Coshocton County Board of
Developmental Disabilities
Policy: General Health Services and Well-Being for Individuals Receiving Services Policy
Policy Number: 2.0
Ohio Revised Code: 5123.61
Ohio Administrative Code Reference: 5123:2-1-02(L)(1)
Board Adopted: 05-15-2003
Board Amended
General Health Services and Well-Being For Individuals Receiving Services
• Purpose
The purpose of this General Health Services and Well-Being Policy is to adhere to the Administrative Code requirements that the Board adopt written policies and procedures that ensure general health and well-being of all individuals receiving services and supports from all programs operated under the authority of the Board.
• Policy
The Board fully recognizes the challenges in meeting the complex health care needs of persons with mental retardation and other developmental disabilities. The Board acknowledges that services should be provided to meet these needs according to the individual's capabilities and to encourage them to achieve maximum functioning in the least restrictive environment(s). However, by so doing, the health of individuals and families receiving services should not be compromised. This policy shall require the establishment of procedures that clearly state the processes by which this policy shall be implemented. The Board authorizes the Superintendent to develop procedures for the General Health and Well-Being of Individuals Receiving Services
It is the position of the Board to address the Board of Nursing and Ohio Department of MRDD requirements specific to delegation of nursing tasks and administration of medication be contained in a stand-alone policy with corresponding procedures to promote safe and accessible nursing care for all program participants.
• Maintenance of Policies
This policy shall be maintained on file in the administrative offices of the Board.
The Board authorizes the Superintendent to develop and implement written procedures consistent with Board policy and applicable rules, regulations and statutes.
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Coshocton County Board of
Developmental Disabilities
Policy Reference: General Health and Well-Being of All Individuals Receiving Services Procedures
Policy Number: 2.1
Ohio Revised Code Reference: 5123:61
Ohio Administrative Code Reference: 5123:2-1-02(L)(1)
Superintendent Approved: 5/18/03
Superintendent Amended:
• I. Reporting of all Accidents and Incidents
All accidents and incidents shall be documented (NUR-05) and reported to the individual's parent(s)/guardian(s)/care provider. All accident and injury reports shall be submitted to the Safety Committee for analysis and recommendations for prevention in the future. The accident or incident report shall be initiated within twenty-four hours of when the accident or incident occurred.
• II. Illness Reports
• Adult Services
Illnesses occurring on Board property or while being involved in an activity under the authority of the Board and any applicable reports (HI-NUR-01) will be initiated within twenty-four hours of occurrence to all involved parties. All applicable report forms shall be completed.
All illnesses are reported to the individuals' parent(s)/guardian(s)/care provider if applicable. Residential providers will also receive a copy of the completed written report as soon as possible. Illnesses of a serious nature shall be reported to the immediate supervisor of the staff member completing the report, or another member of the management team.
• Early Childhood Services
The Hopewell School Student Handbook outlines provisions for injuries or illnesses. All accidents or injury's to children are to be reported in writing to the School Superintendent. Illnesses/Accidents are reported to the child's parent(s)/guardian(s) or care provider.
• III. Absenteeism
• IV. Major Unusual and Unusual Incident Reports
Recording of all major unusual and unusual incident reports by staff shall conform to the policies and procedures specific to MUI's and UI's. (Policy number 15.0 and 15.1)
• V. Providing Routine First Aid Treatment
Routine medical First Aid treatment shall be provided and documented for ill or injured individuals, as appropriate, by a trained staff member.
Staff trained to administer First Aid and CPR treatment shall provide routine treatment within the scope of their training and follow the Board's Bloodborne Pathogens procedures.
• VI. Emergency Treatment, Securing Emergency Squad and Ambulance Services or Personal Physician
If transport for emergency care is warranted the procedures for emergency treatment will be followed.
In the event of an emergency, the following guidelines apply:
• Check the scene and individual.
• Page for assistance if needed.
• Once it's determined Emergency Medical Services (EMS) is needed, have a staff person knowledgeable of the situation make the 911 call to request an ambulance and indicate to 911 operator which door EMS should use upon arrival.
• Have a nurse care for the ill/injured individual using American Red Cross First Aid guidelines as trained.
• The individual's emergency medical authorization form will be sent to the hospital with the individual.
• As soon as time permits staff first responding to the situation should begin the incident report per program procedures.
Emergency building procedures at the Hopewell School and Hopewell Industries, Inc., outline procedures for emergency treatment.
• VII. First Aid and CPR Training to Appropriate Certified, Registered and Licensed Staff
All registered, certified, and licensed staff designated by position description or by statutory program requirements shall receive First Aid and CPR training as terms of their employment with the Board by a valid First Aid and CPR instructor. First Aid and CPR training shall be kept current by all designated registered, certified and licensed staff as terms of their continued employment with the Board with First Aid training every three years and CPR yearly.
• VIII. First Aid Facilities, Equipment, and Supplies
The program shall designate an area in each facility for First Aid treatment. Appropriate First Aid supplies and equipment will be maintained in all facilities and vehicles operated by the Board. First Aid supplies and equipment shall be adequate to address all routine and initial emergency situations until professional help arrives. A Program Director or designee shall conduct regular audits of the First Aid supplies and equipment to ensure it is available to handle routine and emergency situations.
• IX. Training Personnel in the Recognition of and Reporting of Abuse and Neglect
All staff employed at the Board shall be trained in the recognition of abuse and neglect and reporting requirements upon hire and every three years thereafter taught by RN.
• X. Providing for Management of Communicable Diseases
Individuals receiving services and employees of the Board may come in contact with minor or serious illnesses as a condition of enrollment or employment.
The following practices have been established by the Board:
• Initial and annual training will be done for all staff on the Board bloodborne pathogen policy and procedure, per Federal OSHA regulations, as well as communicable diseases. This includes routine use of universal precautions to control the spread of communicable disease, modes of transmission, recognition and prevention of common and uncommon communicable disease.
In cases of diagnosed communicable disease individuals, parents/guardians/care providers may be notified as appropriate. The decision related to informing others of the infection will be made by the Superintendent or designee.
Temporary exclusion for individuals with specific communicable disease or conditions will adhere to the Ohio Department of Health published communicable disease guidelines, in addition to guidelines contained in Adult and Early Childhood Services program handbooks.
Every effort will be made to isolate ill individuals until parents/guardians/care providers can be contacted to transport from the facility. Guidelines for returning to program services will be communicated to all individuals per the applicable program handbook.
• XI. Posting of Emergency Numbers by Phones
Emergency telephone numbers are posted by each phone in Board operated facilities.
• XII. Health Care Records and Emergency Medical Treatment Authorization
Current health information shall be on file for each individual receiving services as required by rules and regulations specific to each program. This health information may include, but not be limited to: diagnosis, authorization for emergency medical treatment (NUR-01), a record of current immunizations (NUR-03), a current list of medications, and a list of any allergies and treatments.
A nursing assessment shall be done by the program nurse for individuals attending Hopewell Industries, (NUR-08), no less than once per year to evaluate and update any health-related issues.
Request for special tasks or administration of medication shall follow the Board Policies and Procedures (1.0, 1.1, 1.2, 1.3, 1.4 and 1.5) specific to administration of medications and task delegation.
Emergency medical authorization forms (NUR-01) shall be updated annually and copies distributed to all applicable service providers including the transportation department in the event of an accident or injury occurring in transit. Emergency medical authorization forms shall accompany individuals on outings with Board staff.
• XIII. Notice of Written Policies and Procedures to all Personnel, Persons Served and Parents/Guardians/Care Providers and Residential Service and/or Support Providers
These written policies and procedures shall be communicated to all personnel, persons served, parents of a minor or guardians, and residential services, support providers and shall be made available in each program facility upon request.
Notification shall occur annually and at intake or enrollment into Board programs and services.
Forms Used with this Procedure:
Hopewell School Student Handbook provisions for injuries or illnesses
NUR-01 Emergency Medical Authorization
NUR-03 Immunizations
NUR-05 Accident/Incident Report
NUR-08 HI Annual Employee Medical Assessment
NUR-16 Request for Current Medical Information
NUR-17 Change of Medical Information
NUR-18 Medication Change Form
HI-NUR-01 Employee Illness Report
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Coshocton County Board of
Developmental Disabilities
Policy: Safety and Building Emergency Plans Policy
Policy Number: 3.0
Ohio Revised Code Reference:
Ohio Administrative Code Reference: 5123: 2-1-02 (K)(1-9)
Board Approved: 05-15-2003
Board Amended:
I. Policy
Safety is the first priority in the delivery of services and supports of every staff employed by the Board. During the decision making process of each day, safety must guide and rule every action. Each staff person is responsible to account for the safety and whereabouts of each individual under their authority. This responsibility does not end until another authorized person assumes that obligation.
II. Staffing Qualifications and Training
A. All board staff shall have credentials as required by the appropriate state agency or licensing board before providing services or supports to individual or individuals and their families.
B. In the event of establishment of a swimming program operated directly or through contract by the Board, a person shall be present possessing either a current water safety instructor certificate, or a senior lifesaving certificate, or adapted aquatics certificate.
C. All staff shall successfully complete background checks, driver's abstracts (where the position requires) and drug test prior to employment. Staff shall receive training in specialized areas such as recognition and reporting of abuse and neglect, reporting of unusual incidents, delegated nursing training for applicable board workers and any other specialized training required to ensure the safety of those receiving services and supports.
D. At least one staff member shall be trained in techniques of fire suppression at each facility operated by the Board.
III. Practicing Safety
A. The Board shall have systems in place to increase the likelihood of successful evacuations of the facilities in the event of emergencies or natural disasters and lessen the risks to all persons being served including staff. Building evacuation drills will be conducted as required by the Administrative Code and be conducted as outlined in building emergency plans.
B. The Board shall initiate practices of tracking and analyzing unusual incidents, major unusual incidents to identify patterns and trends for the purpose of recommending preventive measures.
C. A safety committee shall be composed and regularly meet for the purpose of addressing safety needs in the program. Special attention shall be directed to the review of any accident reports for the purpose of initiating recommendations to prevent reoccurrence.
IV. Facilities
Each facility owned or operated by the Board shall be inspected in accordance with applicable local and state entity rules and regulations. Facilities shall conform to the design and be equipped in conformance with all applicable laws including the Americans with Disabilities Act and Section 504 if the Rehabilitation Act of 1973.
V. Review and Adoption of Policies and Procedures
This Policy shall be maintained on file in the administrative offices and reviewed and updated as needed.
The Coshocton County Board of DD authorizes the superintendent to develop and implement written procedures consistent with the Board policy and applicable rules, regulations and statues.
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Coshocton County Board of
Developmental Disabilities
Policy Reference: Safety and Building Emergency Plans Procedures
Policy Number: 3.1
Ohio Revised Code Reference:
Ohio Administrative Code Reference: 5123: 2-1-02 (K)(1-9)
Superintendent Approved: 5/18/2003
Superintendent Amended: 07/28/2003, 11/14/2003, 03/06/2007
I. Inspections of Facilities and Vehicles
A. An annual fire inspection of all Board owned and leased facilities shall be conducted by the local Fire Marshall or designee.
B. In accordance with transportation policies and procedures, the State Highway Patrol shall inspect all buses annually.
C. All inspections shall be documented and any recommendations implemented upon receipt of written or verbal reports from the inspectors or surveyors.
D. All fire extinguishers and alarms shall be properly located, identified and kept in good working order and inspected no less than once per year.
E. At least one staff member shall be trained in techniques of fire suppression at each facility operated by the Board.
F. Storage of combustibles or flammable materials shall effectively be separated from all rooms or work areas in such a manner to inhibit the spread of fire. At the fire inspections, the Marshal or designee shall be asked to review the storage areas to ensure they are safe and adequate.
G. The building supervisor is responsible to ensure all hallways, entrances, ramps and corridors are kept clear and unobstructed at all times.
H. Power equipment, fixed or portable, should include operating guards as required by the operator's manuals or in compliance with OSHA and the Division of Safety and Hygiene, Bureau of Workers' Compensations standards for safety.
I. The County Board will contract with qualified licensed electricians to perform all electrical work.
J. All staff are trained annually in lock out tag out, safety precautions, and electrical hazard recognition and reporting.
K. The chairperson of the Safety Committee has the authority to conduct periodic safety reviews (SAF - 04) of facilities and notify the building supervisor to correct any potential safety issues. The safety director shall keep the Superintendent apprised of any potential safety issues.
L. At any time a staff member or enrollee suspects there may be a safety issue of any type, they are encouraged to contact the safety chairperson or building supervisor to notify them of the concern. A suggestion box is also available at each board site.
II. Facility Drills
A. At all Board facilities, fire drills shall be conducted at least once per month. There shall be at least two exit fire drills during the first two weeks of a school term. Results of the drills shall be documented (SAF - 01) by a designated staff member and submitted to the Safety Committee to review the effectiveness of the exercise. All written reports and analysis shall be submitted to the Superintendent or their designee.
