WHO IS ACCREDITED?

Private Organization Accreditation

Consumer Credit Counseling Service of the Savannah Area's mission is to provide the best non-profit community service, dedicated to delivering professional and confidential counseling, debt management, housing counseling and consumer education to all segments of the community regardless of ability to pay.
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VOLUNTEER TESTIMONIAL

Judy Kay, LCSW

Volunteer Roles: Peer Reviewer; Team Leader

In administration for 22 of 24 years at Child Saving Institute, a COA-accredited not-for-profit child welfare agency in Omaha, Nebraska. Retired approximately two years ago, I moved to Tucson, Arizona, where I advocate for children's rights as a Court Appointed Special Advocate (CASA) volunteer to three young children.
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Purpose

The organization’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.

FOC
BSM 5: Restrictive Behavior Management Interventions

Restrictive behavior management interventions are used in a manner that protects the safety and well-being of service recipients and personnel in crisis situations when less-restrictive measures have proven ineffective.

Update:

  • Added Evidence - 05/07/18

Interpretation: This standard prohibits the use of seclusion, and manual or mechanical restraint for the purposes of routine discipline, compliance, or convenience.

The use of mechanical restraints is prohibited for public or private non-medical, community-based facilities that serve children and youth according to the Public Health Service Act, as amended by the Children’s Health Act of 2000. As referenced in BSM 1.01, organizations serving youth involved with the juvenile justice system may be subject to different laws and regulations, and should familiarize themselves with any laws and regulations addressing the behavior management interventions they are permitted to employ.

NA The organization prohibits the use of restrictive behavior management interventions.

Rating Indicators
1
The organization's practices fully meet the standard, as indicated by full implementation of the practices outlined in the BSM 5 Practice standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the BSM 5 Practice standards.
3
Practice requires significant improvement, as noted in the ratings for the BSM 5 Practice standard; and/or
  • One of the BSM 5 Fundamental Practice Standards received a 3 or 4 rating.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the BSM 5 Practice standards; and/or
  • Two or more of the BSM 5 Fundamental Practice Standards received a 3 or 4 rating.

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    • Authorization and reauthorization procedures including qualifications of authorized personnel
    • Procedures for continuous monitoring during a restrictive intervention
    • Incident reports
    • Behavior management logs
    • Documentation of compliance with legal requirements
    • Documentation of continuous monitoring during a restrictive intervention
    • Interview:
      1. Authorizing personnel
      2. Direct service personnel
      3. Supervisory personnel
      4. Persons served
    • Seclusion room observation

  • BSM 5.01

    Qualified personnel authorize each restrictive behavior management intervention, in accordance with any applicable federal or state requirements.

    Interpretation:  Personnel are qualified through annual training and evaluation.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • Authorization procedures need clarifying.
    3
    Practice requires significant improvement; e.g.,
    • There have been instances of restrictive intervention without authorization by qualified personnel but corrective action is occurring; or
    • Documentation is weak.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
    • There have been instances of restrictive intervention without authorization by qualified personnel and corrective action has not been initiated; or
    • Practices are in violation of applicable legal requirements; or
    • Written procedures do not address use of qualified personnel.

  • FP
    BSM 5.02

    Service recipients are monitored continuously, face-to-face, and assessed at least every 15 minutes for any harmful health or psychological reactions.

    Update:

    • Added Note - 05/07/18

    Note: Refer to BSM 5.06 for the maximum time allowed for a restrictive intervention.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • In a few rare instances there was a lapse in monitoring or assessment but corrective action was taken immediately.
    3
    Practice requires significant improvement; e.g.,
    • In more than a few instances there was a lapse in monitoring or assessment but corrective action was taken immediately; or
    • Documentation is weak; or
    • Procedures need significant strengthening.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all.
    • Lapses occur with some frequency and corrective action is not taken; or
    • There are no procedures; or
    • Procedures are not routinely followed.

  • FP
    BSM 5.03

    Procedures address safe methods for involuntarily escorting individuals.

    Update:

    • Revised Standard - 05/07/18

    Interpretation: This includes methods such as the backwards escort.

    NA The organization does not escort individuals or use seclusion.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • Procedures need clarifying.
    3
    Practice requires significant improvement; e.g.,
    • Procedures are inadequate; or
    • There have been instances where procedures were not followed; or
    • Documentation is weak.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
    • There are no procedures; or
    • Procedures are not routinely followed.

  • FP
    BSM 5.04

    Seclusion rooms conform to existing licensing and/or fire safety requirements and are limited to one person at a time.

