CARROLL COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
PROCEDURE: POSITIVE SUPPORT STRATEGIES:
Positive teaching and support between staff and individuals is essential to assisting individuals to: develop productive work skills; feel good about themselves; and develop skills to adjust to social and work situations. It is important that staff give positive social feedback to individuals on an ongoing basis for appropriate work and social interaction. In addition to this informal and ongoing feedback, various approved forms of positive reinforcements and schedules may be necessary to teach and support individuals to learn new positive behaviors while redirecting undesirable behaviors as identified in each individual plan.
General Intervention Strategies to Prevent or Increase Behavior
General Intervention Strategies are those teaching strategies or planning processes that may be used to increase or decrease behaviors and are implemented without prior committee approval. This category of strategies includes positive reinforcement and other strategies uniquely associated with effective teaching and learning. They also include simple correction procedures, and modifying the environment to increase choice and control by the individual. Some general intervention strategies require that staff receive specialized training. Those strategies must be monitored by the person’s IP team and accurate data must be recorded if they are to be used most effectively.
Chronological age of the individual, frequency and duration of the intervention, and specific regulatory restrictions should be considered before any efforts to categorize interventions.
The following two sections list several strategies that could be categorized as “general intervention strategies.”
Prevention and Behavior Support Strategies
Many disruptive behaviors can be reduced or eliminated by giving the individual more choice and control in his/her life through person-centered planning and by scheduling interesting and meaningful activities in a positive environment.
Examples of prevention and behavior support strategies:
- Giving an individual options to choose from in all activities and areas of life.
- Meeting individuals’ basic needs (including the need for a varied and interesting program, opportunity for exercise, “breaks”, etc.
- Providing developmentally and age appropriate activities and expectations.
- Developing a positive, reinforcing and supportive atmosphere.
- Developing and maintaining good rapport.
- Developing a caring attitude on part of staff.
- Developing an effective communication system that helps each individual express wants, needs and feelings.
- Providing ample opportunities to choose preferred activities or items.
- Ensuring consistent and adequate communication between the individual, staff, home and work.
- Controlling voice volume (loudness, softness).
- Implementing environmental changes (or changing physical environment of individual; i.e. moving furniture, painting an area, reducing noise, changing location of peers, brighten work area, etc.).
- Providing verbal and other forms of praise for appropriate behavior.
- Reviewing staff behavior to ensure it is not part of the problem.
- Knowing and respecting the individual’s likes and dislikes; strengths, needs
and personal goals.
- Being aware of medical conditions that might account for inappropriate behaviors.
- Maintaining consistent routines with the ability to be flexible when needed.
- Providing simple correction.
- Providing consistent and calm intervention.
- Helping the person develop and maintain friendships and other relationships.
Strategies to Increase Desirable Behaviors
All staff that has direct contact with individuals is encouraged to develop and use an array of positive planning and teaching strategies. Planning can result in consumer driven services and supports based on individual’s choices and preferences. Plans based on individual choice are most likely directed toward positive activities.
Planning and teaching strategies can range from simple actions by the service provider directed toward the individual to informal oral contracts between the service provider and the individual to written formal programs specifying the detailed expectations to be met for rewards to be earned. Positive programs are most effective when they clearly define behaviors and include a variety of meaningful and relevant reinforcers. Very frequent rewards may be necessary for individuals who do not have the capability to make time-delayed connections between their behavior and the rewards. Care should be taken to ensure that rewards are meaningful and relevant to the individual. If there is a question about whether or not a procedure could be aversive to an individual, the Behavior Management Specialist should be consulted.
Examples of strategies to increase desirable behavior:
Positive reinforcement, errorless learning; forward/backward chaining, shaping/fading, Modeling/imitation, systematic use of prompts, rehearsal, token economy without response cost, self-management techniques (e.g. having the individual record his/her own behavior frequency), contracts with positive consequences, group contingent reinforcement, participating in a chosen activity, spending time with a chosen friend.