B. At all Board facilities, tornado drills shall be conducted in the months of March through November. Results of the drills shall be documented (SAF - 02) by a designated staff member and submitted to the Safety Committee to review the effectiveness of the exercise. All written reports analysis shall be submitted to the Superintendent or their designee.
III. Written Emergency Building Plans
A. The Board utilizes the emergency procedures flip chart located by each phone in the facilities that outline emergency phone numbers and procedures for addressing fire, explosion, hazardous materials, tornado, bomb threats, earthquakes, disaster response procedures, program closings, utility emergencies, first aid, emergencies, and communicable diseases. Egress maps outline safe areas are located at each room at all facilities.
B. The emergency procedures flip chart (SAF - 07) also contains procedures related to emergency closing.
1. In case of early emergency closure due to weather or building emergency all program participants, families and residential providers will be notified in advance if possible of early dismissal for program enrollees.
2. No program participant will be dropped off at their homes without prior contact of family or caregiver, if so indicated in the ISP.
3. If unable to reach the family, emergency contact, or caregiver at the primary phone number staff will ensure a responsible party is available to guarantee the health and safety of the program participant. If initially unable to contact family, emergency contact or caregiver, program participant will remain at the County Board until a family member or caregiver can be contacted. This notice includes families receiving home-based services and persons in other sites receiving or providing services.
IV. Reporting of Accidents and Injuries
A. All accidents and injuries shall be reported within 24 hours of occurrence (NUR - 05). Accident and injury reports shall be submitted to the Safety Committee for analysis and recommendations for prevention in the future.
B. Reporting accidents and injuries shall be in accordance with the Board administrative procedures (2.1) for General Health and Well Being of All Individuals Receiving Services.
C. Health information and special job considerations will be reported to appropriate supervisory personnel.
V. Weapons
A. Individuals and staff are prohibited from bringing firearms or knives, metal knuckles, straight razor, explosives, noxious irritation or poisonous gasses, poisons, drugs and other items possessed with the intent to use, sell, harm, threaten, or harass staff, individuals, parents, volunteers or other community members on Board property, in a Board vehicle, or to any Board sponsored activity.
B. If a staff person or individual brings or displays a dangerous weapon on Board property, in a Board vehicle or at any Board sponsored activity, the following procedures will apply:
1. Call sheriff, as determined by the Superintendent or designee;
2. Do not attempt to disarm;
3. Clear the area or evacuate the facility.
C. Notwithstanding, tools such as pocket knives, scrapers, utility knives, banding cutters or other tools are permitted provided they are required to perform a task assigned and used solely for the intended purposes, and not for intimidation nor as a weapon.
VI. Threats
A. Any threat shall be reported. If an individual tells a staff member they want to do bodily harm to someone or themselves, the staff members shall document the threat on an incident report form (NUR - 05) and immediately hand deliver it to their supervisor.
B. At no time can a threat be ignored.
C. When a threat of serious nature has been documented and submitted, the supervisor shall notify the Superintendent or designee.
D. The Superintendent or designee will decide if it should be reported to law enforcement for necessary follow-up.
E. The contact of law enforcement shall be documented on the incident form specifying the date it was reported and to whom.
VII. Communication of Emergency Building Plans and Safety Procedures
A. Building emergency plans and safety policies and procedures shall be available and communicated to all members of the staff.
B. Emergency procedures are located near each phone at all facilities operated by the Board outlining plans to address all emergencies. (SAF - 07)
C. Staff is required to become familiar with the content of the emergency procedures and the Board policies and procedures specific to safety.
D. Emergency procedures and safety policies and procedures are reviewed with new employees at formal orientation provided by the Board.
E. Any revision to the emergency building plans or policies and procedures are communicated to staff via inservice or memo.
VIII. Safety Committee
A. Membership
1. The Superintendent shall appoint 5 members to the Safety Committee.
2. Appointees shall include:
a. Safety Coordinator
b. One representative from each building
c. Individual receiving service
3. The Safety Coordinator serves as chairperson of the committee
4. Appointees serve on committee at Superintendent discretion.
B. Duties
1. Review accident reports and initiate recommendations of prevention at a future time, including communication of health information and special job considerations to appropriate supervisory personnel.
2. Conduct periodic safety reviews of facilities. (SAF - 04, SAF - 08, SAF - 09)
3. Address safety issues referred by staff or enrollees (see I.I.) (SAF - 06)
4. Review facility drills for effectiveness. (SAF - 05)
5. Periodically review written building emergency plans and submit recommendations to the Superintendent.
6. Annually review policy and procedure for Safety and Building Emergency Plans and submit recommendations to the Superintendent.
7. Initiate the annual review of these procedures by all staff.
8. Establish a regular meeting schedule and maintain records of meetings.
Forms used with this procedure:
Accident/Incident
Drill Reports
NUR - 05 Accident/Incident Report
SAF - 01 Fire Drill Record
SAF - 02 Tornado Drill Record
SAF - 03 Safety Committee Meeting Agenda
SAF - 04 Permanent Safety Fixtures
SAF - 05 Emergency Plan/Drill Analysis
SAF - 06 Request for Maintenance
SAF - 07 Emergency Procedures Booklets
SAF - 08 HI Walk Through Checklist
SAF - 09 HS Walk Through Checklist
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Coshocton County Board of
Developmental Disabilities
Policy: Delegated Nursing including Administration of Medication Services Policy
Policy Number: 1.0
Ohio Revised Code Reference: 5126.35, 5126.351, 5126.352
Ohio Administrative Code Reference: 5123: 2-1-07
Board Adopted: 1/9/2003
Board Amended:
• PURPOSE
To establish a Health Policy, which ensures that necessary medical treatments and medications are delivered to individuals with mental retardation and/or developmental disabilities by competent, trained staff.
• APPLICATION
This policy applies to all prescribed medical treatments and medications to be delivered by Board staff to individuals with mental retardation and/or developmental disabilities.
• POLICY
• The Coshocton County Board of Developmental Disabilities shall permit the delegation of giving or applying prescribed medication or to perform delegated nursing tasks to employees of the Board who have successfully completed training. Such delegation may be done only by an appropriately trained nurse and only when certain conditions are met, as stipulated in the Ohio Revised Code.
• Furthermore, Board employees may give or apply prescribed medication and/or perform delegated nursing tasks on individuals enrolled in Board services or supports at the following settings:
• Hopewell School
• Hopewell Industries, Inc.
• While transported in a vehicle operated by or under contract with the Board, on field trips conducted in this state by the Board, or when involved in some other activity conducted under the Board's authority that is at a location different from any of the above settings.
C. The Superintendent is authorized to establish procedures to be utilized in the implementation of this policy that will meet the requirements of the Ohio Revised Code and rules established by both the Ohio Department of Developmental Disabilities and the Ohio Board of Nursing. Such procedures shall include, but not be limited to: training for the nurse and Board employees, conditions under which the delegation of giving or applying prescribed medications or the delegation of nursing tasks may occur, and conditions under which a Board employee may perform delegated nursing services.
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Coshocton County Board of
Developmental Disabilities
Policy Reference: Criteria and Standards for Nurses Delegating to Board Workers Procedures
Policy Number: 1.1
Ohio Revised Code Reference: 5126.35, 5126.351, 5126.352
Ohio Administrative Code Reference: 5123:2-1-07
Superintendent Approved: 1/11/03
Superintendent Amended:
A. Assessment. Before any delegation of medications/nursing tasks may be done, a registered nurse shall complete the following:
1. A Student/Employee Medical Assessment (NUR - 28) of the current health status of the individual on whom the tasks is to be performed and a determination that it is delegable and the health status of the individual will not be adversely affected by the delegation of the nursing task to the Board worker. A visual assessment of the conditions at the setting related to the delegation of nursing tasks shall be included noting any needs on the Student/Employee Medical Assessment (NUR - 28). This Nursing Assessment shall be conducted whenever there is a change in health status, site, or a physician/health care professional authorization and at a minimum of twice a year.
2. The Nursing Assessment shall include an assessment of the individual who needs nursing care, the types of nursing care (s)he requires, the amount and the nature of the assessment(s) performed by other licensed health care professionals, and the training and skills of the Board worker who will have the medications/nursing tasks delegated to them. If the Nursing Assessment indicates that the requirements established can be met, then the medication/nursing task may be delegated to the Board worker by the nurse.
3. The Nursing Assessment shall determine if direct supervision with the licensed nurse available on site is needed or if indirect supervision provided by a licensed nurse who is always accessible via some form of telecommunication is needed. Factors to be considered in making this determination are:
a. The number of individuals who require nursing tasks and the medical condition of the individuals.
b. The types and number of nursing tasks that will be delegated.
c. The consistency, dependability, and reliability of the trained Board workers who will be performing the delegable nursing tasks;
d. If the licensed nurse is assuming responsibility for more than one setting, the distance between settings, the accessibility of each setting, and any unusual traffic problems that may be incurred in reaching each setting;
e. The availability of emergency aid should the nurse be too far from the setting to get there in a timely manner; and
f. If on-site supervision is provided, Board workers shall have immediate access to an intercom phone with the capabilities of broadcasting the need for the nurse immediately.
B. A registered nurse may delegate delegable nursing tasks directly to the trained Board worker who is to perform the nursing task or may delegate a portion of the overall care to a licensed practice nurse (LPN) who may then delegate the delegable nursing tasks to trained Board worker who is to perform them. A licensed practical nurse may delegate delegable nursing tasks only at the direction of a registered nurse.
C. A licensed nurse is not responsible for the delegation performed by another licensed health care professional to a Board worker.
D. A licensed nurse shall make the decision to delegate delegable nursing tasks to trained Board workers based on nursing knowledge. A nursing task is delegable if the registered or the licensed practical nurse, at the direction of a registered nurse delegating the task, determines that all of the following apply:
1. The task requires no nursing judgment on the part of the trained Board worker performing the task;
2. The results of the task are predictable;
3. The task can be safely performed according to exact, unchanging directions, with no need to alter the standard procedures for performing the task;
4. Performance of the task does not require that compact and acute observations and decisions be made;
5. There are no safety concerns with regard to the frequency of performing the task; and;
6. The consequences of interrupting the performance of the task or improperly performing the task are minimal and not life threatening.
E. The delegating nurse shall ensure:
1. That the resources necessary for giving oral and/or applying topical prescribed medications are available on site to the Board workers;
2. That step by step written directions for all delegable nursing tasks to be performed by the Board workers are available on site;
3. That information about accessing the licensed nurse is available to the Board workers (this should include phone numbers);
4. That a system used for procuring back-up nursing supervision is available to Board workers;
5. The emergency systems available to the site are listed and available to Board workers;
6. That secure storage for medications and the documentation of the giving of oral and/or applying of topical prescribed medications are available;
7. That ongoing monitoring of compliance with the applicable laws, rules, and policies is provided, at a minimum, during quarterly visits to each site and that this monitoring is documented; and
8. That regular and ongoing communication with the delegated nurse and all Board workers performing delegated medication/nursing tasks occurs and is documented at least once a month. Documentation shall be maintained by the delegating nurse.
F. Delegation of each delegable nursing task by a licensed nurse is limited in application to a single specified individual.
G. After a delegable medication/nursing task for an individual is determined to be delegated, the delegating nurse shall:
1. Determine the conditions under which the trained Board worker may perform the task as listed in Student/Employee Medical Assessment (NUR - 28).
2. Ensure that the Feeding In Lunchroom (NUR - 21) and Toileting/Hygiene (NUR - 22) is available at all times to the trained Board worker. The trained Board worker performing the task shall follow the instructions for the task in the same manner each time the task is performed and shall document the performance of the task.
3. Ensure that supervision is available for the trained Board worker who will be performing the delegable nursing task. The trained Board worker shall not perform the delegated task unless at least indirect supervision is available (this means that the nurse can be reached by telecommunication when out of the building) and they may perform the task only on the individual specified by the delegating nurse; and
4. Withdraw delegation if the trained Board worker is not performing the tasks according to his/her training.
H. Board workers shall not delegate any nursing task.
Forms used with this procedure:
NUR-21 Feeding in the Lunchroom
NUR-21 Toileting/Hygiene
NUR-28 Student/Employee Medical Assessment
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Coshocton County Board of
Developmental Disabilities
Policy Reference: Supervision of the Performance of Nursing Tasks by Trained Board Workers Procedures
Policy Number: 1.2
Ohio Revised Code Reference: 5126.35, 5126.351, 5126.352
Ohio Administrative Code Reference: 5123:2-1-07
Superintendent Approved: 1/11/03
Superintendent Amended:
A. Delegation and supervision of trained Board workers in the performance of delegable nursing tasks shall be performed by a licensed nurse with the following qualifications:
1. Completion of an approved professional or practical nursing education program;
2. Current active licensure in Ohio to practice as a registered nurse or a licensed practical nurse;
3. Certification of training of completion of the "Train the Instructor Program" for RN which shall be maintained in the certification file;
4. Knowledge of the appropriate sections of the revised code and the administrative code;
5. Familiarity with the nursing care needs of individuals supported by MRDD Boards; and
6. Employment, by, contracted, or in an agreement with, the Board to delegate to and supervise the performance of delegated nursing tasks inclusive of giving oral and/or applying topical prescribed medications by trained MRDD Board workers.
