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Behavioral Support

Tier 1 Service

Page posted: 10/01/03

Page reviewed: 2/19/13

Page updated: 3/7/14

Legal Authority

Federally approved BI and CADI Waiver Plans, Minn. Stat. 245D.03

Definition

Behavioral Support: Service to increase positive behavior and decrease or eliminate severe, challenging behavior.

Covered Services

Behavioral support may be provided in the home or community. Covered services include the following:

  • • Complete an individualized functional assessment of target behaviors
  • • Develop a positive behavior support plan that may also include specific reactive or emergency strategies
  • • Implement the plan
  • • Train and supervise caregivers and behavior staff as needed to implement the plan
  • • Reassess and modify the plan periodically
  • Non-covered Services

    Authorized services cannot supplant or duplicate services available through other funding sources such as Medicare, Medicaid and private insurance. See resources for services that should be maximized before this service.

    Assessment Guidelines

    Prior to initial authorization of behavioral support services:
    1. Obtain documentation of a mental health diagnostic, cognitive, neuropsychological, or neurological assessment.
    2. Document recommendations from the diagnostic assessment.
    3. Assist the person to access recommended services available through other funding sources.

    4. Update the community support plan to ensure state plan mental health and behavioral support services are integrated and coordinated.

    Choice of Providers

    Lead agency

    When a person is residing in a setting where the residential provider also provides behavioral support services, the case manager must ensure there is documentation of the person's choice of behavioral support providers.

    Roles and Responsibilities

    Behavioral support service consists of three progressive staffing levels. More than one staffing level can be authorized. The following determine the level(s) of behavioral support to be authorized:

  • • Person’s assessed needs
  • • Environmental factors
  • • Personal choice that includes an analysis of risk and benefit
  • • Informed consent
  • • Person’s history (history of behavior, services, how the person has responded to treatments, etc.)
  • Each staffing level has associated functions.

    Waiver behavior professionals

    1. Complete individualized functional assessments.
    2. Develop person-centered, positive practice, individualized behavior support plans that identify specific proactive and, if necessary, reactive intervention strategies.
    3. Distribute plans to those with a need to know.
    4. Evaluate effectiveness of the service.
    5. Modify plans as necessary.
    6. Provide onsite instructional learning regarding the use of behavioral
    interventions.
    7. Train and supervise waiver behavior analysts and specialists.

    Waiver behavior professional consultative activities may be delivered face-to-face or via remote communication, such as telephone or web.

    Waiver behavior analysts

    1. Oversee implementation of the person-centered, positive practice behavior support plan, which includes assessing the adequacy of the plan.
    2. Train and direct waiver behavior specialists or caregivers who implement the behavior support plan.
    3. Provide feedback to and coordinate with the waiver behavior professional.
    4. Design data collection methodology.
    5. Train and oversee data collection.

    Waiver behavior specialists

    1. Collect and record behavioral data.
    2. Communicate questions or concerns to the waiver behavior professional or analyst.
    3. Implement the person-centered, positive practice behavior support plan.

    Provider Standards and Qualifications

    Payments will be made only to those entities or persons that meet the current licensure requirements of Minn. Stat. chapter 245D.

    Providers licensed under 245D must report all uses of controlled procedures, emergency use of manual restraint and prohibited procedures according to Minn. Stat. 245D.06, subd. 5 to DHS via the Behavioral Intervention Report Form DHS-5148 (PDF).

    Minnesota Stat. 245C requires all licensed programs to conduct background studies. Minn. Stat. 245D.03 lists individuals subject to background studies. Providers are required to complete and submit individual background studies using New Electronically Transmitted Study (NETStudy) through DHS licensing.

    Service providers may apply for a 245D license.

