CD 843: Interventions to preserve life and prevent serious bodily harm

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Questions and Answers

What training is mandated for staff in relation to managing inmates who may self-injure?

Nutritional management training

Crisis negotiation techniques

Advanced rehabilitation methods

Suicide and self-injury intervention training (correct)

Under what condition can the Pinel Restraint System be authorized for use?

When all less restrictive measures have failed (correct)

When the inmate requests it

When family members agree to it

Only in maximum security institutions

What is required to be available in institutions using the Pinel Restraint System?

A suitable bed, chair, or stretcher (correct)

An operational surveillance system

Training for all inmates on its use

Regular mental health assessments

Who has the authority to modify the conditions of High Watch or Modified Watch?

The Institutional Head or Executive Director Signup and view all the answers

What should happen if mental or physical health assessments cannot be conducted within specified timeframes while on High or Modified Watch?

The inmate is transferred to a regional treatment centre Signup and view all the answers

What is the role of the Chief, Mental Health Services in relation to video-recordings of the Pinel Restraint System use?

To ensure they are reviewed and concerns reported Signup and view all the answers

What consideration is advised when authorizing or modifying the use of the Pinel Restraint System?

Risk-related advice from Health Services Signup and view all the answers

What responsibility does the receiving facility have upon an inmate's transfer for management of the Pinel Restraint System?

They assume authority for managing the restraints and watch conditions Signup and view all the answers

How often does the Chief of Mental Health Services present data on the use of the Pinel Restraint System and enhanced observation?

Monthly at the IMHT meeting Signup and view all the answers

What is the purpose of the IMHT reviewing all uses of restraints or enhanced observation after an incident?

To propose strategies for future incidents Signup and view all the answers

Which committee reviews data on the Pinel Restraint System every quarter?

Regional Complex Mental Health Committee Signup and view all the answers

At what frequency does the National Complex Mental Health Committee review the data related to the Pinel Restraint System?

Bi-annually Signup and view all the answers

What should be considered for any inmate transfer at risk of suicide or self-injury?

Referral to a Regional Treatment Centre or appropriate healthcare facility Signup and view all the answers

What must occur when an inmate is placed in the Pinel Restraint System?

Document the modification of use or removal Signup and view all the answers

What is the primary purpose of enhancing observation levels for inmates?

To manage suicidal risks and self-injury Signup and view all the answers

Which role does a health care professional NOT have in the context of inmate mental health management?

Decide the inmate's sentence duration Signup and view all the answers

What is required to be documented when a non-health care professional suspects a suicide risk?

Referral for further health services Signup and view all the answers

Which of the following is NOT a responsibility of staff and contractors working with suicidal inmates?

Providing spiritual guidance only Signup and view all the answers

What is the purpose of conducting a mental health assessment within 24 hours of an inmate being placed in the Pinel Restraint System?

To evaluate if the inmate's needs can be met at their current institution Signup and view all the answers

Under what circumstances can High or Modified Watch levels be used for inmates?

After considering alternative measures and risk assessment Signup and view all the answers

What must staff and contractors ensure when intervening with a self-injurious or suicidal inmate?

Follow the guidelines of CD 567 and CD 567-2 Signup and view all the answers

Inmates informed about spiritual support have access to which of the following?

Culturally appropriate support by Elders/Spiritual Advisors Signup and view all the answers

Which of the following does NOT need to be documented according to standard processes?

Inmate's gender and age Signup and view all the answers

What is the Immediate Needs Checklist – Suicide Risk used for?

Assess suicide risk within 24 hours of specific inmate interactions Signup and view all the answers

What is a key aspect of managing self-injury or suicidal behavior among inmates?

Communicate openly and collaboratively Signup and view all the answers

When should the Standing Orders related to inmate care be reviewed?

Regularly and updated as required Signup and view all the answers

What must occur once an inmate has been on High or Modified Watch for more than 72 hours?

The case will be presented to the Interdisciplinary Mental Health Team. Signup and view all the answers

What documentation will be used to record an inmate’s activities during High Watch?

Observation Report (CSC/SCC 1006) Signup and view all the answers

Which item is specifically provided to inmates on High Watch?

A security gown Signup and view all the answers

What is required before placing an inmate on Mental Health Monitoring?

A health care professional must identify the need. Signup and view all the answers

What happens after an inmate remains on High or Modified Watch for more than 5 days?

The Chief of Mental Health Services will review the case. Signup and view all the answers

What determines the frequency of monitoring for inmates placed on Mental Health Monitoring?

The health care professional Signup and view all the answers

In what situation will personal items, such as clothing, be allowed for an inmate on Modified Watch?

While under continuous observation Signup and view all the answers

What documentation must be prepared by the health care professional after reviewing an inmate's medication administration profile?

High Watch Observation Form (CSC/SCC 1434) Signup and view all the answers

Which of the following indicates that an inmate has been properly placed on High Watch?

They are continuously observed. Signup and view all the answers

What must be ensured during monitoring of a female inmate by male staff?

A female staff member must be present at all times. Signup and view all the answers

Which statement about enhanced observation is true?

