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.		  
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  PRACTICE

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

The customs, habits, values, skills, technology, beliefs, and religious, social, and political behaviors of a group of people in a specific period of time.		  
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  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.		  
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  PROCEDURES

Written instructions that outline the steps for performing a task(s) or operationalizing an administrative or service delivery process. A procedure can be written as a step-by-step set of instructions or as a narrative description of a process. A procedure tells someone how to do something not just what to do.

Unlike policies, procedures do not need to be approved or reviewed by the governing body, and need not be associated with a specific policy. For example, whereas a broad anti-discrimination policy requires grievance or other procedures in order to be operationalized within an organization, assessment procedures do not require a governing body approved assessment policy.

Note: Procedures are sometimes referred to as administrative policies.

  
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  PARENTS

Parents can include: birth, foster, kinship, and adoptive parents. Please see service standards for more specific information about use of this term. 		 
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  LEGAL GUARDIAN

A person who has legal responsibility for the care and management of a person incapable of administering his/her own affairs. In the case of a minor child, the guardian is charged with the legal responsibility for the care and management of the child and of the minor child's estate.		  
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  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.		  
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  PERSONNEL

The body of employees and/or volunteers that carries out the organization's tasks under the organization's administration and/or supervision. This definition does not include foster parents who are specifically referenced in relevant standards		  
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  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. 		 
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  MANAGEMENT

See ADMINISTRATION		  
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  TREATMENT MODALITY

The application of therapeutic agents, techniques, and procedures to assist a client. Examples include individual, group, and family counseling.		  
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  MANUAL RESTRAINT

The practice of physically holding a person's arms, legs, or head to prevent harm to self and others. 		 
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  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.		  
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  LOCKED SECLUSION

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

A written compilation that describes the client and the services delivered. Records can be in hard copy and/or electronic format. The case record can be used as a source of information for quality improvement or other evaluation activities, for research purposes, or to demonstrate accountability to funding bodies. 		 
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  FAMILY

Two or more people who consider themselves family and who assume obligations, functions, and responsibilities generally essential to healthy family life. Child care and child socialization, income support, long-term care, and other caregiving are among the functions of family life. The definition of "family" will rest with an individual's indication of who plays a family member role, including current or former foster family, adoptive family, extended family members, fictive kin, or significant others. Organizations that believe family is the central constellation in a child's life, and that family attachments are of primary importance for human development, will strive to work with professional staff to develop a common understanding of "family."		  
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  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.		  
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  ASSESSMENT

An evaluation, which utilizes professional expertise and skills in the collection and analysis of data to understand and describe the nature of service needs of an individual, family, or group. Assessment, as in needs assessment, is also used to determine priorities of program planning and service development for the organization as a whole. See also DIAGNOSIS.		  
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  CLIENT

See service recipient.		  
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  SUPERVISION

Assumption of responsibility for directly overseeing and evaluating the work or work products of personnel within an organization. Also includes inspecting the act or process of accomplishing a function or activity.		  
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  MEDICATION

A prescribed or over-the-counter drug that is injected, taken orally, applied topically, or otherwise administered.		  
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  TREATMENT PLAN

See SERVICE PLAN		  
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Behavior Support and Management
  
Private Org Public Agency  

BSM 2: Behavior Support and Management Practices*

 
A culture and structure exists within every facility and foster home that promotes respect, healing, and positive behavior and prevents the need for restrictive behavior management interventions.

BSM 2.01

 

The organization:

  1. provides an explanation for and offers a copy of its written behavior support and management philosophy and procedures to service recipients or their parents or legal guardians at admission;
  2. informs service recipients or parents or legal guardians of strategies used to maintain a safe environment and prevent the need for restrictive behavior management interventions;
  3. has procedures that address harassment and violence towards other service recipients, personnel, and, as applicable, foster parents;
  4. obtains the service recipient’s or parent’s or legal guardian’s consent when restrictive behavior management interventions are part of the treatment modality; and
  5. when the service recipient is a minor, notifies the parents or legal guardians promptly when manual restraint, mechanical restraint, or locked seclusion were used.
Interpretation: COA recognizes that it may be difficult for organizations providing residential juvenile justice services to involve youths' parents or legal guardians, especially when youth are placed outside of their communities and far from their families; however, organizations should still strive to involve families to the extent possible. In any instance when promptly notifying parents or legal guardians in the wake of an intervention proves difficult, the organization should document its efforts to initiate contact in the case record. See JJC 4.03 for guidance on ways to minimize barriers to family participation.
Interpretation: Consent should be reviewed on an annual basis. The service recipient, and/or parent or legal guardian, has the right to refuse consent to treatment and the organization may determine that the individual cannot be served as a result of refusal. When an organization serves youth involved with the juvenile justice system and services are involuntary, obtaining consent may not be relevant.
Research Note: The service recipient, and/or parent or legal guardian, has the right to refuse consent to treatment and the organization may determine that the individual cannot be served as a result of refusal. Such consent should not exceed one year.

