COA - Council On Accreditation

	Behavior Support and Management

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

Introduction

Effective behavior support and management practices begin with support from leadership that encourages an environment in which the need for restrictive interventions is minimized to the greatest extent possible. A culture that promotes respect, healing, and positive behavior, and provides individuals with the support they need to manage their own behaviors, can help prevent emergency situations. Training for personnel and foster parents is an essential component of maintaining a safe work and service environment. Training also prevents injuries and deaths in crisis situations that warrant the use of restrictive interventions as a last resort. Agencies that maintain a process for reviewing incidents when they do occur have the opportunity to make changes in their practices to support the safest environment possible and further reduce the use of restrictive interventions.

Update: Added Second Note, Added Second NA - 06/01/10

Added Second Note and Second NA

Note: All agencies will be required to complete PA-BSM 1, PA-BSM 2, and PA-BSM 3. Any service that uses isolation, manual or mechanical restraint, and/or locked seclusion in facilities, and any foster home that uses manual restraint, will complete the standards in this section, as applicable to the behavior support and management interventions they employ. Restrictive behavior management interventions are those that restrict, limit, or curtail a person’s freedom of movement. Related terms found in COA’s glossary include isolation, manual restraint, mechanical restraint, and locked seclusion.

COA's standards permit most agencies to employ these interventions only to prevent a person from harming him or herself or others. However, when required or authorized by law, agencies serving youth involved with the juvenile justice system may also use restrictive interventions for other purposes, as referenced throughout the standards in this section. Nevertheless, these agencies should still strive to create a culture that promotes respect, healing, and positive behavior, and minimize the use of restrictive behavior management interventions to the extent possible.

Some agencies serving youth involved with the juvenile justice system and accredited under COA's Juvenile Justice Corrections (PA-JJC) service section may lock youth in their rooms for routine purposes (e.g., during sleep periods), as opposed to in response to an incident. Although this practice does restrict a person's freedom of movement, it differs from the types of restrictive behavior management interventions addressed in this section insofar as it is utilized on a routine, ongoing basis, rather than in response to a specific incident. Accordingly, this practice is addressed in PA-JJC 14, and standards referencing "isolation," "locked seclusion," or "restrictive behavior management interventions" do not apply.

Note: PA-BSM does not apply to PA-FEC programs, but in agencies providing multiple services, including PA-FEC, the Standards will apply and must be implemented in the non-FEC programs.

Note: Please see Self-Paced Training: Behavior Support and Management (BSM) in the Tools Index for additional assistance with this standard.

NA The agency does not provide services to individuals face-to-face.

NA The agency provides financial education and counseling (PA-FEC) services only.


	PURPOSE: The agency’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.


	LEADERSHIP A nonprofit organization's leadership consists of its governing body, chief executive officer, and may also include its senior management. In a public agency the term refers to the agency head and administration team. The term "leadership" is not generally applied to for-profit organizations. With respect to COA standards, in for-profit organizations the term leadership applies to the owner and board of directors if one exists.


	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.


	TRAINING Instruction so as to make fit, qualified, or proficient in a skill or body of knowledge.


	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


	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.


	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.


	ISOLATION The practice of separating a person from others and placing him/her in a monitored, non-locked or "quiet" room in order to calm the person. A person in isolation is physically prevented from leaving the designated space or room where s/he is placed. For purposes of COA accreditation, isolation is distinguished from TIME-OUT.


	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.


	MANAGEMENT See ADMINISTRATION


	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.


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


	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.