Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 384 - BEHAVIOR TREATMENT IN RESIDENTIAL CHILD CARE FACILITIES › Section 384.20 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Agency Behavior Treatment Plan" means an agency document that
				outlines to the Department all behavior treatment procedures that may be
				employed at the facility. The plan shall include:
* Behavioral Treatment Purpose Statement: This statement shall
				stipulate the agency's rationale for using behavioral treatment techniques and
				the appropriateness and rationale for use with the populations served, as well
				as its intended forms (i.e., crisis prevention, behavior interventions, and/or
				behavior management).
* Definitions Section: This section shall identify the
				facility-specific definitions for all forms of behavior treatment and related
				procedures/protocols used by the facility.
* Behavior Treatment Restrictions: This section shall detail
				the behavior treatment procedures that are prohibited by the facility.
* Behavior Treatment Components: This section shall identify
				one of the five models of crisis intervention and behavior management currently
				allowable under this section and provide an outline of each specific method of
				crisis prevention, behavior intervention, and behavior management to be
				employed at the agency. A designee of the Director must independently review
				and recommend any model of crisis intervention and behavior management not
				outlined in this section for approval by the Director before it can be employed
				at any facility. This section shall also include an agency's specific response
				to situations in which a behavior management intervention intentionally or
				unintentionally results in either the child and/or the staff being prone on any
				surface. For each identified treatment procedure, the outline shall include:
				the ultimate purpose, clinical criteria/determination process, general
				operational details, general overview of the quality assurance and improvement
				mechanisms, emergency procedures, employment and training criteria, and
				family/guardian and child's attorney notification procedures.
* Appendices: Appendices may be included, as necessary, to
				describe the behavior treatment techniques used by the facility.
"Approved crisis intervention and prevention procedures and
				models" are those procedures and models approved by the Department of Children
				and Family Services and the governing body of the child care facility. (The
				approved models under this Part are listed in Appendix A.) The procedures are
				taught as part of mandatory training expressly for use in responding to
				emergency situations when a child presents dangerous behavior that could not
				have been anticipated, or the procedures specified in the child's current
				individual treatment plan would not successfully control the imminently
				dangerous behavior.
"Behavior intervention techniques" refers to the systematic
				application of methods designed to influence the behavior of one or more
				individuals through behavioral techniques (e.g., token economies and point
				systems) that have been approved in compliance with the requirements set forth
				in Section
				384.30.
"Behavior management techniques" are techniques that prevent or
				limit an individual's ability to initiate or continue presenting some specific
				dangerous behaviors. Behavior management techniques include manual restraint,
				seclusion, and other restrictive procedures approved in compliance with the
				requirements of Section 384.30. Examples of this type of procedure include, but
				are not limited to, the re-direction of a child and/or manual restraint.
"Behavior Treatment Committee" means a professional review or
				behavior treatment review committee formed by one or more child care facilities
				and composed of persons with technical expertise in the use of crisis
				prevention, and behavior management techniques. At least one member of the
				committee must be a person who is not an owner, employee, principal
				shareholder, owning at least 5% of the stock of the corporation or member of
				the governing body of any of the participating child care facilities. This
				committee fulfills a quality assurance function and reviews for technical
				acceptability the use of a facility's applicable behavior treatment procedures
				that have been outlined in the facility's Behavior Treatment Plan. This would
				include a retrospective examination of at least 13% of all interventions, or
				25% of all interventions in the case of programs with fewer than 25 total
				residents, and all grievances submitted concerning the use of restrictive
				intervention to determine whether there is a clinical basis for the use of the
				procedure, whether a procedure of this level is warranted, and what is the
				standard of best clinical practice. The committee shall meet at least once per
				quarter, and written documentation (i.e., minutes) of all meetings shall be
				maintained. A quality assurance/quality improvement committee may function as
				the Behavior Treatment Committee when the committee membership meets the
				requirements of this definition.
"Chemical restraint", a prohibited practice by this Part, means
				the use of any psychoactive medication that is not a part of a medical
				diagnostic or treatment procedure for the express purpose of restricting an
				individual's freedom of movement that is used during a behavioral crisis or
				behavioral emergency and results in the sedation of the child.
