STATEMENTS OF POLICY
Title 55—PUBLIC WELFARE
DEPARTMENT OF PUBLIC WELFARE
[ 55 PA. CODE CH. 3800 ]
Prone Restraints in Children's Facilities
[39 Pa.B. 7111]
[Saturday, December 19, 2009]Scope
This statement of policy applies to child residential and day treatment facilities, State youth development centers and youth forestry camps.
Purpose
The purpose of this statement of policy is to clarify that prone position manual restraints (''prone restraints'') are prohibited in child residential and day treatment facilities that are licensed under 55 Pa. Code Chapter 3800 (relating to child residential and day treatment facilities).
Background
The use of a restraint as an intervention is a growing concern within this Commonwealth, Nationally and internationally. The Department of Public Welfare shares this concern.
Restraints bring the risk of serious injury or death of the child or staff; emotional harm and trauma to the child or staff; and also disrupt the relationships among the child, family members, peers and staff. Prone restraints are particularly dangerous because they can impede or even prevent breathing by placing pressure or weight on the child's respiratory system. According to the Coalition Against Institutionalized Child Abuse, at least 73 children in the United States have died in the last 18 years as a result of being restrained. Most of these deaths resulted from the child being restrained in the prone position. See http://www.caica.org/RESTRAINTS%20 Death%20List.htm. All program offices will work together to eliminate the use of prone restraints in all facilities that serve children.
Discussion
Prone restraints are those in which a child is held face down on the floor. This places a child at risk of decreased functional lung volume by putting pressure on the child's chest wall and putting the child in a position that makes it difficult to monitor respiratory status. In normal breathing, chest muscles and the diaphragm, key respiratory muscles, work in concert. During a prone restraint, the chest has difficulty expanding, and the diaphragm has difficulty descending into the abdomen. This can result in asphyxia, which is the body's diminished ability to intake oxygen and to eliminate carbon dioxide, and it can lead to impairment of vital organs, especially the brain, and result in death.
Because prone restraints apply pressure or weight on a child's respiratory system, they are prohibited under § 3800.211(b) (relating to manual restraints).
Regulation Interpretation
The regulation interpretation is contained in Annex A.
Effective Date
This statement of policy is effective June 21, 2010.
Contact Person
Angie Logan, Office of Policy Development (717) 772-4141.
ESTELLE B. RICHMAN,
Secretary(Editor's Note: Title 55 of the Pennsylvania Code is amended by adding § 3800.211a to read as set forth in Annex A.)
Fiscal Note: 14-BUL-081. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 55. PUBLIC WELFARE
PART V. CHILDREN, YOUTH AND FAMILIES MANUAL
Subpart E. RESIDENTIAL AGENCIES, FACILITIES AND SERVICES
CHAPTER 3800. CHILD RESIDENTIAL AND DAY TREATMENT FACILITIES § 3800.211a. Prone position manual restraint—statement of policy.
(a) Prone position manual restraint is a restraint during which a child is held face down on the floor.
(b) Prone position manual restraint is prohibited under § 3800.211(b) (relating to manual restraints) because it applies weight or pressure on the child's respiratory system.
[Pa.B. Doc. No. 09-2316. Filed for public inspection December 18, 2009, 9:00 a.m.]
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