B. Licensed practical nurses who delegate to and supervise Board workers in the performance of nursing tasks shall work at the direction of a registered nurse that is always available via telecommunication.
C. When supervision is provided, the registered nurse shall:
1. Ensure the reassessment of the skills of the Board workers by him/herself or the delegating nurse at least twice a year.
Forms used with this Procedure: None
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Coshocton County Board of
Developmental Disabilities
Policy Reference:
Policy Number: 1.3
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Coshocton County Board of
Developmental Disabilities
Policy Reference: Storage and Administering Medications Procedures
Policy Number: 1.4
Ohio Revised Code Reference: 5126.35, 5126.351, 5126.352
Ohio Administrative Code Reference: 5123:2-1-07
Superintendent Approved: 1/11/2003
Superintendent Amended:
All provisions for administration of medication by unlicensed Board workers shall adhere to the Board Procedures for Delegation of Nursing Tasks including the giving or applying of medications.
All medications received at Board operated facilities shall be pharmacy-labeled to indicate the owner, contents, required dosage, schedule, Doctor and method of administration. Such medication shall be secured in a locked cabinet and handled only by designated staff persons.
At Hopewell School when medications are delivered, they should be given to a Board nurse. If a nurse is not in the building, the following Board staff may accept the incoming medication:
- Principal
- Fiscal Supervisor
- Fiscal Assistant
Upon accepting medications, the staff member will place the medication in the locked medication cupboard, making sure the lock is secure when finished. The staff member will notify the RN or LPN that medications were delivered and placed in the medication cupboard. The RN or LPN will check in the medication prior to staff dispensing the medication, and prepare a medication administration record as needed. The LPN can do this if the RN is unavailable.
At Hopewell Industries when medications are delivered, they should be given to a Board nurse. If a nurse is not in the building, the following Board staff may accept the incoming medication:
- Workshop Director
- Secretary Staff ( not including subs)
- Managers
Upon accepting medications, the staff member will ask the individual delivering the medications if the medication has changed. If the delivery person acknowledges a change, the delivery person (e.g. supported living provider) shall put the change in writing to be left with the medication. A Board nurse shall check and verify all medications coming into the building with existing orders. Any other Board staff member accepting medications shall not be responsible for checking medications.
1. Staff shall immediately place medication in locked cabinet.
2. Leave a message for the nurse indicating medication has arrived, is secured, and needs to be removed and secured by them
***Note: If the nurses are out of the building and a medication change or newly prescribed medication and order are brought to Hopewell School/Hopewell Industries, please note that the medication CAN be locked up, but CANNOT be given until a Board nurse has checked the order and medication, and prepared an official medication administration record. This may require the parent/guardian/care provider to administer the medication the initial day and/or up to a few days.
***Note: If all above mentioned Board staff are unavailable to accept medications, the individual delivering them will need to bring them back at a later time.
Forms Used with this Procedure:
NUR-14 Nursing/Medication Chart
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Coshocton County Board of
Developmental Disabilities
Policy Reference: Authorization for Medication/Nursing Tasks Procedures
Policy Number: 1.5
Ohio Revised Code Reference: 5126.35, 5126.351, 5126.352
Ohio Administrative Code Reference: 5123:2-1-07
Superintendent Approved: 1/11/03
Superintendent Amended:
General
1. A physical signed by a physician which is current within six (6) months is to be submitted upon enrollment to Adult Services. For Children's Services, a physical signed by a physician must be current within three (3) months of placement. The Coshocton County Board of DD Medical Evaluation (NUR - 09) can be used. For individuals receiving medications of nursing tasks performed by the board nurse or delegated employees, this physical shall be updated annually. The Emergency Medical Authorization form (NUR - 01) are to be updated annually, and as changes occur and will be submitted to the nurse.
2. Nurses and/or authorized Board workers are not permitted to assume responsibility for giving and/or applying any medication or completing any nursing tasks unless the Emergency Medical Authorization (NUR - 01) is received.
3. A Permission to Administer Medication (NUR - 07) and/or a Medical Procedure Permission (NUR - 10) or Request for Nursing and Delegated Nursing Service (NUR - 18) must be signed by the physician or health care professional, and parent or guardian. Prior to giving and/or applying any medication or performing any delegated nursing task by any board worker, this form must be completed and submitted to the nurse.
4. A Permission to Administer Medication form (NUR - 07) and/or a Medical Procedure Permission (NUR - 10) or Request for Nursing and Delegated Nursing Service (NUR - 18) are valid for a maximum of one (1) year. At the end of that time, a new form must be obtained.
5. Any change of medication/nursing task requires a Permission to Administer Medications form (NUR - 07) or Medical Procedure Permission form (NUR - 10) or Request for Nursing and Delegated Nursing Service (NUR - 18) must be submitted.
6. All forms must be entirely completed upon submission to Coshocton County Board of DD staff or they will be returned to the individual/responsible party for completion as required.
a. A Statement of Delegation form (NUR - 30) is to be completed and signed by the delegating registered nurse indicating Board workers authorized to give or apply medications or perform the nursing task specified.
b. In a rare emergency situation, orders for a change in medications/nursing tasks can be made when the nurse discusses this change directly with the health care professional over the telephone. The nurse can accept this in lieu of a Permission to Administer Medications Form (NUR - 07) and/or Medical Procedure Permission form (NUR - 10) and writes a verbal order on the Permission to Administer Medications form (NUR - 07) and/or Medical Procedure Permission form (NUR - 10). The completed Permission to Administer Medications form (NUR - 07) and/or Medical Procedure form (NUR - 10) from the health care professional must arrive within five (5) working days. If not received by this time, the nurse will follow-up and determine if further verbal authorization will be accepted.
c. When the giving and/or applying of medications or the performing of a nursing tasks has been delegated to a trained Board worker, the Board worker shall have access to a copy of all up-to-date authorization forms applicable to each individual's medications or task required.
Forms used with this procedure:
Emergency Medical Authorization (NUR - 01)
Permission to Administer Medication (NUR - 07)
Medical Procedure Permission (NUR - 10)
Request for Nursing and Delegated Nursing Service (NUR - 18)
Medical Evaluation (NUR - 09)
Statement of Delegation (NUR - 30)
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Coshocton County Board of
Developmental Disabilities
Policy : Incidents Adversely Affecting Health and Safety Policy
Policy Number: 15.0
Ohio Revised Code Reference: 5123.61, 5123:044, 1.14, 149.43, 2151.03, 2151.031, 2151.421, 2901.01, 2907.01, 2911, 2913, 5123:171, 5123.19, 5123.51, 5123.604, 5124.61, 5123.62, 5126.02, 5126.22, 5126.221, 5126.25, 5126.281, 5126.431
Ohio Administrative Code Reference: 5123: 2-17-01 , 5123: 2-17-02.
Board Adopted: 04-10-2003
Board Amended :
I. SUBJECT - INCIDENTS ADVERSELY AFFECTING HEALTH AND SAFETY
II. PURPOSE
A. The purpose of this policy is to promote a process to address incidents that adversely affect the health and safety of individuals. The policy and procedures should:
• Promote the prompt and accurate reporting of each occurrence of any incident;
• Guard against a future recurrence through education of the staff and those individuals served by the Board;
• Facilitate preventive actions that should be taken to assist in ensuring health and safety of individuals.
B. It shall be the responsibility of each service provider, each entity providing services and the governing authority of each entity to ensure the health and safety of the individual. Assurance of health and safety of the individual will be the priority and focus of any and all services provided from any source.
III. APPLICATION
This policy shall apply to the Board and all providers. "Provider" means all persons and entities that provide specialized services, as defined in Section 5126.281 of the ORC, and that are subject to regulation by the Department regardless of payment source, including a respite care provider certified under Section 5123.171 of the ORC, a provider licensed under Section 5123.19 of the ORC or certified under Section 5126.431 of the ORC, or a provider approved to provide Medicaid services under Home and Community Based Services Waivers administered by the Department. Provider also includes a Board when providing the services or Board contracting entity as defined in Section 5126.281 of the ORC. Nothing in the policy shall relieve any person of responsibility to comply with their duty to report as contained within 5123.61 of the ORC.
IV. POLICY
A. Responsibility of Certain Persons to Report Incidents
1. The Board requires that any person listed below, who has reason to believe that a person with mental retardation or a developmental disability has suffered any wound, injury, disability, or condition of such a nature as to reasonably indicate abuse or neglect of that person, shall immediately report or cause reports to be made of such information to a law enforcement agency or to the Board. If the report concerns a resident of a facility operated by the Ohio Department of Mental Retardation and Developmental Disabilities the report shall be made either to a law enforcement agency or the Department. (5123.61 ORC)
2. As used in the preceding paragraph "person" means:
a. Board member, superintendent, or any other employee of the Board; or
b. Board member, administrator, or employee of a residential facility licensed by ODMRDD;
c. Board member, administrator, or employee of any other public or private provider of services to a person with mental retardation or a developmental disability;
d. An individual who is employed in a position that includes providing specialized services to an individual with mental retardation or a developmental disability;
e. Any DD employee as defined in 5123.50 O.R.C. (5123.61 ORC)
3. Reports required under this policy shall be made forthwith by telephone or in person and shall be followed by a written report. The reports shall contain the following:
• The names and addresses of the person with mental retardation or a developmental disability and the person's custodian, if known; the age of the person with mental retardation or a developmental disability; and any other information that would assist in the investigation of the report.(5123.61 ORC)
5. Any person or any hospital, institution, school, health department, or agency participating in the making of reports pursuant to 5123.61 ORC, any person participating as a witness in an administrative or judicial proceeding resulting from the reports, or any person or governmental entity that discharges responsibilities under sections 5126.31 to 5126.33 of the Revised Code shall be immune from any civil or criminal liability that might otherwise be incurred or imposed as a result of such actions except liability for perjury, unless the person or governmental entity has acted in bad faith or with malicious purpose. (5123.61 ORC)
6. No employer or any person with the authority to do so shall discharge, demote, transfer, prepare a negative work performance evaluation, reduce pay or benefits, terminate work privileges, or take any other action detrimental to an employee or retaliate against an employee as a result of the employee's having made a report under 5123.61 ORC. This division does not preclude an employer or person with authority from taking action with regard to an employee who has made a report under this section if there is another reasonable basis for the action. (5123.61 ORC)
7. Reports made under this section are not public records as defined in section 149.43ORC. Information contained in the reports on request shall be made available to the person who is the subject of the report (not the perpetrator (PPI)), to the person's legal counsel, and to agencies authorized to receive information in the report by the board.
B. Review of Reports
1. The Board shall review reports of abuse and neglect made under 5123.61 ORC and reports referred to it under 5101.611 ORC to determine whether the person who is the subject of the report is an adult with mental retardation or a developmental disability in need of services to deal with the abuse or neglect. The Board shall give notice of each report to the registry office of ODMRDD pursuant to 5123.61 ORC on the first working day after receipt of the report. If the report alleges that there is a substantial risk to the adult of immediate physical harm or death, the board shall initiate review within twenty-four hours of its receipt of the report. If the board determines that the person is sixty years of age or older but does not have mental retardation or a developmental disability, it shall refer the case to the county department of job and family services. If the board determines that the person is an adult with mental retardation or a developmental disability, it shall continue its review of the case (5126.031 ORC)
• For each review over which the board retains responsibility it shall do all of the following:
a. Give both written and oral notice of the purpose of the review to the adult and, if any, to the adult's legal counsel or caretaker, in simple and clear language;
b. Visit the adult, in the adult's residence if possible, and explain the notice given above;
• Request from the registry office any prior reports concerning the adult or other principals in the case;
• Consult, if feasible, with the person who made the report under section 5101.61 or 5123.61 ORC and with any agencies or persons who have information about the alleged abuse or neglect;
• Cooperate fully with law enforcement agency responsible for investigating the report and for filling any resulting criminal charges and, on request, turn over evidence to the agency;
• Determine whether the adult needs services, and prepare a written report stating reasons for the determination. No adult shall be determined to be abused, neglected, or in need of services for the sole reason that, in lieu of medical treatment, the adult relies on or is being furnished spiritual treatment through prayer alone in accordance with the tenets and practices of a church or religious denomination of which the adult is a member or adherent (5126.031 ORC).
