Emergency Use of Manual Restraints Policy Name* First Last Is it the policy of this licensed provider (Aveyron Homes, Inc.) to promote the rights of persons served by this program and to protect their health and safety during the emergency use of manual restraints?*YesNo“Emergency Use of Manual Restraint” means:*A. Using a manual restraint when a person poses an imminent risk of physical harm to themselves or othersB. It is the least restrictive intervention that would be achieve safetyC. Both A & BIs property damage, verbal aggression, or a person’s refusal to receive or participate in treatment or programming on their own, constitute an emergency?*YesNoWhat positive support strategies and technique must be used to de-escalate a person’s behavior before it poses an inherent risk of physical harm to self and others?*A. Follow individualized strategies in a person’s coordinated service and support plan and coordinated service and support addendumB. Shift the focus by verbally redirecting the person to a desired alternative activityC. Model desired behaviorD. Reinforce appropriate behaviorE. Offer choices, including activities that are relaxing and enjoyableF. Use positive verbal guidance and feedbackG. Actively listen to a person and validate their feelingsH. Create a calm environment. Speak calmly using reassuring words, consider volume, tone and non-verbal communicationI. Simplify a task or routine or discontinue until the person is calm and agrees to participateJ. Respect the person’s need for physical space and/or privacyK. All of the aboveWhen using Emergency use of a Manual Restraint on a continual basis, it must be addressed in a person’s coordinated service and support plan addendum.*YesNoAre these the 6 prohibited procedures under this policy: Chemical Restraint, Mechanical Restraint, Manual Restraint, Time Out, Seclusion, Any Aversive or Deprivation Procedures*YesNoAre these the 2 Manual Restraints allowed by this provider /program: Physical Escort, One staff person arm restraint in standing position*YesNoDoes a complete, uniform and LEDGIBLE copy of the report need to be maintained for the person’s service recipient record?*YesNoEach single incident of emergency use of manual restraint must be reported separately. A single incident is when the following condition have been met:*A. After implementing the manual restraint, staff attempt to release the person at the moment staff believes that the person’s conduct no longer poses an imminent risk of physical harm to self or others and less restrictive strategies can be implemented to maintain safetyB. Upon the attempt to release the restraint, the person’s behavior immediately re-escalatesC. Staff must immediately re-implement the manual restraint in order to maintain safetyD. Both A & CE. All of the aboveStaff does not need to assure the mental, physical and emotional condition of the person who is being manually restrained is being assessed and intervention is provided when necessary to maintain the person’s health and safety and prevent injury to the person, staff involved and others involved throughout the emergency use of a manual restraint?*YesNoCommentsThis field is for validation purposes and should be left unchanged.