Ala. Admin. Code r. 660-5-49-.02
Current through Register Vol. 43, No. 1, October 31, 2024
Section 660-5-49-.02 - Introduction(1)Purpose - This policy is designed to serve several functions for children, their families, DHR and provider staff when behavior management interventions are deemed necessary for children to manage existing or learn new behaviors. These functions are the identification of general guidelines for behavior management interventions; a description of interventions which may be utilized when helping children manage existing or learn new behaviors; the identification of prohibited interventions; and the provision of guidelines and procedures for managing behaviors through the development of behavior management plans which use interventions that are in accordance with generally accepted professional standards. Provider responsibilities for behavior management are included in this policy as guidelines to follow when serving DHR children.(2)Glossary: Various terms used in this policy are described below:(a)Advocacy - The promotion of governmental and agency responsiveness to individual and class needs.(b)Age-Appropriate Child - A child age 10 and older (except a child with severe mental retardation) or a child under age 10 who is intellectually capable of understanding and communicating ideas and opinions concerning the subject matter being discussed or considered.(c)Antecedent - An event or any series of events ("reasons," "causes," or "prior learning") that contributes to a behavior's occurrence or frequency.(d)Behavior Management - Treatment interventions that teach or increase the frequency of desirable behaviors and/or modify or extinguish undesirable behaviors by using reinforcers and/or punishments or altering or controlling the environment and other events or conditioners affecting behavior.(e)Child and Family Planning Team - The individuals involved in the planning and/or delivery of services for a child and family.(f)Consequences - An event following a behavior which is used in managing the behavior and teaching self-regulation.(g)Crisis - A situation where seclusion, restraint, or medication is used to protect children from a behavior which could seriously harm the child, harm others or cause substantial property damage and an appropriate Qualified Child Care Professional (QCCP) is not available to examine the child and assess the child's physical and psychological condition.(h)Crisis Plan - A plan developed in partnership with the age-appropriate child and the family to protect the child in the event a behavior is displayed which could harm the child, harm others or cause substantial property damage.(i)Discipline - The process of teaching a child healthy behaviors by responding to the behaviors in a manner that develops and promotes self-control and self-esteem.(j)Isolation - The physical placement of a child in an unlocked room for a time-limited period including isolation of a child in an unlocked room other than the child's own room; isolation of a child age 10 or over in his or her own room for more than two hours; isolation of a child under age 10 in his or her own room for more than one hour; and repeated confinement of a child in his or her room or any other room (including time-out) that subjects the child to lengthy social isolation.(k)Medication - Drugs prescribed for their effect on mood thought or behavior excluding non-psychotropic drugs such as those prescribed for physical conditions (e.g., antibiotics, insulin).(l)Provider - Any individual, agency, or organization that utilizes behavior management interventions while serving children in the custody and/or planning responsibility or the Department of Human Resources.(m)Punishment - Taking away something desirable or adding something undesirable to cause a decrease in the occurrence of a behavior.(n)Qualified Child Care Professional (QCCP) - the following individuals may serve as QCCPs: 1. A licensed medical doctor with three years residence training in psychiatry;2. A physician licensed to practice in the state of Alabama, with either specialized training or one year's experience in working with children in out-of-home placements;3. A psychologist with a doctoral or master's degree from an accredited program who has either specialized training or one year's experience in working with children in out-of-home placements;4. A social worker or professional counselor with a master's degree from an accredited program (and licensed in the state of Alabama) who has either specialized training or one year's experience in working with children in out-of-home placements;5. A registered nurse with (a) a graduate degree in psychiatric nursing, (b) a concentration in pediatric nursing or (c) one year's experience in working with children in out-of-home placements; or6. A child care professional with a graduate degree in child development or human development who has either specialized training or one year's experience in working with children in out-of-home placements.(o)Reinforcer - A response, such as praise or a tangible reward, that strengthens a desired behavior. Reinforcers can also involve taking away something undesirable (i.e. room restriction) to increase the likelihood of appropriate behavior.(p)Restraint - Limiting or restricting a child's freedom of movement or use of the limbs. It includes Mechanical Restraint which is restricting a child's freedom of movement or use of limbs or body by applying devices such as cuffs, ties, nets, tubes, bags, straps, head gear, etc.; and Physical Restraint which is restricting a child's freedom of movement by physically holding the child for an extended period of time or repeatedly over time.(q)Reward - A response given to acknowledge and support desired behavior.(r)Safety - The condition or state of being free and/or secure from reasonable or foreseeable harm, danger, or injury.(s)Seclusion - The isolation of a child in a locked seclusion room, a locked time-out-room, or any other locked room or place of confinement.(3)Children Covered by Policy - This policy applies to all children in the custody and/or planning responsibility of the Department. Providers using behavior management interventions must follow these policies when designing and implementing behavior management plans for children in the custody and/or planning responsibility of DHR.(4)Disagreements and Grievances - Disagreements and grievances about the type of behavior management interventions being used will be addressed in a fair, timely, and impartial manner by DHR and providers. Procedures for conflict resolution shall be established by the appropriate provider or provider agency. The parent(s) and age-appropriate child will be informed of these procedures in a manner understandable to them. The Department of Human Resources shall make age-appropriate children and their parents aware, in an effective manner, of the availability of advocacy and appropriate support services to assist them in pursuing a grievance in case of a disagreement. (a) The parent(s) or age-appropriate child may request the child be discharged from the provider's program if the conflict cannot be resolved. Likewise, the provider can withdraw services or discharge the child from placement. However, the provider or DHR, whichever is appropriate, must give sufficient (i.e., as soon as possible, but not less than 30 days) written advance notice of the intent to withdraw services or discharge the child from placement in order to permit the child and family planning team to plan and provide appropriate alternative services or placement. Sufficient written advance notice may be waived only pursuant to the decision of the child and family planning team when the ISP is reviewed prior to the decision to move the child. Author: Jerome Webb
Ala. Admin. Code r. 660-5-49-.02
New Rule: Filed August 6, 2003; effective September 10, 2003.Statutory Authority:R.C. v. Fuller case (R.C. v. Hornsby, No. 88-H-1170-N, Consent Decree) (M.D. Ala. Approved December 18, 1991).