3. The board shall arrange for the provision of services for the prevention, correction or discontinuance of abuse or neglect or of a condition resulting from abuse or neglect for any adult who has been determined to need the services and consents to receive them. These services may include, but are not limited to, service and support administration, fiscal management, medical, mental health, home health care, homemaker, legal, residential services and the provision of temporary accommodations and necessities such as food and clothing. The services do not include acting as a guardian, trustee, or protector as defined in 5123.55 ORC. If the provision of residential services would require expenditures by ODMRDD the board shall obtain the approval of ODMRDD prior to arranging the residential services (5126.031 ORC). To arrange services, the board shall:
• Develop an individualized service plan identifying the types of services required for the adult, the goals for the services, and the persons or agencies that will provide them;
• In accordance with rules established by the director of mental retardation and developmental disabilities, obtain the consent of the adult or the adult's guardian to the provision of any of these services and obtain the signature of the adult or guardian on the individual service plan. An adult who has been found incompetent under Chapter 2111 of the Revised Code may consent to services. If the board is unable to obtain consent, it may seek, if the adult is incapacitated, a court order pursuant to 5126.33 ORC authorizing the board to arrange these services.
4. The board shall ensure that the adult receives the services arranged by the board from the provider and shall have the services terminated if the adult withdraws consent.
• On completion of a review, the board shall submit a written report to the registry office established under 5123.61 ORC. If the report includes a finding that a person with mental retardation or a developmental disability is a victim of action or inaction that may constitute a crime under federal law or the law of this state, the board shall submit the report to the law enforcement agency responsible for investigating the report. Reports prepared under this section are not public records as defined in 149.43 ORC. (5126.031 ORC)
6. The board shall provide comprehensive formal training for employees and other persons authorized to implement the requirements of this section. (5126.031 ORC)
C. Review of Reports by Another Entity
Notwithstanding the requirement of 5126.31 ORC that a board review reports of abuse and neglect, one of the following government entities, at the request of the board shall review the report instead of the board if circumstances specified in rules adopted by ODMRDD exist:
• Another county board of mental retardation and developmental disabilities;
• The department;
• A regional council of government established pursuant to Chapter 167. of the Revised Code;
• Any other government entity authorized to investigate reports of abuse and neglect. (5126.311 ORC)
D. Determination of Investigation
After reviewing a report of abuse and neglect under section 5126.31 ORC or a report of a major unusual incident made in accordance with rules adopted under 5123.612 ORC the board shall conduct an investigation if circumstances specified in rules adopted by ODMRDD exist. If the circumstances specified in the rules exist, the board shall conduct the investigation in the manner specified by the rules. (5126.313 ORC)
E. Denial or Obstructing Access to Residence
1. If during the course of the review conducted under 5126.31 ORC or the investigation conducted under 5126.313 ORC, any person denies or obstructs the board's access to the residence of the adult who is the subject of the review or investigation, the board may file a petition with the probate court of the county in which the residence is located for a temporary restraining order, in accordance with Civil Rule 65, to prevent the denial or obstruction of access. If the court finds reasonable cause to believe that the adult is abused or neglected and that access to the adult's residence has been denied or obstructed, the court shall issue a temporary order restraining the interference or obstruction. After the order has been obtained, at the request of the board, an officer of the law enforcement agency investigating the report shall accompany representatives of the board to the adult's residence.
2. If the person refuses to allow or interferes with the provision of services described in 5126.31 ORC to an adult who has consented to them, the board may file a petition with the probate court of the county in which the adult resides for appropriate injunctive relief in accordance with Civil Rule 65. (5126.32 ORC)
F. Investigation of Incidents by MEORC/MUI Advisory Council
The Board will contract with MEORC/MUI Advisory Council for the investigation and review of incidents to be done in accordance with 5126.221 ORC and other applicable federal and state statues, rules and regulations, including Board policy.
G. Confidentiality
Staff are bound by confidentiality. Major unusual incident reports, and information within the reports, shall not be shared with other staff or anyone else. Staff shall ensure reports, and/or information within the reports, are released to the appropriate parties. Employees should refer all persons requesting such information to the appropriate program Director.
H. Development of Procedures to Implement this Policy
The Board authorizes the Superintendent and or designee to develop and implement written procedures consistent with Board policy and applicable rules, regulations and statutes. Such procedures shall include: notification and reporting requirements for major unusual incidents; investigating major unusual incidents; review, remedy, and prevention of major unusual incidents; analyzing major unusual incidents to identify patterns and trends; unusual incidents; access to records; oversight of major unusual incidents and unusual incident requirements; and training and technical assistance. Such procedures shall also address providers as defined in the application section of this policy.
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Coshocton County Board of
Developmental Disabilities
Policy Reference : Incidents Adversely Affecting Health and Safety Procedures
Policy Number: 15.1
Ohio Revised Code Reference: 5123.61, 5123:044, 1.14, 149.43, 2151.03, 2151.031, 2151.421, 2901.01, 2907.01, 2911, 2913, 5123:171, 5123.19, 5123.51, 5123.604, 5124.61, 5123.62, 5126.02, 5126.22, 5126.221, 5126.25, 5126.281, 5126.431
Ohio Administrative Code Reference: 5123: 2-17-01 , 5123: 2-17-02 .
Superintendent Adopted: 04-11-2003
Superintendent Amended:
I. APPLICATION
A. This procedure applies to all providers. "Provider" means all persons and entities that provide specialized services, as defined in Section 5126.281 of the ORC, and that are subject to regulation by the Department regardless of payment source, including a respite care provider certified under Section 5123.171 of the ORC, a provider licensed under Section 5123.19 of the ORC or certified under Section 5126.431 of the ORC, or a provider approved to provide Medicaid services under Home and Community Based Services Waivers administered by the Department. Provider also includes a Board when providing the services or Board contracting entity as defined in Section 5126.281 of the ORC.
B. All provider and Board staff shall receive training on incidents adversely affecting health and safety at the time of initial employment and annually thereafter under section (5123:2-17-02 OAC). The Board shall ensure that the staff responsible for conducting investigations receive annual Department approved training.
II. DEFINITIONS
A. General
1. "Board" means the Coshocton County Board of Developmental Disabilities
2. "Department" means the Ohio Department of Mental Retardation and Developmental Disabilities
3. "Individual" means a person with mental retardation and/or developmental disabilities
4. "MEORC MUI OFFICE/MEORC" means the Mid-East Ohio Regional Council of Government Major Unusual Incident Office of Investigation and Review and/or its employees/investigative agents.
5. "Working Day" means Monday, Tuesday, Wednesday, Thursday, or Friday, except when that day is a holiday as defined in Section 1.14 of the ORC.
B. Unusual Incidents
"Unusual Incident means an event/occurrence/series of events/occurrences involving and/or affecting an individual or individuals which is/are not consistent with routine operation, policies, procedures or the care and habilitation plan of the individual, but is/are not an incident/incidents or major unusual incident/incidents as defined in this procedure. Administering incorrect medication or failure to administer medication as prescribed shall be considered and reported as an Unusual Incident unless the medication error would other constitute a Major Unusual Incident.
C. Major Unusual Incident
"Major Unusual Incident (MUI)" means the alleged, suspected, or actual occurrence of an incident that adversely affects the health and safety of an individual, including acts committed or allegedly committed by one individual against another individual, and are inclusive of, but not limited to the following:
1. "Abuse" means any of the following:
a. "Physical Abuse" which is defined as the use of physical force that can be reasonably expected to result in physical harm or serious physical harm as defined in ORC 2901.01, including, but not limited to, hitting, slapping, pushing, and/or throwing objects at an individual.
b. "Sexual Abuse" which is defined as unlawful sexual conduct or sexual contact as defined in ORC 2907.01.
c. "Verbal Abuse" which is defined as using words and/or gestures to threaten, coerces, intimidate, harass, or humiliate an individual.
2. "Misappropriation" means depriving, defrauding, or otherwise obtaining the real and/or personal property of an individual by any means prohibited by Section 2911 and 2913 of the ORC.
3. "Neglect" means when there is a duty to do so, failing to provide an individual with any treatment, care, goods, supervision, or services necessary to maintain the health and safety of the individual. (NUR - 23)
4. The death of any individual by any cause.
5. An incident involving an individual that requires the involvement of law enforcement and results in the arrest of, filing charges against, or incarceration of the individual.
6. Attempted suicide by the individual regardless of whether or not any harm resulted.
7. Fire, natural disaster, and/or mechanical failure at any place at which the individual receives services that results in overnight relocation of the individual or an inability to provide the individual with services for at least a twenty-four hour period.
8. An incident in which an individual cannot be located for a period of time longer than eight hours unless one of the following circumstances exists:
a. The individual's plan specifies a different period of time.
b. Prior arrangements have been made for the individual to be gone for a period of time exceeding eight hours; or
c. Other circumstances indicate that the individual is in immediate jeopardy,
d. Including notification of law enforcement.
• "Medical emergency" means the sudden onset of a medical condition that requires emergency medical intervention.
• Any unplanned or unscheduled hospital admission.
• Any injury of an unknown or suspicious origin that requires treatment that only physician, physician assistant, or nurse practitioner can provide or any injury of a known or non-suspicious origin that has a significant impact on the individual's physical health.
12. The use of any behavior support method, including restraint or time-out that is implemented in a manner prohibited by rules promulgated by the Department of by federal regulations or rules.
13. Any violation of the rights enumerated in Section 5123.62 of the ORC that adversely affects the health or safety of an individual.
14. A series of similar unusual incidents establishing a pattern or trend that may have an impact on the health and safety of an individual as determined during the routine review conducted in accordance with these procedures. A pattern is a series of incidents that may have an impact on health and safety. Three incidents in a week or five in a month constitute a pattern or trend.
III. NOTIFICATION AND REPORTING REQUIREMENTS OF MAJOR UNUSUAL INCIDENTS
All providers shall cooperate with all investigations conducted by other entities, and shall respond to all requests for additional information made by the Board (including MUI-06), MEORC - MUI Office or any investigating entity as soon as practicable, but within five (5) working days of receipt of the request.
A. Immediate Action
Immediately upon identification or notification of a MUI (MUI-02), the provider shall take all reasonable measures to ensure the health and safety of all individuals served. Such measures shall include the following:
1. Immediate and ongoing medical attention as appropriate.
2. Removal of an employee from direct contact when the employee is alleged to have been involved in abuse or neglect until the provider has sufficiently determined that such removal is no longer necessary; and/or
3. Other measures to protect the health and safety of the individual, as necessary.
B. Provider to Board Notification Requirements
1. The provider shall immediately notify the Board by telephone or fax during normal working hours, or by calling the Service and Support Administration (SSA) Emergency Telephone number (documented on the on-call telephone log), after normal working hours, under any of the following circumstances;
• The MUI requires notification of a law enforcement agency;
• The MUI requires notification of a public children services agency;
• The provider has received inquiries from the media regarding an MUI that has not been previously reported;
• The MUI raises immediate concerns regarding the individual's health and safety such that more immediate notification regarding the incident is necessary; or
• All other MUI's.
2. Such notification shall include the immediate action taken by the provider to ensure the individual(s) health and safety. The provider and Board shall discuss any disagreements regarding reasonable measures in order to resolve the differences. In the event that an agreement cannot be reached between the provider and Board, the Board shall request the Department make the determination.
3. The provider shall submit a written incident report to the Board by 5:00 p.m. the next working day following the provider's initial knowledge of any MUI. This report shall be submitted in a format prescribed by the Department, including notification to the legal guardian or advocate.
4. The Board shall designate a contact person to receive or manage receipt of all reports required under these procedures. The contact person shall ensure that a system exists whereby providers may make all reports required by this procedure and shall communicate this system to providers.
5. Nothing in these procedures shall prohibit a provider from contacting law enforcement or the public children services agency prior to notifying the Board.
C. Provider Notification to Legal Guardian or Advocate
As soon as practicable, but no later than 24 hours after becoming aware of an MUI, the provider shall verbally notify the legal guardian or advocate selected by the individual, unless the legal guardian or advocate is the primary person involved that forms the basis for the reported incident. In the event the provider is unable to verbally notify the guardian or advocate, the provider shall document all efforts made to comply. The information provided the legal guardian or advocate may include:
• A summary of the occurrence.
2. Immediate preventative measures taken to ensure the health and safety of the individual.
D. Board Notifications
1. Immediately upon notification of a report of an MUI from a provider, the Board shall notify the following parties as may be necessary:
a. The law enforcement agency, as defined in ORC 5123.61, having jurisdiction over the location at which the incident occurred if the MUI includes conduct that would constitute a possible criminal act, including abuse and neglect. This report shall be made immediately upon notification that the incident has occurred.
b. The local public children services agency and municipal or county peace office in the county in which the individual resides pursuant to ORC 2151.421 and rules adopted pursuant to that section if the individual is under 21 years of age and meets the definition of an abused or neglected child as defined in ORC 2151.03 and 2151.031 (NUR-12). This report shall be made no later than 24 hours after the Board's receipt of the initial notification from the provider.
c. The service and support administrator/service coordinator unless that person is the primary person involved that forms the basis for the reported incident.
d. The licensed or certified provider of residential or supported living services where the individual resides if the incident occurs at a program operated by the Board or Board contracting entity.
