Standards for private organizations

2020 Edition

Behavior Support and Management (BSM) 2: Behavior Support and Management Practices

Behavior support and management practices promote respect, healing, and positive behavior and prevent the need for restrictive behavior management interventions.
2020 Edition

Currently viewing: BEHAVIOR SUPPORT AND MANAGEMENT (BSM)

VIEW THE STANDARDS

Purpose

The organization’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and personnel.
Note: Please see the Case Record Checklist for additional guidance on this standard.
1
The organization's practices fully meet the standard, as indicated by full implementation of the practices outlined in the BSM 2 Practice standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the BSM 2 Practice standards.
3
Practice requires significant improvement, as noted in the ratings for the BSM 2 Practice standard.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the BSM 2 Practice standards.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • BSM procedures including procedures for:
    1. obtaining consent
    2. notifying parents/guardians of incidents involving restrictive interventions
    3. conducting assessments and developing behavior management plans
  • Copy of written behavior support and management philosophy and procedures provided to service recipients and/or parents/legal guardians
  • Interviews may include:
    1. Program directors
    2. Relevant personnel
    3. Persons served
  • Review case records

BSM 2.01

The organization:
  1. provides an explanation for and offers a copy of its written restrictive behavior support and management philosophy and procedures to service recipients or their parents/legal guardians at admission;
  2. annually obtains the individual’s and/or parent’s/legal guardian’s consent when restrictive behavior management interventions are part of the treatment modality;
  3. informs the individual and/or parent/legal guardian of the service implications, if any, of refusing to sign; and
  4. when the individual is a minor or has a legal guardian, notifies the parents/legal guardians promptly when the individual is involved in an incident involving a restrictive intervention.
Juvenile Justice

Interpretation

COA recognizes that it may be difficult for organizations providing residential juvenile justice services to involve youths' parents/legal guardians, especially when youth are placed outside of their communities and far from their families; however, organizations should still strive to involve families to the extent possible. When promptly notifying parents/legal guardians in the wake of an intervention proves difficult, the organization should document its efforts to initiate contact in the case record.

Additionally, when an organization provides involuntary services to youth involved with the juvenile justice system, obtaining consent may not be required.
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 minor clarification; or
  • One of the required elements is not fully addressed.
3
Practice requires significant improvement; e.g.,
  • Two of the elements are not fully addressed; or
  • One element is not addressed at all; or
  • Annual consents are not consistently obtained; or
  • Parents or legal guardians are frequently not notified.
4
Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
  • Three or more of the elements are not fully addressed; or
  • Two of more of the elements are not addressed at all.

Fundamental Practice

BSM 2.02

The organization collaborates with the individual and/or parent/legal guardian to assess for:
  1. the individual’s perception of emotional and physical safety;
  2. past experiences with restrictive behavior management interventions;
  3. antecedents or emotional triggers and the resulting behaviors;
  4. previous successes in utilizing strategies and coping skills to mitigate the need for restrictive behavior management interventions;
  5. psychological and social factors that can influence use of such interventions, including trauma history; and
  6. medical conditions or factors that could put the person at risk.
Examples: Medical factors can include issues related to use of medications, such as an insulin imbalance. Psychological and social factors may include psychosis or claustrophobia.
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 minor clarification; or
  • One of the elements is not fully addressed.
3
Practice requires significant improvement; e.g.,
  • Two of the elements are not fully addressed.
4
Implementation of the standard is minimal or there is no evidence of implementation at all; e.g.,
  • One of the elements is not addressed at all.

Fundamental Practice

BSM 2.03

A behavior support and management plan is based on assessment results and:
  1. identifies proactive, strengths-based strategies that will help the person de-escalate their behavior and prevent harassing, violent, or out-of-control behavior;
  2. specifies interventions that may or may not be used, taking the individual’s trauma history into account;
  3. is modified as necessary; and
  4. is developed in collaboration with the individual and is signed by the person, their parent/legal guardian, and personnel, as appropriate.

Interpretation

The behavior support and management plan, sometimes called a crisis plan, can be part of, and reviewed with, the overall service or treatment plan.
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 strengthening; or
  • There are a few instances where signatures were missing.
3
Practice requires significant improvement; e.g.,
  • Two of the elements need strengthening; or
  • One of the elements is not addressed at all; or
  • There is no evidence that the plans, once developed, are reviewed or updated; or
  • Most plans are not signed.
4
Implementation of the standard is minimal or there is no evidence of implementation at all.