C.M.R. 14, 197, ch. 5, app 197-5-FOUR
Positive Support Plans or Behavior Management Plans designed to support a Person with Challenging Behavior must be approved as prescribed by these regulations prior to implementation. The Planning Team is responsible for providing the required documentation and obtaining the necessary level of review and approval.
The following chart defines five levels of support, intervention, restriction and required approval. Each level has required planning, documentation, and review which must be obtained prior to implementation. Each Plan must be reviewed for approval at the level of the most restrictive component of the Plan.
Positive Support Plans and Behavior Management Plans are considered in the following categories.
Level 1 | Support for the Person to participate meaningfully in his/her community life. | |
Description: - No restrictions of Rights - Non-coercive intervention with voluntary participation by the Person | Examples include, but not limited to: - Physical & mental health assessment and treatment - Environmental modification - Communication support - Teaching Skills - Physical prompts for teaching or personal support without Coercion - Voluntary Timeout | |
Required Approval: Planning Team, including the Case Manager | Required Documentation: Functional Assessment, Positive Support Plan | |
Level 2 | Programs which are designed to modify or redirect a Person's behavior | |
Description: - Non-coercive intervention with voluntary participation by the Person - Some programs which restrict a Person's activities or Rights for safety reasons - Preservation of personal property and safety measures involving incendiary material or sharps - Positive Behavior Modification Techniques | Examples include, but not limited to: - In-Home Stabilization for a maximum of one hour for safety and assessment - Securing of incendiary material, clothes, shoes or sharps with documented safety issues or problematic misuse, when the Person does not communicate an objection. - Restriction of food or liquid (with doctor's health or safety recommendation) - Verbal Redirection or verbal prompting to redirect behavior - Non-Exclusionary Timeout - Locks that the Person is able to unlock | |
Required Approval: Planning Team, including the Case Manager | Required Documentation: Functional Assessment, Positive Support Plan, Transition Plan toward more naturally occurring reinforcers, In-Home Stabilization Plan as indicated | |
Level 3 | Programs which restrict a Person's Rights as enumerated in 34-B M.R.S. §5605 | |
Description: - Planned Restriction of Rights - An intervention to which the Person or the Person's Guardian, as appropriate, communicates an objection - Use of Coercion | Examples include, but not limited to: - Physical Redirection - In-Home Stabilization for more than one hour for safety and assessment, not to exceed 24 hours. - Property Removal (other than for Imminent Risk) - Restriction of communication (other than to a Guardian, Advocate or Crisis Team); - Restriction of privacy - Search of the Person or personal space - Restriction of food or liquid - Buzzers/alarms/sensors or locks that the Person is unable to disarm or unlock on doors/windows, etc. -Electronic monitoring Devices (video, ankle bracelet, etc.), - Releasing (briefly holding the Person in order to release oneself and/or another person from a physical hold such as a bite or hair hold) - Planned use of Law Enforcement - Restriction of a communication device that prohibits the Person's ability to communicate. - Restriction of a communication device when the device is being used for an illegal activity. | |
Required Approval: Planning Team, including the Case Manager, Case Management Supervisor, Review Team Signatures | Required Documentation: Functional Assessment (Updated), Positive Support Plan, Behavior Management Plan, In-Home Stabilization Plan as indicated, Physician's Evaluation, Psychiatric Medication Plan as indicated | |
Level 4 | All programs with a Restraint component | |
Description: - Planned Use of Restraint - Planned Removal of staff - Use of Coercion - Must not include Prohibited Practices | Examples include, but not limited to: - Physical Restraint/interventions - Any physical force or threat thereof to cause a Person to move. - Physically confining a Person - Blocking - Temporary removal of staff - In-Home Stabilization for more than one hour for safety and assessment, when Behavior Management Plan includes possibility of renewal of In-Home Stabilization after 24 hours. -Use of a Restraint without an attempt to release, longer than 15 minutes -Use of a Specialized Restraint - Restraint that prohibits the Person's ability to communicate, such as a restraint that interferes with a person's ability to use gestural communication or sign language | |
Required Approval: Planning Team, including the Case Manager, Case Management Supervisor, Review Team Signatures | Required Documentation: Functional Assessment (Updated), Positive Support Plan, Behavior Management Plan, Psychological Assessment, Physician's Evaluation, In-Home Stabilization Plan as indicated, Psychiatric Medication Plan as indicated | |
Level 5 | Programs considered only in exceptional and rare instances where no less restrictive measure can safely meet the need to keep a Person from danger to self or others. | |
Description: - Programs that propose significant restriction or unusual risk to the Person - The level of risk or restriction must not outweigh the potential harm from the Challenging Behavior being addressed - Programs that pose a potential harm that the Statewide Review Panel deems atypical may be required to meet Level 5 review requirements - Prohibited Practices will not be considered for approval. | Examples include, but not limited to: - Some Mechanical Restraints (other than those expressly prohibited by these regulations), such as splints, mitts, or helmet may be approved for use in unusual circumstances for purposes of Behavior Management. Examples of unusual circumstances may include transitioning from institutional programs or family settings into a setting governed by these regulations. - Supine, or face-up floor Restraint - Chemical Restraint - Noxious Interventions - Binding of wrist to waist or wrist to bed | |
Required Approval: Planning Team, including the Case Manager Case Management Supervisor Review Team Signatures Commissioner or designee Signature | Required Documentation: Functional Assessment (Updated), Positive Support Plan, Behavior Management Plan In-Home Stabilization Plan as indicated Psychological Assessment, Physician's Evaluation, Psychiatric Medication Plan as indicated Second Clinical Opinion Statewide Review Panel Recommendation | |
C.M.R. 14, 197, ch. 5, app 197-5-FOUR