    Waiver behavior professionals

    Waiver behavior professionals must have competencies in areas related to:

  • • Behavior reduction/elimination strategies that promote least restrictive approved alternatives
  • • Co-occurring mental health or neurocognitive disorders
  • • Data collection, tracking and reporting
  • • Demonstrated expertise with populations being served, and
  • • Ethical considerations related to behavioral services
  • • Functional analysis
  • • Functional assessment
  • • Measurement of behavior and interpretation of data
  • • Identifying desired outcomes
  • • Selecting intervention strategies to achieve desired outcomes
  • • Staff/caregiver training
  • • Support plan monitoring and revisions
  • Provider qualifications

    1. Psychologist licensed under Minn. Stat. §148.88 to 148.98 with competencies as identified above actively listed with the Minnesota Board of Psychology OR
    2. Clinical Social Worker licensed as an independent clinical social worker under Minn. Stat. chapter 148D, or a person with a master's degree in social work from an accredited college or university, with at least 4,000 hours of post-master's supervised experience in the delivery of clinical services in the above competency areas OR
    3. Physician licensed under Minn. Stat. chapter 147 and certified by the American Board of Psychiatry and Neurology or eligible for board certification in psychiatry OR
    4. A licensed professional clinical counselor licensed under Minn. Stat. §148B.29 to 148B.39 with at least 4,000 hours of post-master's supervised experience in the delivery of clinical services who has demonstrated competencies in the above areas OR
    5. A person with a master's degree from an accredited college or university in one of the behavioral sciences or related fields, with at least 4,000 hours of post-master's supervised experience in the delivery of clinical services OR
    6. A registered nurse who is licensed under Minn. Stat. §148.171 to 148.285 and who:

  • • Is certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric and mental health nursing by a national nurse certification organization OR
  • • Has a master's degree in nursing or one of the behavioral sciences or related fields from an accredited college or university or its equivalent, with at least 4,000 hours of post-master's supervised experience in the delivery of clinical services
  • Waiver behavior analysts

    Waiver behavior analysts must either:

    1. Have obtained a baccalaureate degree, master’s degree or a PhD in a social services discipline OR
    2. Meet the qualifications of a Mental Health Practitioner as defined in Minn. Stat. §245.462, subd. 17.

    In addition to the above, waiver behavior analysts must have all of the following:

  • • 4 years of supervised experience working with individuals who exhibit challenging behaviors as well as co-occurring mental disorders or neuro-cognitive disorder
  • • 10 hours of instruction in functional assessment and functional analysis
  • • 20 hours of instruction in the understanding of the function of behavior
  • • 10 hours of instruction on design of positive practices behavior support strategies
  • • 20 hours of instruction on the use of behavior reduction approved strategies used only in combination with behavior positive practices strategies
  • • A determination by a waiver behavior professional to have the training and prerequisite skills required to provided positive practice strategies as well as behavior reduction approved/permitted intervention to the person who receives behavioral support
  • • Direct supervision by a waiver behavior professional
  • Waiver behavior specialists

    Waiver behavior specialists must have:

    1. An associate’s degree in a social services discipline OR
    2. Two (2) years of supervised experience working with individuals who exhibit challenging behaviors as well as co-occurring mental disorders or neurocognitive disorder.

    In addition to the above, behavior specialists must have all of the following:

  • • Minimum of 4 hours of training in functional assessment
  • • 20 hours of instruction in the understanding of the function of behavior
  • • 10 hours of instruction on design of positive practices behavioral support strategies
  • • Determination by a waiver behavior professional to have the training and prerequisite skills required to provide positive practices strategies as well as behavior reduction approved intervention to the person who receives behavioral support
  • • Direct supervision by a waiver behavior professional
  • Additional 245D resources

    College of Direct Supports courses
    DHS Licensing
    MHCP Provider Training resources

    Resources

    Adult Rehabilitative Mental Health Services (ARMHS)
    Children’s Therapeutic Services and Supports
    (CTSS)
    Diagnostic Assessment in the MHCP manual

    Mental Health Services in the MHCP manual

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