2. By 5:00 p.m. on the working day immediately following receipt of the written incident report submitted by the provider the Board shall enter preliminary information regarding the incident through the online ITS established by the Department.
3. If the provider is a developmental center, all reports required by this procedure shall be made directly to the Department or as specified by the Department.
IV. INVESTIGATING MAJOR UNUSUAL INCIDENTS
• Immediately upon receipt of a report of an MUI, the Board shall review the incident to ensure that the provider has taken all reasonable measures necessary to protect the health and safety of the individual(s) and determine whether any additional actions must be taken. The Board will report all MUI's for investigation and review per the MEORC-MUI Office procedures. MEORC-MUI shall employ personnel who meet certification of Investigative Agent as required by the Department.
• Employees of the Mid East Ohio Regional Council Major Unusual Incident (MEORC - MUI), Office of Investigation and Review shall employ personnel assigned to no other responsibilities or any other function including administrative or direct provision of services and supports.
C. The Board may request a separate review or investigation of any MUI, or may request that a separate review or investigation be conducted by another county board, the MEORC-MUI Office, the Department or any other entity authorized to conduct such investigations.
D. The MEORC-MUI Office shall immediately commence an investigation or review of the MUI utilizing the protocol set forth by the Department, if any of the following circumstances are present:
• Abuse, neglect, or misappropriation;
• Any injury of an unknown or suspicious origin as defined in the definitions section of these procedures;
• Suspicious or accidental death;
• The individual cannot be located pursuant to the definitions section of these procedure; or
• Any other MUI the Board determines should be investigated based upon a review of the incident and reasonable measures taken by the provider.
E. The Board shall request that the Department conduct a separate investigation and provide the Department with the basis for this request. A separate investigation shall be conducted if the following circumstances are present and shall be completed in 30 calendar days unless the investigation is being conducted by a Law Enforcement agency or local public Children Services agency:
1. The MUI includes an allegation that the person responsible for the incident is:
a. The Board Superintendent or the Executive Director of MEORC;
b. A Board management employee as specified in Section 5126.22 of the ORC;
c. A current member of the Board appointed pursuant to Section 5126.02 of the ORC; or
d. Person having any known relationship with any of the persons previously specified in these procedures.
2. The MUI includes an allegation that a Board employee is responsible for the death of an individual, has committed sexual abuse against an individual, or has committed any other abuse or neglects against an individual that has resulted in an emergency room visit or hospitalization.
3. A county board or developmental center has requested that the Department conducts a separate investigation, and the Department has determined that there is a reasonable basis for the request.
4. An individual, advocate selected by the individual, or the legal guardian, as applicable, or provider has made a complaint to the Department regarding an investigation conducted by the Board or developmental center, and the Department has determined that there is a reasonable basis for the complaint.
E. Provider Investigation
• If the provider is an ICF/MR, the ICF/MR shall investigate all MUI incidents involving individuals receiving services from the ICF/MR in accordance with federal regulations.
• If the MUI involves an individual residing in an ICF/MR, including a developmental center, and an incident occurs at a program operated by the county board or a county board contracting entity, the county board shall be responsible for ensuring compliance with all requirements of the MUI rule.
• An ICF/MR, excluding a developmental center, shall submit to the county board a copy of its investigation report within (14) fourteen days of becoming aware of a MUI.
• If the provider is not an ICF/MR, the provider may conduct a separate investigation of an MUI in accordance with Section 5123: 2-17-02 of the OAC. If the provider conducts a separate investigation, the provider shall submit to the Board a copy of its investigation within fourteen days of becoming aware of an MUI.
V. INVESTIGATION/REVIEW
A. The MEORC-MUI Office, upon receipt of the allegation from the County Board shall notify the County Board of what action it will take:
• An investigative review will be conducted; or
• An investigation utilizing the investigation protocol will be conducted; or
• Another entity will be conducting the investigation.
B. By the 20 th working day from the discovery date of the MUI, the MEORC-MUI Office will provide notification to the County Board (MUI-03) that the investigation/review has been completed.
C. The Board, upon receipt of notification that the investigation/review has been completed by the MEORC-MUI Office and no later than the 25 th working day from the discovery date of the MUI, shall:
• Coordinate the development of a prevention plan to ensure the individual's health and safety.
2 . Provide a written summary/case disposition of the review and/or investigation findings to the individual or the advocate selected by the individual or the legal guardian, as applicable, and the provider (MUI-04, MUI-05). The written summary shall include:
a. A statement of the facts of the incident;
b. The findings of the investigation;
c. All preventative measure implemented in response to the incident (MUI-01);
d. The right to submit written comments to the Board regarding the investigation's conclusion and any preventive measures implemented in response to the incident; and
e. The right to dispute the findings by following the Departments Complaint Resolution rule or the Board's Administrative Resolution of Complaints and Due Process Policy.
3. Any written comments received by the Board shall be submitted to the Department.
D. The Board will wait at least five (5) working days for comments from the above parties prior to recommending the case for closure and submitting a report on the investigation to the Department.
• The Board shall submit a report on the investigation to the Department within 30 working days of the receipt of a report of an MUI. The report shall be submitted through the Department ITS. The Board/MEORC-MUI Office may request reasonable extensions of the time period for submission of the report. If any extension is granted, the Board/MEORC-MUI Office shall provide interim reports and shall identify alternative actions that may assist with the timely conclusion of the report as requested by the Department.
• If another entity will be conducting the investigation, the Board, MEORC MUI Office and/or the provider shall cooperate with the investigations conducted and shall respond to all requests for additional information as soon as practicable but within five (5) working days of receipt of the request.
VI. REVIEW, REMEDY, AND PREVENTION OF MUI
A. The Board and all providers shall develop and implement a written procedure for the internal review of all major unusual incidents and shall be responsible for taking all reasonable steps necessary to prevent the reoccurrence of MUIs. Providers, other than the Board shall provide the Board with their written procedures once developed and whenever modified.
B. The Board and provider shall jointly determine what constitutes reasonable steps necessary to prevent the reoccurrence of MUIs. If the Board and provider are unable to reach agreement, the Department shall make the determination.
C. If the Board or provider lacks sufficient resources to take such steps, the Board or provider may make a written request for assistance from the Department. The Board shall provide any additional information necessary to conduct the review, including copies of all investigation reports that have been prepared. Such additional information shall be provided within the time period specified by the Department
D. Rights of Ohioians with disabilities and information related to incidents adversely affecting health and safety shall be distributed at individual planning meetings or upon request of the individual or guardian. Information shall be contained in pamphlets developed by the board.
VII. CLOSING CASES
A. The Department shall determine when to close cases of abuse, neglect, misappropriation, death, and other cases investigated by the Department and shall solicit input from the Board prior to making the determination. The Board shall provide the Department any additional information requested to make the determination regarding closure of the case.
B. The Board shall determine when to close cases other than those specified above. The Board may close cases that have been referred to local public children services agency or law enforcement as long as appropriate preventative measures were taken.
C. The Department shall be responsible for ensuring that all cases have been properly closed.
D. The Board and/or Department shall consider the following when determining case closure:
• Whether all reasonable measures have been taken to ensure the health and safety of the individual;
• Whether a thorough investigation of the incident has been conducted;
• Whether the incident is part of a pattern or trend requiring additional action;
• Whether appropriate measures have been implemented to prevent reoccurrence;
• Whether all requirements set forth in statute and/or rule have been satisfied; and,
• Whether the case meets the criteria for referral to the Department Abuse Registry Unit pursuant to section 5123.51 of the ORC.
E. When the Department notifies the Board the case has been properly closed, the Board shall notify the provider that the case has been closed.
VIII. ANALYZING MUI'S TO IDENTIFY PATTERNS AND TRENDS
The Board and provider shall use the guidelines of the Department to review and analyze MUIs to identify patterns and trends.
A. Quarterly Analysis
1. The Board shall prepare a quarterly report utilizing information contained on the Department ITS for each provider in the county. The report shall identify the number and types of incidents that have occurred. The end of the quarter is defined as the last day of March, June, September and December.
2. The provider shall review the quarterly reports prepared by the Board to identify patterns and trends and take appropriate action as needed. Upon the request of the Board and/or Department, the provider shall furnish evidence that the review has been conducted and appropriate action has been taken. The report shall be completed within 30 calendar days following the request from the Board or the Department.
B. Annual Analysis
1. All providers, including the Board, shall conduct an annual review and analyze the data for that calendar year to identify patterns and trends and take corrective action(s) where needed.
2. Each provider shall complete a thorough analysis, including corrective measures that have been implemented to address concerns raised through the analysis. All providers shall submit their analysis and any corrective measures that have been implemented to the Board within 45 calendar days following the end of the calendar year.
IX. UNUSUAL INCIDENTS
A. The Board and all providers shall develop and implement a policy and procedure that requires any person who becomes aware of an unusual incident to report it to the person designated by the Board and provider who can initiate proper action.
B. Reports must be made no later than 24 hours after the occurrence of the incident and this shall be included in the policy and procedure of the provider.
C. The Board and provider shall develop and implement a written policy and procedure for the internal review of all unusual incidents to ensure that appropriate actions have been taken to protect the health and safety of individuals and patterns and/or trends have been identified and reviewed.
D. At a minimum, the Board and provider shall review unusual incidents one time per week to determine whether a series of unusual incidents that would constitute an MUI has occurred. The provider shall maintain a log of unusual incidents and said log and related records shall be made available to the Board and Department upon request.
E. The Board and provider shall use the guidelines of the Department to review and analyze unusual incidents to identify patterns and trends.
F. No later than 30 days after the end of a quarter, the Board and provider shall prepare a quarterly report. The report shall identify the number and types of incidents that have occurred. The end of the quarter is defined as the last day of March, June, September and December.
G. The Board shall periodically but at least quarterly review the log maintained by each provider to ensure that patterns and trends have been identified and corrective actions have been taken. The Department shall develop guidelines that may be used to assist providers and the Board in conducting reviews of unusual incidents and identifying patterns and trends.
X. ACCESS TO RECORDS
A. Reports made under Section 5123.61 of the ORC and Section 5123:2-17-02 of the OAC are not public records as defined in Section 149.43 of the ORC. Records may be provided to parties authorized to receive said records in accordance with Sections 5123.613 and 5126.044 of the ORC.
B. The Board and MEORC MUI Office shall not review, copy, or include in any reports required by Section 5123:2-17-02 of the OAC personnel records of an employee that are confidential under state or federal statutes or rules, including medical records, insurance records, Worker's Compensation records, immigration status forms (I-9), and Social Security numbers.
C. The Board and MEORC MUI Office may review, but not copy, personnel records that include confidential information about an employee including, but not limited to, payroll records, performance evaluations, disciplinary records, correspondence to employees regarding employment status, motor vehicle drivers records, professional licenses, and criminal records checks. The Board and MEORC MUI Office may include in reports required by Section 5123: 2-17-02 of the OAC information about the results of the review of personnel records specified in these procedures.
D. The Board and MEORC MUI Office may review and copy personnel records prepared in connection with the provider's daily operations, such as training records, time sheets, and work schedules.
E. Upon the request of the Department, the provider shall provide copies of personnel records that are not deemed confidential to the Department.
F. The provider shall redact any confidential information contained in a record that is copied before the copies are provided to the Board or MEORC MUI Office.
• Any party entitled to receive any report required by Section 5123: 2-17-02 of the OAC may waive receipt of the report. Any waiver of receipt of a report shall be made in writing.
Forms used in this procedure:
MUI-01 Preventative Measures/Interventions
MUI-02 Incident Notification Form
MUI-03 Mid-East Ohio Regional Council MUI Written summary/case disposition
MUI-04 MUI Closure
MUI-05 MUI Closure
MUI-06 Witness Statement
NUR-12 Suspected Child Abuse/Neglect
NUR-23 Nursing Medication Error
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Coshocton County Board of
Developmental Disabilities
Policy: Behavior Support Policy
Policy Number: 21.0
Ohio Revised Code Reference: 5126.281, 5126.05, 5126.43.1, 5123.17.1, 5123.19
Ohio Administrative Code Reference: 5123.2-1-02(J), 5123:2-17-02, 5123:2-1-12,
Board Adopted: 2/13/2003
Board Amended :
I. PHILOSOPHY
The Coshocton County Board of Developmental Disabilities recognizes that an important part of habilitative programming for individuals who receive services is behavioral habilitation. Through this policy the Board seeks to establish guidelines and procedures to assure that all individuals are fully accorded their right to behavior support and assist individuals receiving services from the county board programs to manage their own behaviors. Emphasis will be placed on least restrictive environment and least intrusive form of service used. The goal of behavioral intervention is to develop behaviors and skills which help individuals live and work in the least restrictive setting consistent with their needs and to promote the following: personal growth, development, independence, opportunities for daily decision-making, individual choice, self-determination and self-support.