"Child for whom the Department is legally responsible" means a
				child for whom the Department has temporary protective custody, custody or
				guardianship via court order, or a child whose parents have signed an adoptive
				surrender or voluntary placement agreement with the Department.
"Child care facility" or "facility", as used in this Part,
				means a child care institution, group home, youth emergency shelter (as
				restricted by 89 Ill. Adm. Code 410, Licensing Standards for Youth Emergency
				Shelters), secure child care facilities or any other facility approved by the
				Department to use manual restraint or seclusion.
"Child care supervisor" means a person who supervises those
				persons whose primary responsibility is daily care of children, known as child
				care staff, and who are qualified in accordance with 89 Ill. Adm. Code
				404.13.
"Child welfare supervisor" means a person with a Masters of
				Social Work degree from an accredited school of social work or an equivalent
				Masters degree in a human services field and two years of full time supervised
				experience in a social work setting. At least one child welfare supervisor in a
				facility shall have at least two years of experience as a supervisor.
"Dangerous behavior" means behavior that is likely to result or
				has resulted in harm to self or others, if not immediately contained.
"Department" means the Illinois Department of Children and
				Family Services. (Section 2.02 of the Child Care Act of 1969 [225 ILCS
				10/2.02 ])
"Developmental disability" means a disability that is
				attributable to mental retardation, cerebral palsy, epilepsy or autism; or any
				other condition that results in impairment similar to that caused by mental
				retardation and that requires services similar to those required by mentally
				retarded persons. Such disability must originate before the age of 18 years, be
				expected to continue indefinitely, and constitute a substantial
				handicap.
"Director" means the Director of the Department of Children and
				Family Services.
"Discipline" means providing specific consequences for
				infractions of the rules of a child care facility as a means of helping
				children both to develop self-control and to learn they are responsible for
				their actions. For purposes of this Part, discipline is a behavior intervention
				technique.
"Extended restriction" means periods of touching or holding by
				direct person-to-person contact for a period of less than five minutes.
				Physical restriction shall not constitute manual restraint if it is
				accomplished with minimum force and is used to prevent a child from completing
				an act that is likely to result in harm to self or others or to escort a child
				to a quieter environment. Extended restriction must be documented in the
				child's record, i.e., progress notes.
"Human Rights Committee" means a group of three or more persons
				that includes an attorney, or access to an attorney, who understands mental
				health law. At least one member of the Human Rights Committee shall not be the
				owner, employee, principal shareholder owning at least 5% of the stock of the
				corporation, or member of the governing body of any of the participating child
				care facilities. Human Rights Committees may be formed by one or more child
				care facilities. Human Rights Committees are charged with assuring that
				children's rights are protected. The committee is responsible for reviewing
				procedures and practices for intrusive or restrictive behavior interventions
				that are expressed in the child care facility's Behavior Treatment Plan. The
				committee assures that the facility's procedures assure, among other things,
				that processes and practices address informed consent, due process and
				grievances, least restrictive practices, and appropriateness of fit to the
				population served and that they broadly reflect community standards for
				conduct. The Committee also recommends acceptance of the facility's practices
				to the Chief Executive Officer for referral to the governing body for approval.
				The Human Rights Committee must meet at least annually.
"Individual treatment plan" means the current intervention and
				treatment program for a specific child that has been prepared by an
				interdisciplinary team that may include, but is not limited to, the child, DCFS
				caseworker, private agency/institution caseworker, therapist or psychiatrist,
				foster parents and parents, as clinically and legally appropriate.
"Manual restraint" means a behavior management technique
				involving the use of physical contact or force, characterized by measures such
				as arm or body holds, subject to the provisions of Section
				384.50.
"Mechanical restraint", as used in this Part, means any device
				(including but not limited to straight jacket, arm/leg restraints, and
				four-point restraints), other than personal physical force, used to directly
				restrict the limbs, head or body of a person. The term does not include medical
				restraint. Mechanical restraint may not be used in facilities licensed by the
				Department of Children and Family Services, except as allowable under 89 Ill.
				Adm. Code 411 (Licensing Standards for Secure Child Care Facilities).
"Medical restraint" means a process used for the partial or
				total immobilization of a person for the purpose of performing or maintaining a
				medical/surgical procedure under the supervision of a licensed physician or
				registered nurse or as a physician-ordered treatment for self-injurious
				behavior.
