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PDFWAC 388-107-0410

Management of escalating behaviors.

(1) An enhanced services facility must have a specific procedure for deescalating, preventing, and redirecting aggressive and challenging behavior. This protocol must always be the first approach and strategy in resolving behavioral issues and must include:
(a) Training on prevention of escalation of behavior before it reaches the stage of physical assault;
(b) Techniques for staff to use in response to challenging client behaviors;
(c) Evaluation of the safety of the physical environment;
(d) Issues of respect and dignity of the resident; and
(e) Use of the least restrictive physical and behavioral interventions depending upon the situation.
(2) If the facility uses holding techniques to physically restrain residents in emergency situations and as part of behavioral intervention protocols, the facility must:
(a) Ensure that all staff authorized to use holding techniques receive department-approved training on specific techniques prior to using them;
(b) Describe the types of holding techniques that are safe and effective for the individual in the resident's person-centered service plan;
(c) Use other established resident-specific behavioral interventions first to attempt to deescalate the situation;
(d) Limit the holding technique to specific emergent situations where behavioral interventions have not been successful in deescalating a situation and the resident is at imminent risk of harm to self or others due to aggressive behavior;
(e) Limit the duration of the holding technique to only until the arrival of emergency personnel or the emergency ceases;
(f) Release residents from the holding technique as soon as possible;
(g) Instruct observers on how to recognize signs of distress by the resident and fatigue by the staff; and
(h) Document:
(i) The reason for use of the holding technique;
(ii) Other behavioral interventions attempted prior to the use of the holding technique;
(iii) The duration of the use of the holding technique;
(iv) The assessment by a qualified assessor; and
(v) The condition of the resident at the time of release from the holding technique.
[Statutory Authority: RCW 70.97.230 and HCBS Final Rule 42 C.F.R. WSR 16-14-078, § 388-107-0410, filed 7/1/16, effective 8/1/16. Statutory Authority: Chapter 70.97 RCW. WSR 14-19-071, § 388-107-0410, filed 9/12/14, effective 10/13/14.]
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