Describe Your Organization S Approach to Behavior Support and Management and How It Is

Describe your organization’s approach to behavior support and management and how it is implemented in practice to promote positive behavior (e.g., Our organization operates a residential treatment program for adjudicated youth who have a history of violence and aggressive behavior. We have taken the following steps to promote a positive, therapeutic environment and ensure the safety of our service recipients and staff…). Include the full spectrum of behavioral support interventions that your organization utilizes (e.g., point programs, level systems, time out, manual restraint, etc.). If your organization uses any restrictive interventions (e.g., isolation, manual restraint, locked seclusion, and mechanical restraint), provide your organization’s rationale for their use.

MHCO provides basic foster care in a residential setting. Residents have some risk factors and trauma to overcome, but are able to learn to manage behaviors within their environment without the use of restrictive interventions. Behavior support and management is used to provide a means for teaching that stresses encouragement and empowerment for exhibiting appropriate and acceptable behaviors and ensure that the safety of the resident and other stakeholders is guaranteed while using the least amount of intervention possible. Employees are trained in utilizing methods for promoting respect, supporting positive behavior, de-escalating volatile situations, promoting a safe work and service environment, reducing emergency situations, reducing distress, and applying behavior management interventions. The administration of behavior support and management techniques is not delegated to untrained individuals or stakeholders either by commission, omission, or by default. Expectations and standards for resident behavior are reasonable, age appropriate, and within his or her ability to achieve.

Direct care personnel use a method of behavior support and management appropriate for the resident’s age, development, and behavior. Time-out, Natural and Logical Consequences, and response meetings are the approved interventions of behavior support and management. As a last resort, physical restraint may be used in limited circumstances. Direct care personnel communicate, counsel, and process with residents after use of the intervention to explain the technique and why the management tool was necessary and seek supervisor assistance when needed.

Non-isolation time-out is defined as the removal of a resident to a separate, unlocked room or other identified location from which the resident is not physically prevented from leaving. This behavior support and management technique is used for residents up to the age of ten (10). Residents are only to be in time-out for a period appropriate to his or her age and development (i.e. one minute per year of age). Time-out is utilized to give the resident time and space from a situation to decrease frustration, process choices, and reset behavior.

Employees are trained to use a Natural and Logical Consequence approach as a behavior support and management intervention based upon the Systematic Training for Effective Parenting program. Natural and Logical Consequences are utilized to assist residents in analyzing the benefits of choosing appropriate behaviors and understanding how choices impact their lives.

Employees protect residents from harm, abuse, neglect, and exploitation. If a situation between residents demonstrates bullying or harassment, direct care personnel arrange for an immediate response meeting with the residents, supervisor, and his or her family to develop an anti-bullying safety plan, attend additional campus training, attend conflict resolution or anger management class, or participate in other interventions.

Employees use non-violent crisis intervention techniques to de-escalate or diffuse crisis situations. Employees use every other approved technique available to de-escalate or diffuse crisis situations before employing the use of physical restraint. In the model developed by the Crisis Prevention Institute, physical restraint is considered least restrictive through holds while sitting in chairs or standing. If these measures do not de-escalate the crisis situation, employees call for additional support from supervisors. MHCO administration recognizes that there will be times that a physical restraint would need to be utilized for the safety of a resident. In order for restraints to be done as safely as possible, personnel are trained in proper techniques and to learn effective ways to de-escalate a situation before behavior becomes life endangering. Does your organization use restrictive behavior management under any circumstances?

Physical restraint holds are only authorized if the resident is placing himself or herself or another person in grave danger, alternative, less restrictive means have failed, the resident has no health problems precluding the use of physical restraint, and the resident does not appear to be medically fragile to a point where the use of restraint could cause physical harm. The restraint takes place following a period of observation of the resident’s health status (i.e. respiration and vital signs) immediately prior to physical intervention. Physical restraint is not authorized as a means of punishment, discipline, or convenience, with excessive force, or while the employee is in an angered or highly emotional state which would increase the potential for resident harm or excessive force. All physical restraints are administered in the least restrictive manner possible to protect the resident from imminent risk of harm.

MHCO did not utilize any restraints or holds in 2016. Due to the age and type of population that the program serves, using natural and logical consequences and de-escalation techniques have been effective in behavior management and support of residents. Identify a part of your behavior support and management policies and practices that have been: the most difficult to advance, and indicate the reasons why; and the least difficult to advance, and indicate the reasons why (e.g., Changes in state regulations have increased the number of adolescents admitted with a history of sexually acting out behavior. Consequently, we’ve had to modify our behavior support and management practices to include…).

One of the most difficult aspects of behavior support and management to advance is helping direct care personnel match natural and logical consequences to the resident’s behavior and choices. MHCO is training personnel to utilize teachable moments with residents to emphasize natural consequences to their behavior. Giving residents opportunities to change the behavior and earn back or rescind the consequence, remaining consistent in addressing behavior of residents, and recognizing trauma reactions in behavior are being addressed in individual and team supervision and training with direct care personnel. Team supervision includes both primary and alternate direct care personnel to promote consistency in applying consequences.

The least difficult part of behavior and support management is the transition from North Carolina Interventions (NCI) to Nonviolent Crisis Prevention (CPI). NCI physical restraints are primarily for teens and adults that weigh 100 pounds or more. MHCO only had a few staff members trained in NCI physical restraints. All staff will be trained in CPI techniques which are least restrictive and proportionate to residents’ varying ages and body sizes. CPI is also more focused in de-escalation techniques than NCI. Does your organization use any established behavior support and management interventions, e.g., The Therapeutic Crisis Intervention System (TCI)?

Employees use non-violent crisis intervention techniques to de-escalate or diffuse crisis situations. The Crisis Prevention Institute’s (CPI) crisis development model identifies levels of behavior that present opportunities to defuse a potential crisis situation and approaches to use in each level. CPI focuses on de- escalation techniques and physical restraint that is least restrictive and proportionate to residents’ varying ages and body sizes Provide any additional information about your organization’s behavior support and management policies and procedures that would increase the Peer Team’s understanding of how the practice(s) support a safe environment and reduce the need for restrictive interventions.

The MHCO Administrator endorses the policy that the organization does not use restraint as a planned method in controlling resident behavior and that restraint is only utilized in emergency situations by certified staff. Any restraints or other critical incidents are reported to the NC Licensing Division. All incidents are reviewed monthly by the PQI Core Group and PQI Subcommittee. The PQI teams recommend any corrective or follow-up action in response to the issues outlined in the monthly reports. MHCO utilizes this feedback to process changes needed in behavior management procedures.