Current through Register Vol. 48, No. 38, September 20, 2024
Each child care facility that accepts children for whom the
Department of Children and Family Services is legally responsible shall develop
an Agency Behavior Treatment Plan that describes the facility's programming. In
addition, each child for whom the Department is legally responsible shall have
an individual treatment plan that identifies those specific components of the
overall Behavior Treatment Plan that will be applied to that child and the
specific behaviors the individual treatment plan is intended to address. All
plans submitted to the Department shall be written to assure that the facility
will use behavior treatment techniques in a safe, humane manner that fosters a
child's self-discipline.
a) Licensed
child care facilities or their supervising agency shall develop an Agency
Behavior Treatment Plan describing the behavior treatment techniques, as
defined in Section
384.20, to be used by
the facility. This plan shall include a detailed description of:
1) each of the facility's approved crisis
prevention/intervention procedures as defined in Section 384.20;
2) each of the facility's approved specific
behavior intervention techniques as defined in Section 384.20; and
3) each of the facility's approved behavior
management techniques, as defined in Section 384.20, to control actions that
present a danger to self or others.
b) The Agency Behavior Treatment Plan shall
be approved by the governing body of the facility and the Department (the
guardian or authorized agents of the guardian). The specific requirements for
the plan are set forth in subsections (c) through (e). Licensed child care
facilities shall submit their written Agency Behavior Treatment Plans to the
Department (through their licensing representative) for approval by October 1,
2002. Agency Behavior Treatment Plans shall not be implemented until approval
by the Department has been obtained. At the Director's designation and
appointment, individuals familiar with acceptable practices of crisis
intervention and behavior management shall review with appropriate Department
licensing staff the Agency Behavior Treatment Plan. The Department shall
respond in writing within 14 days after receipt of the written plan with regard
to approval, denial or request for amendment of the new plan.
c) The Agency Behavior Treatment Plan shall
contain the following general components:
1)
a written statement of the ultimate purpose in employing any treatment
procedure;
2) a detailed
description of the full range of treatment procedures or combination of
procedures employed, including the operational details of the treatments
themselves;
3) a detailed
description of the agency's ongoing system for collecting and reviewing monthly
aggregate data that reflect the use of restrictive treatment elements,
including the number of applications of seclusion and/or manual restraint, the
number of individuals whose behavior resulted in seclusion and/or manual
restraint, the names of staff members who participated in each instance of
seclusion or restraint, the range and average length of seclusion and/or manual
restraint, and unusual incidents and injuries;
4) a procedure for handling and reporting
behavior emergencies; and
5)
procedures for carrying out these provisions consistent with the needs of
disabled individuals.
d)
The Agency Behavior Treatment Plan shall contain the following information
regarding personnel:
1) a description of the
credentials of the personnel involved in designing, approving, implementing,
monitoring and overseeing the implementation of the behavior treatment
procedures;
2) a system for
required training and assuring the competency (both written and practical) of
individuals involved in all facets of behavior treatment, including a plan for
ensuring that all nursing staff associated with the agency receive annual
training on the potential consequences, complications, and/or physical side
effects associated with being physically restrained while taking any
medications;
3) documentation that
all personnel who come into contact with children subscribe to a Code of Ethics
adopted by the governing body. The agency's or institution's Code of Ethics
must be endorsed by or reflect the Codes of Ethics of a professional and
reputable organization (i.e., National Association of Social Workers,
Association of Public Human Service Agencies, the Department or the DCFS Office
of the Inspector General) but it must specifically address an employee's
obligations with respect to interventions and contact with children as a child
welfare professional;
4) a policy
for the discipline and/or discharge of personnel who violate the facility's
policies and procedures on the use of behavior treatments;
5) a procedure providing for training and the
annual certification of all persons using behavior treatment techniques,
including training in the areas of the physiology of respiration, the
circulatory system, and the body's response to excitement and stress;
and
6) a procedure for ensuring
that documentation of all training and retraining in the use of behavior
treatment shall be maintained in the personnel files of staff. If the facility
operates an organized self-governance program, documentation of all training
and retraining of each child authorized to participate in behavior management
and discipline shall be maintained in the child's case file.
e) Agency Behavior Treatment Plans
shall contain a quality assurance mechanism that includes:
1) a procedure for review of the child's
medical record that shall contain explicit documentation by the consulting
physician for the facility that there are no medical contradictions to the use
of specific behavior treatment techniques. This assessment and documentation
must be renewed following any significant change in the child's medical
condition.
