Current through Register Vol. 42, No. 5, February 29, 2024
(1)
Purpose - This policy is designed to
serve several functions for children, their families, DHR and provider staff
when behavior management interventions are deemed necessary for children to
manage existing or learn new behaviors. These functions are the identification
of general guidelines for behavior management interventions; a description of
interventions which may be utilized when helping children manage existing or
learn new behaviors; the identification of prohibited interventions; and the
provision of guidelines and procedures for managing behaviors through the
development of behavior management plans which use interventions that are in
accordance with generally accepted professional standards. Provider
responsibilities for behavior management are included in this policy as
guidelines to follow when serving DHR children.
(2)
Glossary: Various terms used in this
policy are described below:
(a)
Advocacy - The promotion of governmental
and agency responsiveness to individual and class needs.
(b)
Age-Appropriate
Child - A child age 10 and older (except a child with
severe mental retardation) or a child under age 10 who is intellectually
capable of understanding and communicating ideas and opinions concerning the
subject matter being discussed or considered.
(c)
Antecedent - An event or any series of
events ("reasons," "causes," or "prior learning") that contributes to a
behavior's occurrence or frequency.
(d)
Behavior
Management - Treatment interventions that teach or increase
the frequency of desirable behaviors and/or modify or extinguish undesirable
behaviors by using reinforcers and/or punishments or altering or controlling
the environment and other events or conditioners affecting behavior.
(e)
Child and Family
Planning Team - The individuals involved in the planning
and/or delivery of services for a child and family.
(f)
Consequences - An event following a
behavior which is used in managing the behavior and teaching
self-regulation.
(g)
Crisis - A situation where seclusion,
restraint, or medication is used to protect children from a behavior which
could seriously harm the child, harm others or cause substantial property
damage and an appropriate Qualified Child Care
Professional (QCCP) is not available to examine the child and assess the
child's physical and psychological condition.
(h)
Crisis
Plan - A plan developed in partnership with the
age-appropriate child and the family to protect the child in the event a
behavior is displayed which could harm the child, harm others or cause
substantial property damage.
(i)
Discipline - The process of teaching a
child healthy behaviors by responding to the behaviors in a manner that
develops and promotes self-control and self-esteem.
(j)
Isolation - The physical placement of a
child in an unlocked room for a time-limited period including isolation of a
child in an unlocked room other than the child's own room; isolation of a child
age 10 or over in his or her own room for more than two hours; isolation of a
child under age 10 in his or her own room for more than one hour; and repeated
confinement of a child in his or her room or any other room (including
time-out) that subjects the child to lengthy social isolation.
(k)
Medication - Drugs prescribed for their
effect on mood thought or behavior excluding non-psychotropic drugs such as
those prescribed for physical conditions (e.g., antibiotics,
insulin).
(l)
Provider - Any individual, agency, or
organization that utilizes behavior management interventions while serving
children in the custody and/or planning responsibility or the Department of
Human Resources.
(m)
Punishment - Taking away something
desirable or adding something undesirable to cause a decrease in the occurrence
of a behavior.
(n)
Qualified Child Care Professional (QCCP)
- the following individuals may serve as QCCPs:
1. A licensed medical doctor with three years
residence training in psychiatry;
2. A physician licensed to practice in the
state of Alabama, with either specialized training or one year's experience in
working with children in out-of-home placements;
3. A psychologist with a doctoral or master's
degree from an accredited program who has either specialized training or one
year's experience in working with children in out-of-home placements;
4. A social worker or professional counselor
with a master's degree from an accredited program (and licensed in the state of
Alabama) who has either specialized training or one year's experience in
working with children in out-of-home placements;
5. A registered nurse with (a) a graduate
degree in psychiatric nursing, (b) a concentration in pediatric nursing or (c)
one year's experience in working with children in out-of-home placements;
or
6. A child care professional
with a graduate degree in child development or human development who has either
specialized training or one year's experience in working with children in
out-of-home placements.
(o)
Reinforcer - A response, such as praise
or a tangible reward, that strengthens a desired behavior. Reinforcers can also
involve taking away something undesirable (i.e. room restriction) to increase
the likelihood of appropriate behavior.
(p)
Restraint - Limiting or restricting a
child's freedom of movement or use of the limbs. It includes Mechanical
Restraint which is restricting a child's freedom of movement or use of limbs or
body by applying devices such as cuffs, ties, nets, tubes, bags, straps, head
gear, etc.; and Physical Restraint which is restricting a child's freedom of
movement by physically holding the child for an extended period of time or
repeatedly over time.
(q)
Reward - A response given to acknowledge
and support desired behavior.
(r)
Safety - The condition or state of being
free and/or secure from reasonable or foreseeable harm, danger, or
injury.
(s)
Seclusion - The isolation of a child in a
locked seclusion room, a locked time-out-room, or any other locked room or
place of confinement.
(3)
Children Covered by
Policy - This policy applies to all children in the custody
and/or planning responsibility of the Department. Providers using behavior
management interventions must follow these policies when designing and
implementing behavior management plans for children in the custody and/or
planning responsibility of DHR.
(4)
Disagreements and Grievances -
Disagreements and grievances about the type of behavior management
interventions being used will be addressed in a fair, timely, and impartial
manner by DHR and providers. Procedures for conflict resolution shall be
established by the appropriate provider or provider agency. The parent(s) and
age-appropriate child will be informed of these procedures in a manner
understandable to them. The Department of Human Resources shall make
age-appropriate children and their parents aware, in an effective manner, of
the availability of advocacy and appropriate support services to assist them in
pursuing a grievance in case of a disagreement.
(a) The parent(s) or age-appropriate child
may request the child be discharged from the provider's program if the conflict
cannot be resolved. Likewise, the provider can withdraw services or discharge
the child from placement. However, the provider or DHR, whichever is
appropriate, must give sufficient (i.e., as soon as possible, but not less than
30 days)
written advance notice of the intent to withdraw services
or discharge the child from placement in order to permit the child and family
planning team to plan and provide appropriate alternative services or
placement. Sufficient written advance notice may be waived
only pursuant to the decision of the child and family
planning team when the ISP is reviewed prior to the decision to move the child.
Author: Jerome Webb