The following behavioral intervention strategies do not require committee approval:
- Positive reinforcement to reward appropriate behavior and promote learning. Examples include any of a variety of objects, activities, and interaction such as giving tokens, stars, stickers (etc.); extra privileges, praise; touch (pat on the back, a hug); and extra attention (informal or formal). Failure to earn a reinforcer shall not be construed as withholding of a reinforcer.
- Listening to an individual’s initial complaint without interrupting. Feelings of individuals can be discounted by cutting them short by not hearing what they have to say, which may lead to disruptive behaviors.
- Teaching alternative acceptable behaviors for handling situations. “What do you think you should do the next time you don’t like the work?” Be creative and make recommendations or demonstrate to individual. Give several options. Have the individual practice or repeat what has been suggested. This may require regular practice sessions.
- Self-management training to teach the individual to recognize when he/she is losing control. What signal should he/she look for which indicates they may have problems? What do we need to do to keep calm? Specific recommendations can be obtained from the behavior management specialist.
- Planned ignoring following the display of specific undesirable behaviors.
- Structural supports which arrange the environment (including people) to prevent the occurrence of certain targeted behaviors. This is not done contingent upon the occurrence of the target behavior, but is structured ahead of time to maximize learning opportunities or vocational performance. Examples include placing toys out of sight before class or organizing work areas to separate two individuals who distract each other. Structural supports also include enriching the environment by such things as modifying temperature, color, lighting, noise level, crowding, and improving the density of positive reinforcement to encourage the display of the desired behavior. Classroom rules and guidelines as required by the Ohio Department of Education which are not otherwise in conflict with these procedures may be considered structural supports.
- Differential reinforcement of other behaviors (DRO) is a procedure in which the display of a target behavior postpones delivery of reinforcement. The
individual receives scheduled reinforcement for a variety of other behaviors, but not when engaging in the target behavior.
8. Differential reinforcement of incompatible behaviors (DRI) – is a reward procedure in which a behavior which cannot occur, i.e., is incompatible with, at the same time as a target behavior is reinforced. For example, if the target behavior is “out of seat,” a DRI procedure would be to reward the individual when he or she is in the seat.
9, Verbal or gestural feedback to indicate to the individual that a specific behavior is inappropriate and should not occur again.
- Physical, gestural, and verbal cues or prompts to direct a person to a desirable behavior that is then reinforced.
- Graduated manual guidance means the use of minimal physical assistance and/or prompts necessary in order to help an individual correctly perform a desired behavior or task. The degree of physical assistance is faded systematically as the person becomes more able to perform a given activity independently. Graduated manual guidance is a teaching technique using, for example, hand-over-hand physical prompts or arm and wrist support to teach the individual how to engage in a desired educational or habilitative activity. (Note: Graduated manual guidance is used to facilitate a behavior and should not be confused with physically intervening with an individual in such a way as to physically prevent the individual from being able to engage in the behavior, which would be restraint).
- Simple restitution means having an individual correct, to the extent possible, the damage or destruction done to another’s property. This may involve superficially repairing an object, e.g., taping a broken radio, replacing an equal quantity of an edible that was consumed or rendered inedible by the individual, or with team approval, repayment in cash for the destroyed item. The individual/guardian must consent to make restitution.
CARROLL COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
PROCEDURE: Behavior support strategies that include restrictive measures.
(1) “County board” means a county board of developmental disabilities.
(2) “Department” means the Ohio department of developmental disabilities.
(3) “Director” means the director of the Ohio department of developmental disabilities or his or her designee.
(4) “Individual” means a person with a developmental disability.
(5) “Individual plan” or “individual service plan” means the written description of services, supports, and activities to be provided to an individual.
(6) “Informed consent” means a documented written agreement to allow a proposed action, treatment, or service after full disclosure provided in a manner the individual or his or her guardian understands, of the relevant facts necessary to make the decision. Relevant facts include the risks and benefits of the action, treatment, or service; the risks and benefits of the alternatives to the action, treatment, or service; and the right to refuse the action, treatment, or service. The individual or his or her guardian, as applicable, may revoke informed consent at any time.
(8) “Prohibited measure” means a method that shall not be used by persons or entities providing specialized services. “Prohibited measures” include:
(a) Prone restraint. “Prone restraint” means a method of intervention where an individual’s face and/or frontal part of his or her body is placed in a downward position touching any surface for any amount of time.
