Code of Maine Rules
14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
197 - OFFICE OF AGING AND DISABILITY SERVICES
Chapter 5 - REGULATIONS GOVERNING BEHAVIORAL SUPPORT, MODIFICATION AND MANAGEMENT FOR PEOPLE WITH INTELLECTUAL DISABILITIES OR AUTISM IN MAINE
Section 197-5-2 - DEFINITIONS

5.02-1 Advocate: means an employee of the Protection and Advocacy Agency designated pursuant to 5 M.R.S §19502 with whom the Department has contracted to provide the services described in 34-B M.R.S. §5005- A.

5.02-2 Autism Spectrum Disorder: means as defined by 34-B M.R.S. §6002 ("Autism defined").

5.02-3 Aversive: means an intervention or action intended to modify behavior that could cause harm or damage to a Person, or could arouse fear or distress in that Person, even when the intervention or action appears to be pleasant or neutral to others. This is a Prohibited Practice. See Section 5.06.

5.02-4 Behavior Management: means strategies implemented to prevent the occurrence of Challenging Behavior or to keep the Person or others safe by reducing the factors that lead to the Challenging Behavior or otherwise limiting the Person's ability to engage in the Challenging Behavior.

5.02-5 Behavior Management Plan: means a written plan that describes all planned interventions which include restrictions of Rights or the use of Restraint.

5.02-6 Behavior Modification: means teaching strategies, Positive Supports and other interventions to support a Person to learn Prosocial Behavior and alternatives to Challenging Behavior. Behavior Modification strategies must be included in the Positive Support Plan.

5.02-7 Blocking: means a momentary deflection of a Person's movement, without holding, when that movement would otherwise be destructive or harmful. Blocking is considered a Restraint.

5.02-8 Case Manager: means the individual assigned pursuant to 34-B M.R.S. §5201(6) to coordinate services for the Person.

5.02-9 Challenging Behavior: means behavior that:

5.02-10 Chemical Restraint: means the use of a prescribed medicine when the primary purpose of the medication is a response to behavior rather than a physical condition; and the prescribed medication is a drug or dosage that would not otherwise be administered to the Person as part of a regular medication regimen; and the prescribed medicine impairs the Person's ability to engage in or accomplish the Person's usual activities of daily living (as compared to the Person's usual performance when the medicine is not administered) by causing disorientation, confusion, or an impairment of physical or mental functioning. Medications that help a Person sleep during the Person's regular sleeping hours are not considered Chemical Restraints.

5.02-11 Coercion: means the use of force or threats, including the threat of diminishment of any right or privilege, to cause a Person to do something against the Person's will.

5.02-12 Commissioner: means the Commissioner of the Department of Health and Human Services (DHHS).

5.02-13 Correspondent: means a person designated by the Maine Developmental Services Oversight and Advisory Board to act as a next friend of a Person with Intellectual Disabilities or Autism.

5.02-14 Department: means the Department of Health and Human Services (DHHS).

5.02-15 Emergency: means a situation in which there is Imminent Risk of harm or danger to the Person or community. Risk of criminal detention or arrest constitutes an Emergency.

5.02-16 Escort: means physical assistance to support a Person to stand or walk when the person who is providing the support follows the lead of the Person being supported. The use of physical force, the threat of the use of physical force, or the use of any coercive action to move or compel a Person to move is not an Escort. It is a Restraint.

5.02-17 Functional Assessment: means a systematic analysis of factors, both internal and external to the person, which may be contributing to his/her Challenging Behavior.

5.02-18 Guardian: means an individual, organization or state agency appointed and designated with legal responsibility of a Person deemed not to have capacity, pursuant to 18-A M.R.S., Article 5, Part 3.

5.02-19 Imminent Risk: means reasonably certain to occur at any moment; such that a reasonable and prudent person would take steps instantly to protect the Person or the community against the risk.

5.02-20 In-Home Stabilization: means a limited period of time for which a Person whose Challenging Behavior has placed that Person or the community in Imminent Risk of harm may be denied access to the community for safety and assessment.

