Ala. Admin. Code r. 660-5-49-.06

Current through Register Vol. 43, No. 1, October 31, 2024

Section 660-5-49-.06 - DHR Responsibilities

(1)General Guidelines - Plans designed to address behavioral needs must be systematic, based upon a careful assessment of the child's behavior, and utilize behavior management interventions which are in accordance with generally acceptable professional standards. Interventions will be based primarily on rewards, redirecting and re-education rather than punishment; consistently implemented in all areas of a child's life (e.g., school, church or leisure activities); implemented in a therapeutically appropriate manner according to the individual treatment plan developed by the provider; and timely evaluated for effectiveness. Children are to be referred to providers qualified and trained to authorize and implement behavior management interventions. DHR staff shall be aware of a provider/facility's behavior management policy and may request a copy, when needed, to assure it is consistent with Departmental policy and provides children the same rights as children in DHR approved foster homes. If the need for intervention becomes apparent after placement, and the provider is not appropriately trained to authorize and implement the needed intervention, DHR shall assist the provider to secure the needed training.

(2)Assessing Behavioral Needs - DHR staff shall partner with the appropriate team members to explain and assist the age appropriate child and the child's family to understand the need for behavior management interventions. Assessments are to include information gathered from the social, medical, educational, psychological, and legal life domains (areas of family functioning) and will address child and family's strengths and needs; child's current and past behaviors; events, conditions or circumstances that trigger or affect the behavior; purpose the behavior serves and how it is displayed; frequency and duration of the behavior; previous interventions used to manage the behavior and their effectiveness; child's degree of readiness to learn self-control; and targeted areas for behavioral improvement and increased self-control. When a child's behavior indicates the need for medication, a medical assessment is required. The DHR worker is responsible for providing the physician with the child's history, information about the caregiver's capabilities and the changing needs of the child and family, and to assure the physician has explored alternative treatment interventions. (Refer to section on medication for more detailed information.)

(3)Designing And Implementing The Behavior Management Plan - Behavior management plans are to be individualized for each child, developed, and authorized in advance by the child and family planning team. The more restrictive interventions must also be authorized in advance unless there is a crisis situation. The behavior management plan and any adjunct treatment plans must be documented in the ISP and will include the child and family's strengths and needs as they relate to the desired behavioral outcomes; a clear description of the targeted behavior(s) to be managed (i.e. specific situation(s) where the behavior occurs, how it is displayed by the child, its frequency and duration); the desired outcomes for the targeted behaviors; the interventions to be used for teaching positive, alternative replacement behavior and how they will be implemented; the methods and frequency for evaluating the effectiveness of the interventions; and if applicable, the crisis plan outlining acceptable responses for managing dangerous behaviors. When case information reveals a child has a history of or the potential to display dangerous behavior, service provider and placement referrals are to be made to appropriately qualified and trained providers and placement resources. The individualized service plan for these children must include a crisis plan outlining acceptable responses for managing the dangerous behavior. Foster family home providers may use a behavior management intervention (e.g., prolonged grounding, exceeding defined time-out limits) which has not been previously authorized and documented in the individualized service plan when a crisis situation arises. The intervention will not be used any longer than necessary to protect the child or others from harm or to help the child gain control. The foster parent must document use of the intervention and notify the DHR worker immediately (i.e., no more than one (1) working day later) of the crisis and subsequent use of the intervention. Residential providers may also use an intervention not previously authorized and documented in the individual service plan when a crisis arises. The residential provider must have a procedure in place which requires notification of a qualified child care professional (QCCP) who is available to assess the crisis and make decisions regarding the need for and use of the intervention. The same procedure used by foster family home providers regarding documentation, notification of the DHR worker, and review at the next ISP meeting is to be followed.

(4)Assessing And Monitoring Behavior Management Interventions - DHR shall work in partnership with providers as interventions are assessed for effectiveness in managing targeted behaviors. Assessment and monitoring shall occur according to the methods and frequency identified in the behavior management and individualized service plans. An intervention will be discontinued when it is no longer needed to manage a behavior or when the intervention is not effective and a more appropriate one has been identified.

(5)Discharge Planning And Training For Managing Behaviors - When changes in a child's placement or provider responsible for implementing behavior are going to occur, information must be supplied to the subsequent caregiver/provider and will include the child's behavior management plan including behavioral expectations and desired outcomes, prior interventions that have been both successful and unsuccessful, and current interventions used to manage the behavior(s). Training regarding behavior management intervention(s) used by the current caregiver/provider shall be provided to the parent(s), family member(s), or foster care provider to whom the child is expected to be discharged. Training on implementing the specific interventions shall be provided by a qualified source that has training and experience in the implementation of the behavior management interventions. The Department will assist the caregiver with locating any needed training.

Author: Jerome Webb

Ala. Admin. Code r. 660-5-49-.06

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).