II. PURPOSE
The purpose of this document is to
A. Regulate the use of behavioral interventions so that the rights, safety, welfare and due process of individuals receiving county board services are adequately protected at all times, and
B. Facilitate appropriate behaviors and minimize behaviors that end to isolate individuals from their community, and
C. Focus on positive teaching and support strategies
Any use of aversive methods will be substantiated, applied to a minimum degree both in type and duration and carried out concurrently with positive approaches. Standing or as needed programs are prohibited for the control of behavior.
III. ACCESS
These policies and procedures, including administrative resolution procedures in accordance with Rule 5123:2-1-12 shall be available to all staff, persons receiving services from the County Board, parents of minor children, legal guardians and providers.
IV. APPLICATION
This policy and subsequent procedures applies to all Board Employees and all providers. As used in the Behavior Support policy and procedures, "provider" refers to all persons and entities that provide specialized service, as defined in ORC 5126:281 and that are subject to regulation by the department, regardless of source of payment including a contracting entity of CCBDD, a Licensed provider as defined under ORC 5123:19, a Supported Living provider as defined in ORC 5126:43.1, a Respite Care Certified provider as defined under ORC 5123:17.1 and 5126:05, a provider approved to provide Medicaid services under Home and community Based Services Waivers administered by ODMRDD.
Exclusions: A provider does not mean an Intermediate Care Facility for the Mentally Retarded (ICFMR) as Certified Title XIX of the Social Security Act. However, this policy and procedure applies to residents of an ICFMR in the application of behavior supports in Board operated facilities and/or when services are provided
By a provider meeting the above definition.
V. DEVELOPMENT OF PROCEDURES
The Board authorizes the Superintendent to develop and implement written procedures consistent with Board policy and applicable rules, regulations and statutes. Behavior support policy and procedures shall be reviewed annually to ensure that they are in compliance with current ODMRDD rules governing the use of behavior support.
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Coshocton County Board of
Developmental Disabilities
Policy Reference: Behavior Support Procedures
Policy Number: 21.1
Ohio Revised Code Reference: 5126.281, 5126.05, 5126.43.1, 5123.17.1, 5123.19
Ohio Administrative Code Reference: 5123.2-1-02(J), 5123: 2-17-02 , 5123: 2-1-12
Superintendent Approved: 2/15/2003
Superintendent Amended :
I. BEHAVIOR SUPPORT GUIDELINES
A. Behavior Support Procedures will be available to all staff, individuals receiving services from the county board, parents of minor children, legal guardians and providers.
B. Behavior Support Plans shall:
i. Focus on positive teaching and support strategies and encourage use of the least restrictive environment and least intrusive forms of services;
ii. Promote growth, development and independence of the individuals, specify a hierarchy of these teaching and support strategies, ranging from most positive or least intrusive to least positive and most intrusive, including approvals and review procedures;
iii. Be developed in accordance with department guidelines and relevant to local, state and federal statutes and regulations;
iv. Specify the individual conduct to be allowed or not allowed;
v. Be available to staff who provide service, individuals, parents of minor children, legal guardians, and providers;
vi. To the extent possible be formulated with the individual's participation;
vii. Ensure that an individual must not discipline another individual except as part of an organized system of self government.
viii. Consider medical factors in the development of all behavior support plans.
ix. Be developed according to the findings of the behavior assessment which is required to be completed prior to implementation of any written behavior support plan.
C. Climate for Behavioral Supports shall be characterized by:
i. Interactions and speech which reflect respect, dignity, and a positive regard for the individual;
ii. The setting of acceptable behavioral limits for the individual;
iii. The absence of group punishment;
iv. The absence of demeaning, belittling or degrading speech or punishment;
v. Staff speech which is even-toned made in positive and personal terms and void of threatening overtones or coercion;
vi. Conversations with the individual rather than about the individual while in the individual's presence;
vii. Respect for the individual's privacy by not discussing the individual with someone who has no right to the information; and
viii. The use of people-first language instead of referring to the individual by trait, behavior, or disability.
II. BEHAVIOR SUPPORT COMMITTEE
A. The Ohio Administrative Code authorizes the Superintendent to appoint members of the Behavior Support and Human Right committees to implement board policy and procedures specific to behavior support. Members of the BSC will be appointed by the Superintendent to implement Board policy and procedure specific to behavior support. The members of the committee will include individuals knowledgeable in behavior support procedures, including administrators, and persons employed by a provider that are responsible for implementing behavior support plans, but not those directly involved with the plan being reviewed. The Behavior Support Committee will meet one time per month January through November.
i. The behavior support committee review and approves or rejects all plans that incorporate aversive methods, including use of restraint and time-out. The use of restraint and time-out:
1. Shall be discontinued if it results in serious harm or injury to the individual, or does not achieve the desired results as defined in the behavior support plan.
2. Any use of restraint or time-out in an unapproved manner or without obtaining required consent, approval or oversight shall be reported as a Major Unusual Incident or an unusual incident shall be reported as such pursuant to Rule 5123:2-12-02 of the Administrative Code.
3. Within five working days after local approval of a behavior support plan using restraint or time-out, the county board or provider shall notify the Department by facsimile or other electronic means using Form BEH-06. Upon request by the Department, the county board or provider shall submit any additional information regarding the use of the restraint or time-out.
4. Any use of restraint or time-out that results in an injury that meets the definition of a Major Unusual Incident or an unusual incident shall be reported as such pursuant to Rule 5123:2-17-02 of the Administrative Code.
Note: The use of restraint and time-out requires prior approval from the Director of ODMRDD before using the following methods of restraint:
a. Any emerging methods and technology designated by the Director as requiring prior approval and
b. Any other extraordinary measures designated by the Director as requiring approval, including brief application of electric shock to a part of the individual's body following an identified behavior.
ii. The behavior support committee reviews and approves or rejects all plans that incorporate aversive methods by assuring the plan contains the required components and the Team followed all required procedures as stipulated in the behavior support rule and by the County Board policies and procedures as follows:
1. Systematic, planned intervention using manual, mechanical or chemical restraints shall be used only when necessary to protect health and safety, and only when all other conditions required by the behavior support rule are met.
2. Medication for behavior control shall not be used unless it is prescribed by and under the supervisions of licensed physician who is involved in the interdisciplinary process. PRN (as often as needed) medications used for behavior modification will not be used in the facilities or vehicles of the Coshocton County Board of DD or by any provider.
3. Prior documented, informed consent is obtained from the individual receiving services from the county board program, or guardian (if the individual is eighteen years old or older), or from the parent or guardian (if the individual is under eighteen years of age) and documented on BEH-11. When informed consent cannot be documented in writing at the time it is obtained, such consent shall be documented in writing within three days of the implementation of the plan. The written, informed consent shall be updated at least annually.
4. Training and experience required for staff who develop behavior support plans and for all persons employed by a provider who are responsible for implementing plans are specified, and required training is documented on BEH-13.
5. Revisions to a behavior plan requiring behavior support committee approval shall require written informed consent from the individual receiving services from the county board program, or guardian (if the individual is eighteen years of age or older), or from the parent or guardian (if the individual is under eighteen years of age).
6. The behavior support plan shall be presented in a manner that can be understood by the individual/guardian or parent of a minor.
7. Regular review of all behavior support plans is held, at least, in conjunction with individual plan updates and documented on BEH-08.
8. Plans that incorporate aversive methods, including restraint and time-out, shall be reviewed as determined by the team, but at least every thirty days and documented on BEH-08.
9. Status reports (BEH-08) on an aversive method shall be provided to the individual receiving services from the county board, parent or guardian (if the individual is eighteen years of age or older), or from the parent or guardian (if the individual is under eighteen years of age).
10. Status reports shall be provided to the provider for individuals who receive services from the provider.
III. HUMAN RIGHTS COMMITTEE
A. As appointed by the Superintendent, the human rights committee will include:
i. One parent of a minor, or guardian of an individual eligible to receive services from a county board of DD.
ii. A member of county board or provider convening the committee
iii. An individual receiving services from a county board of DD
iv. Qualified individuals who have either experience or training in contemporary practices to support behaviors of individuals with developmental disabilities and
v. One member with no direct involvement in the county board's program.
B. The Human Rights Committee will meet quarterly or as otherwise scheduled by the Chairperson.
C. The Human Rights Committee reviews and approves or rejects all behavior support plans using aversive methods, including restraints and time-out, and those which involve potential risks to the individual's rights and protections. The Human Rights Committee shall ensure that the rights of the individual are protected.
D. As allowed in rule, one Human Rights Committee may serve more than one county board or provider.
IV. PROHIBITED ACTIONS
A. Prohibited actions are reported as Major Unusual Incidents, and include the following:
i. Any physical abuse of an individual such as striking, spitting on, scratching, shoving, paddling, spanking and pinching, corporal punishment or any action to inflict pain.
ii. Any sexual abuse of an individual.
iii. Medically or psychologically contraindicated procedures.
iv. Psychological/verbal abuse such as threatening, ridiculing, or using abusive or demeaning language.
v. Placing an individual in a room with no light.
vi. Subjecting the individual to damaging or painful sound.
vii. Denial of breakfast, lunch or dinner
viii. Squirting an individual with a substance as a consequence for a behavior.
ix. Time-out in a time-out room exceeding one hour for any one incident, and exceeding more than two hours in a twenty-four hour period.
x. Standing or as needed programs for the control of behavior.
xi. Implementation of a discontinued behavior plan.
B. Time-out room usage requirements:
i. Shall not be key locked, but the door may be held shut by a staff individual or by a mechanism that requires constant physical pressure from a staff individual to keep the mechanism engaged.
ii. Must be adequately lighted and ventilated, and provide a safe environment for the individual.
iii. An individual in a time-out room must be protected from hazardous conditions, including, but not limited to, presence of sharp corners and objects, uncovered light fixtures, or unprotected electrical outlets.
iv. An individual in a time-out room must be under constant visual supervision by staff at all times.
v. A record of time-out room activities must be kept.
vi. Emergency placement (without a written plan) of an individual in a time-out room is not allowable.
V. POSITIVE INTERVENTIONS
A. All service providers who have direct contact with individuals in the program are encouraged to develop and use an array of positive reinforcement interventions and opportunities to promote the display of appropriate behavior and minimize the display of inappropriate behaviors. The forms that such interventions may take are virtually limitless. They can range from simple actions by the service provider/staff such as informal contracts between service provider and individual to written formal programs specifying the detailed expectations to be met in order for rewards to be earned. Positive programs are best when there are clearly defined behaviors that are to be rewarded, a variety of reinforcement schedules including very frequent reward for individuals who do not have the capability to make time delayed connections between their behavior and the reward, and rewards that are meaningful and powerful to the individual.
i. All behavior support methods, both formal and informal shall be integrated into individual plans and be designed to provide a systematic approach to assist the person to learn new positive behaviors while reducing undesirable behaviors.
ii. An intervention hierarchy of teaching and support strategies ranging from the most positive or least intrusive to the least positive or most intrusive will be considered in the development of all formal behavior plans, including approvals and review procedures. This hierarchy shall consist of the following:
1. Gestural cues or prompts
2. Verbal cues or prompts
3. Visual prompts
3. Any type of hands-on or physical cues or prompts
iii. Positive behavior programs must contain components that are strictly positive and conceptually sound. Prior to the implementation of any behavior plan, the following must be completed:
1. A behavior assessment to systematically identify environmental factors that proceed and are concurrent with the target behavior.
2. A functional analysis to systematically identify factors that reinforce the target behavior(s).
iv. The purpose of such analyses is to determine the most appropriate teaching and support strategies. The behavior support plan must be developed according to the findings of the behavior assessment.
v. Medical factors are a required consideration in the development of a behavior support plan.
vi. In the event that a program has some aspect which could be construed as meeting the definition of an aversive intervention, the program must be brought to the attention of the Behavior Support Committee and discussed at the next regular meeting of the committee.
B. NONAVERSIVE INTERVENTIONS THAT MAY BE USED WITHOUT FORMAL APPROVAL
i. The Coshocton County Board of Mental Retardation and Developmental Disabilities believes that staff members must recognize the importance of ongoing behavior support in program settings. Most of the time, effective behavior support can be achieved with planned positive consequences. Occasionally consequences designed to increase a desirable behavior may need to be combined with a plan to reduce or eliminate a behavior. Any intervention designed to increase or reduce a behavior can potentially be aversive. When developing an intervention, it is important to consider whether or not the procedure employs consequences that would be natural in that setting (i.e., loss of pay for missing work), or are contrived (i.e., removal of tokens for inappropriate behavior). The more contrived the contingency, the more likely that it is an aversive intervention and will need BSC approval.
ii. The following behavioral support strategies do not require BSC approval unless a pattern and/or trend has been identified:
1. Positive reinforcement to reward appropriate behavior and promote learning. Examples include any of a variety of objects, activities, and interaction such as giving tokens, stars, stickers (etc.); extra privileges, praise; touch (pat on the back, a hug); and extra attention.