    Update:

    • Revised Standard - 05/07/18

    Interpretation: Seclusion rooms need to be outfitted with a door that easily opens in case of emergency, such as a spring lock door.

    Note: Please see Facility Observation Checklist - Private, Public, Canadian for additional assistance with this standard.

    NA The organization does not use locked seclusion.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • The organization does not have evidence of conformance to licensing and/or fire safety requirements for one of its isolation or seclusion rooms, but has initiated a process to obtain it.
    3
    Practice requires significant improvement; e.g.,
    • The organization does not have evidence of conformance with licensing and/or fire safety requirements for one or more of its isolation or seclusion rooms and has not initiated a process to obtain it; or
    • There have been instances where a seclusion or isolation room has been used for more than one person.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all.

  • FP
    BSM 5.05

    During a restrictive behavior management intervention staff assess the service recipient’s need for food, water, and use of bathroom facilities and provide access when safe and appropriate.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • Procedures need clarifying.
    3
    Practice requires significant improvement; e.g.,
    • Procedures are inadequate; or
    • There have been instances where procedures were not followed, but corrective action has been initiated; or
    • Documentation needs significant strengthening.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
    • There are no procedures; or
    • Procedures are not routinely followed.

  • FP
    BSM 5.06

    Restrictive behavior management interventions are used only in crisis situations, when less-restrictive measures have proven ineffective, are discontinued as soon as possible, and are limited to the following maximum time periods per episode:

    1. 15 minutes for children aged nine and younger, for all restrictive behavior management interventions;
    2. 30 minutes for individuals aged ten and older, undergoing manual or mechanical restraint;
    3. 30 minutes for individuals aged ten to thirteen in seclusion; and
    4. one hour for individuals aged fourteen and older in seclusion.

    Update:

    • Added Interpretation - 05/07/18

    Interpretation: If the state law is more stringent in the maximimum time periods per episode, then the organization must follow the time frames set by the state law.

    Interpretation: Restrictive behavior management interventions are discontinued immediately if they produce adverse side effects such as illness, severe emotional or physical stress, or physical injury. Timeframes may be extended on a case-by-case basis, but qualified personnel with the authority to make such decisions must approve all extensions, as referenced in BSM 5.07.

    Interpretation: As referenced in BSM 1.02, organizations serving youth involved with the juvenile justice system may be authorized to use restrictive interventions to prevent escapes or protect property, but should only do so when absolutely necessary, as referenced throughout these standards.

    Further, although organizations serving youth involved with the juvenile justice system may be authorized to use time limits that exceed those listed in the standard, COA expects these organizations to meet the timeframes outlined in the standard whenever possible. When it is necessary to extend timeframes in order to maintain safety, security, and order (for example, when youth must be transported in mechanical restraints in order to prevent escape, and travel time is greater than 30 minutes), qualified personnel must approve the extension, and the intervention should be discontinued as soon as possible.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • Procedures need clarifying.
    3
    Practice requires significant improvement; e.g.,
    • Procedures are inadequate; or
    • There have been instances where procedures were not followed, but corrective action has been initiated; or
    • Documentation needs significant strengthening.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
    • There are no procedures; or
    • Procedures are not routinely followed.

  • FP
    BSM 5.07

    Reauthorization by qualified personnel is required for each instance of isolation, locked seclusion, manual restraint, or mechanical restraint that exceeds the maximum time limit.

    Update:

    • Revised Standard - 05/07/18

    Intepretation: Indivudals are qualified to reauthorize a restrictive intervention through training and evaluation and in accordance with any applicable federal or state requirements.

    Note: See maximum time limits outlined in BSM 5.06.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • Procedures need clarifying.
    3
    Practice requires significant improvement; e.g.,
    • Procedures are inadequate; or
    • There have been instances where procedures were not followed, but corrective action has been initiated; or
    • Documentation needs significant strengthening.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
    • There are no procedures; or
    • Procedures are not routinely followed.

  • BSM 5.08

    The organization has procedures to address the safe removal of individuals in seclusion or mechanical restraint in the event of an emergency evacuation.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g.,  
    • Procedures need clarifying.
    3
    Practice requires significant improvement; e.g., 
    • Procedures are inadequate; or
    • There have been instances where procedures were not followed, but corrective action has been initiated; or
    • Documentation needs significant strengthening.
    4
    Practice requires significant improvement; e.g., 
    • Procedures are inadequate; or
    • There have been instances where procedures were not followed, but corrective action has been initiated; or
    • Documentation needs significant strengthening.
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