5.02-21 Intellectual Disabilities: is defined at 34-B M.R.S. §5001(3) ("Definitions").

5.02-22 IST: means an Individual Support Team consisting of the Person, if they choose, members of the Person's Planning Team and other professionals, family, or friends that the Planning Team determines would be supportive to the Person in a time of crisis. The IST is developed by the Planning Team and operates under the Planning Team's direction. The role of the IST is to develop and coordinate services designed (1) to prevent crisis situations or (2) provide support during a crisis.

5.02-23 Mechanical Restraint: means an apparatus employed to restrain a Person, or the act of using an apparatus to address Challenging Behavior. A Mechanical Restraint is any item worn by or placed on the Person to limit behavior or movement and which cannot be removed by the Person. Mechanical Restraints include, but are not limited to, devices such as mittens, straps, arm splints and helmets. They do not include positioning or adaptive devices when used prescriptively in accordance with 34-B M.R.S. §5605 ("Rights and Basic Protections of a Person with Intellectual Disabilities or Autism").

5.02-24 Noxious: means distasteful, unpleasant or intolerable to the Person.

5.02-25 Over correction: means a response requiring a Person to clean or fix the environment more than necessary to restore it to its original state, and/or to practice repeatedly the correct way to do something as a consequence for having done something wrong. This is a Prohibited Practice.

5.02-26 Protection and Advocacy Agency: is the agency designated pursuant to 5 M.R.S. §19502 with whom the Department has contracted to provide the services described in 34-B M.R.S. §5005- A.

5.02-27 Painful: means that which causes strong emotional or physical discomfort to a Person.

5.02-28 Person: means an adult with Intellectual Disabilities or Autism.

5.02-29 Personal Plan: means a plan, as required by 34-B M.R.S. §5470-B ("Personal planning"), that articulates and identifies the needs and desires of the Person and describes services which will be offered to achieve them. The Personal Plan may include a Person-Centered Plan (PCP), an individual service plan, a Positive Support Plan, a Behavior Management Plan or other plans that describe services.

5.02-30 Physicians' Evaluation: means a review by a physician or a physician assistant to determine the safety of a proposed intervention.

5.02-31 Planning Team: means the Person and others identified by the Person and/or his/her guardian who are responsible for developing a Person's Personal Plan as required by 34-B M.R.S. §5470-B ("Personal planning")

5.02-32 Positive Behavior Modification Technique: means a method of changing behavior to increase opportunities for meaningful participation in the community, making choices, and learning skills to engage in Prosocial Behavior.

5.02-33 Positive Support: means a support intended to increase opportunities for meaningful participation in the community, making choices and learning skills to engage in Prosocial behavior.

5.02-34 Positive Support Plan: means a component of the Personal Plan that supports individual growth, enhances quality of life, and attempts to decrease or eliminate the need for more restrictive measures.

5.02-35 Prosocial Behavior: means behavior that occurs when a Person demonstrates concern and empathy for others and acts in ways that benefit others.

5.02-36 PRN (Pro Re Nata) Medications: means medications prescribed to address specific symptoms on an as-needed basis.

5.02-37 Psychiatric Medications: means drugs prescribed to stabilize or improve mood, mental status, or behavior. These medications are sometimes called "psychotropic" or "psychoactive" medications. For purposes of these regulations, Psychiatric Medications include holistic remedies, hormonal agents or homeopathic substances, if intended to modify behavior.

5.02-38 Psychiatric Medication Support Plan: means a plan describing both the psychiatric treatment such as medication or therapy and Positive Supports designed to address the Challenging Behavior.

5.02-39 Psychological Assessment: means an evaluation by a licensed psychologist.

5.02-40 Qualified Intellectual Disability Professional (Q.I.D.P.): is a person defined by 42 Code of Federal Regulations (CFR) §483.430.

