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Behavior Support and Management Introduction
Purpose
The organization’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and personnel.Introduction
Interpretation
Organizations serving youth involved with the juvenile justice system may be legally authorized to use restrictive interventions to prevent escapes, or protect property in order to maintain safety, security, and order. However, they should still only employ restrictive interventions when absolutely necessary, as referenced throughout these standards.Additionally, some organizations serving youth involved with the juvenile justice system and accredited under COA's Juvenile Justice Residential Services (JJR) standards may lock youth in their rooms for routine purposes (e.g., during sleep periods), as opposed to doing so in response to an incident. Although this practice does restrict a person's freedom of movement, it differs from the types of restrictive behavior management interventions addressed in this section insofar as it is utilized on a routine, ongoing, basis, rather than in response to a specific incident. Accordingly, this practice is addressed in JJR 14, and the standards in this section do not apply to that practice.
NA The organization’s behavior support and management policy submitted as ASE 2 self-study evidence prohibits all use of restrictive behavior management interventions.
Note: Restrictive interventions are those that involuntarily restrict, limit, or curtail a person’s freedom of movement and include manual restraint, mechanical restraint, and seclusion. Federal guidelines consider any restriction of an individual’s movement a restrictive intervention. Related definitions can be found in COA’s glossary.
Timeout or isolation are colloquial terms that may or may not include restrictive interventions. For the purpose of these standards, any instance where an individual is placed in a room separate from others and they cannot voluntarily leave (whether the door is locked or personnel is preventing the individual from leaving) will be referred to as seclusion and considered a restrictive intervention.
Note: Organizations that work with populations with developmental delays and utilize protective clothing, such as protective helmets, will address those interventions in PRG 5.02 and PRG 6.03.
Note: Behavior Support and Management (BSM) will be NA when the policy referenced in ASE 2 prohibits restrictive interventions.
Note: Please see the BSM Reference List for the research that informed the development of these standards.
Note: For more information about changes made in the 2020 edition, please see the BSM Crosswalk.
Behavior Support and Management (BSM) 1: Oversight of Restrictive Behavior Management Interventions
BSM 1.01
- safety measures to be taken when emergency situations arise, including which restrictive behavior management interventions may be used to protect service recipients from harming themselves or others;
- other practices that may be used and under what circumstances; and
- prohibited practices, including chemical restraint, corporal punishment, and behavior control methods that interfere with the individual's right to humane care.
- is used according to the requirements for treatment authorized by a court;
- is provided using specified criteria in a person’s approved treatment plan as per a physician’s order to provide medical treatment for a specific diagnosis and known progression of symptoms, such as in cases of a PRN; or
- is administered when necessary (PRN) to prevent immediate, substantial, and irreversible deterioration of a person’s mental status when prescribed by a physician or other qualified medical practitioner.
- One of the elements needs greater specificity or clarity in the policy.
- Two of the elements need greater specificity or clarity in the policy; or
- The policy is too vague to provide guidance to personnel.
- One of the elements is not implemented.
BSM 1.02
- by any person other than trained, qualified personnel;
- as a substitute for appropriate staffing patterns, for the convenience of personnel or as punishment;
- in response to property damage that does not involve imminent danger to self or others; and
- when contraindicated in the individual's service or behavior plan.
- There have been a few instances where behavior management interventions were used inappropriately, but corrective action was implemented immediately.
- There have been a few instances of prohibited interventions, and no evidence of immediate and appropriate corrective action.
BSM 1.03
- compares organization practices to current information and research on effective practice;
- uses findings from quarterly risk management reviews of restrictive behavior management to inform personnel about current practice and the need for change;
- revises policies and procedures when necessary;
- determines whether additional resources are needed; and
- supports efforts to minimize the use of restrictive behavior management interventions.
- One of the elements is not regularly included in the reviews.
- Two of the elements are not regularly included in the reviews; or
- Reviews are not done sufficiently often to effectively monitor practices; or
- The committee does not include personnel from all levels.
- Three of the elements are not regularly included in the review; or
- There is no committee, or participation is limited to management.
BSM 1.04
- review any preemptive measures taken to avoid the intervention;
- determine whether or not the individual’s behavior support and management plan was followed; and
- assess the measures’ effectiveness.
- Notification and administrative review regularly occur, but procedures need clarifying; or
- Notification has occasionally exceeded one working day.
