Guidelines 578-1
Therapeutic Quiet Room

Authorities

• Corrections and Conditional Release Act (CCRA), sections 3, 3.1, 4, 15.1, 30, 31, 76, 77, 80, 86, 87 and 88
• Corrections and Conditional Release Regulations (CCRR), sections 17, 18 and 102

Purpose

To provide guidance to staff on the processes for the use of the therapeutic quiet room.

Application

Applies to all staff working in women offender institutions.

Responsibilities

1. The Institutional Head will ensure that a process is in place and documented in a standing order for use of the therapeutic quiet room (TQR) within a Structured Living Environment and ensure its appropriate application.
2. The Manager, Intensive Intervention Strategy, and the Correctional Manager, Intensive Intervention Strategy, will develop a process, in consultation with the Chief, Mental Health Services, or delegate, for approval and use of the TQR, which will consider both the clinical and operational needs of the site.
3. Staff facilitating the use of the TQR will:
   1. ensure that inmates are aware of this option upon admission to the Structured Living Environment or while receiving support and outreach services outside of the Structured Living Environment and before it is included in their treatment plan
   2. be responsible for activities surrounding the use of the TQR
   3. meet with the inmate when they leave the TQR to ascertain the reason if they are leaving early, to review the effectiveness of their time in this room and to ensure their wellbeing. This will be documented in the Therapeutic Quiet Room Accountability Sheet (CSC/SCC 1242).

Procedures

Use of the Therapeutic Quiet Room

4. Use of the TQR is strictly voluntary. It may be utilized as part of an overall management strategy to assist inmates in preventing emotional dysregulation by removing themselves from anxiety-provoking situations, to engage in self-soothing skills and thus enhance their emotional ability to cope.
5. The TQR may be accessed by:
   1. inmates who live in the Structured Living Environment
   2. inmates who participate in support and outreach services. The decision should be made at the Interdisciplinary Team meeting and the use of the TQR should be identified as a voluntary option in the inmate's treatment plan.
6. Visual checks will be applied consistently for Structured Living Environment or support and outreach services inmates and documented in the Therapeutic Quiet Room Accountability Sheet (CSC/SCC 1242).
7. Use of the TQR is not available to inmates assessed as requiring High or Modified Watch for suicide/self-injury or as a result of a serious mental illness with significant impairment. These situations will be managed in accordance with CD 843 - Interventions to Preserve Life and Prevent Serious Bodily Harm.
8. The priority for the use of the TQR is for inmates and the room may not be used by staff for counselling space unless it is vacant.
9. The TQR will not usually be used for longer than a one-hour period. This period may be shorter depending on the inmate's needs or longer if case specifics determine it to be appropriate.
10. More than one period of use can occur for the same inmate in the same day.
11. The TQR will not be used by more than one inmate at the same time.
12. Staff facilitating the use of the TQR will:
    1. complete the Therapeutic Quiet Room Accountability Sheet each time an inmate requests the use of the TQR. The form will be submitted to the Chief, Mental Health Services, and the Manager, Intensive Intervention Strategy, and placed on the inmate's Electronic Medical Record and Case Management file
    2. record in the unit logbook each time an inmate starts and ends a period in the TQR.