It is designed for inmates at risk of self-injury or suicide. Signup and view all the answers

What form is completed by the health care professional or Institutional Head for Mental Health Monitoring?

Mental Health Monitoring Form (CSC/SCC 1436) Signup and view all the answers

When should the Regional Complex Mental Health Committee be notified?

When an inmate remains on High Watch for more than 15 days. Signup and view all the answers

What is the primary purpose of modifying the observation level when increased risk to self or others is perceived?

To adjust the level of monitoring required Signup and view all the answers

In what situations is the Pinel Restraint System allowed to be used?

After all other alternatives have been attempted and found ineffective Signup and view all the answers

What should be done to prevent positional asphyxia when an inmate is restrained?

Position them on their back with head elevated Signup and view all the answers

How should pregnant inmates be positioned when subjected to the Pinel Restraint System?

Tilted on their left side Signup and view all the answers

What must be done immediately following the application of the Pinel Restraint System if a Nurse is present?

Provide a full health assessment of the inmate Signup and view all the answers

What should staff do if no Nurse is present during the application of the Pinel Restraint System?

Call for a Nurse and ensure assessment within two hours Signup and view all the answers

What happens if an inmate refuses a post-use of force health assessment?

The Nurse will document refusal and schedule a repeat assessment Signup and view all the answers

What is essential to maintain while an inmate is placed in the Pinel Restraint System?

Constant monitoring for their safety Signup and view all the answers

What documentation must be completed when a change in observation level occurs?

The appropriate observation form (CSC/SCC 1434, 1435, or 1436) Signup and view all the answers

What must be assessed if a Nurse is not present during the application of restraints?

The physical and mental health of the inmate Signup and view all the answers

What should be reported to the Nurse on duty during an observation of a restrained inmate?

Changes in the inmate's behavior or physical state Signup and view all the answers

What rights must an inmate be informed of when placed in the Pinel Restraint System?

The right to engage an advocate Signup and view all the answers

What is the purpose of assessing the inmate’s health after the use of the Pinel Restraint System?

To ensure the inmate's safety and well-being Signup and view all the answers

Which of the following is NOT a part of the health assessment during the application of the Pinel Restraint System?

Attitude towards staff Signup and view all the answers

What is the minimum frequency for a Nurse to perform health assessments during the first hour after application of the Pinel Restraint System?

Every 15 minutes Signup and view all the answers

What should be documented if an inmate refuses to cooperate with range of motion exercises while in restraints?

The refusal to cooperate should be recorded Signup and view all the answers

How often must the IMHT develop an intervention strategy if restraint equipment use exceeds eight hours?

No later than 24 hours from the original placement Signup and view all the answers

What kind of health assessment is done after the removal of the Pinel Restraint System?

A post-removal health assessment by a Nurse Signup and view all the answers

What alert gets activated if an inmate poses a current risk of suicide or self-injury?

Current Risk of Suicide/Self-Injury Alert Signup and view all the answers

Which of the following is NOT a requirement during the use of the Pinel Restraint System?

Immediate transfer to a maximum-security facility Signup and view all the answers

What must a health care professional assess within six hours after applying the restraints?

Mental health assessment Signup and view all the answers

What will happen if the intervention strategy does not lead to the removal of restraints within 24 hours?

The Chief, Mental Health Services will complete a review Signup and view all the answers

What role does the Chief, Mental Health Services play in the context of the intervention strategy?

They complete a review if intervention strategies are ineffective Signup and view all the answers

What is required if an inmate remains in restraints for over 72 hours?

A Regional Complex Mental Health Committee review will occur Signup and view all the answers

Which of the following is included in the health assessment following the application of the Pinel Restraint System?

Consideration for removal of restraints Signup and view all the answers

What opportunity is NOT offered to inmates under the Pinel Restraint System?

To engage in recreational activities Signup and view all the answers

How frequently should the IMHT review active Current Risk of Suicide/Self-Injury Alerts?

Monthly Signup and view all the answers

What is done to document a refusal to participate in care while in the Pinel Restraint System?

It should be noted in the medical record Signup and view all the answers

What type of support is provided for inmates post-restriction?

Reintegration support and open communication Signup and view all the answers

Study Notes

Institutional Policies for Inmate Safety and Mental Health

Staff Training: Staff receive training on suicide/self-injury intervention and Pinel Restraint System use, adhering to National Training Standards.
Restraint System Availability: Appropriate beds/chairs/stretchers for the Pinel Restraint System are provided, except in minimum security institutions and Healing Lodges.
Restraint Use Criteria: The Pinel Restraint System is a last resort for self-injury likely to cause serious harm, after less restrictive measures fail. Authorization is given by the Institutional Head or the Treatment Centre Executive Director.
Enhanced Observation Levels: High Watch or Modified Watch, and modifications to observation conditions (monitoring & access to items), are authorized based on ongoing risk assessments. Mental Health Monitoring is authorized when a health professional is unavailable.
Video Review and Reporting: All Pinel Restraint System usage is reviewed with the Mental Health Services Chief; concerns reported to Regional & National committees (Mental Health).
Health Services Input: Risk advice from Health Services is considered before authorizing or modifying restraints or enhanced observation.
Transfers and Referrals: If needed assessments (mental/physical) can't be completed within timeframes, inmates are transferred to a Treatment Centre or health facility.