(b) Use of a manual restraint or mechanical restraint that has the potential to inhibit or restrict an individual’s ability to breathe or that is medically contraindicated.
(c) Use of a manual restraint or mechanical restraint that causes pain or harm to an individual.
(d) Disabling an individual’s communication device.
(e) Denial of breakfast, lunch, dinner, snacks, or beverages.
(f) Placing an individual in a room with no light.
(g) Subjecting an individual to damaging or painful sound.
(h) Application of electric shock to an individual’s body.
(i) Subjecting an individual to any humiliating or derogatory treatment.
(j) Squirting an individual with any substance as an inducement or consequence for behavior.
(k) Using any restrictive measure for punishment, retaliation, instruction or teaching, convenience of providers, or as a substitute for specialized services.
(9) “Provider” means any person or entity that provides specialized services.
(10) “Qualified intellectual disability professional” has the same meaning as in 42 C.F.R. 483.430 as in effect on the effective date of this rule.
(11) “Restrictive measure” means a method of last resort that may be used by persons or entities providing specialized services only when necessary to keep people safe and with prior approval by the human rights committee in accordance with paragraph (F) of this rule. “Restrictive measures” include:
(a) Manual restraint. “Manual restraint” means use of a hands-on method, but never in a prone restraint, to control an identified action by restricting the movement or function of an individual’s head, neck, torso, one or more limbs, or entire body, using sufficient force to cause the possibility of injury and includes holding or disabling an individual’s wheelchair or other mobility device. An individual in a manual restraint shall be under constant visual supervision by staff. Manual restraint shall cease immediately once risk of harm has passed. “Manual restraint” does not include a method that is routinely used during a medical procedure for patients without developmental disabilities.
(b) Mechanical restraint. “Mechanical restraint” means use of a device, but never in a prone restraint, to control an identified action by restricting an individual’s movement or function. Mechanical restraint shall cease immediately once risk of harm has passed. “Mechanical restraint” does not include:
(i) A seatbelt of a type found in an ordinary passenger vehicle or an age-appropriate child safety seat;
(ii) A medically-necessary device (such as a wheelchair seatbelt or a gait belt) used for supporting or positioning an individual’s body; or
(iii) A device that is routinely used during a medical procedure for patients without developmental disabilities.
(c) Time-out. “Time-out” means confining an individual in a room or area and preventing the individual from leaving the room or area by applying physical force or by closing a door or constructing another barrier, including placement in such a room or area when a staff person remains in the room or area.
(i) Time-out shall not exceed thirty minutes for any one incident nor one hour in any twenty-four hour period.
(ii) A time-out room or area shall not be key-locked, but the door may be held shut by a staff person or by a mechanism that requires constant physical pressure from a staff person to keep the mechanism engaged.
(iii) A time-out room or area shall be adequately lighted and ventilated and provide a safe environment for the individual.
(iv) An individual in a time-out room or area shall be protected from hazardous conditions including but not limited to, sharp corners and objects, uncovered light fixtures, or unprotected electrical outlets.
(v) An individual in a time-out room or area shall be under constant visual supervision by staff.
(vi) Time-out shall cease immediately once risk of harm has passed or if the individual engages in self-abuse, becomes incontinent, or shows other signs of illness.
(vii) “Time-out” does not include periods when an individual, for a limited and specified time, is separated from others in an unlocked room or area for the purpose of self-regulating and controlling his or her own behavior and is not physically restrained or prevented from leaving the room or area by physical barriers.
(d) Chemical restraint. “Chemical restraint” means a medication prescribed for the purpose of modifying, diminishing, controlling, or altering a specific behavior. “Chemical restraint” does not include medications prescribed for the treatment of a diagnosed disorder identified in the “Diagnostic and Statistical Manual of Mental Disorders” (fifth edition) or medications prescribed for treatment of a seizure disorder. “Chemical restraint” does not include a medication that is routinely prescribed in conjunction with a medical procedure for patients without developmental disabilities.
