Code of Massachusetts Regulations › 115 CMR - DEPARTMENT OF DEVELOPMENTAL SERVICES › Title 115 CMR 5.00 - Standards To Promote Dignity › Section 5.02 - Definitions

Current through Register 1525, July 5, 2024
For purposes of
				115
				CMR 5.00, the following terms shall have the following
				meanings:
Behavior Safety Plan
. A document,
				prepared by a Positive Behavior Support (PBS) Qualified Clinician, describing
				the plan for a rapid response to the challenging behavior of an individual.
The Behavior Safety Plan
must be a separate document
				from the Intensive Positive Behavior Support Plan (PBSP) document.
Chemical Restraint
. The non-consensual
				use of medication, not for treatment, but for the purpose of impairing the
				individual's freedom of movement. Chemical restraint does not include
				medication administered subject to the provisions of
				115 CMR 5.15.
Corporal Punishment
. The application
				of painful stimuli to the body as a punishment for certain behavior and
				includes, but is not limited to, hitting, pinching, the use of electric
				contingent skin shock or infliction of other pain.
Crisis Prevention, Response and Restraint (CPRR)
				Curriculum
. A standard, Department approved curriculum which
				includes training on de-escalation using Positive Behavior Supports, debriefing
				requirements and the monitoring of persons subject to a restraint. Each
				Department vendor may select from the list of Department qualified CPRR
				Curriculum providers and shall only use the procedures contained in the
				specific selected curriculum.
Crisis Prevention, Response and Restraint
				Individual Modification Plan (CPRR Individual Modification Plan)
.
				A document providers must use to modify a restraint technique contained in a
				Department approved CPRR curriculum, where use is contraindicated due to a
				medical or psychological condition of an individual. A
CPRR
				Individual Modification Plan
must describe the reason the approved
				restraint is contraindicated, including the specific condition and how the
				modification will address the condition. A CPRR Individual Modification Plan
				developed due to a medical condition must be supported by an order from a
				physician, dentist, physician's assistant or nurse practitioner. A CPRR
				Individual Modification Plan developed in response to a psychological condition
				must be supported by an order from a PBS Qualified Clinician. Individual
				modifications of restraint techniques must be approved by the Department CPPR
				Curriculum Review Committee prior to implementation. The Department CPRR
				Curriculum Review Committee shall not approve any modification which is
				identified at
				115 CMR 5.14(15)
				 including, but not limited to, physical
				restraint in a prone position.
Emergency
:
(a) the occurrence of serious self-injurious behavior.
(b) the occurrence of serious physical assault;
(c) the substantial risk of serious self-injurious behavior;
				or
(d) the substantial risk of serious physical assault.
Environmental Modification
.
				Alterations or changes to the physical environment, such as altering lighting,
				sound, colors, or temperatures, to lessen an individual's responsiveness which
				may trigger challenging behavior.
Evidence-based Practice
. Strategies
				based on procedures, assessments and interventions validated through
				peer-reviewed research.
Informed Consent
. The knowing consent
				voluntarily given by an individual (or by the individual's guardian, if
				applicable) who can understand and weigh the risks and benefits involved in the
				particular decision or matter.
Mechanical Restraint
. Any limitation
				of movement achieved by means of a physical device. Mechanical restraint does
				not include devices utilized in accordance with
				115 CMR
				5.12 or
				5.13.
Positive Behavior Support (PBS)
. A
				systematic, person centered approach to understanding the reasons for behavior
				and applying evidence-based practices for prevention, proactive intervention,
				teaching and responding to behavior, with the goal of achieving meaningful
				social outcomes, increasing learning and enhancing the quality of life across
				the lifespan. PBS is a three-tiered system that includes Universal Supports,
				Targeted Supports, and Intensive Supports, as defined in
				115 CMR
				5.14(5).
Response Blocking
. A procedure in
				which staff physically intervene as soon as the individual begins to emit a
				challenging behavior in order to prevent the completion of the targeted
				behavior. Response blocking is used mostly as a treatment to manage
				self-injurious behavior; however, it also is used as a defensive procedure when
				an individual is aggressing toward a staff person. Response blocking as
				described in CPRR-approved curricula (used defensively or to block self-injury)
				is not a restrictive procedure.
Restraint
. Any method used to limit an
				individual's freedom of movement over the individual's active resistance.
				Restraint of individuals with intellectual or developmental disability may only
				be used in cases of emergency. Restraint does not include hand-over-hand
				assistance with activities of daily living or skill acquisition.
Restrictive Procedure
. A procedure
				that restricts an individual's freedom of movement or requires an individual,
				through coercion, to perform a task which is non-scheduled, not essential for
				acquiring a skill or learned task, or not essential for his or her health and
				well-being, or removes something an individual owns or has earned. Restrictive
				procedures do not include hand-over-hand assistance with activities of daily
				living or skill acquisition.
Seclusion
. Any act which involuntarily
				places an individual alone in a locked room or other area from which there is
				no egress.
Substantial Risk
. A serious, imminent
				threat of bodily harm, where this is the present ability to enact such
				harm.
Time Out from Positive Reinforcement
.
				The contingent withdrawal of the opportunity to earn positive reinforcement or
				the loss of access to a form of positive reinforcement for a specified time.
				Time out from positive reinforcement is limited to a period not to exceed 15
				minutes. Physical removal over active resistance to a time out is a
				restraint.