(a) Treatment and habilitation services shall be designed to maximize the potential of the participant. Services shall be provided in the setting that is the least restrictive for the participant.
(b) Participants shall have a positive behavior support plan in place if restraints are outlined in their individualized plan of care.
(c) A participant with a challenging behavior identified by the plan of care team shall have a current functional behavioral analysis conducted within the last year to learn what the person is trying to communicate through the behavior(s), the function or possible purpose for the behavior(s), to explore antecedents and contributing factors to behaviors, and to review and describe potentially positive behavioral supports and interventions in order to develop a positive behavior support plan. - (i) Challenging behaviors may include actions by the participant that constitute a threat to the person's immediate health and safety, the health and safety of others in the environment, a persistent pattern of behaviors that inhibit the participant's functioning in public places and integration within the community, or uncontrolled symptoms of a physical or mental condition.
- (ii) The functional behavioral analysis shall include data compiled regarding all challenging behaviors exhibited, and be utilized to develop the positive behavior support plan used by the provider during the provision of waiver services.
- (iii) A provider or provider staff knowledgeable of the participant shall complete the functional behavior analysis, which shall include input from the team, participant, and any legally authorized representative(s).
(d) A positive behavior support plan, based upon a current functional behavioral analysis, shall be developed for a participant in order for employees working with the person to understand and recognize the communication and behaviors exhibited by the person. The positive behavior support plan shall describe agreed upon supports to assist the participant using proven support techniques and non-restrictive interventions. At a minimum, a positive behavior support plan shall: - (i) Include the components of the template provided on the Department's website.
- (ii) Maintain the dignity, respect, and values of the participant;
- (iii) Use a person-centered approach with the participant involved in the development of the plan on a level appropriate for that person;
- (iv) Aim to minimize the use of restraints;
- (A) If restraints are used then the positive behavior support plan has failed, and must be reviewed to possibly add or modify the service environment or behavioral interventions;
- (v) Be specific and easily understood, so direct care employees can implement it appropriately and consistently;
- (vi) Be approved by verification of a signature by the participant or any legally authorized representative(s) through informed consent;
- (A) As part of the informed consent process, education shall be given by the provider to the participant and any legally authorized representative(s);
- (B) This education shall include information about positive behavior supports that may be used and the risks and benefits of any supplemental plan for the use of a restraint or prescribed psychoactive medication if the positive behavior support plan fails.
- (vii) Define the antecedents and the targeted behavior(s) that need to be replaced or reduced;
- (viii) List positive behavioral supports that assist the participant in replacing targeted or challenging behaviors with appropriate replacement behaviors;
- (ix) Provide protocols for providers and provider employees to recognize emerging targeted behaviors, and determine the appropriate interventions to implement positive behavioral supports;
- (x) Provide protocols, which focus on positive interventions that are deemed least restrictive and most effective, for employees to use when targeted behaviors take place;
- (xi) Reference the protocol in the plan, for the use of any PRN medication that may be a part of the positive behavior support plan as recommended by the treating medical professional and can be requested by the participant to help manage stress, anxiety, or behaviors. The use of a PRN for this purpose shall comply with Section 19(b) of this Chapter;
- (xii) Be reviewed every six (6) months by the provider(s) and the case manager to assess the effectiveness of the plan, or more frequently if needed;
- (xiii) Include specific guidelines for tracking and analyzing the antecedents related to the occurrence of a targeted behavior, the actual behavior(s) displayed, and the results of positive behavioral interventions; and
- (xiv) Be included as a formal component of the individualized plan of care.
(e) A provider employee implementing a positive behavior support plan shall receive participant specific training on the positive behavior support plan, and on specific positive de-escalation techniques and interventions before they begin working with the participant.
048-45 Wyo. Code R. § 45-17