policies and these rules, including the ability to recognize and respond to signs of physical distress in children who are subject to a physical management. 
5.  Appropriate professional boundaries (both physical and emotional) between staff and children while in placement at the facility and after discharge. 
6.  Annual review of these regulations by all appropriate staff members of the facility. 
7.  All staff must have a minimum of twenty (20) clock-hours of on-going job specific training a year. Training may include areas listed above. 
8.  Individuals that are qualified by education, training, and experience must provide staff training.
9.  Staff training must include training exercises in which staff members successfully demonstrate in practice the techniques which they have learned for managing emergency safety intervention. 
10.  The facility must document in the staff personnel record that the training and demonstration of competency were successfully completed.  Documentation must include the date training was completed and the name of persons certifying the completion of training. 

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Instructions: replace lines 2253188 through 223201.] 
7.714.933  Required Notification [Rev. eff. 6/1/12]
A.  The facility shall immediately notify the child's legal custodian, and/or the responsible agency of any serious illness or serious injury resulting in medical treatment away from the facility, hospitalization or death involving a child in care. 
B.  The facility shall notify the legal custodian, and/or placing authority as soon as possible upon discovery that a child has run away.
C.  Critical incidents shall be reported as outlined in Section 7.701.52.
D.  A report about a death must include:
1.  The child's name, birth date, address, and telephone number.
2.  The names of the child's parent(s) or guardian(s) and their address and telephone number if different from that of the child.
3.  Date of the fatality.
4.  Brief description of the incident or illness leading to the death.
5.  Names and addresses of witnesses or persons who were with the child at the time of death.
6.  Name and address of police department or authority to whom the report was made.
E.  Any change in the status of the facility that would affect care of children shall be immediately reported to the licensing agency.
F.  The facility must immediately notify the Department of any court order or physician’s order that violates these regulations.
G.  The facility must notify the parent(s), guardian(s), or placing authority regularly of the issues related to the care of the child including use of time out rooms, discipline, treatment, behavior management, physical management, restraint and seclusion, and restriction of rights. 

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Instructions: replace line 1135633.] 
7.715.46  Discipline [Rev. eff. 6/1/12]

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Instructions: replace lines 1135653 through 1135654.] 

[E.]
15.  Use of physical management, seclusion or restraint as discipline for a youth. 

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