Private Organization Accreditation

Sweetser, a Maine non-profit agency operating since 1828, provides comprehensive mental and behavioral health and substance abuse treatment services. Statewide, it serves around 15,000 consumers a year, including children, adults, and families in outpatient, office-based, and residential settings.


Children's Foundation of Mid America

James W. Thurman, President/CEO

Children’s Foundation of Mid America has been accredited through COA since 1983. The process of accreditation ensures that we meet or exceed the highest standards in the industry.
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The organization’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.


Effective behavior support and management practices center around preemptive interventions, such as identifying challenging behaviors and working with the service recipient and their support systems to create practical solutions in order to minimize the need for crisis interventions (including, but not limited to, restrictive interventions) to the greatest extent possible. A culture that promotes respect, healing, and positive behavior, and provides individuals with the support they need to manage their own behaviors, can help prevent the need for crisis interventions. Involving the service recipient and appropriate family members or support systems early on, by identifying triggers and previous successes in coping with escalating behaviors creates a collaborative approach to behavior support management and helps provide personnel and the individual early insight to challenging behaviors. Training for personnel is an essential component of maintaining a safe work and service environment. Training also prevents injuries and deaths in crisis situations, including those that warrant the use of restrictive interventions as a last resort. Organizations that maintain a process for reviewing incidents when they do occur have the opportunity to make changes in their practices to support the safest environment possible and further reduce the use of restrictive interventions.

Interpretation: Throughout these standards, the phrase “crisis interventions” and “challenging behaviors” are used. Challenging behaviors refers to harassing, violent, or out of control behaviors that threaten the safety of oneself or others. Crisis intervention include restrictive interventions or, for organizations that prohibit such interventions or other “last resort” options (e.g., calling the police or removing the individual from the program). When the standards are addressing restrictive interventions, it will be explicit and the standard will have an NA for organizations that prohibit restrictive interventions.

Interpretation: Timeout or isolation are colloquial terms that may or may not include restrictive interventions. For the purpose of these standards, any instance where a service recipient is placed in a room separate from others and cannot voluntarily leave said room (whether the door is locked or staff is preventing the individual to leave) will be referred to as seclusion and considered a restrictive intervention.

Research Note: The challenging behaviors that invoke crisis interventions are often times rooted in the individual’s personal trauma and crisis interventions, whether or not they are restrictive, run the risk of retraumatizing the individual. The literature on trauma informed care identifies six core strategies for reducing the need for crisis interventions: leadership toward organizationl change, use of data to inform practice, workforce development, use of restraint and seclusion reduction tools, improved the service recipient’s role, and debriefing techniques. 

NA The organization does not provide services to individuals face-to-face.

NA The organization provides financial education and counseling (FEC) services only

NA The organization provides Employee Assistance Program (EAP) services only.

Note: All organizations are required to complete BSM 1, BSM 2, and BSM 3. Any service that uses isolation, manual or mechanical restraint, and/or locked seclusion in facilities. BSM 4, BSM 5, and BSM 6 are not applicable in organizations that prohibit the use of restrictive behavior management interventions. Restrictive behavior management interventions are those that restrict, limit, or curtail a person’s freedom of movement and include isolation, manual restraint, mechanical restraint, and locked seclusion. Related definitions can be found in COA’s glossary.

Note: BSM does not apply to FEC programs, but in organizations providing multiple services, including FEC, the Standards will apply and must be implemented in the non-FEC programs.

Note: Organizations that permit foster homes to employ manual restraints will complete all the standards in this section, as applicable, as well as FKC 20.

Note: Organizations that work with populations with developmental delays and utilize protective clothing, such as protective helmets, will address those intervention in CR 4.05 and TS 5.02.

Note: Restrictive interventions are those involuntarily restrict, limit, or curtail a person’s freedom of movement and include manual restraint, mechanical restraint, and seclusion. Federal guidelines consider any restriction of an individual’s movement a restrictive intervention. Related definitions can be found in COA’s glossary.

Note: Some organizations serving youth involved with the juvenile justice system and accredited under COA’s Juvenile Justice Residential Services (JJR) service system may lock youth in their rooms for routine purposes (e.g., during sleep periods), as opposed to in response to an incident. Although this practice does restrict a person’s freedom of movement, it differs from the types of restrictive behavior management interventions addressed in this section insofar as it is utilized on a routine, ongoing, basis, rather than in response to a specific incident. Accordingly, this practice is addressed in JJR 15, and standards referencing "seclusion," or "restricted behavior management interventions" do not apply.

Note: Please see BSM Reference List for a list of resources that informed the development of these standards.

Behavior Support and Management Narrative

Self-Study Evidence
    • 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…).
      1. Include the full spectrum of behavioral support interventions that your organization utilizes (e.g., point programs, level systems, time out, manual restraint, etc.).
      2. If your organization uses any restrictive interventions (e.g., manual restraint, seclusion, and mechanical restraint), provide your organization’s rationale for their use.
    • Does your organization use restrictive behavior management under any circumstances?
    • Identify a part of your behavior support and management policies and practices that have been:
      1. the most difficult to advance, and indicate the reasons why; and
      2. 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…).
    • Does your organization use any established behavior support and management interventions, e.g., The Therapeutic Crisis Intervention System (TCI)?
    • 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.
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