	Behavior Support and Management

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

BSM 1: Philosophy and Organization Policy*

The organization’s governing body and management promote a safe and therapeutic environment and provide necessary supports and resources to:

keep staff, foster parents, and service recipients safe; and
minimize the use of restrictive behavior management interventions.

BSM 1.01

The organization’s behavior support and management policies and practices comply with federal, state, and local legal and regulatory requirements.

Interpretation: The Public Health Service Act, as amended by the Children’s Health Act of 2000 and the Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services to Individuals Under Age 21 are federal regulations that govern the use of behavior management in the United States. Organizations serving youth involved with the juvenile justice system may be subject to different laws and regulations.

Note: COA recognizes that the laws or regulations governing organizations serving youth involved with the juvenile justice system may sometimes authorize practices that conflict with the standards to which COA holds other organizations, and has addressed some of the potential discrepancies throughout the standards in BSM.

Note: The organization is required to comply with the more stringent standard or regulation.

BSM 1.02

Behavior support and management policies cover:

practices used to maintain a safe environment and prevent the need for restrictive behavior management interventions;
whether isolation, manual or mechanical restraint, or locked seclusion are permitted as emergency safety measures;
other practices that may be used and under what circumstances; and
prohibited practices, including chemical restraint.

Update: Revised Standard, Added First Interpretation - 05/01/11

BSM 1.02 Original Standard:

Behavior support and management policies cover:

practices used to maintain a safe environment and prevent the need for restrictive behavior management interventions;
whether isolation, manual or mechanical restraint, or locked seclusion are permitted as emergency safety measures;
other practices that may be used and under what circumstances; and
prohibited practices.

Interpretation: Chemical restraints do not include situations when a psychopharamacological drug: (1) is used according to the requirements for treatment authorized by a court; or (2) is administered in an emergency to prevent immediate, substantial, and irreversible deterioration of a person's mental status when prescribed by a physician or other qualified medical practitioner.

Interpretation: Although most organizations only use restrictive behavior management interventions in emergencies to prevent harm to self or others, organizations serving youth involved with the juvenile justice system may also be legally authorized to use restrictive interventions to prevent escapes, or protect property, in order to maintain safety, security, and order. However, they should still only employ restrictive interventions when absolutely necessary, as referenced throughout these standards.

Note: Refer to COA's glossary for a definition of chemical restraint.

BSM 1.03

The CEO and senior management conduct regular reviews of the use of behavior support and management interventions and:

review how organization practices compare with current information and research on effective practice;
use findings from quarterly risk management reviews of restrictive behavior management to inform staff about current practice and the need for change;
revise policies and procedures when necessary;
determine whether additional resources are needed; and
support efforts to minimize the use of restrictive behavior management interventions.

Note: Refer to the PQI standards regarding quarterly risk management reviews and corrective action and the RPM standards regarding annual risk management audits.

Research Note: Agreement has been reached among experts that the best way to reduce injuries and deaths is to minimize the use of restraints to the greatest extent possible. Reductions in the use of locked seclusion and restraint can also contribute to less staff turnover.

BSM 1.04

The program or clinical director is notified following each use of locked seclusion or manual or mechanical restraint, and each incident is administratively reviewed no later than one working day following an incident.

NA The organization prohibits the use of restrictive behavior management interventions.

QUICK JUMP TO


	PURPOSE: The organization’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.

RELATED FILES


	BEHAVIOR SUPPORT AND MANAGEMENT The use of specialized interventions to guide, control, and redirect client behaviors. Examples of behavior management approaches used in residential treatment settings include mediation, time out, locked seclusion, and physical restraint.


	PRACTICE Established actions or ways of proceeding in the regular performance of organizational duties. Policies and procedures often guide practice.


	SERVICE RECIPIENT The individuals, groups, organizations, or communities that use, receive, or benefit from programs and services. Service recipients can include consumers, patients, family members, legal guardians, advocates, public/private organizations, employers, and purchasers. All are regarded as significant stakeholders served in a variety of agencies and practice settings.


	GOVERNING BODY A person or persons with the legal authority and responsibility to set policy and oversee the operations of an organization. Generally, the governing body is a group, such as a board of directors or board of trustees. While the exact responsibilities of the governing body depend on the nature and character of the organization, the governing body has minimum fiduciary responsibilities to the organization set by statute, regulation, and case law, and typically assume responsibilities for long term planning, risk management, and evaluation and effectiveness of management.


	FOSTER PARENTS State- or county-licensed adults who provide a temporary home for children whose birth parents are unable to care for them. Foster parents are not considered employees or personnel and are specifically referenced in all relevant standards.


	RESTRICTIVE BEHAVIOR MANAGEMENT Interventions that restrict, limit, or curtail a person's freedom of movement to prevent harm to self or others. These interventions include isolation, manual or mechanical restraint, and locked isolation.


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	SENIOR MANAGEMENT Employees who assume administrative oversight for the organization's programs. Senior management positions may include vice presidents, chief operating officers, assistant commissioners, directors, or other positions that involve management of program administration. The term does not include supervisors of direct service workers.


	RESEARCH For purposes of COA accreditation, all forms of internal or external research involving persons served except internal program evaluation and outcomes research, or educational projects performed by students and interns that are part of their professional training.


	Effective Practice Applies to practices supported by consistent findings of benefit in a large number of studies, conducted over time, in multiple applied settings using the most rigorous designs feasible given the phenomenon of interest, and with conclusions that are clearly compatible with the study methodology and findings. Outcomes are both identified and explained. A wide range of evidentiary support has been found for most practices labeled effective.


	MANAGEMENT See ADMINISTRATION


	RISK MANAGEMENT A systematic process of evaluating and reducing potential risks that may befall personnel, clients, an organization, or a facility. Risk management activities are directed toward reducing an organization's legal and financial exposure, especially to lawsuits.


	AUDIT See FINANCIAL AUDIT


	PROGRAM A system of services offered by an organization. For example, an organization providing a mental health service may offer several mental health programs to different populations, e.g., a mental health program for adolescent teens. The word "program" can be used interchangeably with the word "service" or to describe specific programs.


	LOCKED SECLUSION The practice of placing a person in a locked room to prevent harm to self and others.


	CLINICAL The study, assessment, and diagnosis of the client situation followed by direct treatment to help the client achieve prescribed goals.


	MECHANICAL RESTRAINT The use of any physical device to limit movement and prevent harm to self or others, not including devises such as prescribed orthopedic devices, surgical dressings or bandages, protective helmets, or any other methods that involve physical holding of an individual for the purpose of conducting routine physical examinations, conducting tests, protecting the child from falling out of bed, or to permit the child to participate in activities without the risk of physical harm.