Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 197 - OFFICE OF AGING AND DISABILITY SERVICES › Chapter 5 - REGULATIONS GOVERNING BEHAVIORAL SUPPORT, MODIFICATION AND MANAGEMENT FOR PEOPLE WITH INTELLECTUAL DISABILITIES OR AUTISM IN MAINE › Appendix 197-5-FOUR - LEVELS OF INTERVENTION: POSITIVE SUPPORT AND BEHAVIOR MANAGEMENT PLANS (LEVELS 1-5)

Current through 2024-29, July 17, 2024
Positive Support Plans or Behavior Management Plans designed
				  to support a Person with Challenging Behavior must be approved as prescribed by
				  these regulations prior to implementation. The Planning Team is responsible for
				  providing the required documentation and obtaining the necessary level of
				  review and approval.
The following chart defines five levels of support,
				  intervention, restriction and required approval. Each level has required
				  planning, documentation, and review which must be obtained prior to
				  implementation. Each Plan must be reviewed for approval at the level of the
				  most restrictive component of the Plan.
Positive Support Plans and Behavior Management Plans are
				  considered in the following categories.
Level 1
Support for the Person to participate
							 meaningfully in his/her community life.
Description:
- No restrictions of Rights
- Non-coercive intervention with voluntary
							 participation by the Person
Examples include, but not limited
							 to:
- Physical & mental health assessment and
							 treatment
- Environmental modification
- Communication support
- Teaching Skills
- Physical prompts for teaching or personal support
							 without Coercion
- Voluntary Timeout
Required Approval:
Planning Team, including the Case Manager
Required Documentation:
Functional Assessment, Positive Support Plan
Level 2
Programs which are designed to modify or
							 redirect a Person's behavior
Description:
- Non-coercive intervention with voluntary
							 participation by the Person
- Some programs which restrict a Person's activities
							 or Rights for safety reasons
- Preservation of personal property and safety
							 measures involving incendiary material or sharps
- Positive Behavior Modification Techniques
Examples include, but not limited
							 to:
- In-Home Stabilization for a maximum of one hour for
							 safety and assessment
- Securing of incendiary material, clothes, shoes or
							 sharps with documented safety issues or problematic misuse, when the Person
							 does not communicate an objection.
- Restriction of food or liquid (with doctor's health
							 or safety recommendation)
- Verbal Redirection or verbal prompting to redirect
							 behavior
- Non-Exclusionary Timeout
- Locks that the Person is able to unlock
Required Approval:
Planning Team, including the Case Manager
Required Documentation:
Functional Assessment, Positive Support Plan,
							 Transition Plan toward more naturally occurring reinforcers, In-Home
							 Stabilization Plan as indicated
Level 3
Programs which restrict a Person's Rights as
							 enumerated in 34-B M.R.S. §
														5605
Description:
- Planned Restriction of Rights
- An intervention to which the Person or the Person's
							 Guardian, as appropriate, communicates an objection
- Use of Coercion
Examples include, but not limited
							 to:
- Physical Redirection
- In-Home Stabilization for more than one hour for
							 safety and assessment, not to exceed 24 hours.
- Property Removal (other than for Imminent
							 Risk)
- Restriction of communication (other than to a
							 Guardian, Advocate or Crisis Team);
- Restriction of privacy
- Search of the Person or personal space
- Restriction of food or liquid
- Buzzers/alarms/sensors or locks that the Person is
							 unable to disarm or unlock on doors/windows, etc. -Electronic monitoring
							 Devices (video, ankle bracelet, etc.),
- Releasing (briefly holding the Person in order to
							 release oneself and/or another person from a physical hold such as a bite or
							 hair hold)
- Planned use of Law Enforcement
- Restriction of a communication device that
							 prohibits the Person's ability to communicate.
- Restriction of a communication device when the
							 device is being used for an illegal activity.
Required Approval:
Planning Team,
							 including the Case Manager, Case Management Supervisor,
Review Team Signatures
Required Documentation:
Functional Assessment (Updated), Positive Support
							 Plan, Behavior Management Plan, In-Home Stabilization Plan as indicated,
							 Physician's Evaluation, Psychiatric Medication Plan as indicated
Level 4
All programs with a Restraint
							 component
Description:
- Planned Use of Restraint
- Planned Removal of staff
- Use of Coercion
- Must not include Prohibited Practices
Examples include, but not limited
							 to:
- Physical Restraint/interventions
- Any physical force or threat thereof to cause a
							 Person to move.
- Physically confining a Person
- Blocking
- Temporary removal of staff
- In-Home Stabilization for more than one hour for
							 safety and assessment, when Behavior Management Plan includes possibility of
							 renewal of In-Home Stabilization after 24 hours.
-Use of a Restraint without an attempt to release,
							 longer than 15 minutes
-Use of a Specialized Restraint
- Restraint that prohibits the Person's ability to
							 communicate, such as a restraint that interferes with a person's ability to use
							 gestural communication or sign language
Required Approval:
Planning Team, including the Case Manager,
Case Management Supervisor,
Review Team Signatures
Required Documentation:
Functional Assessment (Updated),
Positive Support Plan, Behavior Management
							 Plan,
Psychological Assessment, Physician's
							 Evaluation,
In-Home Stabilization Plan as indicated,
Psychiatric Medication Plan as indicated
Level 5
Programs considered only in exceptional and
							 rare instances where no less restrictive measure can safely meet the need to
							 keep a Person from danger to self or others.
Description:
- Programs that propose significant restriction or
							 unusual risk to the Person
- The level of risk or restriction must not outweigh
							 the potential harm from the Challenging Behavior being addressed
- Programs that pose a potential harm that the
							 Statewide Review Panel deems atypical may be required to meet Level 5 review
							 requirements
- Prohibited Practices will not be considered for
							 approval.
Examples include, but not limited
							 to:
-
Some Mechanical Restraints (other than
							 those expressly prohibited by these regulations), such as splints, mitts, or
							 helmet may be approved for use in unusual circumstances for purposes of
							 Behavior Management.
Examples of unusual circumstances may include
							 transitioning from institutional programs or family settings into a setting
							 governed by these regulations.
- Supine, or face-up floor Restraint
- Chemical Restraint
- Noxious Interventions
- Binding of wrist to waist or wrist to bed
Required Approval:
Planning Team, including the Case Manager Case
							 Management Supervisor
Review Team Signatures Commissioner or designee
							 Signature
Required Documentation:
Functional Assessment (Updated),
Positive Support Plan, Behavior Management Plan
							 In-Home Stabilization Plan as indicated Psychological Assessment, Physician's
							 Evaluation,
Psychiatric Medication Plan as indicated Second
							 Clinical Opinion Statewide Review Panel Recommendation