5.04-1
Positive Supports Must Be the First Approach
When a Person is exhibiting Challenging Behavior, the
Planning Team must design Positive Supports to help increase Prosocial Behavior
and eliminate or reduce the frequency and severity of the Challenging Behavior.
The Planning Team must conduct a Functional Assessment and create a Positive
Support Plan which recommends strategies to:
A. Assist the Person to live in a home which
is safe, integrated into the Person's community, and which offers ready access
to activities, friends, and relatives; and
B. Provide the Person with opportunities and
assistance to:
1. Learn how to make choices
and exercise personal autonomy;
2.
Manage and control daily activities, pursue personal goals, and access quality
health care;
3. Form and maintain
friendships and other relationships; and
4. Participate in a broad range of activities
that the Person enjoys and which promote independence and positive recognition
by self and others. These activities include, but are not limited to, work,
leisure, social activities and personal interests.
C. Make changes to the physical and social
environment in a way that ensures supports are provided to expand opportunities
for independence, inclusion and choice.
5.04-2
Medical and Mental Health
Assessment and Treatment
The Planning Team must ensure the Positive Support Plan
includes documentation of consultation with licensed professionals to assess
for the existence of physical or mental health conditions.
A. The Positive Support Plan must document
consideration of physical health and psychosocial issues that may be
contributing to the Challenging Behavior.
B. The Positive Support Plan must document
how it incorporates factors related to trauma. Consideration must be given to
the emotional and physical impact of the use of Restraint or other
interventions.
C. When a physical
or mental health condition is identified, the Positive Support Plan must
address it through clinical and other appropriate support measures.
The Planning Team must incorporate a Functional Assessment to
develop an individualized Positive Support Plan. The Positive Support Plan and
the Functional Assessment may be a combined document or separate
documents.
D. The Planning
Team must develop a procedure for documentation and review of the use of all
strategies. At a minimum this documentation must be reviewed and approved by
the Planning Team annually.
5.04-3
Use of Psychiatric
Medications
When Psychiatric Medications are prescribed, the Planning
Team must adhere to special procedures to ensure monitoring of the effects of
such medication on health and mental functioning. Psychiatric Medications used
as a Chemical Restraint must also comply with other sections of this regulation
on Chemical Restraints.
A. Planning
Teams must monitor and document the use of Psychiatric Medications at least
annually.
B. When Psychiatric
Medications are prescribed, a Psychiatric Medication Support Plan is required
for monitoring purposes. The plan must be updated whenever there is a change.
1. The Psychiatric Medication Support Plan
and the Positive Support Plan can either be separate documents or integrated
into one comprehensive plan.
2. The
overall plan needs to incorporate the psychiatric treatment
such as medication or therapy, as well as, a Functional Assessment
andPositive Support Plan designed to address the Challenging
Behavior.
C. A
Psychiatric Medication Support Plan is a component of the Personal Plan that
must include, but is not limited to:
1. A list
of medications, target symptoms, diagnosis and prescribing
physician(s);
2. The parameters for
use of medications prescribed as Psychiatric Medication PRN or "as
needed";
3. The behavioral criteria
to determine whether the medication is effective, such as changes in behavior,
mood, thought or functioning;
4.
Identification of side effects or adverse reactions that must be reported to
the prescribing physician when they occur;
5. The potential risks of long term
use;
6. Other supports which may
help alleviate the Person's symptoms (may be included in the Positive Support
Plan);
7. A plan for data
collection, review and monitoring of medication effectiveness, side effects and
dosage; and
8. The doctor's order
attached for Psychiatric PRN Medication;
D. All orders for the use of Psychiatric PRN
Medication must be prescribed by a physician, approved by the Person or
Guardian, administered by properly trained staff, and included in the
Psychiatric Medication Support Plan.
1. The
physician's order must specify the written instructions that describe specific
symptoms for which Psychiatric PRN Medication may be used, the exact dosage,
the exact timeframe between dosages, and the maximum dosage to be given in a
twenty-four (24) hour period.
2. If
there is a Guardian, and the Guardian provides consent for a Psychiatric PRN
order, the Guardian's consent must include specific written instructions for
how the Guardian will be notified about each administration of a Psychiatric
PRN medication.
3. After each
administration of a Psychiatric PRN medication, the prescribing physician must
be notified within twenty-four (24) hours of the administration of the
medication, unless otherwise instructed in writing by the physician.
