Current through August 31, 2023
Each agency must develop and implement written policies and
procedures that address the development of participants' social skills and
management of maladaptive behavior. These policies and procedures must include
statements that address: (3-17-22)
01.
Adaptive and Maladaptive Behavior. The agency must address
possible underlying causes or function of a behavior and identify what the
participant may be attempting to communicate by the behavior.
(3-17-22)
02.
Behavior
Intervention. Positive behavior interventions must be used prior to and
in conjunction with, the implementation of any restrictive intervention.
Interventions must address the following: (3-17-22)
a. Social Skills Development. Focus on
developing or increasing participants' social skills. (3-17-22)
b. Prevention Strategies. Ensure and document
the use of positive approaches to increase social skills and decrease
maladaptive behavior while using least restrictive alternatives and consistent,
proactive responses to behaviors. (3-17-22)
c. Behavior replacement. Ensure that programs
to assist participants with managing maladaptive behavior include teaching of
alternative adaptive skills to replace the maladaptive behavior.
(3-17-22)
d. Protected Rights.
Ensure the safety, welfare, and human and civil rights of participants are
adequately protected. (3-17-22)
e.
Objectives and Programs. Ensure that objectives and intervention techniques are
developed or obtained and implemented to address self-injurious behavior,
aggressive behavior, inappropriate sexual behavior, and any other behaviors
that significantly interfere with participants' independence or ability to
participate in the community. Ensure that reinforcement selection is
individualized and appropriate to the task and not contraindicated for medical
reasons. (3-17-22)
f. Participant
Involvement. Ensure programs developed by the agency involve the participants,
to the best of their ability, in developing the plan to increase social skills
and to manage maladaptive behavior. (3-17-22)
g. Written Informed Consent. Ensure programs
developed by an agency to assist participants with managing maladaptive
behaviors are conducted only with the written informed consent of the
participant, or legal guardian, where applicable. When programs used by the
agency are developed by another service provider the agency must obtain a copy
of the informed consent. (3-17-22)
h. Review and Approval. Programs developed by
an agency to manage maladaptive behavior are implemented after the review and
written approval of the residential habilitation professional. If the program
contains restrictive or aversive components, an individual working within the
scope of their license or certification must also review and approve, in
writing, the program prior to implementation. When programs implemented by the
agency are developed by another service provider, the agency must obtain a copy
of these reviews and approvals. (3-17-22)
03.
Appropriate Use of
Interventions. Employees of the agency must not use physical, verbal,
sexual, or psychological abuse, or punishment. For the purposes of these rules,
punishment is any procedure in which an adverse consequence is presented that
is designed to produce a decrease in the rate, intensity, duration, or
probability of the occurrence of a behavior; or, the administration of any
noxious or unpleasant stimulus or deprivation of a participant's rights or
freedom for the purpose of reducing the rate, intensity, duration, or
probability of a particular behavior. Employees of the agency must not withhold
food or hydration that contributes to a nutritionally adequate diet. The agency
must ensure that interventions used to manage participants' maladaptive
behavior are never used: (3-17-22)
a. For
disciplinary purposes; (3-17-22)
b.
For the convenience of staff; (3-17-22)
c. As a substitute for a needed training
program; or (3-17-22)
d. By
untrained or unqualified staff. (3-17-22)
04.
Use of Restraint on
Participants. No restraints, other than physical restraint in an
emergency, must be used on participants prior to the use of positive behavior
interventions. The following requirements apply to the use of physical
restraint on participants: (3-17-22)
a.
Physical restraint. (3-17-22)
i. Physical
restraint may be used in an isolated emergency to prevent injury to the
participant or others and must be documented and reviewed in the participant's
record by the direct service staff and the residential habilitation
professional. Documentation must include a debrief with the participant and
staff involved focusing on strategies to avoid the occurrence of future
physical restraints. (3-17-22)
ii.
Physical restraint may be used in a non-emergency setting when a written
behavior change plan is developed by the participant and their guardian, if
applicable, their team, and a qualified residential habilitation professional.
Informed participant consent is required.
(3-17-22)