BSM 2.02

 

Personnel and foster parents support positive behavior by:

  1. developing positive relationships with service recipients;
  2. building on strengths and reinforcing positive behavior; and
  3. responding consistently to all incidents of harassment or violence.

BSM 2.03

 

The organization prohibits:

  1. the use of restrictive behavior management interventions by service recipients, peers, or any person other than trained, qualified staff, or foster parents;
  2. excessive or inappropriate use of restrictive behavior management interventions as, for example, a form of discipline or compliance, or for the convenience of staff or foster parents; and
  3. use of restrictive behavior management interventions in response to property damage that does not involve imminent danger to self or others.
Update: Revised Standard, Revised First Interpretation, Added NA - 05/01/11

BSM 2.03 Original Standard and First Interpretation:

The organization prohibits:

  1. the use of restrictive behavior management interventions by service recipients, peers, or any person other than trained, qualified staff, or foster parents;
  2. chemical restraint;
  3. excessive or inappropriate use of restrictive behavior management interventions as, for example, a form of discipline or compliance, or for the convenience of staff or foster parents; and
  4. use of restrictive behavior management interventions in response to property damage that does not involve imminent danger to self or others.

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.

“Excessive or inappropriate use” of restrictive behavior management interventions refers to use that is not consistent with the requirements of BSM 5.

Interpretation: “Excessive or inappropriate use” of restrictive behavior management interventions refers to use that is not consistent with the requirements of BSM 5.

Interpretation: As referenced in BSM 1.02, organizations serving youth involved with the juvenile justice system may also be authorized to use restrictive interventions to prevent escapes or protect property, but should only do so when absolutely necessary, as referenced throughout these standards.

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

BSM 2.04

 
Each service recipient participates in a screening of the potential risk of harm to self or others to determine the need for behavior support and management interventions.
Interpretation: Organizations that prohibit the use of restrictive behavior management interventions may conduct a program wide assessment of the potential risk of harm by or to clients to determine the most appropriate behavior support and management interventions. Any organization that provides direct care and supervision to children, vulnerable adults, or individuals with a history of danger to self or others must conduct individual screenings.

BSM 2.05

 

Service recipients identified as being in need of restrictive behavior management interventions are assessed for:

  1. antecedents to harassing, violent, or out-of-control behavior;
  2. the effectiveness of previous uses of behavioral interventions;
  3. psychological and social factors that can influence use of such interventions; and
  4. medical conditions or factors that could put the person at risk.
Interpretation: Medical factors may include issues related to use of medications, such as an insulin imbalance. Psychological and social factors may include psychosis, history of abuse or other trauma, or claustrophobia.
Interpretation: This standard is typically related to BSM 2.04. However, when organizations serving youth involved with the juvenile justice system also use restrictive behavior management interventions for other purposes (such as to prevent escapes during transport), any youth who might be subject to these interventions should be assessed for the factors listed in this standard, regardless of whether the screening addressed in BSM 2.04 indicates risk of harm to self or others.
Research Note: A common traumatic element is the massive control of one person over another. For individuals with a history of abuse or other trauma, undergoing a restrictive behavior management intervention can be extraordinarily retraumatizing.
NA The organization prohibits the use of restrictive behavior management interventions.

BSM 2.06

 

A behavior support and management plan is based on assessment results and:

  1. identifies strategies that will help the person de-escalate their behavior and prevent harassing, violent, or out-of-control behavior;
  2. specifies interventions that may or may not be used;
  3. is modified as necessary; and
  4. is developed and signed by the person, his/her parent or legal guardian, and the foster parent or personnel, as appropriate.
Note: The behavior support plan, sometimes called a crisis plan, can be part of, and reviewed with, the overall service or treatment plan.
Note: Organizations serving youth involved with the juvenile justice system should refer to the Interpretation to BSM 2.01 regarding the involvement of youths' parents or legal guardians.
NA The organization prohibits the use of restrictive behavior management interventions.
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PURPOSE: The organization’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.
 
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