Conn. Agencies Regs. § 17a-238-10

Current through September 27, 2024

Section 17a-238-10 - Approval process for behavioral support plans which include aversive procedures

Aversive procedures shall be reviewed and approved as follows:

(a) The interdisciplinary team shall identify the need for a behavioral support plan.

(b) Staff with appropriate training and experience in positive behavioral supports shall be assigned to design and implement the plan. All plans shall include and emphasize components designed to increase positive behaviors and be based on a completed functional analysis.

(c) The functional analysis shall be:

(1) conducted by, or under the supervision of a person who has documented training in behavior analysis with an emphasis on positive behavioral support; and

(2) based on direct observation of the individual, interviews with significant others, and review of available data such as assessment reports prepared by other professionals.

(d) The functional analysis shall include:

(1) an interview with the individual or those who know him best;

(2) a systematic observation of the occurrence of the undesirable behavior over an extended period of time for an accurate definition and description of the frequency, duration and intensity;

(3) a systematic observation of the immediate antecedent events associated with each instance of the display of the undesirable inappropriate behavior;

(4) a systematic observation and analysis of the consequences following the display of the behavior to determine the function the behavior serves for the individual, i.e., to identify the specific environmental or physiological outcomes produced by the behavior;

(5) an analysis of the communicative intent of the behavior, identified in terms of what the individual is either requesting or protesting through the display of the behavior;

(6) an ecological analysis of the settings in which the behavior occurs most frequently. Factors to consider shall include the physical setting, the social setting, the activities and the nature of instruction, scheduling, the quality of communication between the individual and staff and other individuals, the degree of independence, the degree of participation, the amount and quality of social interaction, the degree of choice, and the variety of activities;

(7) a review of records for health and medical factors which may influence behaviors (e.g. medication levels, sleep cycles, health, diet, psychological or neurological factors); and

(8) a review of the history of the behavior to include the effectiveness of all previously used behavior supports and interventions.

(e)Behavioral Support Plan Development

A behavioral support plan based on the functional analysis and emphasizing positive behavioral interventions shall be developed and shall include:

(1) baseline data;

(2) evidence that the individual or others will be harmed more by the undesirable behavior continuing than by the application of the procedure;

(3) a statement from a physician that the proposed aversive procedure is not medically contraindicated;

(4) methods for increasing positive behaviors and decreasing undesirable behaviors;

(5) objective and specific definitions of the undesirable behaviors;

(6) methods for measuring the undesirable behaviors and positive behaviors to be learned or increased;

(7) consequences for the undesirable behaviors;

(8) a plan for reducing or eliminating the use of the aversive procedure;

(9) criteria for reducing or eliminating the use of the aversive procedures;

(10) the circumstances under which the aversive procedure shall be used and a procedure for supervising implementation of the intervention;

(11) who shall be responsible for monitoring the behavioral support plan;

(12) a graph or other data summary of both positive and undesirable behavior, over the life of the intervention;

(13) a plan for providing any staff training; and

(14) a plan for integration of the program in all settings as appropriate.

(f) The interdisciplinary team shall approve the behavioral support plan and designate the person who may authorize administration of the plan if the plan is approved. The plan author, the case manager and other necessary interdisciplinary team members shall present the proposed plan to the program review committee for review.

(g) The program review committee shall review all behavioral support plans using aversive procedures for clinical appropriateness. This review shall include:

(1) a comprehensive review of previous plans to ensure that positive or less aversive techniques have been tried and found to be ineffective or are not clinically appropriate; and that the aversive procedures are not being used due to lack of staff, inadequately trained staff, or lack of positive behavioral interventions;

(2) assurance that the plan is appropriate for the individual based on a functional analysis as defined in Section 17a-238-8 of these regulations;

(3) assurance that the plan includes:

(A) positive behavioral supports

(B) baseline data

(C) clearly defined objectives

(D) techniques

(E) data collection methods and reliability checks

(F) length of treatment

(G) review schedule

(H) plan for reduction in use of aversive procedures

(4) assurance that adequate and consistent staff and resources are available to implement the plan;

(5) assurance that the plan for training staff in the procedures to be used is appropriate and that staff training is documented; and

(6) assurance that the plan is implemented as designed.

(h) The individual, parent, guardian or advocate, or person familiar with the individual shall be encouraged to attend the program review committee meeting for the purpose of hearing the presentation and presenting any opposing views.

(i) The program review committee (including a representative from the human rights committee) shall recommend approval or disapproval of the plan to the regional or training school director.

(j) If the human rights committee representative finds that the plan or its review presents a human rights problem, he shall notify the regional or training school director who shall ensure a human rights committee review within thirty (30) days prior to approving any use of the procedure even on a temporary basis.

(k) If the human rights committee representative identifies no human rights problem, temporary approval may be recommended on behalf of the human rights committee.

(l) The plan and the program review committee's recommendations shall be sent to the human rights committee in all cases.

(m) The human rights committee shall review the plan and program review committee findings and provide a written recommendation to the regional or training school director within 30 days of receiving the plan from the program review committee.

(n) After considering the recommendations of the program review committee the regional or training school director shall, within ten (10) days, approve or disapprove the plan.

If the regional or training school director decides to approve the plan despite the program review committee or human rights committee recommendation for disapproval, the reason for the approval along with the plan and the committee's recommendations shall be sent to the commissioner. The commissioner shall concur with the plan approval before it may be implemented.

(o) Any plan that includes the use of an aversive device or provisions which inflict pain to affect an undesirable behavior of any individual which is recommended for approval by the program review committee, the human rights committee and the regional or training school director, shall require approval by the commissioner before implementation.

Conn. Agencies Regs. § 17a-238-10

Effective November 17, 1994