2. Planned ignoring (including withholding reinforcers listed in #1) following the non-display of specific undesirable behaviors. This is an effective procedure when plenty of reinforcers are usually available as appropriate behaviors are displayed. Planned ignoring may not be utilized following the display of an undesirable behavior unless approved by BSC.
3. Structural supports refer to arranging the environment (including people) to prevent the occurrence of certain targeted behaviors. This is not done contingent upon the occurrence of the target behavior, but is structured ahead of time to maximize learning opportunities or vocational performance and decrease opportunities for undesirable behaviors. Examples include placing toys out of sight before class or organizing work areas to separate two individuals who distract each other. Structural supports also include enriching the environment by such things as modifying temperature, noise level, crowding, and improving the frequency of positive reinforcement to encourage the display of appropriate behavior.
4. Differential reinforcement of behaviors other than the one to be reduced (DRO).
5. Differential reinforcement of incompatible behaviors (DRI).
6. Verbal or gestural feedback to indicate to the individual that a specific behavior is inappropriate and should not occur again.
7. Physical, gestural, and verbal cues or prompts to direct a person to a desirable behavior which is then reinforced.
8. Graduated manual guidance in an instructional/training environment.
9. Voluntary Time-away or offered breaks from situations/instruction.
10. Redirection
11. Simple correction.
12. Natural consequence
13. Self-management techniques such as having the individual record or rate his or her own behavior.
14. Counseling by school or workshop administrative staff.
VI. AVERSIVE INTERVENTIONS THAT REQUIRE FORMAL APPROVAL
A. The use of any formal behavioral support plan shall be substantiated, applied to the minimum degree both in type and duration and carried out concurrently with positive approaches. Whenever an aversive intervention is employed to eliminate maladaptive behaviors, the individual's record must document the fact that positive and less aversive teaching and support strategies are demonstrated to be ineffective prior to use of more intrusive procedures. Before implementation of an aversive intervention plan, approval of the Behavior Support Committee must be obtained. In addition, the ISP/IFSP/IEP/IPP team, and guardian approval are required. Finally, prior to its use, all approved programs must be in-serviced to those who will implement the plan. In-servicing should be conducted by those knowledgeable with the procedures and rationale of the program. In addition, the Human Rights Committee must also give approval prior to the program being implemented.
B. Restraint and time out are only used with behaviors that are destructive to self or others and only when all other conditions required by the behavior support rule are met. Use of aversive behavioral techniques without the necessary approvals may constitute abuse. Aversive behavior support methods are never used for retaliation, staff convenience or as a substitute for an active treatment program.
VI. BEHAVIOR SUPPORT PLAN APPROVAL PROCESS
A. An employee of the Coshocton County Board of MR/DD or of Hopewell Industries, Inc., a contract agency of the County Board , or any contracting agency/provider may develop and submit a behavior plan to the Behavior Support Committee for its review and approval. A team representative submits the proposed plan to the Committee Chairperson who will then schedule a BSC meeting, unless the monthly scheduled meeting is within two weeks. A team representative presents the proposed plan to the BSC and is available for questions or BSC recommendations.
B. Formal behavior support plans using aversive interventions shall be written for an individual and put into effect only after all of the following conditions have been met:
i. The minimal content of the plan (BEH-07 and BEH-03) include but are not limited to:
1. Case History
2. Results of a behavior assessment/functional analysis
3. Baseline data
4. Behaviors to be increased
5. Behaviors to be decreased
6. Procedures to be used
7. Individuals responsible for implementation
8. Plan review guidelines
9. Signature/date block
10. Area for dissenting opinions;
ii. Behavior has been specified on the previous or current Plan as an educational or habilitative need;
iii. Evidence indicating that positive less aversive teaching and support strategies have been ineffective;
iv. Medical factors are considered in the development of the plan;
v. Behavior assessment and analysis shall be completed prior to implementation of any written behavior support plan. The plan shall be developed in accordance with the findings of the behavior assessment and analysis;
vi. Positive and aversive behavioral interventions used are specific;
vii. A fading component will be included in behavioral support plans to be used when established criteria for the reduction of target behaviors is reached;
viii. Positive intervention is part of the intervention strategies in the plan;
ix. Written informed consent (BEH-11) is obtained as follows:
1. Prior to implementation of a new behavior plan:
a. For minors: The parent/guardian, teacher, and principal must give written approval.
b. For adults:
i. Consent of the individual or guardian;
Prior documented informed consent is obtained from the individual receiving services from the Board, or documented informed consent from the guardian if the individual is eighteen years old or older. When informed consent cannot be documented in writing at the time it is obtained, such consent shall be documented in writing within three days of implementation. This written informed consent shall be updated at least annually. Informed consent shall constitute as an agreement to allow a proposed action, treatment or service to happen after a full disclosure of the relevant facts. This information shall include the risks and benefits of such action, treatment or service; acceptable alternatives to such action, treatment or service; the consequences of not receiving such action, treatment or service and the right to refuse such action, treatment or service.
ii. Consent of the individual's team;
a. A majority of voting members must agree to the proposed plan;
b. All members of the individual's team are permitted to vote regarding behavioral support plans. However, when more than one member from an outside agency is present, only one member may place the vote that represents the agency's position.
c. Any team member may file a dissenting opinion with the superintendent regarding the implementation of a behavior management plan. The Superintendent or designee will respond to the Behavior Support Committee Chairperson concerning the dissenting opinion. The plan will not be implemented until the superintendent has rendered a decision. If the superintendent accepts the dissenting opinion, the team must reconvene to reach consensus and resolve the disagreement before the plan can be implemented.
x. Prior approval or rejection of the Behavior Committee is obtained and documented on the Behavior Plan Authorization Form (BEH-10);
xi. Prior approval or rejection of the Human Rights Committee is obtained and documented on the Behavior Plan Authorization Form (BEH-10);
xii. Within five working days of local approval of a behavioral support plan involving the use of restraint or a time-out room the Department will be notified on form BEH-06.
xiii. Behavior support plans must be inserviced to those direct service providers who will implement the plan. Inservicing is to be conducted and documented (BEH-13) by individuals experienced, knowledgeable, and appropriately trained in the procedures for developing and implementing behavioral support plans.
xiv. Regular review procedures are identified.
[Note: The use of any emerging methods, technology, or extraordinary measures (including electric shock) requires prior approval from the Director.]
VIII. REQUIREMENT FOR REGULAR REVIEW
A. The Behavior Support Committee is responsible for reviewing all applicable behavior support plans and behavior support plan proposals. In general, aversive plans will be reviewed no less than every 30 calendar days or as defined in the Plan. More frequent reviews will be conducted when the situation warrants or as requested at the ISP/IFSP/IEP/IHP meeting. Status reports (BEH-08) on an aversive plan shall be provided to the person receiving services from the county board, parent, if under eighteen, guardian and/or to the residential facility if applicable.
i. During reviews adjustments may be made in behavior support plan with the approval of the Committee, to include informed consent.
ii. A behavior support plan may be recommended for discontinuation by the Behavior Support Committee or through agreement at ISP/IFSP/IEP/IHP reviews.
iii. The Behavior Support Committee may defer a program that is temporarily not appropriate or necessary. An example: deferring the implementation of a behavior support plan when an individual's medical status changes. Once deferred, plan documentation is not required although behavioral data should continue to be recorded.
iv. After six months, the Committee must decide whether to reinstate or discontinue a deferred plan.
v. While a plan is deferred, it may not be used. However, the plan may be reinstated by the recommendation of the Team and endorsed by the Behavior Support Committee. A written rationale must be submitted to the Behavior Support Committee at the next regular meeting.
vi. For every individual with a current behavior program, the review must be addressed at all ISP, IFSP, IEP, and IHP conferences and updates. Additional reviews may be held at any time based on a request by one or more team members. The review will be included in the individual's permanent record.
IX. ENFORCEMENT
A. Failure to adhere to the procedural requirements of a behavioral intervention strategy may constitute a violation of the individual's right to habilitation. This includes either program implementation errors or documentation errors. The former includes but is not limited to failing to implement the plan as written, implementing it incorrectly, or implementing the plan for behaviors not specified in the plan. Documentation errors include but are not limited to failing to accurately document the display of inappropriate behaviors, failing to document the use of behavioral interventions (positive or negative), failing to document behaviors or interventions within 30 minutes of the event, or falsely recording behavior or program data.
When any of these situations arise, case management shall be notified via a Behavior Incident Form (BEH-04).
X. EMERGENCY SITUATION
A. An emergency situation exists when an individual's behavior presents a gross disruption to the educational or habilitation process, such that immediate intervention is needed. This may occur with the entry of a new individual or a current individual who displays behaviors the severity of which has not previously been observed and are severe enough that a program is needed prior to data collection. In such situations an interim program may be used with the written approval of an ad hoc subcommittee of the Behavior Support Committee and written approval of the parent or guardian, if applicable. The subcommittee must have at least three members. Once issued, the program is to be used for no more than 60 calendar days unless re-authorized by the subcommittee and parent or guardian, if applicable.
B. Within ten working days of the implementation of an emergency plan, approval will be obtained from the HRC chairperson or designee. All emergency programs are to be submitted to the Behavior Support and Human Rights Committee for review at the next regular meeting of the Committee.
C. It is the responsibility of those staff persons implementing the program to assure that it is never used beyond the 60-day limit.
XI. CRISIS SITUATION
A. A crisis situation is defined as a situation in which an individual's behavior presents an immediate danger of injury to self or others:
i. Danger to self - Self abuse of sufficient force to cause bodily injury; engaging in a behavior that has a high potential for bringing about injury such as running out of the building or jumping from a moving vehicle.
ii. Danger to others - Physical aggression toward others with sufficient force to cause bodily injury.
B. Behavior support procedures used under crisis situations do not require prior approval of the Behavior Support Committee. However, a copy of the Behavior/Incident form (BEH-04) is to be sent to Case Management for MUI consideration.
C. A single crisis situation may result in the team writing a formal behavior support plan but if a crisis situation occurs more than three times in one month or six times in six months, a strategy must be developed in ameliorate the situation. The strategy may be a formal or informal intervention, environmental manipulations, or other interventions depending on the outcome of an analysis of the communicative function of the behavior.
i. Use of Crisis Intervention:
1. In general, only procedures and techniques approved by the Board should be used during a crisis. However, staff persons are expected to take whatever approved action is necessary to interrupt and prevent behavior that is dangerous or destructive.
2. Use of crisis intervention is to be recorded on the Behavior/Incident Report. A copy of the report is maintained in the accident/incident report file, the case manager and the individual or, when appropriate, parent or guardian.
ii. Administrative Crisis Intervention Options:
1. Immediate removal from premises
2. Law enforcement involvement
3. Alternative service delivery option
XII. ALTERNATIVE SERVICE DELIVERY OPTION
A. When behavior support procedures designed to deal with a crisis/emergency situation prove to be ineffective, an alternative service delivery option may be necessary. This option will take place only when the individual's presence poses a continuing threat to persons or property. When such a situation exists, an alternative service delivery option allows the team to continue county board services in an alternative environment.
B. For any individual receiving county board services, alternative service delivery option will not take place for more than 10 aggregate days in a school year without the ISP, IFSP, IHP or IEP committee being reconvened to determine if a change in placement is appropriate.
C. The alternative service delivery option is implemented with the prior approval of the Superintendent and can be a recommendation to the Superintendent by the team or by the Behavior Support Committee.
Forms to be used with these procedures:
Behavior Assessment - BEH - 05
ODMRDD Notification Form
Behavior Support Committee Checklist - BEH - 07
Informed Consent Form - BEH - 11
Behavior Plan Outline - BEH - 03
Behavior/Incident Report - BEH - 04
Team Status Report - BEH - 08
Behavior Plan Training documentation - BEH-13
Behavior Plan Authorization - BEH-10
Behavior Support Photo Release Statement - BEH - 09
Behavior Support Photo Release Statement (Adult) BEH - 15
Behavior Support Documentation - BEH - 12a
Behavior Support Documentation - BEH - 12b
Adult Services Behavior Log - BEH - 14
School Behavior Log - BEH - 02
Bus Behavior Log - BEH - 01
APPENDIX A
DEFINITIONS
AVERSIVES are stimuli of an unpleasant or intrusive nature typically employed as part of behavioral intervention. Procedures using aversive interventions have the purpose of reducing a target behavior when the aversive event is presented as a consequence of or contingent upon that behavior. Any behavioral intervention can potentially have aversive properties depending on the individual and the application of the intervention. All interventions listed in this policy under aversive sections are considered aversive regardless of their impact on the individual's behavior.