(12) “Risk of harm” means there exists a direct and serious risk of physical harm to the individual or another person. For risk of harm, the individual must be capable of causing physical harm to self or others and the individual must be causing physical harm or very likely to begin causing physical harm.
(13) “Service and support administrator” means a person, regardless of title, employed by or under contract with a county board to perform the functions of service and support administration and who holds the appropriate certification in accordance with rule 5123:2-5-02 of the Administrative Code.
(14) “Specialized services” means any program or service designed and operated to serve primarily individuals with developmental disabilities, including a program or service provided by an entity licensed or certified by the department. If there is a question as to whether a provider or entity under contract with a provider is providing specialized services, the provider or contract entity may request that the director of the department make a determination. The director’s determination is final.
(15) “Team,” as applicable, has the same meaning as in rule 5123:2-1-11 of the Administrative Code or means an interdisciplinary team as that term is used in 42 C.F.R. 483.440 as in effect on the effective date of this rule.
(A) Development of a behavioral support strategy that includes restrictive measures
(1) A behavioral support strategy shall never include prohibited measures.
(2) A behavioral support strategy may include manual restraint, mechanical restraint, time-out, or chemical restraint only when an individual’s actions pose risk of harm.
(3) A behavioral support strategy may include restriction of an individual’s rights only when an individual’s actions pose risk of harm or are very likely to result in the individual being the subject of a legal sanction such as eviction, arrest, or incarceration. Absent risk of harm or likelihood of legal sanction, an individual’s rights shall not be restricted (e.g., by imposition of arbitrary schedules or limitation on consumption of food, beverages, or tobacco products).
(4) The focus of a behavioral support strategy shall be creation of supportive environments that enhance the individual’s quality of life. Effort is directed at:
(a) Mitigating risk of harm or likelihood of legal sanction;
(b) Reducing and ultimately eliminating the need for restrictive measures; and
(c) Ensuring individuals are in environments where they have access to preferred activities and are less likely to engage in unsafe actions due to boredom, frustration, lack of effective communication, or unrecognized health problems.
(5) A behavioral support strategy that includes restrictive measures requires:
(a) Documentation that demonstrates that positive and non-restrictive measures have been employed and have been determined ineffective; and
(b) An assessment conducted within the past twelve months that clearly describes:
(i) The behavior that poses risk of harm or likelihood of legal sanction;
(ii) The level of harm or type of legal sanction that could reasonably be expected to occur with the behavior;
(iii) When the behavior is likely to occur; and
(iv) The individual’s interpersonal, environmental, medical, mental health, and emotional needs and other motivational factors that may be contributing to the behavior.
(6) Persons who conduct assessments and develop behavioral support strategies that include restrictive measures shall:
(a) Hold professional license or certification issued by the Ohio board of psychology; the state medical board of Ohio; or the Ohio counselor, social worker, and marriage and family therapist board; or
(c) Hold a bachelor’s or graduate-level degree from an accredited college or university and have at least three years of paid, full-time (or equivalent part-time) experience in developing and/or implementing behavioral support and/or risk reduction strategies or plans.
(7) A behavioral support strategy that includes restrictive measures shall:
(a) Be designed in a manner that promotes healing, recovery, and emotional wellbeing based on understanding and consideration of the individual’s history of traumatic experiences as a means to gain insight into origins and patterns of the individual’s actions;
(b) Be data-driven with the goal of improving outcomes for the individual over time and describe behaviors to be increased or decreased in terms of baseline data about behaviors to be increased or decreased;
(c) Recognize the role environment plays in behavior;
(d) Capitalize on the individual’s strengths to meet challenges and needs;
(e) Delineate measures to be implemented and identify those who are responsible for implementation;
(f) Specify steps to be taken to ensure the safety of the individual and others;
(g) As applicable, identify needed services and supports to assist the individual in meeting court-ordered community controls such as mandated sex offender registration, drug-testing, or participation in mental health treatment; and
(h) As applicable, outline necessary coordination with other entities (e.g., courts, prisons, hospitals, and law enforcement) charged with the individual’s care, confinement, or reentry to the community.
