411-055-0365 Behavioral Interventions (1) Disclosures. (a) The service provider must disclose the facility's policies and practices, as identified in the Residency Agreements, to a prospective individual or the prospective individual's legal representative. (b) The individual, or their legal representative, must agree to the limitations and interventions prior to admission. (2) Person-Centered Service Plans (PSP). The manner and degree of allowable behavior interventions must be consistent with the individual's Behavior Support Plan. (a) The provider's initial assessment shall be initiated as part of the screening process and completed within one week of the admission date. (b) Reassessment must be provided: (A) Within one month of the admission date. (B) At least four times a year, or more frequently if: (i) The individual receives a Safeguarding Intervention; (ii) The individual's need as noted at monthly IDT service plan meeting have changed and require reassessment; or (iii) Direct care staff implementing the Behavior Support Plan give feedback that a reassessment should be completed. (c) Individually-based limitations must be applied as described in OAR 411-004-0040 and must: (A) Have an established time limit for periodic review to determine if the limitation should be terminated or remains necessary. (B) Be supported by a specific need and documented in the person-centered service plan by completing and signing a program approved form documenting the consent to the appropriate limitation. (C) Be reviewed at least annually to determine if the limitation should be terminated or remains necessary. (3) The Behavior Support Plan shall identify direct care staff intervention strategies. (4) For each individual, the initial Behavior Support Plan: (a) Must be reviewed and approved by the IDT and Department staff. (b) Must have a subsection of the Behavior Support Plan identified as a Crisis Plan. The Crisis Plan must include: (A) Identification of triggers or indicators of escalation. (B) Procedures and strategies to defuse, de-escalate, and minimize the likely behaviors that could require a Safeguarding Intervention. (C) Procedures to follow in managing a crisis situation. (D) Whether or not the individual has received IDT and Department authorization for Safeguarding Interventions. (5) Use of any Safeguarding Interventions for an adult is permitted in an IIC program if the Behavior Coordinator approved the use of the Safeguarding Interventions to be used in a Behavior Support Plan. (6) A Behavior Coordinator may only include a safeguarding intervention in the plan when all of the following conditions are met: (a) The safeguarding intervention is directed for use only: (A) As strategy for addressing emergency crises. (B) For as long as the situation presents imminent danger to the health or safety of the individual or others. (C) As a measure of last resort. (b) The Behavior Coordinator has weighed and documented in the BSP the potential risk of harm to an individual from the safeguarding intervention against the potential risk of harm from the behavior. (c) The Safeguarding Intervention is in accordance with a Department -approved behavior intervention curriculum or the behavior coordinator has secured written authorization from the curriculum's oversight body to modify the safeguarding intervention. A copy of the authorization to modify a safeguarding intervention must be attached individual's service plan. (d) The Behavior Coordinator acknowledges that prior to the implementation of any safeguarding intervention, an individual must have an individually-based limitation for restraint in accordance with OAR 411-004-0040. (7) The Department does not authorize a Safeguarding Intervention that includes, but is not limited to, any of the following characteristics: (a) Abusive, as defined in OAR 411-020-0002(1)(h). (b) Aversive. (c) Coercive. (d) For convenience. (e) Disciplinary. (f) Demeaning. (g) Mechanical. (h) Prone or supine restraint. (i) Pain compliance. (j) Punishment. (k) Retaliatory. (8) When a service plan is newly developed or revised and includes a Safeguarding Intervention, the plan must include a summary of all of the following: (a) The nature and severity of imminent danger requiring a safeguarding intervention. (b) A history of unsafe or challenging behaviors exhibited by the individual. (c) A description of the training and characteristics required for the designated person applying the safeguarding intervention. (d) Less intrusive measures determined to be ineffective or inappropriate for the individual. (9) A qualified staff applying safeguarding interventions must be trained on the use of safeguarding interventions by a person who is appropriately certified in Department approved behavior intervention curriculum. (10) A behavior coordinator must only use safeguarding interventions the behavior coordinator is certified to use, and that direct care staff have been trained to provide. (11) A Safeguarding Intervention may be used when: (a) The Safeguarding Intervention is used as part of the Crisis Plan; (b) Less restrictive alternatives have been tried and evaluated and documented before the use of the Safeguarding Interventions; (c) The facility staff using the intervention has successfully completed the Department-approved trainings; (d) The intervention is used for the shortest time possible; and (e) The Safeguarding Intervention does not include excessive use of force. (12) The manner and degree of allowable behavior interventions, including an appropriate level of Safeguarding Interventions for the individual, must be included in the individual's Behavior Support Plan. Any force used must be consistent with the Behavior Support Plan and may not be excessive. (13) Safeguarding Interventions, if used, may only be used as a de-escalating intervention to minimize risk or harm to the individual or others and as an option of last resort. Restraints may only be used for the shortest time possible and only until the Behavior Coordinator evaluates the behavior and develops care plan interventions to meet the individual's needs. (14) The use of restraints may never be used for convenience of the provider or to discipline the individual. (15) Use of Safeguarding Interventions may be considered abuse if a protective services investigation determines. (a) A Behavioral Consultant has not conducted a thorough assessment before implementing a physician's direction for use of Safeguarding Interventions. (b) Less restrictive alternatives have not been evaluated before the use of Safeguarding Interventions. (c) Safeguarding Interventions is used for convenience or discipline. (d) Is for an excessive time or uses excessive force. (16) In an emergency or short-term situation, monitored separation from other residents in the resident's room may be permitted, if used for a limited period of time. Separation may only be used when: (a) It as part of the Behavior Support Plan. (b) Is included as part of their individually-based limitation. (c) Other interventions have been attempted but have been unsuccessful. (d) Implemented by direct care staff that have successfully completed the Department-approved training. (e) Used as a de-escalating intervention until the Behavior Coordinator evaluates the behavior and develops a new BSP with revised interventions to meet the individual's needs. The Behavior Coordinator must evaluate the individual and the BSP no more than 30 minutes after the separation occurs. (f) The individual is monitored no less frequently than every 10 minutes while separated from others. (g) The individual needs to be secluded from certain areas of the facility because their presence in a specific area poses a risk to health or safety of the individual or another. However, such actions shall be considered abuse if an APS investigation determines: (A) A Behavioral Consultant has not conducted a thorough assessment before implementing any separation. (B) Less restrictive alternatives have not been evaluated before the use of any separation. (C) Separation is used for convenience or discipline. (D) Separation is for an excessive time or uses excessive force. (17) The IDT must meet on a monthly basis, or more frequently if needed, to meet the requirements in these rules. Participants may attend via telephone or secured video conferencing. Statutory/Other Authority: ORS 409.050, 410.070, 443.450 Statutes/Other Implemented: ORS 409.050, 410.070, 443.400 - 443.455, 443.991 History: APD 20-2019, adopt filed 06/26/2019, effective 06/28/2019