CRISIS RESTRAINT means using a manual restraint technique as an emergency measure. This type of restraint is used only when necessary to protect the individual or others from injury when less restrictive interventions have not been successful. Crisis restraint includes all measures used to temporarily inhibit, control, or limit the movement or normal function of any portion of an individual's body. Crisis restraint may be used prior to, but is never used as a substitute for a planned behavioral intervention. There should be documentation that:
1. the specific behavior exhibited by the individual necessitated the use of restraint and;
2. the specific restraining technique employed.
MANUAL RESTRAINT means physically holding an individual to inhibit, control, or limit the movement or normal function of any portion of a person's body as a part of a systematic, planned behavioral intervention. Manual restraint, employed only when other less restrictive measures have failed, will be applied with concern for good body alignment, and for the comfort of the individual when possible. Manual restraint will not be used for the convenience of staff. Manual restraint may be used during a crisis situation or as an integral part of an individual behavior plan. There should be documentation that:
1. the specific behavior exhibited by the individual necessitated the use of restraint and;
2. the specific restraining technique employed.
MECHANICAL RESTRAINT means the application of device(s) to inhibit, control or limit the movement or normal function of any portion of a person's body. These devices include any item devised to prevent individuals from inflicting injury to themselves or others. Such items may include the following: helmets that are tied or affixed in such a manner that removal cannot be easily accomplished by the individual; jumpsuits, belts or other clothing that cannot be removed by the individual; padded leather belts and leather cuffs; mittens securely fastened around the wrist with a small tie. Mechanical restraints may be used in situations to prevent injury to self or others and only as part of a planned behavioral or medical intervention. Handcuffs and straight jackets are not to be used. There should be documentation that:
1. the specific behavior exhibited by the individual necessitated the use of restraint and;
2. the specific restraining technique employed.
MEDICAL RESTRAINT refers to the use of any items or measures that inhibit, control, or limit the movement or normal function of any portion of an individual's body to permit treatment, promote healing, prevent an infection, protect an individual's wound or injury from further damage, or protect the person from injuring himself or herself. Medical restraints are not considered to be behavioral restraints. Medical restraints will be prescribed by qualified medical professionals, including the program nurse in consultation with the school principal or workshop director or his or her designee.
CHEMICAL RESTRAINT is medication for behavior control which has not been prescribed or supervised by a licensed physician or does not have a corresponding diagnosis to the medication.
TIME-OUT an aversive behavior intervention.
Exclusionary : An intervention by which an individual, after displaying undesirable behavior, is immediately restricted from the opportunity to acquire positive reinforcement from the environment for a specified period of time.
Non-exclusionary: The removal of the individual, as a consequence for a problem behavior to another table, area in the room, or to another room with no modification in the activity normally taking place at the time. Supervision of the individual must be at least comparable to the setting from which the individual was removed. This is a non-aversive intervention.
Room : A specially designed room that is devoid of reinforcing materials, activity, and people. A time out room must follow the requirements as specified in the Behavior Support Procedures.
ANTECEDENT is anything that occurs prior to a behavior or event
BASELINE DATA are the prevailing rate, frequency or duration of a behavior before an intervention is introduced. Baseline measures are continued until enough information has been gathered to develop an appropriate hypothesis about the behavior and intervention. This information can be used as a basis of comparison to assess the effects of an intervention.
BEHAVIOR ASSESSMENT/ANALYSIS refers to systematically investigating an individual's underlying motivation for engaging in the behavior (i.e. what function does the behavior serve for the individual?)
BEHAVIOR SUPPORT is a planned organization of environmental (physical and human) elements to promote desired patterns of behavior. The planned organization can include structuring the environment and/or the use of positive or aversive stimuli to increase or decrease the occurrence of a target behavior.
CRISIS SITUATION is a situation in which an individual's unanticipated behavior presents an immediate daner of injury to self, others, or the destruction of property. In the event of dangerous or life-threatening behaviors, immediate intervention may be necessary.
DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIORS (DRO) is a procedure in which the display of a target behavior or behaviors postpones delivery of reinforcement. The individual receives scheduled reinforcement for a variety of other behaviors but not when engaging in the target behavior(s).
DIFFERENTIAL REINFORCEMENT OF INCOMPATIBLE BEHAVIORS (DRI) is a reward procedure in which a behavior that cannot occur (i.e., is incompatible with) at the same time as a target behavior is reinforced. For example, if the target behavior is "out of seat" a DRI procedure would be to reward the individual when he or she is in the seat.
EMERGENCY SITUATION exists when an individual's behavior presents a gross disruption to the educational or habilitative environment, such that immediate intervention is needed.
EXTINCTION means discontinuing reinforcement of a behavior previously reinforced, (e.g., planned ignoring or withholding of attention).
FADING is a procedure involving the gradual removal of prompts, reinforcements, or restraints until the person is able to respond independently.
GENERALIZATION means the display of a target behavior in settings or situations, with persons or with materials other than those used in training.
GRADUATED MANUAL GUIDANCE means the use of minimal physical assistance and/or prompts necessary in order to help an individual correctly perform a desired behavior or task. The degree of physical assistance is faded systematically as the person becomes more able to perform a given activity independently. Graduated manual guidance is a teaching technique using, for example, hand-over-hand physical prompts or arm and wrist support to teach the individual how to engage in a desired educational or habilitative activity. [Note: When physically intervening with an individual in such a way as to prevent or inhibit a behavior, this is considered a form of restraint. Graduated manual guidance is used to facilitate a behavior.]
INTERVAL SCHEDULES OF REINFORCEMENT means a schedule in which reinforcement is made contingent upon the passage of time before the response is reinforced.
1. Fixed Interval (FI) schedule - when a particular response following the passage of a specific constant amount of time is scheduled for reinforcement. For example, an FI 3 indicates that reinforcement follows the first occurrence of the response after three minutes have passed.
2. Variable Interval (VI) schedule - when a variable time interval must occur prior to the reinforced response. The time interval has a specific average and usually varies within a specified range. For example, a VI 6 indicates that an average of six minutes passes before the response receives contingent reinforcement.
MAINTENANCE means continuing the desired behavior over time by means such as gradually decreasing the reinforcers, altering reinforcement schedules, and gradually decreasing artificial prompts.
MECHANICAL SUPPORT means items that are used only for the purpose of providing for an individual's physical safety, support, maintenance of optimal body alignment, and protection, including preventing infirmed or physically handicapped individuals from falling, supporting the individual during a prescribed diagnostic or medical procedure, or transporting the individual by way of stretcher or wheelchair. These items can include but are not limited to wheelchair trays, lap trays, play pens, splints, braces, adapted wheelchairs, sandbags, seatbelts, helmets, soft ties, sheets, a sleeveless cloth jacket, and other orthopedic devices. Such items, when used for mechanical support, are not considered restraints. Qualified therapists, together with medical professionals, will prescribe the mechanical supports and arrange for their provision.
MEDICATION means a natural or chemically synthesized substance which is intended to be used for the purpose of treatment, prevention of illness, or diagnostic study.
MODELING PROCEDURE means a stimulus control procedure that uses demonstrations to prompt an imitative response.
NATURAL CONSEQUENCE is the unplanned or reasonable outcome of a behavior, which would occur independent of any staff intervention.
NEGATIVE REINFORCEMENT means the removal of a stimulus as a consequence of a response and results in the maintenance or an increased rate of the behavior. A behavior has been negatively reinforced if it increases or is maintained due to the contingent removal or reduction of a stimulus. This procedure is sometimes referred to as escape conditioning. An example demonstrates the need to be aware of negative reinforcement and how inappropriate behaviors can be inadvertently encouraged. Demands are placed on an individual who responds by displaying a temper tantrum and aggression. This result in the removal of the demand as the service provider deals with the behavior which has by then become more important than the original demand. The inappropriate behavior has been reinforced by the successful escape from the demand.
OVERCORRECTION means a corrective procedure consisting of two basic components: first, requiring the individual to restore the environment to a state vastly improved over that which existed prior to a behavior which disrupted the environment; and second, positive practice , i.e., requiring the individual to repeatedly perform an appropriate substitute behavior. Overcorrection is considered to be an aversive intervention.
PLANNED IGNORING permits behavior to continue without responding, either verbally or non-verbally (e.g. no eye contact)
POSITIVE PRACTICE means a procedure which requires the individual to actively practice correct forms of some relevant, alternative, and more adaptive behavior.
POSITIVE REINFORCER is a stimulus, such as an object or event, which follows or is presented as a consequence of a response, and results in the rate of that response increasing or being maintained. Praise, attention, recognition of achievement and effort, special events, and activities are positive reinforcers for many people. Nontechnical terms for a positive reinforcer include incentives and rewards.
PUNISHMENT means the presentation of any consequence following a response which effectively decreases the frequency of that response. Examples are presentation of an aversive event or the removal of a positive event.
RATIO SCHEDULES OF REINFORCEMENT means a schedule in which reinforcement is made contingent upon the emission of a number of responses before one response is reinforced.
Fixed Ratio (FR) schedule - when a constant number of responses must occur prior to the reinforced response. For example, an FR 3 schedule indicates that each third response is reinforced.
Variable Ratio (VR) schedule - when a variable number of responses must occur prior to the reinforced response. The number of responses usually varies around a specified average. For example, a VR 6 means that an average of one of six performances is reinforced.
READY BEHAVIOR means appropriate behavior that the individual must exhibit, sufficient to indicate that the disruptive or crisis incident has passed. Unless otherwise specified in individual behavior programs, ready behavior is defined as calm verbal statements expressing the intent to behavior appropriately or behavioral demeanor devoid of agitation, tantrum like behavior, and emotional distress.
REQUIRED RELAXATION means a technique that involves teaching an individual to display quiet and relaxed behaviors. This is accomplished by requiring the individual to maintain a position (usually but not always prone on a mat) that is conducive to becoming calm, relaxed, and regaining self-control. Manual restraint may or may not be part of a required relaxation procedure. Unless the relaxation is completely voluntary, this technique is an aversive procedure.
RESPONSE COST means an aversive procedure in which an individual, upon display of a target behavior, loses a specific item, activity, privilege, or opportunity. If, for example, due to behavior the individual loses a trip that has been earned, is removed from a trip that is in progress, or has tokens removed that have already been earned, these are response costs. [Note: If a scheduled contingent activity is withheld or the individual fails to meet criterion (e.g., to attend the token store), this is not response cost and is not an aversive].
RESTITUTION means having an individual correct, to the extent possible, the damage or destruction done to another's property. this may involve superficially repairing an object (e.g., taping a broken radio), replacing an equal quantity of an edible that was consumed or rendered inedible by the individual, or with team approval, repayment in cash for the destroyed item. The individual who is his or her own guardian must be present and participate in the decision to make restitution.
RIBBON TIME OUT is a nonaversive intervention which involves the removal of a stimulus cue (e.g., watch, wrist band, ID bracelet, necklace, etc.) contingent upon the display of a target behavior. The cue signals other that when the individual is wearing it, he/she is entitled to frequent and varied positive reinforcers that are meaningful for the individual. When the stimulus cue has been removed, this is the signal that the individual is not to receive attention or other reinforcers. The cue should be an item that has intrinsic value to the individual and takes on further conditioned reinforcement value based on the subsequent pattern of reinforcement the individual receives from others when the cue is worn. The stimulus cue may not be the private property of the individual.
SATIATION means the loss of effectiveness of a reinforcing item or event due to overuse. It is also an aversive technique that involves requiring an individual to engage in an undesirable behavior repeatedly so the display of the behavior no longer has reinforcing properties for the individual.
SELF-MANAGEMENT TECHNIQUES include any of a variety of activities which are designed to encourage the individual to participate in, reflecting upon, monitoring, regulate, or provide feedback on his or her own behavior. The ultimate goal of all behavioral interventions is to shift the responsibility of managing inappropriate behavior from the service provider to the individual himself or herself.
SIMPLE CORRECTION means requiring the individual to restore the environment to the same state that existed prior to his/her disruptive behavior. Simple correction is not considered an aversive intervention.
TARGET BEHAVIOR refers to a problem behavior that has been defined in a program as behavior to be modified, reduced or eliminated. A target behavior also refers to positive, appropriate behaviors that are encouraged and rewarded as part of a positive reinforcement program.
TOKEN ECONOMY refers to an integrated system of reinforcement which is used to encourage appropriate adaptive behaviors across the individual's programmed environments. Tokens (exchangeable reinforcers) are given contingent upon the display of target behaviors and are later exchangeable for a reinforcing object or event. Token Reinforcer is an object or signifier that can be exchanged at a later time for a reinforcing item or activity.
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