(8) When a behavioral support strategy that includes restrictive measures is deemed necessary by the individual and his or her team, the qualified intellectual disability professional or the service and support administrator, as applicable, shall:
(a) Ensure the strategy is developed in accordance with the principles of person-centered planning and incorporated as an integral part of the individual plan or individual service plan.
(b) Submit to the human rights committee documentation based upon the assessment that clearly indicates risk of harm or likelihood of legal sanction described in observable and measurable terms and ensure the strategy is reviewed and approved by the human rights committee in accordance with paragraph (F) of this rule prior to implementation and whenever the behavioral support strategy is revised to add restrictive measures, but no less than once per year.
(c) Secure informed consent of the individual or the individual’s guardian, as applicable.
(d) Provide an individual or the individual’s guardian, as applicable, with written notification and explanation of the individual’s or guardian’s right to seek administrative resolution if he or she is dissatisfied with the strategy or the process used for its development.
(e) Ensure the strategy is reviewed by the individual and the team at least every ninety days to determine and document the effectiveness of the strategy and whether the strategy should be continued, discontinued, or revised. A decision to continue the strategy shall be based upon review of up-to-date information which indicates risk of harm or likelihood of legal sanction is still present.
(B) Implementation of behavioral support strategies with restrictive measures
(1) Restrictive measures shall be implemented with sufficient safeguards and supervision to ensure the health, welfare, and rights of individuals receiving specialized services.
(2) Each person providing specialized services to an individual with a behavioral support strategy that includes restrictive measures shall successfully complete training in the strategy prior to serving the individual.
CARROLL COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
PROCEDURE: CRISIS INTERVENTION
When redirection and other positive interventions have not been successful, more intrusive procedures may be used, without prior approval, to restore health and safety.
Any use of restraint must be the least restrictive intervention that is likely to be effective in resolving the emergency situation. Restraint can be use with behaviors that are destructive to self or others. Crisis restraint may be used at these times to temporarily inhibit, control, or limit the movement and/or normal function of any portion of an individual’s body. Only those crisis restraint techniques approved by the Behavior Support Review and Human Rights Review committees shall be utilized and staff must have successfully completed training. Staff in the position to respond to crisis intervention must be trained in the use of de-escalation and preventive measures. No person will be held in supine or prone positions or wrestling holds.
1. A crisis situation exists when an individual’s behavior presents an immediate danger of injury to self, and/or others.
- Danger to self — self-abuse of sufficient force to cause bodily injury; engaging in a behavior that has a high potential for bringing about injury such as running out of the building or jumping from a moving vehicle.
- Danger to others – physical aggression toward others with sufficient force to cause bodily injury.
Restraint as an intervention in a crisis may only be used for behaviors destructive to self or others.
2. During a crisis situation staff will utilize physical crisis intervention skills, utilizing the least restrictive approach as possible. Physical crisis intervention techniques used during a crisis situation do not require prior approval of a behavior plan, if the techniques used are those taught by an approved course.
3. Staff are expected to take whatever action is necessary to interrupt and prevent behavior that is destructive to self or others, utilizing approved physical handling techniques.
4. When restraint is needed for crisis intervention the team should begin to gather the information needed to develop a plan or improve an existing plan to address the issue in whatever way the data and situation indicates is needed.
If the episode of aggression is due to a known, and not likely to be replicated situation, it is permissible to document the incident without further proceeding to develop a support plan. If the cause of the aggression is not known, the team should meet to discuss if additional measures are required. Addressing the need for crisis intervention at the individuals planning meeting and the likelihood of future intervention should be discussed by the team. Measures taken to avoid future crisis situations and de-escalation strategies should be part of the discussion at the team meeting. Any medical factors contributing to the crisis situation should be addressed and taken into account as part of the planned intervention.
All crisis situations as defined above shall be documented on the Behavior Incident Report. The reports will be monitored for frequency of incidents to determine the need for the development of a behavior support plan.
5. Training shall be provided to staff of pre-intervention skills and physical handling techniques. Annual refresher course in crisis intervention skills will be provided following initial training.