Security

13. Physical force must never be used to place an inmate in the TQR.
14. Restraints (soft or hard) will not be used while the inmate is in the TQR.
15. The inmate will not be monitored via direct observation and/or camera while using the TQR. Visual checks of the inmate are to be made no more than 20 minutes apart and recorded on the Therapeutic Quiet Room Accountability Sheet.
16. Inmates who use the TQR will have access to a washroom. The washroom will be searched before the inmate has access to it. If there is no inmate-designated washroom in the administrative area of the Structured Living Environment, the inmate will be permitted to return to the main living area to use the washroom. A plan to address this need will be developed by the Manager, Intensive Intervention Strategy, and approved by the Institutional Head.
17. The TQR will remain unlocked while it is being used by an inmate and remain locked while it is not in use. It will also be locked while the inmate is using the washroom.
18. The TQR will be searched before and after an inmate uses it. This should be recorded as a routine search pursuant to CD 566-9 - Searching of Cells/Rooms, Vehicles and Other Areas.
19. The inmate will be required to have only minimal personal belongings in their possession and may be subject to a search prior to entering the TQR, pursuant to CD 566-7 - Searching of Offenders.
20. Should the inmate engage in self-injurious behaviour, the situation will be managed in accordance with CD 843 - Interventions to Preserve Life and Prevent Serious Bodily Harm. An assessment of continued use of the TQR will be completed by the Interdisciplinary Team and all activities and discussions will be recorded on the Therapeutic Quiet Room Accountability Sheet.
21. Should the inmate become verbally or physically aggressive, staff will immediately consult the Correctional Manager, Intensive Intervention Strategy (CMIIS), when available, or the Duty Correctional Manager when the CMIIS is not available. A summary of the case conference must be recorded in the Therapeutic Quiet Room Accountability Sheet as well as a Casework Record and/or a Statement/Observation Report.

Annex A - Cross-References and Definitions

Cross-References

• CD 001 - Mission, Values and Ethics Framework of the Correctional Service of Canada
• CD 566-7 - Searching of Offenders
• CD 566-9 - Searching of Cells/Rooms, Vehicles and Other Areas
• CD 578 - Intensive Intervention Strategy in Women Offender Institutions/Units
• CD 843 - Interventions to Preserve Life and Prevent Serious Bodily Harm

Integrated Mental Health Guidelines

Definitions

Behavioural Counsellor: a staff member who works with inmates at a women offender institution/unit, under the direct supervision of the Manager, Intensive Intervention Strategy, but who executes certain duties under the functional supervision of a registered health care professional.

Correctional Manager, Intensive Intervention Strategy: a Correctional Manager position unique to women offender institutions/units and whose incumbent oversees the management and supervision of correctional operations components of the Intensive Intervention Strategy.

High Watch: an enhanced observation status for inmates who are at imminent risk for suicidal or self-injurious behaviour or who have been identified by a health care professional as having a serious mental illness with significant impairment where there is a risk of serious bodily harm that cannot be safely managed within the normal institutional routine, during which the inmate is under continuous direct observation.

Interdisciplinary Team: an intervention body chaired by the Manager, Intensive Intervention Strategy, and comprised of the Correctional Manager, Intensive Intervention Strategy, registered health care professionals, Parole Officers, Primary Workers, Behavioural Counsellors, Elders, Indigenous Liaison Officers and/or ad hoc members as required.

Manager, Intensive Intervention Strategy: an interventions manager position unique to women offender institutions/units whose incumbent oversees the administration of the Intensive Intervention Strategy, including but not limited to planning and administering finances, directing the work of the Interdisciplinary Teams, and directly supervising Behavioural Counsellors.

Modified Watch: an enhanced observation status for inmates who are at elevated risk for suicidal or self-injurious behaviour, or who have been identified by a health care professional as having a serious mental illness with significant impairment where there is a risk of serious bodily harm that cannot be safely managed within the normal institutional routine, during which the inmate is under continuous observation.

Registered health care professional: an individual registered or licensed for the practice of health or mental health care in Canada and preferably in the province or territory of practice (certain positions however, require registration in the province or territory of practice).

Structured Living Environment: specialized accommodation at women's facilities (excluding Okimaw Ohci Healing Lodge) for inmates classified as minimum or medium security, which also offers intermediate mental health beds as well as an accommodation option that is more structured as there is a continuous presence of staff available.

Therapeutic quiet room: a space for inmates in the Structured Living Environment that may be used as part of an overall management strategy to assist inmates in preventing emotional dysregulation by removing themselves from anxiety-provoking situations, to engage in self-soothing skills and thus enhance their emotional ability to cope. Inmates participating in support and outreach services are also authorized to utilize the TQR.