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Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


Positive supports

Page posted: 1/20/15

Page reviewed:

Page updated:

Legal authority

Minn. Stat. §245D.06, subd. 5-8, Minn. Stat. §245.91, Minn. Stat. §245D.04, subd. 3(c)

Background

Minn. Stat. Ch. 245D requires all providers to transition away from use of punitive practices and procedures, such as seclusion and restraint. DHS now prohibits these practices and procedures.

Providers must use positive supports instead. More information is available on DHS – Person-centered practices, positive supports and the Jensen Settlement agreement.

Applicability

This page applies to organizations that provide services and supports to people with disabilities and people older than age 65 who receive services licensed under Minn. Stat. Ch. 245D.

Definition

Positive supports: Strategies used to increase quality of life and decrease challenging behavior. These strategies teach new skills and change a person's environment.

Approved procedures

Minnesota requires the use of positive supports. Providers must use strategies that encourage a person to use productive, alternative ways to deal with stress without the use of aversive or punishing procedures. Examples of positive supports strategies include:

  • · Modifying the environment to the person’s behavior and routine.
  • · Providing positive reinforcement.
  • · Providing alternatives to undesired behaviors.
  • · Teaching the person new skills.

    • Prohibited procedures

    Minnesota law prohibits the following procedures:

  • · Chemical restraint.
  • · Mechanical restraint.
  • · Programmatic use of manual restraint.
  • · Seclusion.
  • · Time out.
  • · Any other aversive or deprivation procedure.

    • DHS determined these procedures should be prohibited when working with all people. This includes people with:

  • · Brain injuries.
  • · Dementia.
  • · Development disabilities.
  • · Mental illness.
  • · Physical disabilities.
  • · Other acquired conditions that were not previously subject to Rule 40.

    • Examples of prohibited procedures

    Prohibited procedures include:

  • · Containing, restricting, isolating, secluding or otherwise removing a person from normal activities without monitoring them.
  • · Denying or restricting a person's access to equipment and devices, such as assistive mobility and communicative devices that facilitate the person's ability to function. When the temporary removal of the equipment or device is necessary to prevent injury to the person or others or serious damage to the equipment or device, the equipment or device must be returned to the person as soon as possible.
  • · Depriving a person of or restricting access to goods and services; requiring a person to earn goods and services that are otherwise available; or using token reinforcement programs or level programs that include a response cost procedure or negative punishment component.
  • · Interacting with a person or others in a manner that ridicules, demeans, threatens or is abusive to them.
  • · Interfering with protections established through state licensing standards or federal regulations governing the program.
  • · Using any action or procedure as punishment.
  • · Using any action or procedure that is medically or psychologically contraindicated.
  • · Using any other interventions or procedures that may constitute an aversive or deprivation procedure (e.g., use of metallic handcuffs or leg hobbles; faradic shock; totally or partially restricting a person’s senses; using a noxious smell, taste, substance, spray or water mist; and presenting intense sounds, lights or other sensory stimuli).
  • · Using painful techniques, including intentional infliction of pain or injury, intentional infliction of fear of pain or injury, dehumanization and degradation.
  • · Using physical intimidation or a show of force.
  • · Using prone restraint.

    • Provider responsibility

    On and after Jan. 1, 2014, certain organizations may no longer use prohibited procedures. Providers licensed under chapter 245D also must:

    1. Base service planning and delivery for people on positive support strategies. Their goal should be to meet and achieve the person’s needs, interests, preferences and desired outcomes.

    2. Support the person’s preferences, goals, service outcomes, daily needs and activities. To accomplish that responsibility, providers should use the principles of:

  • · Person-centered service planning and delivery.
  • · Integrated settings and inclusive service delivery.
  • · Self-determination.

    • 3. Develop a Positive Support Transition Plan, DHS-6810 for people who require intervention to maintain safety when their known behavior poses an immediate risk of physical harm to self or others. Refer to:

  • · Positive Support Transition Plan Review, DHS-6810A.
  • · Positive Support Transition Plan Instructions, DHS-6810B (PDF).
  • · Developing Positive Support Transition Plans: A provider guide for 245D-licensed HCBS services in Minnesota, DHS 6810C (PDF).

    • 4. Report the emergency use of manual restraint and any procedure identified in a positive support transition plan to DHS and the Office of the Ombudsman for Mental Health and Developmental Disabilities using the Behavior Intervention Report Form, DHS-5148.

    Paying for extraordinary needs

    If the rate determined through the statewide Disability Waiver Rate System (DWRS) is not sufficient to meet the person’s extraordinary need, the lead agency may request a rate exception (refer to CBSM – DWRS rate exception requests for instructions).

    The lead agency may be eligible for a disability waiver budget adjustment if the person meets eligibility criteria. If the lead agency has concerns about ability to manage the cost of the person’s support plan within its budget, the lead agency should contact its assigned regional resource specialist.

    Positive supports consultation

    A 245D-licensed provider can provide individual consultation on positive support practices and/or person-centered planning. Typically, a consultant in that role works with other providers who have requested help to serve people with highly complex behavioral and/or medical support needs.

    Qualifications

    To qualify as a consultant, potential providers must have:

  • · The ability to provide individual consultation on positive support practices and/or person-centered planning to current providers of people on waivers with highly complex needs within 30 days.
  • · Current employees who have training and experience necessary to provide the consultation.

    • Paying for the consultation

    To cover the cost of the consultation, the county of financial responsibility could authorize one of the following services.

    Positive supports consultation

    Positive support services (formerly behavioral supports)

    Specialist services

    Person-centered planning consultation

    Family training and counseling

    Request for authorization of emergency use of prohibited procedures

    To protect a person from imminent risk of serious injury due to self-injurious behavior, DHS may grant limited approval for the emergency use of procedures. These procedures would otherwise be prohibited after the 11-month reduction and elimination period if those procedures had been part of the person’s approved positive support transition plan. (For definitions, refer to Minn. Stat. §245.91.)

    Submitting a request

    A designated coordinator or manager from a 245D-licensed provider along with the person’s expanded support team must complete Request for the Authorization of the Emergency Use of Procedures, DHS-6810D.

    Additional resources

    Training

    DHS – College of Direct Support
    TrainLink
    TrainkLink – DSD training news and information
    TrainLink – Person-centered training

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