2) a procedure for
review of any determination made by the treatment team at the child's initial
case staffing as to whether any of the established behavior treatment
procedures would be contraindicated due to psychological or developmental
reasons and documentation by the team in the child's permanent record. This
review and documentation shall be renewed following any significant change in
the child's developmental or psychological condition and at least once per
quarter as part of a treatment review.
3) a process for monitoring and reviewing a
statistically significant sample of individual treatment plans and restraints,
including by a Human Rights Committee, as defined in Section 384.20;
4) a process to ensure that members of the
Behavior Treatment Committee and the Human Rights Committee have been
instructed in the provisions of Part 431 (Confidentiality of Personal
Information of Persons Served by the Department of Children and Family
Services) and that the members have signed an agreement to abide by the
requirements of Part 431;
5) a
policy regarding the use of restrictive behavior treatment techniques that
identifies instances in which such procedures may be contraindicated;
6) a system where instances of behavior that
are dangerous to self or others shall be brought to the attention of
appropriately trained personnel for review;
7) a policy that requires that unanticipated
occurrences, as in emergency circumstances or repeated instances of the use of
potentially restrictive treatments, be brought to the attention of the
administrator;
8) a policy for
informing the child, referring agencies, parents, and guardians prior to
admission concerning the behavior treatment techniques employed by the facility
and the procedures for their administration;
9) a procedure for obtaining the informed
consent of clients/parents/guardians at intake of the behavior treatment
techniques that will be used, as indicated by the client's treatment plan,
except in cases of an unanticipated behavioral emergency; and
10) a policy providing that the child's
parents (unless parental rights have been terminated), guardian, and attorney
shall be advised of their right to be notified of each instance of manual
restraint or seclusion.
f) The facility shall establish policies and
procedures designed to ensure that individual treatment plans are developed,
implemented and reviewed in accordance with current standards of acceptable
behavior practice. At a minimum, these policies and procedures shall provide as
follows:
1) relevant individual client
strengths, adaptive and maladaptive behaviors will be defined and quantified
for non-emergency circumstances before any program that includes potentially
restrictive elements, such as manual restraint and seclusion, is implemented.
The quantification of relevant target behaviors or a functional analysis shall
be an ongoing and integral part of the pre-treatment, treatment and
post-treatment process;
2) every
individual's treatment plan shall include positive reinforcement strategies for
adaptive, socially acceptable behavior;
3) satisfactory evidence that maladaptive
behaviors under consideration for treatment are not the result of
medical/physical problems that would contraindicate behavior
treatment;
4) for any child posing
documented medical or clinical risk factors that may be negatively impacted by
the use of specific behavior treatment techniques, a licensed physician or
registered/licensed nurse must conduct a physical exam of the child during each
application of the procedures, with documentation of the examination to be
noted in the medical record;
5) not
less than quarterly review of potentially restrictive elements included in
individual treatment plans with consideration given to decreasing and
eventually discontinuing those program elements; and
6) provisions shall be included in individual
treatment plans for the maintenance and generalization of adaptive
behaviors.
g) Agency
Behavior Treatment Plans shall be reviewed and approved at least every three
years by the governing body of the agency and the Department.
h) The governing body of the agency and the
Department must approve any amendments to the plan before they are
implemented.
i) Agencies may appeal
adverse licensing decisions concerning the approval of their Agency Behavior
Treatment Plan pursuant to 89 Ill. Adm. Code 383 (Licensing
Enforcement).
