(a) Only staff who have successfully completed competency-based training on the use of restraints may implement restraint procedures. Staff who implement restraint procedures must also complete training on person-specific instructions and other measures regarding restraints contained in an individual's crisis intervention plan or other plan.
(b) The following conditions must be met before a PCP may order a restraint in response to a behavioral crisis:
  (1) the individual's behavior constitutes a behavioral crisis;
  (2) if no PBSP, desensitization plan, or other preventive measures are in place, staff have considered the level of imminent risk of violence or injury and have applied a graduated range of less-restrictive approved procedures as safety permits and the measures have not reduced the risk of imminent physical harm to the individual or others;
  (3) if a PBSP, desensitization plan, or other preventive measures are in place, the individualized procedures for prevention, de-escalation and a graduated range of less restrictive measures have been followed, as safety permits, but have not reduced the risk of imminent physical harm to the individual or others; and
  (4) if a helmet, mittens with ties, wristlets, or other mechanical restraints will be used to prevent self-injury in a behavioral crisis:
    (A) an approved crisis intervention plan allowing the use of the mechanical restraint must be in place; or
    (B) the use of the mechanical restraint must be approved by the individual's psychologist or board certified behavior analyst (BCBA) or the psychologist or BCBA on call, the administrator on duty, and the director of psychology or behavioral services.
(c) If a mechanical restraint is used in accordance with subsection (b)(4)(B) of this section, its use must be reviewed by the chairperson of the facility's human rights committee as soon as possible but within 24 hours after initiation of the restraint.
(d) A psychotropic medication may be ordered as a chemical restraint in response to a behavioral crisis, but only if immediate use of the medication is essential to prevent or mitigate the danger of the individual's harmful behavior and the following conditions have been met:
  (1) the individual is experiencing a behavioral crisis;
  (2) a graduated range of less restrictive alternatives to stop the behavior and protect the individual and others has been attempted, as safety permits, but has not reduced the risk of imminent physical harm to the individual or others;
  (3) the requirements of any component of the ISP have been followed but have not reduced the risk of imminent harm to the individual or others;
  (4) a psychiatrist or PCP has determined that early administration of a regularly prescribed psychotropic medication instead of chemical restraint is not a reasonable option; and
  (5) a psychiatrist or PCP approves and orders the use of the chemical restraint.

Source Note: The provisions of this §967.33 adopted to be effective May 16, 2013, 38 TexReg 2841; transferred effective July 31, 2024, as published in the July 5, 2024, issue of the Texas Register, 49 TexReg 4927