Current through Vol. 42, No. 1, September 16, 2024
(a)
Purpose. The purpose of aPIP
is to ensure the service recipient's safety, when physical, emotional, medical,
financial, legal, or community participation issues place him or her at
risk.
(b)
PIP
elements. The PIP is part of the Individual Plan (Plan) developed with
the participation of the service recipient and Personal Support Team (Team).
The PIP:
(1) uses the least restrictive
approaches necessary to address safety risks identified in the safety risk
assessment per Oklahoma Administrative Code (OAC)
340:100-5-56;
(2) identifies the early signs, clues, or
other indicators of potential safety risks;
(3) describes preventative supports,
services, and actions to take in order to reduce or eliminate safety
risks;
(4) describes detailed
instructions and procedures taken by staff and Team members during a situation
that places the safety of the service recipient or others at risk, including
procedures to:
(A) keep the service recipient
and others as safe as possible;
(B)
defuse, reduce, or eliminate harm or injury; and
(C) secure Team or provider agency staff
assistance;
(5) includes
outcomes targeting skill enhancement, health improvement, choice making,
meaningful relationship development, and community participation;
(6) describes teaching methods in sufficient
detail to provide clear direction to provider agency support staff to assist
the service recipient to learn relevant skills;
(7) identifies methods and time frames to
evaluate the PIP's effectiveness;
(8) is revised when circumstances change or
the PIP is no longer effective;
(9)
treats the service recipient with dignity and is reasonable, humane, practical,
not controlling, and the least restrictive alternative; and
(10) is reviewed by the Team to determine if
the PIP meets OAC 340:100-5-57 requirements. Team review and approval is
documented in the Plan.
(c)
Serious risk or dangerous
behavior. When a PIP addresses challenging behaviors that create serious
risk of physical injury or harm to the service recipient or others, risk of
involvement in civil or criminal processes, or places the service recipient's
physical safety, environment, relationships, or community participation at
serious risk, the PIP must be developed and overseen by the Team and an
appropriately-licensed professional or a family trainer approved by
Developmental Disabilities Services (DDS) with the assistance of the positive
support field specialist.
(d)
Restrictive or intrusive procedures. When the Team determines
restrictive or intrusive procedures, per OAC
340:100-1-2 are
essential for safety, the Team must develop a PIP with a DDS positive support
field specialist's assistance. In addition to the requirements in (b) of this
Section, the Team must:
(1) describe the
severity and frequency of the risk or dangerous behavior;
(2) address any limitations placed on the
service recipient's access to goods, services, and activities and document the
Team's plan to restore access to such;
(3) identify positive approaches used prior
to implementing the restrictive or intrusive procedure;
(4) ensure the procedure does not harm the
service recipient;
(5) describe
methods to help the service recipient develop skills that serve the same
function as, or reduce or eliminate the possibility of, the dangerous behavior
or serious risk. These methods must be individualized and provide clear
direction to provider agency support staff to develop the service recipient's
pro-social and coping skills;
(6)
submit the protocol to the Statewide Human Rights Behavior Review Committee
(SHRBRC) per OAC
340:100-3-14
for initial approval and any time additional restrictive or intrusive
procedures are requested; and
(7)
document annual review and continued PIP approval.
(e)
Physical management.
Aphysical management hold per OAC
340:100-1-2 is only
used to prevent physical injury. Physical management holds are allowed when
supported by a specific assessed need and are documented in the person-centered
Plan. Person-centered Plan documentation includes requirements per OAC
317:40-1-3(b)(8)(A)
through (H). Prompting that does not restrict
the service recipient's movement or choice is not considered physical
management. Any PIP that includes a physical management hold requires the Team,
to:
(1) ask the service recipient's physician
to assess whether the service recipient has any health concerns related to the
use of the physical management procedure;
(2) ask the service recipient's physician to
assess whether the current medication regimen poses any risk for the service
recipient due to the stress of the physical management procedure;
(3) include a DDS approved trainer of
physical management procedures in the planning sessions.
(A) The trainer:
(i) makes recommendations about the
effectiveness and safety of the physical management procedure in particular
environments;
(ii) assists the Team
in identifying alternative approaches when standard procedures do not appear
appropriate for the service recipient or the situation; and
(iii) identifies existing physical obstacles
to the implementation of the procedure for particular staff.
(B) The Team includes the
trainer's recommendations in the development of the PIP;
(4) identify any situation in which physical
management procedures cannot be used because they are unsafe or ineffective per
this subsection; and
(5) comply
with (f) of this Section.
(f)
Emergency intervention.
