Alabama Administrative Code › Title 660 - ALABAMA DEPARTMENT OF HUMAN RESOURCES › Chapter 660-5-49 - BEHAVIOR MANAGEMENT › Section 660-5-49-.06 - DHR Responsibilities

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
General Guidelines
- Plans designed to
			 address behavioral needs must be systematic, based upon a careful assessment of
			 the child's behavior, and utilize behavior management interventions which are
			 in accordance with generally acceptable professional standards. Interventions
			 will be based primarily on rewards, redirecting and re-education rather than
			 punishment; consistently implemented in all areas of a child's life (e.g.,
			 school, church or leisure activities); implemented in a therapeutically
			 appropriate manner according to the individual treatment plan developed by the
			 provider; and timely evaluated for effectiveness. Children are to be referred
			 to providers qualified and trained to authorize and implement behavior
			 management interventions.
DHR staff shall be aware of a
			 provider/facility's behavior management policy and may request a copy, when
			 needed, to assure it is consistent with Departmental policy and provides
			 children the same rights as children in DHR approved foster homes
. If
			 the need for intervention becomes apparent after placement, and the provider is
			 not appropriately trained to authorize and implement the needed intervention,
			 DHR shall assist the provider to secure the needed training.
(2)
Assessing Behavioral
			 Needs
- DHR staff shall partner with the appropriate team
			 members to explain and assist the age appropriate child and the child's family
			 to understand the need for behavior management interventions. Assessments are
			 to include information gathered from the social, medical, educational,
			 psychological, and legal life domains (areas of family functioning) and will
			 address child and family's strengths and needs; child's current and past
			 behaviors; events, conditions or circumstances that trigger or affect the
			 behavior; purpose the behavior serves and how it is displayed; frequency and
			 duration of the behavior; previous interventions used to manage the behavior
			 and their effectiveness; child's degree of readiness to learn self-control; and
			 targeted areas for behavioral improvement and increased self-control. When a
			 child's behavior indicates the need for medication, a medical assessment is
			 required. The DHR worker is responsible for providing the physician with the
			 child's history, information about the caregiver's capabilities and the
			 changing needs of the child and family, and to assure the physician has
			 explored alternative treatment interventions. (Refer to section on medication
			 for more detailed information.)
(3)
Designing And Implementing The Behavior Management
			 Plan
- Behavior management plans are to be individualized
			 for each child, developed, and authorized in advance by the child and family
			 planning team. The more restrictive interventions must also be authorized in
			 advance unless there is a crisis situation.
The behavior management plan
			 and any adjunct treatment plans must be documented in the ISP
and will
			 include the child and family's strengths and needs as they relate to the
			 desired behavioral outcomes; a clear description of the targeted behavior(s) to
			 be managed (i.e. specific situation(s) where the behavior occurs, how it is
			 displayed by the child, its frequency and duration); the desired outcomes for
			 the targeted behaviors; the interventions to be used for teaching positive,
			 alternative replacement behavior and how they will be implemented; the methods
			 and frequency for evaluating the effectiveness of the interventions; and if
			 applicable, the crisis plan outlining acceptable responses for managing
			 dangerous behaviors. When case information reveals a child has a history of or
			 the potential to display dangerous behavior, service provider and placement
			 referrals are to be made to appropriately qualified and trained providers and
			 placement resources.
The individualized service plan for these children
			 must include a crisis plan outlining acceptable responses for managing the
			 dangerous behavior.
Foster family home providers may use a behavior
			 management intervention (e.g., prolonged grounding, exceeding defined time-out
			 limits) which has not been previously authorized and documented in the
			 individualized service plan when a crisis situation arises. The intervention
			 will not be used any longer than necessary to protect the child or others from
			 harm or to help the child gain control. The foster parent must document use of
			 the intervention and notify the DHR worker immediately (i.e., no more than one
			 (1) working day later) of the crisis and subsequent use of the intervention.
			 Residential providers may also use an intervention not previously authorized
			 and documented in the individual service plan when a crisis arises. The
			 residential provider must have a procedure in place which requires notification
			 of a qualified child care professional (QCCP) who is available to assess the
			 crisis and make decisions regarding the need for and use of the intervention.
			 The same procedure used by foster family home providers regarding
			 documentation, notification of the DHR worker, and review at the next ISP
			 meeting is to be followed.
(4)
Assessing And Monitoring Behavior Management
			 Interventions
- DHR shall work in partnership with
			 providers as interventions are assessed for effectiveness in managing targeted
			 behaviors. Assessment and monitoring shall occur according to the methods and
			 frequency identified in the behavior management and individualized service
			 plans. An intervention will be discontinued when it is no longer needed to
			 manage a behavior or when the intervention is not effective and a more
			 appropriate one has been identified.
(5)
Discharge Planning And
			 Training For Managing Behaviors
- When changes in a child's
			 placement or provider responsible for implementing behavior are going to occur,
			 information must be supplied to the subsequent caregiver/provider and will
			 include the child's behavior management plan including behavioral expectations
			 and desired outcomes, prior interventions that have been both successful and
			 unsuccessful, and current interventions used to manage the behavior(s).
			 Training regarding behavior management intervention(s) used by the current
			 caregiver/provider shall be provided to the parent(s), family member(s), or
			 foster care provider to whom the child is expected to be discharged. Training
			 on implementing the specific interventions shall be provided by a qualified
			 source that has training and experience in the implementation of the behavior
			 management interventions. The Department will assist the caregiver with
			 locating any needed training.
Author:
Jerome Webb
Statutory Authority:
R.C. v.
				  Fuller
case (
R.C. v. Hornsby
, No.
				  88-H-1170-N, Consent Decree) (M.D. Ala. Approved December 18, 1991).