(a) Habilitation
services shall be designed to maximize the potential of the participant.
Services shall be provided in the setting that is the least restrictive for the
participant.
(b) Participants shall
have a positive behavior support plan in place if restraints are outlined in
their individualized plan of care.
(c) A participant with a challenging behavior
identified by the plan of care team shall have a current functional behavioral
analysis conducted within the last year to identify what the person is trying
to communicate through the behavior(s), to identify the function or possible
purpose for the behavior(s), to explore antecedents and contributing factors to
behaviors, and to review and describe potentially positive behavioral supports
and interventions in order to develop a positive behavior support plan.
(i) Challenging behaviors may include actions
by the participant that constitute a threat to the person's immediate health
and safety, the health and safety of others in the environment, a persistent
pattern of behaviors that inhibit the participant's functioning in public
places and integration within the community, or uncontrolled symptoms of a
physical or mental condition.
(ii)
The functional behavioral analysis shall include data compiled regarding all
challenging behaviors exhibited, and be utilized to develop the positive
behavior support plan used by the provider during the provision of waiver
services.
(iii) A provider or
provider staff knowledgeable of the participant shall complete the functional
behavior analysis, which shall include input from the team, participant, and
any legally authorized representative(s).
(d) A positive behavior support plan, based
upon a current functional behavioral analysis, shall be developed for a
participant in order for providers working with the person to understand and
recognize the communication and behaviors exhibited by the person. The positive
behavior support plan shall describe agreed upon supports to assist the
participant using proven support techniques and non-restrictive interventions.
At a minimum, a positive behavior support plan shall:
(i) Include the components of the template
provided on the Department's website.
(ii) Maintain the dignity, respect, and value
of the participant;
(iii) Use a
person-centered approach with the participant involved in the development of
the plan on a level appropriate for that person;
(iv) Aim to minimize the use of
restraints;
(v) Be specific and
easily understood, so direct care employees can implement it appropriately and
consistently;
(vi) Include a
signature of the participant or legally authorized representative(s), which
verifies informed consent;
(vii)
Define the antecedents and the targeted behavior(s) that need to be replaced or
reduced;
(viii) List positive
behavioral supports that assist the participant in replacing targeted or
challenging behaviors with appropriate replacement behaviors;
(ix) Provide protocols for providers and
provider employees to recognize emerging targeted behaviors, and determine the
appropriate interventions to implement positive behavioral supports;
(x) Provide protocols, which focus on
positive interventions that are deemed least restrictive and most effective,
for employees to use when targeted behaviors take place;
(xi) Reference the protocol for the use of
any PRN medication that may be a part of the positive behavior support plan, as
recommended by the treating medical professional and can be requested by the
participant to help manage stress, anxiety, or behaviors;
(xii) Be reviewed every six (6) months by the
provider(s) and the case manager to assess the effectiveness of the plan, or
more frequently if needed;
(xiii)
Include specific guidelines for tracking and analyzing the antecedents related
to the occurrence of a targeted behavior, the actual behavior(s) displayed, and
the results of positive behavioral interventions; and
(xiv) Be included as a formal component of
the individualized plan of care.
(e) A provider employee implementing a
positive behavior support plan shall receive participant specific training on
the positive behavior support plan, and on specific positive de-escalation
techniques and interventions, before they begin working with the
participant.
(f) The case manager
shall educate the participant and legally authorized representative about
positive behavior supports that may be used, and the risks and benefits of any
supplemental plan for the use of restraint or prescribed psychoactive
medication if the positive behavior support plan fails.
(g) If restraints are used or law enforcement
is contacted due to a behavioral emergency, the positive behavior support plan
has failed and must be reviewed to possibly add or modify the service
environment or behavioral interventions.
