Current through Register Vol. 63, No. 3, March 1, 2024
(1)
Disclosures.
(a) The service provider must
disclose the facility's policies and practices, as identified in the Residency
Agreements, to a prospective individual or the prospective individual's legal
representative.
(b) The individual,
or their legal representative, must agree to the limitations and interventions
prior to admission.
(2)
Person-Centered Service Plans (PSP). The manner and degree of allowable
behavior interventions must be consistent with the individual's Behavior
Support Plan.
(a) The provider's initial
assessment shall be initiated as part of the screening process and completed
within one week of the admission date.
(b) Reassessment must be provided:
(A) Within one month of the admission
date.
(B) At least four times a
year, or more frequently if:
(i) The
individual receives a Safeguarding Intervention;
(ii) The individual's need as noted at
monthly IDT service plan meeting have changed and require reassessment;
or
(iii) Direct care staff
implementing the Behavior Support Plan give feedback that a reassessment should
be completed.
(c) Individually-based limitations must be
applied as described in OAR 411-004-0040 and must:
(A) Have an established time limit for
periodic review to determine if the limitation should be terminated or remains
necessary.
(B) Be supported by a
specific need and documented in the person-centered service plan by completing
and signing a program approved form documenting the consent to the appropriate
limitation.
(C) Be reviewed at
least annually to determine if the limitation should be terminated or remains
necessary.
(3) The Behavior Support Plan shall identify
direct care staff intervention strategies.
(4) For each individual, the initial Behavior
Support Plan:
(a) Must be reviewed and
approved by the IDT and Department staff.
(b) Must have a subsection of the Behavior
Support Plan identified as a Crisis Plan. The Crisis Plan must include:
(A) Identification of triggers or indicators
of escalation.
(B) Procedures and
strategies to defuse, de-escalate, and minimize the likely behaviors that could
require a Safeguarding Intervention.
(C) Procedures to follow in managing a crisis
situation.
(D) Whether or not the
individual has received IDT and Department authorization for Safeguarding
Interventions.
(5) Use of any Safeguarding Interventions for
an adult is permitted in an IIC program if the Behavior Coordinator approved
the use of the Safeguarding Interventions to be used in a Behavior Support
Plan.
(6) A Behavior Coordinator
may only include a safeguarding intervention in the plan when all of the
following conditions are met:
(a) The
safeguarding intervention is directed for use only:
(A) As strategy for addressing emergency
crises.
(B) For as long as the
situation presents imminent danger to the health or safety of the individual or
others.
(C) As a measure of last
resort.
(b) The Behavior
Coordinator has weighed and documented in the BSP the potential risk of harm to
an individual from the safeguarding intervention against the potential risk of
harm from the behavior.
(c) The
Safeguarding Intervention is in accordance with a Department -approved behavior
intervention curriculum or the behavior coordinator has secured written
authorization from the curriculum's oversight body to modify the safeguarding
intervention. A copy of the authorization to modify a safeguarding intervention
must be attached individual's service plan.
(d) The Behavior Coordinator acknowledges
that prior to the implementation of any safeguarding intervention, an
individual must have an individually-based limitation for restraint in
accordance with OAR 411-004-0040.
(7) The Department does not authorize a
Safeguarding Intervention that includes, but is not limited to, any of the
following characteristics:
(a) Abusive, as
defined in OAR 411-020-0002(1)(h).
(b) Aversive.
(c) Coercive.
(d) For convenience.
(e) Disciplinary.
(f) Demeaning.
(g) Mechanical.
(h) Prone or supine restraint.
(i) Pain compliance.
(j) Punishment.
(k) Retaliatory.
(8) When a service plan is newly developed or
revised and includes a Safeguarding Intervention, the plan must include a
summary of all of the following:
(a) The
nature and severity of imminent danger requiring a safeguarding
intervention.
(b) A history of
unsafe or challenging behaviors exhibited by the individual.
(c) A description of the training and
characteristics required for the designated person applying the safeguarding
intervention.
(d) Less intrusive
measures determined to be ineffective or inappropriate for the
individual.
(9) A
qualified staff applying safeguarding interventions must be trained on the use
of safeguarding interventions by a person who is appropriately certified in
Department approved behavior intervention curriculum.
(10) A behavior coordinator must only use
safeguarding interventions the behavior coordinator is certified to use, and
that direct care staff have been trained to provide.
(11) A Safeguarding Intervention may be used
when:
(a) The Safeguarding Intervention is
used as part of the Crisis Plan;
(b) Less restrictive alternatives have been
tried and evaluated and documented before the use of the Safeguarding
Interventions;
(c) The facility
staff using the intervention has successfully completed the Department-approved
trainings;
(d) The intervention is
used for the shortest time possible; and
(e) The Safeguarding Intervention does not
include excessive use of force.
(12) The manner and degree of allowable
behavior interventions, including an appropriate level of Safeguarding
Interventions for the individual, must be included in the individual's Behavior
Support Plan. Any force used must be consistent with the Behavior Support Plan
and may not be excessive.
(13)
Safeguarding Interventions, if used, may only be used as a de-escalating
intervention to minimize risk or harm to the individual or others and as an
option of last resort. Restraints may only be used for the shortest time
possible and only until the Behavior Coordinator evaluates the behavior and
develops care plan interventions to meet the individual's needs.
(14) The use of restraints may never be used
for convenience of the provider or to discipline the individual.
(15) Use of Safeguarding Interventions may be
considered abuse if a protective services investigation determines.
(a) A Behavioral Consultant has not conducted
a thorough assessment before implementing a physician's direction for use of
Safeguarding Interventions.
(b)
Less restrictive alternatives have not been evaluated before the use of
Safeguarding Interventions.
(c)
Safeguarding Interventions is used for convenience or discipline.
(d) Is for an excessive time or uses
excessive force.
(16) In
an emergency or short-term situation, monitored separation from other residents
in the resident's room may be permitted, if used for a limited period of time.
Separation may only be used when:
(a) It as
part of the Behavior Support Plan.
(b) Is included as part of their
individually-based limitation.
(c)
Other interventions have been attempted but have been unsuccessful.
(d) Implemented by direct care staff that
have successfully completed the Department-approved training.
(e) Used as a de-escalating intervention
until the Behavior Coordinator evaluates the behavior and develops a new BSP
with revised interventions to meet the individual's needs. The Behavior
Coordinator must evaluate the individual and the BSP no more than 30 minutes
after the separation occurs.
(f)
The individual is monitored no less frequently than every 10 minutes while
separated from others.
(g) The
individual needs to be secluded from certain areas of the facility because
their presence in a specific area poses a risk to health or safety of the
individual or another. However, such actions shall be considered abuse if an
APS investigation determines:
(A) A
Behavioral Consultant has not conducted a thorough assessment before
implementing any separation.
(B)
Less restrictive alternatives have not been evaluated before the use of any
separation.
(C) Separation is used
for convenience or discipline.
(D)
Separation is for an excessive time or uses excessive force.
(17) The IDT must meet
on a monthly basis, or more frequently if needed, to meet the requirements in
these rules. Participants may attend via telephone or secured video
conferencing.
Statutory/Other Authority: ORS
409.050,
410.070,
443.450
Statutes/Other Implemented: ORS
409.050,
410.070,
443.400
- 443.455, 443.991