Standards for private organizations

2020 Edition

Behavior Support and Management (BSM) 4: Restrictive Behavior Management Interventions

Restrictive behavior management interventions are used in a manner that protects the safety and well-being of persons served and personnel in crisis situations, when less-restrictive measures have proven ineffective.
2020 Edition

Currently viewing: BEHAVIOR SUPPORT AND MANAGEMENT (BSM)

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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 4 Practice standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the BSM 4 Practice standards.
3
Practice requires significant improvement, as noted in the ratings for the BSM 4 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 4 Practice standards.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • BSM procedures including procedures for:
    1. authorization and reauthorization of restrictive interventions 
    2. continuous monitoring during a restrictive intervention
    3. safely escorting service recipients
    4. provision of food and water and use of bathrooms
    5. time limits on use of restrictive interventions
    6. evacuating individuals in seclusion or mechanical restraint during an emergency

 

  • Documentation of training and qualifications for staff authorizing interventions
  • Restrictive behavior management intervention logs that include documentation of continuous monitoring
  • Interviews may include:
    1. Program directors
    2. Relevant personnel
    3. Persons served
  • Seclusion room observation

 

BSM 4.01

Personnel qualified through annual training and evaluation authorize each restrictive behavior management intervention and reauthorize interventions that exceed maximum time limits, in accordance with any applicable federal or state requirements.
Note: See BSM 4.07 for additional requirements related to reauthorizing restrictive 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.,
  • 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.

 
Fundamental Practice

BSM 4.02

Individuals are monitored continuously, face-to-face, and:
  1. assessed at least every 15 minutes for any harmful health or psychological reactions; and
  2. interventions are discontinued immediately if they produce adverse side effects such as illness, severe emotional or physical stress, or physical injury.
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.

 
Fundamental Practice

BSM 4.03

Procedures address safe methods for involuntarily escorting service recipients.
NA The organization does not escort service recipients or use seclusion.
Examples: This includes methods such as the backwards escort.
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.

 
Fundamental Practice

BSM 4.04

Seclusion rooms:
  1. conform to existing licensing and/or fire safety requirements;
  2. are outfitted with a door that easily opens in case of emergency (e.g. spring lock door); and
  3. are limited to one person at a time.
NA The organization does not use seclusion.
Note: Please see the Facility Observation Checklist for additional guidance on this standard.
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 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 seclusion rooms and has not initiated a process to obtain it; or
  • There have been instances where a seclusion 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.

 
Fundamental Practice

BSM 4.05

During a restrictive behavior management intervention personnel assess the individual’s need for food, water, and use of bathroom facilities and provide access when safe and appropriate.
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 routinely not followed.

 
Fundamental Practice

BSM 4.06

Restrictive behavior management interventions 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.
Juvenile Justice

Interpretation

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 greater than 30 minutes in mechanical restraints in order to prevent escape), qualified personnel must approve the extension, and the intervention should be discontinued as soon as possible.
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.

 
Fundamental Practice

BSM 4.07

Reauthorization is required for each instance of restrictive intervention that exceeds the maximum time limit, and qualified personnel must evaluate the patient every 24 hours before writing a new order for a restrictive intervention.
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 4.08

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