Internal Control Procedures
- Staff members are to notify the building office immediately if emergency situation arises (or as soon as it is safe to do so).
- Staff should take actions necessary to re-establish a safe environment.
- If the situation and availability of personnel safely permits discussion of the situation before taking emergency action, supervisory personnel and direct service staff person will discuss the most appropriate course of action and its implementation.
- Staff person responsible shall file written report before the end of the work day.
- Superintendent/principal/adult services manager, or designee shall attempt to notify the parents or legal guardian, if applicable, by the end of the work day.
CARROLL COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
PROCEDURE: ESTABLISHMENT OF BEHAVIOR SUPPORT AND HUMAN RIGHTS COMMITTEES
A. Behavior Support Committee
The superintendent shall appoint members to the Behavior Support Committee.
Purpose: The Behavior Support Committee reviews and approves or rejects all plans that incorporate aversive methods, including timeout and restraint, and reviews ongoing plans that incorporate aversive methods including time out and restraint.
The Behavior Support Committee is responsible for reviewing all behavior plans and behavior plan proposals on a regular basis. In general, aversive plans will be reviewed every 15-30 calendar days. More frequent reviews will be conducted when the situation warrants or as requested by the individual’s team. Initial and subsequent reviews by the Behavior Support Committee shall be documented on a Status Report.
Behavior plans will be retained only if there is significant data to justify need. i.e.one (l) time a week, 2-3 times a month, or 6 times in a calendar year. Standing or as needed plans for the control of behavior are prohibited. Plans written for staff convenience, or as a substitute for active treatment shall not be approved.
For every individual with a current behavior plan, the reviews must be addressed at all 1P conferences and updates. Additional reviews may be held at any time.
Membership: The Behavior Support Committee shall include persons knowledgeable in behavior support procedures, including administrators and persons employed by a provider who are responsible for implementing behavior support plans, but not those directly involved with the plan being reviewed. The authors of the behavior support plan may attend committee meetings to provide information and to facilitate incorporation of suggested changes. Appointments are for two years
Meetings: Three voting members of the committee should be present to have a quorum. Behavior Support Committee meetings are scheduled as needed by the committee members. Emergency plan reviews will be scheduled as needed.
B. Human Right Committee
The superintendent shall appoint members to the Human Rights Committee.
(1) The human rights committee shall:
(a) Be comprised of at least four persons;
(b) Include at least one individual who receives or is eligible to receive specialized services;
(c) Include qualified persons who have either experience or training in contemporary practices for behavioral support; and
(d) Reflect a balance of representatives from each of the following two groups:
(i) Individuals who receive or are eligible to receive specialized services or family members or guardians of individuals who receive or are eligible to receive specialized services; and
(ii) County boards or providers.
(2) All information and documents provided to the human rights committee and all discussions of the committee shall be confidential and shall not be shared or discussed with anyone other than the individual and his or her guardian and the individual’s team.
(3) The human rights committee shall review, approve or reject, monitor, and reauthorize strategies that include restrictive measures. In this role, the human rights committee shall:
(a) Ensure that the planning process outlined in this rule has been followed and that the individual or the individual’s guardian, as applicable, has provided informed consent and been afforded due process;
(b) Ensure that the proposed restrictive measures are necessary to reduce risk of harm or likelihood of legal sanction;
(c) Ensure that the overall outcome of the behavioral support strategy promotes the physical, emotional, and psychological wellbeing of the individual while reducing risk of harm or likelihood of legal sanction;
(d) Ensure that a restrictive measure is temporary in nature and occurs only in specifically defined situations based on risk of harm or likelihood of legal sanction;
(e) Verify that any behavioral support strategy that includes restrictive measures also incorporates actions designed to enable the individual to feel safe, respected, and valued while emphasizing choice, self-determination, and an improved quality of life; and
(f) Communicate the committee’s determination in writing to the qualified intellectual disability professional or service and support administrator submitting the request for approval.
(4) Members of the human rights committee shall receive department-approved training within three months of appointment to the committee in: rights of individuals as enumerated in section 5123.62 of the Revised Code, person-centered planning, informed consent, confidentiality, and the requirements of this rule.
