14- 197 C.M.R. ch. 5, § 4

Current through 2024-51, December 18, 2024

Section 197-5-4 - POSITIVE SUPPORT (Levels 1-2)

5.04-1Positive Supports Must Be the First Approach

When a Person is exhibiting Challenging Behavior, the Planning Team must design Positive Supports to help increase Prosocial Behavior and eliminate or reduce the frequency and severity of the Challenging Behavior. The Planning Team must conduct a Functional Assessment and create a Positive Support Plan which recommends strategies to:

A. Assist the Person to live in a home which is safe, integrated into the Person's community, and which offers ready access to activities, friends, and relatives; and

B. Provide the Person with opportunities and assistance to:

1. Learn how to make choices and exercise personal autonomy;

2. Manage and control daily activities, pursue personal goals, and access quality health care;

3. Form and maintain friendships and other relationships; and

4. Participate in a broad range of activities that the Person enjoys and which promote independence and positive recognition by self and others. These activities include, but are not limited to, work, leisure, social activities and personal interests.

C. Make changes to the physical and social environment in a way that ensures supports are provided to expand opportunities for independence, inclusion and choice.

5.04-2Medical and Mental Health Assessment and Treatment

The Planning Team must ensure the Positive Support Plan includes documentation of consultation with licensed professionals to assess for the existence of physical or mental health conditions.

A. The Positive Support Plan must document consideration of physical health and psychosocial issues that may be contributing to the Challenging Behavior.

B. The Positive Support Plan must document how it incorporates factors related to trauma. Consideration must be given to the emotional and physical impact of the use of Restraint or other interventions.

C. When a physical or mental health condition is identified, the Positive Support Plan must address it through clinical and other appropriate support measures.

The Planning Team must incorporate a Functional Assessment to develop an individualized Positive Support Plan. The Positive Support Plan and the Functional Assessment may be a combined document or separate documents.

D. The Planning Team must develop a procedure for documentation and review of the use of all strategies. At a minimum this documentation must be reviewed and approved by the Planning Team annually.

5.04-3Use of Psychiatric Medications

When Psychiatric Medications are prescribed, the Planning Team must adhere to special procedures to ensure monitoring of the effects of such medication on health and mental functioning. Psychiatric Medications used as a Chemical Restraint must also comply with other sections of this regulation on Chemical Restraints.

A. Planning Teams must monitor and document the use of Psychiatric Medications at least annually.

B. When Psychiatric Medications are prescribed, a Psychiatric Medication Support Plan is required for monitoring purposes. The plan must be updated whenever there is a change.

1. The Psychiatric Medication Support Plan and the Positive Support Plan can either be separate documents or integrated into one comprehensive plan.

2. The overall plan needs to incorporate the psychiatric treatment such as medication or therapy, as well as, a Functional Assessment andPositive Support Plan designed to address the Challenging Behavior.

C. A Psychiatric Medication Support Plan is a component of the Personal Plan that must include, but is not limited to:

1. A list of medications, target symptoms, diagnosis and prescribing physician(s);

2. The parameters for use of medications prescribed as Psychiatric Medication PRN or "as needed";

3. The behavioral criteria to determine whether the medication is effective, such as changes in behavior, mood, thought or functioning;

4. Identification of side effects or adverse reactions that must be reported to the prescribing physician when they occur;

5. The potential risks of long term use;

6. Other supports which may help alleviate the Person's symptoms (may be included in the Positive Support Plan);

7. A plan for data collection, review and monitoring of medication effectiveness, side effects and dosage; and

8. The doctor's order attached for Psychiatric PRN Medication;

D. All orders for the use of Psychiatric PRN Medication must be prescribed by a physician, approved by the Person or Guardian, administered by properly trained staff, and included in the Psychiatric Medication Support Plan.

1. The physician's order must specify the written instructions that describe specific symptoms for which Psychiatric PRN Medication may be used, the exact dosage, the exact timeframe between dosages, and the maximum dosage to be given in a twenty-four (24) hour period.

2. If there is a Guardian, and the Guardian provides consent for a Psychiatric PRN order, the Guardian's consent must include specific written instructions for how the Guardian will be notified about each administration of a Psychiatric PRN medication.

3. After each administration of a Psychiatric PRN medication, the prescribing physician must be notified within twenty-four (24) hours of the administration of the medication, unless otherwise instructed in writing by the physician.

14- 197 C.M.R. ch. 5, § 4