Emergency intervention is the use of a restrictive or intrusive procedure not
included in a PIP, in response to an unanticipated and unpredictable situation
or event or the sudden occurrence of an event so severe and dangerous urgent
action precludes less restrictive measures. Physical management per OAC
340:100-1-2 is only
used during emergencies to ensure physical safety and prevent injury.
(1) Emergency intervention:
(A) cannot be used as a substitute for
positive approaches or a PIP; and
(B) is used for no longer than necessary to
eliminate the clear and present danger of serious physical harm to the service
recipient or others.
(2)
Physical management must be terminated as soon as the service recipient is calm
or the threat ended with attempts to release every two minutes to ensure the
safety of the service recipient.
(3) When responding to an emergency, no one
may authorize or use an amount of force that exceeds what is reasonable and
necessary under the circumstances to protect the service recipient or
others.
(4) Any person who has
reason to believe abuse occurred is responsible to contact the appropriate
authorities.
(g)
Temporary approval of restrictive or intrusive procedures. After
the first use of an emergency restrictive or intrusive procedure, when the Team
in consultation with the positive support field specialist determine the use of
a restrictive or intrusive procedure must be continued to ensure the safety of
the service recipient or others, the positive support field specialist or DDS
director of psychological and behavioral supports may provide temporary
immediate approval for continued use of restrictive or intrusive procedures.
(1) The DDS case manager contacts the
positive support field specialist to request temporary approval of restrictive
or intrusive procedures to protect the service recipient or others from serious
physical harm.
(2) The positive
support field specialist approves or denies the request for use of emergency
interventions using Form 06MP042E, Request for Temporary Approval of
Restrictive or Intrusive Procedures.
(A) When
the temporary request is approved, the positive support field specialist
assists the Team in ensuring needed structure and training are in place for
safe and proper implementation of the emergency interventions.
(B) Temporary approval lasts no longer than
60-calendar days.
(3)
Form 06MP042E must be completed and sufficient information provided to
demonstrate positive supports were attempted, and that the danger of severe
harm still exists.
(4) When
physical management procedures are autho-rized, training is obtained from an
approved or certified trainer.
(5)
To continue using the temporarily-approved restrictive or intrusive procedure,
the Team must submit within 60-calendar days following approval, a PIP that
incorporates the requested procedures to SHRBRC. When the submitted PIP does
not receive SHRBRC approval, SHRBRC may extend the temporary approval for a
maximum of an additional 60-calendar days.
(h)
Review and revision of the
Plan. The Plan is reviewed and, as necessary, revised when an unexpected
high risk event occurs.
(1) Review and
revision to the Plan is appropriate, when the:
(A) service recipient was recently seen in a
hospital emergency room due to a behavioral crisis;
(B) service recipient was recently admitted
to a psychiatric facility for stabilization;
(C) police were called to intervene because
the service recipient is displaying challenging behavior; or
(D) service recipient was placed in police
custody as the result of his or her challenging behavior.
(2) Team planning must include, at a minimum:
(A) consultation with the positive support
field specialist;
(B) a review of
recent events, including challenging behaviors;
(C) identification of the signs or behaviors
indicating the event may reoccur;
(D) assisting the service recipient to
develop an individualized safety plan;
(E) detailed action steps for provider agency
support staff to follow to reduce reoccurrence; and
(F) consultation with other professional
services, when appropriate.
(3) When a high risk event occurs, the Team
reviews the event to determine if additional action is needed to prevent
further occurrence.
(4) When
psychiatric hospital admission occurs, the Team begins planning upon
notification of a discharge date. A review is held within five-business days
following discharge to meet the requirements of this Section, and address
medication changes per OAC
340:100-5-26.1(d)(2).
(i)
Mechanical restraint in a medical
context. Restraints and mechanical supports used in a medical context
are exempt from (d) of this Section. These exemptions include, but are not
limited to:
(1) sedation prescribed by a
physician or dentist prior to a medical or dental procedure;
(2) restraints used to control the movement
of the service recipient during a time sensitive and necessary medical or
dental procedure;
(3) time-limited
restraints to promote healing following a medical procedure or
injury;
(4) devices prescribed by a
physician, physical therapist, or an occupational therapist to maintain body
alignment or otherwise support or position a service recipient;
(5) devices normally used for safety reasons,
such as car seats or seat belts;
(6) helmets used to protect a service
recipient from injury during or following a seizure;
(7) bed rails used to keep a service
recipient from falling out of bed; or
(8) wheelchair brakes, unless used for the
purpose of restricting mobility.
Added at 15 Ok Reg
2136, eff 5-5-98 (emergency); Added at 16 Ok Reg 1056, eff 4-26-99; Amended at
20 Ok Reg 97, eff 10-16-02 (emergency); Amended at 20 Ok Reg 936, eff 6-1-03;
Amended at 25 Ok Reg 986, eff 5-15-08