(5) Members of the human rights committee shall annually receive department-approved training in relative topics which may include but are not limited to: self-advocacy and self-determination; role of guardians and section 5126.043 of the Revised Code; effect of traumatic experiences on behavior; and court-ordered community controls and the role of the court, the county board, and the human rights committee.
(G) Use of a restrictive measure without prior approval by the human rights committee
(1) Use of a restrictive measure, including use of a restrictive measure in a crisis situation (e.g., to prevent an individual from running into traffic), without prior approval by the human rights committee shall be reported as “unapproved behavior support” in accordance with rule 5123:2-17-02 of the Administrative Code.
(2) Nothing in this rule shall be construed to prohibit or prevent any person from intervening in a crisis situation as necessary to ensure a person’s immediate health and safety.
(H) Reporting of behavioral support strategies that include restrictive measures
After securing approval by the human rights committee and prior to implementation of a behavioral support strategy that includes restrictive measures, the county board or intermediate care facility shall notify the department in a format prescribed by the department.
(I) Recording use of restrictive measures
Each provider shall maintain a record of the date, time, duration, and antecedent factors regarding each use of a restrictive measure other than a restrictive measure that is not based on antecedent factors (e.g., bed alarm or locked cabinet). The provider shall share the record with the individual and the individual’s team whenever the individual’s behavioral support strategy is being reviewed or reconsidered.
(J) Analysis of behavioral support strategies that include restrictive measures
(1) Each county board and each intermediate care facility shall compile and analyze data regarding behavioral support strategies that include restrictive measures and furnish the data and analyses to the human rights committee. Data compiled and analyzed shall include, but are not limited to:
(a) Nature and frequency of risk of harm or likelihood of legal sanction that triggered development of strategies that include restrictive measures;
(b) Nature and number of strategies reviewed, approved, rejected, and reauthorized by the human rights committee;
(c) Nature and number of restrictive measures implemented;
(d) Duration of strategies that include restrictive measures implemented; and
(e) Effectiveness of strategies that include restrictive measures in terms of increasing or decreasing behaviors as intended.
(2) County boards and intermediate care facilities shall make the data and analyses available to the department upon request.
(K) Department oversight
(1) The department shall take immediate action as necessary to protect the health and welfare of individuals which may include, but is not limited to:
(a) Suspension of a behavioral support strategy not developed, implemented, documented, or monitored in accordance with this rule or where trends and patterns of data suggest the need for further review;
(b) Provision of technical assistance in development or redevelopment of a behavioral support strategy; and
(c) Referral to other state agencies or licensing bodies, as indicated.
(2) The department shall compile and analyze data regarding behavioral support strategies for purposes of determining methods for enhancing risk reduction efforts and outcomes, reducing the frequency of restrictive measures, and identifying technical assistance and training needs. The department shall make the data and analyses available.
(3) The department may periodically select a sample of behavioral support strategies for review to ensure that strategies are developed, implemented, and monitored in accordance with this rule.
(4) The department shall conduct reviews of county boards and providers as necessary to ensure the health and welfare of individuals and compliance with this rule. Failure to comply with this rule may be considered by the department in any regulatory capacity, including certification, licensure, and accreditation.
(L) Waiver of provisions of this rule
For adequate reasons and when requested in writing by a county board or provider, the director may waive a condition or specific requirement of this rule except that the director shall not permit use of a prohibited measure as defined in paragraph (C)(8) of this rule. The director shall grant or deny a request for a waiver within ten working days of receipt of the request or within such longer period of time as the director deems necessary and put whatever conditions on the waiver as are determined to be necessary. Approval to waive a condition or specific requirement of this rule shall not be contrary to the rights, health, or safety of individuals receiving services. The director’s decision to grant or deny a waiver is final and may not be appealed.
ADMINISTRATIVE RESOLUTION OF COMPLAINTS:
The Board will make available copies of the administrative resolution of complaints procedures to eligible program applicants and participants, advocates for individuals, parents, caregivers/providers or guardians upon request.
Effective Date 7-25-02, Revised 9/25/02 Thomas Shearer, Supt.