- There have been instances where notification or administrative review did not occur; or
- Procedures need significant strengthening.
- Notification or review does not regularly occur.
Behavior Support and Management (BSM) 2: Behavior Support and Management Practices
Note: Please see the Case Record Checklist for additional guidance on this standard.
BSM 2.01
- provides an explanation for and offers a copy of its written restrictive behavior support and management philosophy and procedures to service recipients or their parents/legal guardians at admission;
- annually obtains the individual’s and/or parent’s/legal guardian’s consent when restrictive behavior management interventions are part of the treatment modality;
- informs the individual and/or parent/legal guardian of the service implications, if any, of refusing to sign; and
- when the individual is a minor or has a legal guardian, notifies the parents/legal guardians promptly when the individual is involved in an incident involving a restrictive intervention.
Additionally, when an organization provides involuntary services to youth involved with the juvenile justice system, obtaining consent may not be required.
- Procedures need minor clarification; or
- One of the required elements is not fully addressed.
- Two of the elements are not fully addressed; or
- One element is not addressed at all; or
- Annual consents are not consistently obtained; or
- Parents or legal guardians are frequently not notified.
- Three or more of the elements are not fully addressed; or
- Two of more of the elements are not addressed at all.
BSM 2.02
- the individual’s perception of emotional and physical safety;
- past experiences with restrictive behavior management interventions;
- antecedents or emotional triggers and the resulting behaviors;
- previous successes in utilizing strategies and coping skills to mitigate the need for restrictive behavior management interventions;
- psychological and social factors that can influence use of such interventions, including trauma history; and
- medical conditions or factors that could put the person at risk.
- Procedures need minor clarification; or
- One of the elements is not fully addressed.
- Two of the elements are not fully addressed.
- One of the elements is not addressed at all.
BSM 2.03
- identifies proactive, strengths-based strategies that will help the person de-escalate their behavior and prevent harassing, violent, or out-of-control behavior;
- specifies interventions that may or may not be used, taking the individual’s trauma history into account;
- is modified as necessary; and
- is developed in collaboration with the individual and is signed by the person, their parent/legal guardian, and personnel, as appropriate.
- One of the elements needs strengthening; or
- There are a few instances where signatures were missing.
- Two of the elements need strengthening; or
- One of the elements is not addressed at all; or
- There is no evidence that the plans, once developed, are reviewed or updated; or
- Most plans are not signed.
Behavior Support and Management (BSM) 3: Restrictive Behavior Management Intervention Training
- proper and safe use of interventions, including when it is appropriate to use a restrictive intervention and time limits for use;
- understanding the experience of being placed in seclusion or a restraint, including the medical and therapeutic risks related to restrictive interventions and the resulting consequences of the misuse of restrictive interventions, including trauma and re-traumatization;
- response techniques to prevent and reduce injury;
- evaluating and assessing physical and mental status, including signs of physical distress, vital indicators, and nutrition, hydration, and hygiene needs;
- readiness to discontinue use of the intervention;
- when medical or other emergency personnel are needed; and
- documentation and debriefing.
- A few personnel have not been trained but only work with clients under the oversight of trained personnel.
- A significant number of personnel have not been trained.
- The organization does not use a nationally recognized curriculum.
Behavior Support and Management (BSM) 4: Restrictive Behavior Management Interventions
Currently viewing: RESTRICTIVE BEHAVIOR MANAGEMENT INTERVENTIONS
VIEW THE STANDARDS
BSM 4.01
- Authorization procedures need clarifying.
- There have been instances of restrictive intervention without authorization by qualified personnel, but corrective action is occurring; or
- Documentation is weak.
- There have been instances of restrictive intervention without authorization by qualified personnel and corrective action has not been initiated; or
- Practices are in violation of applicable legal requirements; or
- Written procedures do not address use of qualified personnel.
BSM 4.02
- assessed at least every 15 minutes for any harmful health or psychological reactions; and
- interventions are discontinued immediately if they produce adverse side effects such as illness, severe emotional or physical stress, or physical injury.
- In a few rare instances there was a lapse in monitoring or assessment, but corrective action was taken immediately.
- In more than a few instances there was a lapse in monitoring or assessment, but corrective action was taken immediately; or
- Documentation is weak; or
- Procedures need significant strengthening.
