CARROLL COUNTY BOARD OF
Policy Reference: Behavior Supports Strategies that include restrictive measures.
ORC citations: 5126.05, 5123.171
OAC citations: 5123:2-1-02(J), 5123:2-17-02, 5123:2-2-06
All individuals served by the Board shall be accorded the rights and dignity of being treated with respect regardless of their actions or behaviors. Furthermore, behavior support shall assist and promote the growth, development and independence of those individuals and promote individual choice in daily decision-making, emphasizing self-determination and self-management. This policy limits the use of and sets forth requirements for development and implementation of behavioral support strategies that include restrictive measures for the purpose of ensuring that:
(1) Restrictive measures are used only when necessary to keep people safe;
(2) Individuals with developmental disabilities are supported in a caring and responsive manner that promotes dignity, respect, and trust and with recognition that they are equal citizens with the same rights and personal freedoms granted to Ohioans without developmental disabilities;
(3) Services and supports are based on an understanding of the individual and the reasons for his or her actions; and
(4) Effort is directed at creating opportunities for individuals to exercise choice in matters affecting their everyday lives and supporting individuals to make choices that yield positive outcomes.
This policy and subsequent procedures applies to all providers of services under the authority of the Board.
(1) This rule applies to persons and entities that provide specialized services regardless of source of payment, including but not limited to:
(a) County boards of developmental disabilities and entities under contract with county boards;
(d) Providers of services funded by Medicaid home and community-based services waivers administered by the department.
(2) Individuals receiving services in a setting governed by the Ohio department of education shall be supported in accordance with administrative rules and policies of the Ohio department of education.
It is the policy of the Board that behavior support will assist an individual to develop acceptable community standards of behavior. To this end, interventions will use the most common everyday consequences and will be applied in the most normal, integrated community settings. These interventions shall contain positive reinforcing components to teach desirable behaviors and will only use aversive consequences when these have been determined to be the least restrictive and least intrusive choices.
The Board encourages the use of behavior support that shall:
Promote the growth, development and independence of the individual; Address the extent to which individual choice will be accommodated in daily decision-making, emphasizing self-determination and self-management, to the extent possible;
Specify the individual’s conduct to be allowed or not allowed;
Be available to all staff, the individual, parents of minor children, legal guardians, and providers;
To the extent possible, be formulated with the individual’s participation; and ensure that an individual must not discipline another individual, except as part of an organized system of self-government.
The written procedures shall:
Focus on positive teaching and support strategies and encourage use of the least restrictive environment and least intrusive forms of services; and, specify a hierarchy of these teaching and support strategies, ranging from positive or least intrusive to least positive or most intrusive, including approvals and review procedures and be developed in accordance with the DODD guidelines and relevant local, state, federal statutes and regulations.
PROMOTION OF A CLIMATE FOR BEHAVIOR SUPPORT:
The Board shall support and encourage an agency climate for behavior support characterized by:
- Interactions and speech which reflect respect, dignity, and a positive regard for the individual;
- The setting of acceptable behavioral limits for the individual;
- The absence of group punishment;
- The absence of demeaning, belittling or degrading speech or punishment;
- Staff speech which is even-toned, made in positive and personal terms and void of threatening overtones or coercion;
- Conversations with the individual rather than about the individual while in the individual’s presence;
- Respect for the individual’s privacy by not discussing the individual with someone who has no right to the information; and
- The use of people-first language instead of referring to the individual by trait, behavior, or disability.
“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.
“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 rule 5123:2-2-06 under paragraph (F). “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.
Use of prohibited and restrictive measures shall be reported as a major unusual incident in accordance with section 5123:2-17-02 of the Administrative Code and the Board policies and procedures for reporting incidents affecting health and safety.
BEHAVIOR SUPPORT PLANNING:
Behavior Support Planning will: (a) be incorporated into the individual plan for each individual; (b) be written with the participation of the individual served and/or the legal guardian to the maximum extent possible, and (c) be designed to help the individual achieve maximum independence and self-direction without hurting themselves or other people.
BEHAVIOR SUPPORT AND HUMAN RIGHTS REVIEW COMMITTEES:
The superintendent shall appoint members to the Board’s:
a) Behavior Support committee, and
b) Human Rights Committee
The Board may recognize validly constituted behavior support and human rights committees of providers; human rights committees of providers must include a representative of the Carroll County Board of DD.
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 Human Rights Committee reviews and prior approves or rejects all behavior support plans using aversive methods, including timeout and restraint, and those which involve potential risks to the individual’s rights and protections.
POLICY AND PROCEDURES:
The behavior support policy and procedures, in addition to the administrative resolution of complaints and due process policy, shall be made available to all individuals, personnel, employees, students, and parents/guardians of individuals being supported by the Board,
The Board authorizes the superintendent to develop and implement written procedures consistent with Board policy and applicable rules, regulations and statutes.
Behavior support policy and procedures shall be reviewed annually to insure that they are in compliance with current DODD rules governing the use of behavior support.