Hillcrest policies, DEEC regulations, JCAHO standards, and best practices for residential care and treatment all prohibit the denial of food and/or a nutritious diet as consequences for negative behavior, for disciplinary reasons, and/or as a behavior management technique (see citations below). However, this standard may sometimes be difficult to interpret and/or implement on a practical level when a student misses or refuses one or more meals or snacks, and/or requests special foods or foods at unscheduled times. This policy statement attempts to clarify some of the contingencies surrounding this issue and provide guidance on how to achieve an appropriate standard of care.

1) A student misses (but has not refused) a meal or snack.

In this case, the student has not refused food, but for whatever reason, was not able to be present when the food was provided.
If a student misses a meal or snack for a valid reason (including being involved in a treatment activity, disciplinary action or emergency intervention such as a hold), staff should provide a reasonable substitute or alternate meal or snack if the meal or snack is no longer available.
This should be done in a manner that clearly communicates to the student that the substitution is not a disciplinary action.

2) A student refuses a meal or snack.

a) If a student refuses to eat a scheduled meal, this is not denial or withholding of food. If the student later requests food at an unscheduled time, such as before the next meal or snack, staff may provide or offer any reasonable alternate form of food (e.g., fruit, sandwich, cereal) rather than providing or offering either the meal that was initially offered and refused, or any other complete meal.
If the student refuses such alternate offerings, staff are not obliged to offer or provide any additional food until the next scheduled meal.
This is consistent with policies, regulations, standards and best practices.

b) If a student refuses to eat a scheduled snack, this is not denial or withholding of food. If the student later requests food at an unscheduled time, staff should inform the student that he/she will have the opportunity to eat at the next scheduled meal. The provision of an alternate or substitute snack is neither necessary not required.
This is consistent with policies, regulations, standards and best practices.

c) Consistent with DEEC regulations, a student has the right to refuse a meal, snack, or a specific form of food. While staff can and should reasonably encourage the student to eat at least some nutritious food, the student must not be coerced by staff to eat, and the student should not receive disciplinary action or consequences (e.g., points, restrictions) for refusing to eat.

If a student refuses two or more consecutive meals (meals, not snacks), nursing and the student’s Clinician should be notified and consulted.

If there is concern associated with health and/or medications because the student is refusing meals, that is a medical issue rather than a disciplinary issue. In this case, disciplinary actions or consequences should not be imposed, but nursing, the Clinician and the Treatment Team should determine how the behaviors and/or concerns should be managed.

3) Food issues may be highly symbolic and meaningful for many students. Therefore, if eating patterns or food issues are causes for concern by any staff or the Treatment Team, the Team should determine how the Team will manage the behaviors or concerns in order to maintain consistency of approach.
As with other problem behaviors, consistency among staff in all disciplines is very important, and individual staff must take care not to “freelance” or unintentionally reinforce problematic behaviors.