UPDATE b Determining Dangerousness to Self:
VII. SECURE OBSERVATION
At times, a youth’s “at risk” or suicide risk behavior may require a level of observation and control beyond that which can be provided by Precautionary Observation. A secure observation room may be provided for a youth whose level of “at risk” or suicide risk behavior constitutes a strong potential threat to the youth’s safety or to the safety of others. For example, the “at risk” youth appears extremely restless, fearful, agitated, depressed or his/her behavior appears unpredictable, volatile or highly impulsive. A secure observation room is a designated safe room within the facility which is used for the purpose of preventing a youth from injuring himself or herself, or others, and to provide continuous staff supervision and monitoring. A secure observation room shall be used for observation of “at risk” youths only when other less restrictive means of control are not effective or appropriate.
The secure observation room shall not be used for youth who present an imminent threat of suicide. Such youth shall be referred for emergency care.
Although authorized for use, secure observation rooms are not required in that Precautionary Observation may preclude the need for a secure observation room in some facilities. However, if an “at risk” youth requires placement in an individual cell (whether locked or unlocked) due to potentially self-injurious or suicide risk behaviors, Secure Observation must be implemented. When a youth on Suicide Precautions (Precautionary Observation or Secure Observation) is placed in disciplinary confinement due to misbehavior, Secure Observation must be implemented or maintained. This means that a youth currently on Precautionary Observation who requires placement in disciplinary confinement must be placed in a secure observation room, and a youth already on Secure Observation who requires placement in disciplinary confinement must remain in the secure observation room until the disciplinary confinement is discontinued. However, a licensed mental health professional must provide written concurrence for a youth to remain in a secure observation room beyond 24 hours for any reason.
The youth in Secure Observation must receive an assessment of suicide risk or follow-up assessment of suicide risk by a licensed mental health professional or a mental health clinical staff person working under the direct supervision of a licensed mental health professional within 8 hours of the youth’s placement in the secure observation room for any reason, or if the youth is placed in the secure observation room during the evening or night shift, the follow-up assessment of suicide risk must be conducted the following morning shift.
A. PURPOSE: This section discusses a framework for Department of Juvenile Justice facilities to implement procedures governing the use of secure observation for potentially self-injurious or
potential suicide risk youths. This section serves to:
1. Specify the criteria used to determine whether a potential suicide risk youth should be placed in a secure observation room;
2. Specify procedures for placing a potential suicide risk youth in a secure observation room;
3. Define staff supervision requirements for potential suicide risk youths who are placed in a
secure observation room;
4. Specify the structural requirements for a room designated for use as a secure observation room;
5. Specify requirements for removal of a youth from secure observation.
B. ACCOUNTABILITY: The superintendent or program director is charged with the responsibility of
daily on-site facility/program management and operation and is accountable for assuring that a
secure observation room is appropriately utilized. The guidelines set forth in this manual are intended to guide the superintendent or program director and staff in the use of secure observation. However, these guidelines are not intended to prescribe every action to be taken or decision to be made in using secure observation rooms. Therefore, it is essential that the superintendent or program director develop and implement a self-monitoring plan addressing the following:
1. Self-Monitoring. Each facility/program must have in place a self-monitoring plan to track, manage and facilitate oversight of secure observation practices. The self-monitoring plan must include at a minimum: a) a tracking system to document frequency of secure
observation use; b) supervisory reviews; c) medical and mental health interventions; d) staff training needs; and e) other practices related to use of secure observation rooms.
2. Proper Use. The facility/program self-monitoring plan must ensure that secure observation is
used in a humane and non-abusive manner.
3. Staff Training. The superintendent or program director is accountable for ensuring that facility/program staff are appropriately trained in the use of secure observation procedures.
C. STRUCTURAL SPECIFICATIONS OF A SECURE OBSERVATION ROOM:
To the extent possible, the structure of a Secure Observation Room should meet the following specifications:
1. Size: A minimum of 35 square feet of unencumbered space. Unencumbered space is usable space that is not encumbered by any furnishing or fixture. At least one dimension of the unencumbered space is no less than 7 feet.
2. Doors: Solid core hardwood or metal that has a shatter-resistant observation window or metal frame with wire mesh (holes no larger than 3/16 inch). The door observation window must permit constant visual and sound monitoring of the youth. A door with bars or expanded metal door is acceptable if small wire mesh or lexan shields the bars from the inside. Outward opening doors are preferable but not required.
3. Floors/Walls: Solid, smooth and high impact resistant without protrusions.
4. Ceilings: Solid, single piece ceiling which is out of the youth’s reach and has no appendages
that can be grasped or tied onto with cloth or other materials.
5. Vents: Must be covered with small mesh or a metal plate (holes no larger than 3/16 inch). Vents must be unreachable to the youth. Edges of wire mesh or metal covering must not be exposed. Vents should not be immediately accessible from the toilet, sink or bed.
6. Lighting: Light fixtures should be recessed and covered with shatter-resistant material such as lexan.
7. Windows: Must be made of shatter-resistant material. Glass windows that are not shatter resistant must be covered with security-rated screens or other materials that prevent access to the glass.
8. Toilet/Sink: Fixtures must be smooth and devoid of handles or parts that cloth or other material could be tied to or hung from. Must be mounted against the wall with water shut off valve outside of room.