5.02-41 Redirection: means the distraction or diversion of a Person's attention away from a Challenging Behavior to a positive or neutral behavior; a suggestion, by word or gesture, that a Person try an alternate activity. Redirection does not include Coercion.

5.02-42 Reinforcement / Reinforcer: means a response, applied after a desirable behavior occurs, which increases the likelihood of the desirable behavior being repeated.

5.02-43 Restraint: means a mechanism or action that limits or controls a Person's voluntary movement against his or her will. Restraint deprives a Person of the use of all or part of the Person's body, or maintains a Person in an area through physical presence, physical limitation or Coercion. Restraint includes Blocking, as well as the Coercive movement of a Person to a place where the Person does not wish to go. Restraint also includes any inaction that limits or controls a Person's voluntary movement, such as refusing to give support to meet a Person's mobility needs. Some Restraints are Prohibited Practices.

5.02-44 Review Team: means a group of persons, as defined by 34-B M.R.S. §5605(13) (B) ("Rights and Basic Protections of a Person with Intellectual Disabilities or Autism - Behavioral Support, Modification and Management"), which is responsible for reviewing Behavior Management programs.

5.02-45 Rights: means those Rights enumerated in 34-B M.R.S. §5605 ("Rights and Basic Protections of a Person with Intellectual Disabilities or Autism".)

5.02-46 Safety Device: means an implement, garment, gate, barrier, lock or locking apparatus, video monitoring or video alarm device, helmet, mask, glove, strap, belt, or protective glove, limited to the person in question whose effect is to reduce or inhibit the person's movement in any way with the sole purpose of maintaining the safety of the person.

5.02-47 Seclusion: means the solitary involuntary confinement of a Person for any period of time in a room or a specific area from which egress is denied by a locking mechanism, barrier or other imposed physical limitation. This is a Prohibited Practice.

5.02-48 Service Provider: means an entity, organization, or individual, funded in whole or in part or licensed or certified by the Department, providing services to adults with Intellectual Disabilities or Autism. This includes employees of the State of Maine, and volunteers and students under the supervision and control of the Service Provider.

5.02-49 Social Role Valorization (SRV): formerly known as normalization, means a framework of service principles and methodologies which has the goal of establishing meaningful roles for people and expectations for regular patterns of daily living in order to increase competency and establish positive social standing, and which adheres to the principles of assisting the Person served to obtain an existence as close to normal as possible and making available to that Person patterns and conditions of everyday life that are as close as possible to the norms and patterns of mainstream society.

5.02-50 Specialized Restraint: is an individualized Restraint approved by the Department to meet a Person's specific needs that cannot be met through a nationally recognized or certified behavior management program.

5.02-51 Statewide Review Panel: means a panel designated and governed by a memorandum of understanding between the Department, the Protection and Advocacy Agency and the Maine Developmental Services Oversight and Advisory Board; whose purpose is monitoring Behavior Management Plans for quality and consistency.

5.02-52 Temporary Removal of Staff: means the denial of a Person's immediate access to support staff, or removal or diminishment of required levels of direct supervision.

5.02-53 Therapeutic Devices: means devices used for body positioning or alignment under the supervision of a medical doctor, occupational therapist or physical therapist.

5.02-54 Timeout, Non-Exclusionary or Reverse: means the immediate discontinuation of Reinforcement (such as interaction with a staff-person) from a Person while the Person remains in an environment which would otherwise be reinforcing. This must not include diminishment of required levels of direct supervision. Staff removing themselves, as a response to Challenging Behavior, to an environment that is not accessible to the Person is a Restriction of Rights reviewable at Level 4.

5.02-55 Timeout, Voluntary: means a break from an activity, or a quiet period initiated by the Person to calm down. Voluntary Timeout may result from a Non-Coercive choice or suggestion offered by staff. Any Coercion or physical intervention constitutes a Restraint.

5.02-56 Token Economy: means a system in which tokens, which may later be exchanged for a desired item or activity, are used as Reinforcers.

5.02-57 Updated Functional Assessment: means a new or review of the original Functional Assessment.