10/19/2016 DCBDD B EHAVIORAL S UPPORT S ERVICES 5123:2-2-06 “B EHAVIORAL SUPPORT STRATEGIES THAT INCLUDE RESTRICTIVE MEASURES ” Updated Rule effective January 1, 2015 Applies statewide, to all environments (ICF / Home & Community) and to all providers of specialized services, regardless of source of payment Limits the use of and sets forth requirements for development and implementation of behavioral support strategies that include restrictive measures 1
10/19/2016 B EHAVIORAL S UPPORT S TRATEGIES The focus of a behavioral support strategy shall be the creation of supportive environments that enhance the individual's quality of life by: Mitigating risk of harm or likelihood of legal sanction Reducing and ultimately eliminating the need for restrictive measures Ensuring individuals are in environments where they have access to preferred activities and are less likely to engage in unsafe actions due to boredom, frustration, lack of effective communication, or unrecognized health problems Ensuring that strategies are developed in accordance with the principles of person-centered planning Strategies shall be incorporated as an integral part of the Individual Service Plan (ISP) A behavioral support strategy shall never include prohibited measures R ESTRICTIVE M EASURES Defined as a method of last resort that may be used by providers of specialized services only when necessary to keep people safe and with prior approval by HRC Temporary in nature and used only in specifically defined situations May include: Manual restraint, mechanical restraint, chemical restraint or time-out , only when there is a direct & serious risk of physical harm to the individual or another person Restriction of an individual's rights only when there is a risk of harm or a likelihood of legal sanction such as eviction, arrest, or incarceration. Shall cease immediately once risk has passed 2
10/19/2016 R ESTRICTIVE M EASURES : M ANUAL R ESTRAINT Use of a hands-on method to control an identified action by restricting the movement or function of an individual's head, neck, torso, one or more limbs, or entire body Includes holding, blocking, or disabling an individual's wheelchair or other mobility device Does not include a method that is routinely used during a medical procedure for patients without developmental disabilities R ESTRICTIVE M EASURES : M ECHANICAL R ESTRAINT Use of a device to control an identified action by restricting an individual's movement or function Does not include: seatbelt of a type found in an ordinary passenger vehicle age-appropriate child safety seat; medically-necessary device used for supporting or positioning body device that is routinely used during a medical procedure for patients without developmental disabilities 3
10/19/2016 R ESTRICTIVE M EASURES : C HEMICAL R ESTRAINT o Use of a medication prescribed for the purpose of modifying, diminishing, controlling, or altering a specific behavior o Does not include: o medications prescribed for the treatment of a diagnosed disorder identified in the DSM-V or medications prescribed for treatment of a seizure disorder o medication that is routinely prescribed in conjunction with a medical procedure for patients without developmental disabilities R ESTRICTIVE M EASURES : T IME O UT Confining an individual in a room or area and preventing them from leaving by applying physical force or by closing a door or constructing another barrier Includes even when a staff person remains in the room or area Shall not exceed 30 minutes for any one incident nor 1 hour in any 24-hour period Shall cease immediately once risk of harm has passed or if the individual engages in self- abuse, becomes incontinent, or shows other signs of illness o Does not include periods when an individual, for a limited and specified time, is separated from others in an unlocked room or area for the purpose of self-regulating and controlling his or her own behavior and is not physically restrained or prevented from leaving the room or area by physical barriers 4
10/19/2016 R ESTRICTIVE M EASURES : R IGHTS R ESTRICTIONS Restriction of an individual's rights as enumerated in section 5123.62 of the Revised Code: http://codes.ohio.gov/orc/5123.62 I NDIVIDUAL R IGHTS : F ROM THE R ULE Individuals with developmental disabilities should be supported in a caring and responsive manner that promotes dignity, respect, and trust with recognition that they are equal citizens with the same rights and personal freedoms granted to Ohioans without developmental disabilities Every individual age 18 years or older is considered an adult, whether or not they have a developmental disability 5
10/19/2016 I NDIVIDUAL R IGHTS : F ROM THE R ULE Services and supports should be based on an understanding of the individual and the reasons for their actions Effort should be directed at creating opportunities for individuals to exercise choice in matters that affect their everyday lives Individuals should be supported to make choices that yield positive outcomes I NDIVIDUAL RIGHTS : C HILDREN For children, teams should consider what is age appropriate regardless of the child’s disability Bedtime Diet Access to recreation and free time Personal care Household responsibilities Community access 6
10/19/2016 I NDIVIDUAL R IGHTS : A DULTS Team members cannot restrict an adult individual’s access to food, drink, tobacco products, adult materials, or alcohol without HRC approval Team members also cannot enforce arbitrary schedules, restrict community outings, restrict access to friends and family, enforce religious practices, or prohibit private time without HRC approval I NDIVIDUAL R IGHTS Medical professionals can make recommendations regarding an adult individual’s diet, sugar intake, tobacco usage, alcohol intake, etc. However medical professionals and team members cannot force adults with disabilities to follow those recommendations as they cannot force adults without disabilities 7
10/19/2016 I NDIVIDUAL R IGHTS Team members are encouraged to educate and empower the individuals that they serve to make informed, healthy choices Team members must recognize that the needs for every individual are different, and the strategies used to help maintain health and safety for every individual will also need to be different Team members can be creative about how they educate and encourage individuals to make healthy choices I NDIVIDUAL R IGHTS Medical interventions used as behavioral interventions (such as splints used to immobilize arms so someone cannot hit/scratch) are subject to the rule Medical interventions that would be used to treat anyone with that medical condition (such as splints to help with contractures) are not subject to rule 8
10/19/2016 R IGHTS V IOLATION E XAMPLES : A DULTS A guardian instructing a provider to withhold an adult individual’s cigarettes A provider denying requested food or drink because the individual’s doctor recommended it A parent guardian enforcing a 9pm bedtime A team denying community outings or visits with family/friends until the individual takes a shower Parents instructing providers to keep the individual’s bedroom or bathroom door open R IGHTS V IOLATION E XAMPLES : C HILDREN Parent instructing a summer camp provider to restrict camp activities based on their child’s behavior at home Parent instructing a provider to place their child in time-out whenever their child curses Parent instructing a provider to give their child Benadryl before bedtime if they having trouble falling sleeping (chemical restraint) 9
10/19/2016 A G OOD R ULE OF T HUMB If you are uncomfortable with what you being asked to do or what you are hearing, there could be a restrictive measure in place Pay attention to language used and ask follow up questions whenever you sense a restrictive measure is being used Contact HRC with any questions: behavior.support@dcbdd.org R ESTRICTIVE M EASURES : P ROHIBITED M EASURES Methods that SHALL NOT be used: Prone restraint (face-down) Manual or mechanical restraint that has the potential to inhibit or restrict an individual's ability to breathe or that is medically contraindicated Manual or mechanical restraint that causes pain or harm to an individual Disabling an individual's communication device Denial of breakfast, lunch, dinner, snacks, or beverages Placing an individual in a room with no light Subjecting an individual to damaging or painful sound Application of electric shock to an individual's body Subjecting an individual to any humiliating or derogatory treatment Squirting an individual with any substance as an inducement or consequence for behavior Using any restrictive measure for punishment, retaliation, instruction or teaching, convenience of providers, or as a substitute for specialized services 10
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