9. Electrical Switches/Outlets: Electrical outlets are not permitted and switches must be located outside the room.
10. Beds: Must provide a security-rated plastic mattress suitable for floor use or suicide resistant bed. The bed must be anchored to the floor or secured to the wall, be of one piece construction (no springs) must be no higher than 18 inches from the floor and have a plastic fire retardant mattress.
D. AUTHORIZATION ANDCRITERIA FOR PLACEMENT IN A SECURE OBSERVATION ROOM:
1. Authorized by the superintendent, program director or his/her designee in conjunction with the Designated Mental Health Authority (in applicable facilities) or licensed mental health staff; and
The youth is demonstrating behaviors that potentially threaten his or her safety (For example, the “at risk” youth appears extremely restless, fearful, agitated, depressed or his/her behavior appears unpredictable, volatile or highly impulsive).
2. The youth is currently on Precautionary Observation and requires placement in disciplinary confinement due to misbehavior. A youth who is already on Secure Observation who requires placement in disciplinary confinement will remain in the secure observation room.
E. PROCEDURES FOR PLACEMENT IN A SECURE OBSERVATION ROOM: The superintendent,
program director or designee must confer with the Designated Mental Health Authority, or other
licensed mental health professional as to whether secure observation is appropriate for a specific youth. The consultation with the licensed mental health professional and reason for secure observation must be documented on the form, “Suicide Precautions Observation Log”, Appendix
R.
When the decision has been made to place an “at risk’ youth in a secure observation room, the following should occur:
1. Sufficient staff should be available to assure the physical means to enforce the placement. 2. The secure observation room must be inspected immediately prior to the youth’s placement to
ensure that it is safe and secure.
3. A staff member of the same sex will conduct a visual check of the youth to determine if there are any observable injuries that would make placement in the secure observation room
inappropriate. The “Health Status Checklist” (Appendix T) must be completed to document the youth’s physical condition. If a physical injury is observed, the youth complains of injury or illness, or the youth has been observed to have experienced a fall, impact or blow to such an extent that injury would be expected, medical personnel must be immediately notified for an immediate assessment and treatment.
4. The youth must be searched by a staff member of the same sex. At the time of the search, all jewelry, pocket items, hair ties, and hair pins must be removed. All clothing items which could be used for self-injury must be removed (e.g., shoes, shoelaces, socks, and belt). The youth
is not to be stripped. The youth is not to be required to dress in any garment or put on
any covering that sexually exposes the youth.
5. The youth must be told that his/her behavior requires observation beyond that normally provided, and a period in the secure observation room is needed until he or she is seen by a mental health clinical staff person.
F. MENTAL HEALTH CONSULTATION, ASSESSMENT OF SUICIDE RISK AND SUPPORTIVE
SERVICES:
1. Each youth placed in a secure observation room due to “at risk” or suicide risk behavior must be immediately referred for an assessment of suicide risk.
The assessment of suicide risk must be conducted by the close of the workday unless the youth is placed in the secure observation room during the evening or night shift. The youth
placed in secure observation during the evening or night shift must receive an assessment of suicide risk during the following day shift.
A youth may not remain in a secure observation room for more than eight hours
unless a licensed mental health professional has been consulted and agrees to a limited time extension.
The youth on Suicide Precautions placed on disciplinary confinement must receive a follow-up assessment of suicide risk by a licensed mental health professional or a mental health clinical staff person working under the direct supervision of a licensed mental health professional within 8 hours of the youth’s placement in disciplinary confinement, or
if the youth is placed on disciplinary confinement during the evening or night shift, the follow-up assessment of suicide risk must be conducted the following morning shift. When Secure Observation is implemented for the youth on Suicide Precautions who is
placed on disciplinary confinement due to misbehavior, the youth may remain in the secure observation room until the disciplinary confinement is discontinued.
However, a licensed mental health professional must provide written concurrence
for a youth to remain in Secure Observation beyond 24 hours for any reason.
2. The superintendent, program director or his/her designee is responsible for consulting the
Designated Mental Health Authority or other licensed mental health professional to discuss the case and refer the youth for an assessment of suicide risk. The superintendent, program director or designee’s consultation with the mental health professional must be documented in the mental health section of youth’s individual healthcare record. The licensed mental health professional’s recommendations with regard to supervision, monitoring and time frame for assessment of suicide risk must be documented.
3. The superintendent or program director and Designated Mental Health Authority (when applicable) or other licensed mental health professional shall confer on cases viewed as urgent and act accordingly. The superintendent or program director‘s consultation with the
Designated Mental Health Authority and referral for assessment of suicide risk must be documented in the mental health section of the youth’s individual healthcare record.
4. Mental health supportive services shall be provided to the youth being maintained on Suicide Precautions, based upon the individualized needs of the youth. Mental health supportive services shall be provided by, or under the direct supervision of, a licensed mental health professional, and shall include, but not be limited to:
a.
Supportive counseling or therapy;b.
Crisis intervention counseling or therapy;c.
On-going assessment/evaluation of suicide potential and mental status;d.
The follow-up assessment of suicide risk conducted prior to the youth’s removal fromSuicide Precautions must consider the youth’s appearance, behavior, affect, emotional
state, insight, cooperation, judgment and statements relevant to suicide risk and dangerousness to self.
5. Mental health supportive services shall be documented and reviewed and signed “as reviewer “ by a licensed mental health professional.