- Lapses occur with some frequency and corrective action is not taken; or
- There are no procedures; or
- Procedures are not routinely followed.
BSM 4.03
- Procedures need clarifying.
- Procedures are inadequate; or
- There have been instances where procedures were not followed; or
- Documentation is weak.
- There are no procedures; or
- Procedures are not routinely followed.
BSM 4.04
- conform to existing licensing and/or fire safety requirements;
- are outfitted with a door that easily opens in case of emergency (e.g. spring lock door); and
- are limited to one person at a time.
Note: Please see the Facility Observation Checklist for additional guidance on this standard.
- The organization does not have evidence of conformance to licensing and/or fire safety requirements for one of its seclusion rooms but has initiated a process to obtain it.
- The organization does not have evidence of conformance with licensing and/or fire safety requirements for one or more of its seclusion rooms and has not initiated a process to obtain it; or
- There have been instances where a seclusion room has been used for more than one person.
BSM 4.05
- Procedures need clarifying.
- Procedures are inadequate; or
- There have been instances where procedures were not followed, but corrective action has been initiated; or
- Documentation needs significant strengthening.
- There are no procedures; or
- Procedures are routinely not followed.
BSM 4.06
- 15 minutes for children aged nine and younger, for all restrictive behavior management interventions;
- 30 minutes for individuals aged ten and older, undergoing manual or mechanical restraint;
- 30 minutes for individuals aged ten to thirteen in seclusion; and
- one hour for individuals aged fourteen and older in seclusion.
- Procedures need clarifying.
- Procedures are inadequate; or
- There have been instances where procedures were not followed, but corrective action has been initiated; or
- Documentation needs significant strengthening.
- There are no procedures; or
- Procedures are not routinely followed.
BSM 4.07
- Procedures need clarifying.
- Procedures are inadequate; or
- There have been instances where procedures were not followed, but corrective action has been initiated; or
- Documentation needs significant strengthening.
- There are no procedures; or
- Procedures are not routinely followed.
BSM 4.08
- Procedures need clarifying.
- Procedures are inadequate; or
- There have been instances where procedures were not followed, but corrective action has been initiated; or
- Documentation needs significant strengthening.
- There are no procedures; or
- Procedures are not routinely followed.
Behavior Support and Management (BSM) 5: Documentation and Debriefing
Note: Please see the Case Record Checklist for additional guidance on this standard.
BSM 5.01
- the justification, use, circumstances, and length of application in the individual’s case record;
- all attempts made prior to the use of a restrictive behavior management intervention in order to preempt it, including the strategies identified in the individual’s behavior management plan; and
- names of the service recipient and personnel involved, reasons for the intervention, length of intervention, and verification of continuous visual observation in a log.
- Procedures need clarifying; or
- In a few instances documentation was not complete.
- Procedures are inadequate; or
- Documentation problems are common but corrective action is being taken.
BSM 5.02
- evaluate physical and emotional well-being;
- identify the need for counseling, medical care, or other services related to the incident;
- identify antecedent behaviors and modify the service plan as appropriate; and
- facilitate the person’s reentry into routine activities.
Interpretation: If the parent or legal guardian is unable to be reached within the 24 hour period, all attempts to reach them should be documented and there should be continued outreach attempts past the 24 hour period to notify them of the incident.
Juvenile Justice Interpretation: Element (c) may not apply when a juvenile justice program uses mechanical restraints to prevent escape during transport.
- One of the elements is not regularly addressed; or
- In a few instances debriefing occurred after 24 hours; or
- In a few instances one of the required attendees was absent.
- Two of the elements are not regularly addressed; or
- In several instances debriefing occurred after 24 hours; or
- In several instances one or two of the required attendees was absent.
- One of the elements is not addressed at all; or
- Timeframes are routinely exceeded; or
- One or more of the required attendees is routinely absent or excluded.
BSM 5.03
- their current physical and emotional status;
- the precipitating events; and
- how the incident was handled and necessary changes to procedures and/or training to avoid future incidents.
- In a few instances one of the elements was not addressed.
- In several instances one of the elements was not addressed; or
- In a few instances staff were not debriefed.
- One of the elements is not addressed at all; or
- Staff are frequently not debriefed.
BSM 5.04
- In a few instances the debriefing did not occur.
- In several instances the debriefing did not occur.