Standards for private organizations

2020 Edition

Behavior Support and Management (BSM) 1: Oversight of Restrictive Behavior Management Interventions

The organization employs restrictive behavior management interventions under the oversight of its management and governing body.
2020 Edition

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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 personnel.
1
The organization's practices fully meet the standard, as indicated by full implementation of the practices outlined in the BSM 1 Practice standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the BSM 1 Practice standards.
3
Practice requires significant improvement, as noted in the ratings for the BSM 1 Practice standards.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the BSM 1 Practice standards.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • BSM policy (see also ASE 2)
  • BSM procedures including incident review procedures
  • Documentation of program director notification of restrictive behavior management interventions 
  • Documentation of committee and administrative reviews of restrictive behavior management interventions for the previous six months
  • Interviews may include:
    1. Program directors
    2. Relevant personnel

Fundamental Practice

BSM 1.01

Behavior support and management policies address:
  1. safety measures to be taken when emergency situations arise, including which restrictive behavior management interventions may be used to protect service recipients from harming themselves or others;
  2. other practices that may be used and under what circumstances; and
  3. prohibited practices, including chemical restraint, corporal punishment, and behavior control methods that interfere with the individual's right to humane care.

Interpretation

 Medications are treatment for targeted symptomatology and should not be considered an intervention for challenging behaviors. In relation to element (c), chemical restraint does not include situations when a psychopharmacological drug:
  1. is used according to the requirements for treatment authorized by a court;
  2. is provided using specified criteria in a person’s approved treatment plan as per a physician’s order to provide medical treatment for a specific diagnosis and known progression of symptoms, such as in cases of a PRN; or
  3. is administered when necessary (PRN) to prevent immediate, substantial, and irreversible deterioration of a person’s mental status when prescribed by a physician or other qualified medical practitioner.

Interpretation

For organizations that have resource parents providing restrictive interventions, the organization needs to clearly outline in the behavior support and management policy the interventions resource parents are permitted to apply and under what circumstances.
Examples: Refer to COA’s definition of restrictive behavior management interventions at the beginning of this section for a list of interventions that may be included in the behavior support and management policy.
Note: Refer to COA's glossary for a definition of chemical restraint.
1
The organization's practices reflect full implementation of the standard.
2
Practices are basically sound but there is room for improvement; e.g.,
  • One of the elements needs greater specificity or clarity in the policy.
3
Practice requires significant improvement; e.g.,
  • Two of the elements need greater specificity or clarity in the policy; or
  • The policy is too vague to provide guidance to personnel.
4
Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
  • One of the elements is not implemented.

Fundamental Practice

BSM 1.02

The organization prohibits the use of behavior management interventions:
  1. by any person other than trained, qualified personnel;
  2. as a substitute for appropriate staffing patterns, for the convenience of personnel or as punishment;
  3. in response to property damage that does not involve imminent danger to self or others; and
  4. when contraindicated in the individual's service or behavior plan.
Juvenile Justice

Interpretation

 Organizations serving youth involved with the juvenile justice system may be authorized to use restrictive interventions to prevent escapes, or protect property, in order to maintain safety, security, and order. However, they should still only employ restrictive interventions when absolutely necessary. 
1
The organization's practices reflect full implementation of the standard.
2
Practices are basically sound but there is room for improvement; e.g.,
  • There have been a few instances where behavior management interventions were used inappropriately, but corrective action was implemented immediately.
3
Practice requires significant improvement; e.g.,
  • There have been a few instances of prohibited interventions, and no evidence of immediate and appropriate corrective action.
4
Implementation of the standard is minimal or there is no evidence of implementation at all.

BSM 1.03

A committee comprised of all levels of personnel conducts regular reviews of the use of behavior support and management interventions and:
  1. compares organization practices to current information and research on effective practice;
  2. uses findings from quarterly risk management reviews of restrictive behavior management to inform personnel about current practice and the need for change;
  3. revises policies and procedures when necessary;
  4. determines whether additional resources are needed; and
  5. supports efforts to minimize the use of restrictive behavior management interventions.
1
The organization's practices reflect full implementation of the standard.
2
Practices are basically sound but there is room for improvement; e.g.,
  • One of the elements is not regularly included in the reviews.
3
Practice requires significant improvement; e.g.,
  • Two of the elements are not regularly included in the reviews; or
  • Reviews are not done sufficiently often to effectively monitor practices; or
  • The committee does not include personnel from all levels.
4
Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
  • Three of the elements are not regularly included in the review; or
  • There is no committee, or participation is limited to management.

BSM 1.04

The program or clinical director is notified following each use of a restrictive behavior management intervention and each incident is administratively reviewed no later than one working day following an incident to:
  1. review any preemptive measures taken to avoid the intervention;
  2. determine whether or not the individual’s behavior support and management plan was followed; and
  3. assess the measures’ effectiveness.
1
The organization's practices reflect full implementation of the standard.
2
Practices are basically sound but there is room for improvement; e.g.,
  • Notification and administrative review regularly occur, but procedures need clarifying; or
  • Notification has occasionally exceeded one working day.
3
Practice requires significant improvement; e.g.,
  • There have been instances where notification or administrative review did not occur; or
  • Procedures need significant strengthening.
4
Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
  • Notification or review does not regularly occur.