Staff Responsibilities

Immediate Intervention: Staff must intervene immediately during self-injury/suicide attempts, following established procedures (CD 567).
Communication: Actions taken with inmates experiencing self-harm or significant mental illness are documented and communicated to all staff/contractors with regular contact.
Documentation: Detailed documentation of all behavioural indications, threats, or actual instances of self-injury/suicide attempts is required.
Inmate Support: Open communication and respect of gender/cultural differences, are key for inmates' recovery. De-escalation and wellness activities are part of support. Specific support for women and Indigenous peoples is highlighted.

Health Professional Responsibilities

Authorizing Mental Health Monitoring: Health professionals authorize Mental Health Monitoring and provide assessments.
Ongoing Risk Mitigation: Provide advice and recommendations to mitigate risks of harm to inmates or others.
Treatment Plans: Engage inmates in treatment plans according to the Integrated Mental Health Guidelines.
Cultural Sensitivity: Engage Elders and Spiritual Advisors to provide culturally sensitive support for Indigenous inmates.
Referral Criteria: Determine if an inmate's needs can be met at their current institution or require a referral to a Treatment Centre/facility within 24 hours of being placed in restraints or an enhanced observation level.
Supervision of Unlicensed Staff: Licensed professionals supervise unlicensed mental health staff.

Suicide Risk Screening

Screening Procedures: The Immediate Needs Checklist - Suicide Risk (CSC/SCC 1433e) is used under several conditions including transfers to any institution and when a health professional is unavailable.

Enhanced Observation Procedures

Last Resort: High Watch & Modified Watch are last-resort measures after all other less restrictive interventions fail.
Time-Limited Use: Enhanced observation levels should be used for the shortest duration.
Risk Assessments: Decisions are made based on individualized risk assessments by health professionals.
Ongoing Assessments: Mental health assessments by health professionals are mandatory within 24 hours of placement on High/Modified Watch, with subsequent frequency determined by the professional.
Inmate Input & Documentation: Inmates are given input and informed of reasons for enhanced observation, with access to relevant documentation. The right to engage an advocate is also noted.
Review Meetings: Cases involving inmates continuously on enhanced observation are reviewed by Interdisciplinary Mental Health Teams (IMHT), the Chief, Mental Health Services, or the Regional Complex Health Committee, depending on the duration of the enhanced observation.
Observation Requirements: Specific documentation and timeframes are laid out for observation of inmates with differing enhanced observation levels. (ie. every 15 minutes).

Pinel Restraint System Procedures

Last Resort: The Pinel Restraint System is a last resort following failed attempts using less restrictive measures.
Trained Personnel: Application and removal are by trained staff only.
Safety Precautions: Appropriate clothing/covering; prevention of positional asphyxia (no face-down placement), is critical, as is the use of the recovery position or lying on the back with head elevated.
Inmate Input: Inmates are offered input, informed of the reasons, and given access to relevant documentation.
Pregnant Inmates: Special considerations for pregnant inmates are highlighted (last resort use, physician approval, and specific positioning guidance).

Health Assessments—Pinel Restraint System

Nurse/Health Professional Presence: Nurse presence is detailed for the application and removal of restraints, encompassing specific assessments and timelines.
Post-Placement Assessments: Both initial and subsequent health assessments after restraint application are required, with specific parameters.
Clinical Need-Driven Assessments: Assessments can be adjusted based on the inmates' clinical needs.
Activities of Daily Living: Inmates are offered opportunities to attend to activities of daily living.
Follow-up and Review: Specific review procedures are noted for exceeding certain restraint duration limits. These include reports to IMHT, Regional Committee, and National Committee, including criteria for transfer.
Removal Assessment: Health professionals complete assessments for risk reduction and enhanced observation, following removal of the restraint.

### Offender Management System (OMS) Alerts

Suicide/Self-Injury Alerts: Alert activation and management procedures for suicide/self-injury risks are outlined. Activations are de-activated once the risk is no longer present.
Serious Mental Illness Alert: Activation and management of alerts for inmates with serious mental illness with significant impairment are detailed.
Monthly/Weekly Reviews: Monthly reviews of suicide/self-injury alerts and weekly review for serious mental illness with significant impairment alerts are mandatory to verify accuracy.

General Monitoring and Quality Improvement

Interdisciplinary Review: The IMHT reviews restraint or enhanced observation uses promptly.
Data Collection and Analysis: The Chief, Mental Health Services, and various committees at regional and national levels collect and review use data on a schedule, including discussions of identified quality improvement initiatives.
Transfer Considerations: Considerations and referrals related to suicidal or self-harming inmates are detailed in the transfer guidelines.
Inmate Support and Communication: Continued support and effective communication for inmates in restraint or enhanced observation situations are prioritized.

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Description

This quiz covers essential training and protocols for staff managing inmates who may self-injure, specifically focusing on the Pinel Restraint System. It addresses authorization conditions, necessary resources, and the responsibilities of mental health services. Additionally, it touches on procedures during high watch situations and data presentation requirements.