42 U.S.C. § 290jj — Requirement relating to the rights of residents of certain non-medical, community-based facilities for children and youth

(a) Protection of rights: (1) In general: A non-medical, community-based facility for children and youth — the Secretary will define this term by regulation — that gets any support from a program funded under this chapter must protect and promote each resident's rights. That includes the right to be free from physical or mental abuse, corporal punishment, and any restraint or seclusion used for discipline or convenience rather than safety. (2) Nonapplicability: A facility that provides inpatient psychiatric treatment for people under 21, as defined elsewhere in the Social Security Act, follows a different set of rules (part H) instead of this section. (3) Applicability of Medicaid provisions: A facility funded through Medicaid must still meet all of Medicaid's existing participation rules, except where this part changes them. (b) Requirements: (1) In general: Staff may only physically restrain or seclude a resident if two things are both true. First, it's an emergency — the restraint or seclusion is the only way to protect the immediate physical safety of the resident, a staff member, or someone else, and less restrictive options have already been tried and found not to work. Second, only a staff member trained and certified by a state-recognized body, following a state-approved process, may impose it. That training must cover a long list of topics: the needs and behaviors of the people the facility serves, building relationships, alternatives to restraint and seclusion, de-escalation methods, avoiding power struggles, when restraint is and isn't appropriate, the physical and mental effects of restraint and seclusion, watching for signs of physical distress and getting medical help, legal issues, the danger of positional asphyxia (being restrained in a way that stops breathing), escape and evasion techniques, time limits, how to get approval to continue a restraint, how to handle restraints that go wrong, paperwork, how to process the experience with the children involved, following up with staff afterward, and investigating injuries and complaints. (2) Interim procedures relating to training and certification: Until a state sets up its own process to properly train and certify staff, the facility itself must create a temporary procedure that meets the requirements below. (A) That procedure must ensure a supervisory or senior staff member trained in restraint and seclusion personally checks on the child's mental and physical well-being face to face, and confirms the restraint or seclusion is being done safely. (B) This check must happen as soon as possible, and no later than one hour after the restraint or seclusion begins. (C) The same supervisory or senior staff member must keep monitoring the situation for as long as the restraint or seclusion continues. (3) Limitations: Facilities cannot use a drug or medication as a restraint to control behavior or limit movement, unless it is a standard treatment for that resident's actual medical or psychiatric condition — using medication just to restrain someone is banned. Mechanical restraints — physical devices used to limit movement — are completely banned in these facilities. Seclusion may only be used when a staff member is continuously watching the resident face to face, and only where strong licensing, accreditation, and internal controls are in place. (c) Rule of construction: (1) In general: Nothing in this section stops facilities from using restraints for medical reasons — to keep someone still for treatment, to support them physically, or to protect them medically. (2) Current law: This part doesn't cancel out or weaken any other federal or state law that already gives residents stronger protection against seclusion and restraint. (d) Definitions: "Mechanical restraint" means using a device to limit how freely a resident can move. "Physical escort" means briefly touching or holding a resident's hand, wrist, arm, shoulder, or back to guide someone who is acting out to a safe place — this does not count as a restraint. "Physical restraint" means physically limiting a resident's ability to move their arms, legs, or head; it does not include a physical escort. "Seclusion" means locking a resident in isolation as a way to control behavior; it does not include a time out. "Time out" means a calming technique, part of an approved treatment plan, where a resident is separated from the group in an unlocked space — this is not the same as seclusion.