Reporting of Unusual Incidents (Restraint/Seclusion) by Child Group Home Providers - Revised

Department of Human Services
Division of Developmental Disabilities
Information Bulletin

Reporting of Unusual Incidents (Restraint/Seclusion) by Child Group Home Providers - Revised
May, 2014


As part of the 2010 renewal of the Children's Residential Waiver with the federal Centers for Medicare and Medicaid Services (CMS), the State was required to enhance its monitoring of the use of restraint and seclusion with children and adolescents residing in Child Group Homes. As a result, the State entered into action plans with federal CMS that, among other things, require Child Group Home providers to report unusual incidents involving restraint and seclusion to the Division of Developmental Disabilities.

Process and Procedure

  1. Title 89: Part 384 Behavior Treatment in Residential Child Care Facilities 

    Rule 384 addresses restraint, seclusion (also referred to as confinement), and other restrictive intervention issues. Part 384.90 states:

    Child care facilities shall report to the Department licensing authority [meaning the Department of Children and Family Services] unusual incidents regarding discipline and behavior management of children placed in the facility.

    1. The facility shall report as an unusual incident:
      • any injury received by a child as a result of discipline or behavior management
      • any 30-day period in which five or more instances of restraint and/or confinement of a specific child occurred
      • any violation of this Part [meaning Rule 384]
    2. Reports shall be made in writing and postmarked within two business days after the unusual incident.
  2. Unusual Incident Reporting Form CFS 119

    The Department of Children and Family Services has provided a form to all Child Group Home providers for use in reporting unusual incidents in order to comply with Part 384.90. That form is entitled Unusual Incident Reporting Form, CFS119 (Revised 12/07).

    In order to quickly begin compiling and monitoring this information on a statewide basis for the Children's Residential Waiver participants, we are adopting the use of this form. 

    The Division's use of this form does not change current reporting requirements between Child Group Home providers and the Department of Children and Family Services. Providers should continue to follow that Department's reporting instructions. The Division's use of the form is in addition to current requirements; it is not in place of those requirements.

  3. Submission of CFS119 to the Division of Developmental Disabilities 

    The forms must be submitted by facsimile or electronic mail to the Division of Developmental Disabilities by the end of the business day following the day of the incident. In the event the report is being submitted based on Item A.2. above, the report must be made by the end of the business day following the fifth, as well as any subsequent, incidents.  For those providers not using the CFS119 but rather are submitting reports to the Department of Children and Family Services via its electronic reporting system, the Division of Developmental Disabilities will accept a "print screen", scan, or other submission of the electronic reports. 

    The specific addresses for use in submitting the forms are:

    Special clarifications regarding the submissions are as follows:

    • Unusual incidents, as defined above, are to be reported to the Division even if they occur outside of the residential area, e.g., in a school setting.  Restraint or seclusion incidents that occur at school or other settings are to be counted when considering the number of incidents of restraint and/or seclusion within a 30-day period.
    • A 30-day time frame governs the reporting of five or more incidents of restraint and/or seclusion.  Each incident of restraint and/or seclusion begins a new rolling 30-day period.
    • The narrative section of the report should provide adequate information for the Division to review the incident.  The method of restraint or seclusion and length of time of restraint or seclusion must be included.
    • Relative to injury as a result of discipline or behavior management, injury is defined in Title 89, Section 331, Appendix A as follows:  The injury must have been accidental and occurred during the course of the restraint.  Physical restraint is a behavior management technique involving the use of physical contact or force, characterized by measures such as arm or body holds, to protect a child from injuring himself/herself or others.  Examples of injuries that are likely to occur during restraint include broken bones, bruises, bumps, strains and rug burns.

Effective Date

The implementation date of the reporting requirement is February 1, 2011.