Chapter 10. Behavior Support Services Program Service Plan

Behavioral consultation;

Temporary augmentation of staff;

Behavioral training; and

Behavioral respite services.

Is developed, in conjunction with the team, by a licensed psychologist, psychology associate under the supervision of a licensed psychologist, licensed behavior analyst, licensed physician, licensed certified social worker, or licensed or certified professional counselor, who shall have training and experience in applied behavior analysis;

Is based on and includes a functional analysis or assessment of each challenging behavior as identified in the IP;

Specifies the behavioral objectives for the individual, and includes:

Takes into account the medical condition of the individual;

Describes the treatment techniques and when the techniques are to be used;

Specifies the emergency procedures to be implemented for the individual with a history of exhibiting behaviors that present a danger to self or serious bodily harm to others;

Includes a description of the adaptive skills to be learned by the individual that serve as functional alternatives to the challenging behavior or behaviors to be decreased;

Identifies the person or persons responsible for monitoring the BP;

Specifies the data to be collected to assess progress towards meeting the BP's objectives; and

Describes and documents each use of mechanical and physical restraint, the reason for its use, and the length of time used.

Approved by the standing committee as specified in COMAR 10.22.02.14E(1)(d); and

Includes written informed consent of the:

Represents the least restrictive, effective alternative, or the lowest effective dose of a medication; and

Is only implemented after other methods have been:

Convene the team within 5 calendar days after an emergency use of a restrictive technique to review the situation and action taken;

Determine subsequent action include whether the development or modification of a BP is necessary; and

Document that the requirements of this regulation have been met.

Any method or technique prohibited by law, including aversive techniques;

Any method or technique which deprives an individual of any basic right specified in Health-General Article, §§7-1002—7-1004, Annotated Code of Maryland, except as permitted in COMAR 10.22.04.03A;

Seclusion;

A room from which egress is prevented; or

A program which results in a nutritionally inadequate diet.

As a substitute for a treatment plan;

As punishment; or

For convenience.

The specific medications that have been prescribed;

The rationale for prescribing each medication;

Any alternate methods of management being used to bring challenging behavior under control; and

Objective data collected by staff and presented to the licensed health care practitioner to indicate that the medication being used is effective in reducing the individual's challenging behavior.

Any potential side effect from the medication outweighs the behavior that will occur without the use of the medication; and

Attempts are being made to gradually decrease the dosage or discontinue the medication when clinically indicated.

A mechanical restraint may only be used:

The licensee shall ensure that a mechanical restraint is designed and used:

If a mechanical restraint is being used for the purpose of §A(1)(a) and (b) of this regulation, the licensee shall:

When a mechanical restraint is being used for the purpose of §A(1)(a) and (b) of this regulation, the licensee shall afford the individual the opportunity:

A licensed health care practitioner who authorized the use of the mechanical restraint shall review the authorization at a minimum of every 90 days, and document its effectiveness and whether continuation is indicated.

Obtain written authorization from the individual's treating licensed health care practitioner; and

Document in the individual's record the reason and guidelines for the use of the restraint, including the time frame the mechanical restraint is to be used.

A mechanical support may only be used if authorized by a licensed health care practitioner.

The licensee shall ensure that a mechanical support is designed and used:

The licensee shall document in the individual's record the reason for use of the mechanical support, when it is to be used, and the directions for its use.

The licensed health care practitioner who authorized the use of the mechanical support shall document its effectiveness and whether continuation is indicated, at least, on an annual basis.

Ordered by a licensed health care practitioner; and

Administered and monitored by a licensed health care practitioner.