"Mental health professional (MHP)" means a person who provides
				services under the supervision of a qualified mental health professional (QMHP)
				and who possesses a bachelor's degree in human services, a practical nurse
				license pursuant to the Illinois Nursing and Advanced Practice Nursing Act [225
				ILCS 65 ], or who has a minimum of five years supervised experience in mental
				health or human services. The mental health professional responsible for making
				clinical decisions regarding the use of manual restraint, seclusion, or other
				restrictive behavior management techniques shall have completed at least 15
				clock hours of training in the application of the specific behavior management
				techniques used by the facility.
"Physician" means a person licensed in the State of Illinois to
				practice medicine in all of its branches.
"Qualified mental health professional (QMHP)" means one of the
				following as defined in 59 Ill. Adm. Code
				132.25 (Medicaid
				Community Mental Health Services Program): licensed physician, psychiatrist,
				psychologist, social worker possessing a master's or doctoral degree in social
				work, registered nurse with at least one year of clinical experience in a
				mental health setting or who possesses a master's degree in psychiatric
				nursing, an occupational therapist with at least one year of clinical
				experience in a mental health setting, an individual with a master's degree and
				at least one year of clinical experience in mental health services and who is
				licensed to practice marriage and family therapy, or an individual possessing a
				master's or doctoral degree in counseling and guidance, rehabilitation
				counseling, social work, vocational counseling, psychology, pastoral
				counseling, or family therapy or related field, who has successfully completed
				a practicum and/or internship that includes a minimum of 1,000 hours, or who
				has one year of clinical experience under the supervision of a QMHP, or who is
				a licensed social worker holding a master's degree with two years of experience
				in mental health services or who is a permanently licensed professional
				counselor under Professional Counselor and Clinical Professional Counselor
				Licensing Act [225 ILCS 107 ] holding a master's degree with one year of
				experience in mental health services.
"SASS" means Screening, Assessment and Support Services, and
				the services are provided by agencies under contract with the Department of
				Children and Family Services or the Illinois Department of Human
				Services.
"Seclusion" means the contingent withdrawal of reinforcing
				stimuli by removing the child from an area to a specifically designated room
				from which egress is restricted. This procedure is considered a behavior
				management technique and as such must be used only as a therapeutic response to
				dangerous behavior. There are two forms of seclusion:
* Staff-assisted seclusion means the room is secured by a
				locking mechanism that engages only when a key, button, or handle is being held
				by a staff member. When that staff member takes his or her hand off the device,
				the door unlocks and the child is able to easily and readily open the door from
				the inside. The door to such a room may not/does not remain locked when
				unattended.
* Key-locked seclusion means the seclusion room has a locking
				device that remains engaged without staff presence. Key-locked seclusion is
				prohibited under this Part
"Self-governance program" means an organized program that
				allows peers to participate in the discipline or behavior management of peers
				under the supervision and control of staff. Effective April 1, 2006, peers
				shall be prohibited from participating in the manual restraint of another
				child. Self-governance programs shall be restricted to programs identified and
				recognized by the Illinois Association of Peer Treatment Agencies and the
				Department of Children and Family Services as using a positive peer group
				treatment model.
"Time-out" means a specific behavior intervention technique of
				short duration used to assist a child in regaining self-control that may be
				authorized by any facility staff person for a maximum of ten minutes beyond the
				time when the child regains self-control, if included in the agency's Behavior
				Treatment Plan submitted to the governing body and the Department and approved
				in accordance with the requirements of this Part. Staff are required to
				document in writing each incident of time-out that exceeds 10 minutes. Any
				series of three or more Exclusionary Timeouts during a facility's standard work
				shift must be reviewed by the Child Care Supervisor within 24 hours. There are
				two types of time-out permitted by this Part.
* Non-exclusionary or Instructional Time-out: A procedure
				involving the contingent withdrawal of reinforcing stimuli, while the child
				remains in the area (e.g., child is seated away from the group, but in the same
				area).
* Exclusionary Time-out: A procedure involving the contingent
				withdrawal of reinforcing stimuli by removing the child from the area (e.g., to
				the hallway or bedroom that does not involve a locked or restricted exit). A
				seclusion room may be used as a time-out room only if egress from the room
				remains unrestricted through closure or by staff and a child is appropriately
				supervised.