BEHAVIOR INTERVENTION
To understand behavior intervention, it helps to first understand behavior. The word behavior generally means the way we act. All day long we display a series of behaviors that are viewed by ourselves and others as positive, negative, or neutral. It is important to note that behaviors don’t just happen. A person’s behavior communicates a want or a need. We form beliefs and respond to people based on our view of their behavior. In simple terms, behavior intervention is to intervene or take action to prevent or change a behavior.
At Mains’l;
- Employees act in ways that create positive environments.
- Employees apply the agency’s values, policies and procedures to make decisions at work.
- Positive support approaches are the first actions employees take when intervening in another person’s behavior.
- Aversive or deprivation procedures are not used.
- Employees do not perform an emergency use of manual restraint unless they have completed training on this policy and procedure and have been trained in person and demonstrated competence in the safe and correct use of manual restraint on an emergency basis according to the requirements of the state or program rules (see references on last page).
- We require documentation that positive approaches have been tried and have been unsuccessful as a condition of implementing an emergency use of manual restraint.
- Employees treat people with dignity, respect and are trained to build their skills and knowledge related to how to do this well.
In the course of your time with Mains’l and in your personal life, you will be performing behavior interventions and people will be performing them on you. The procedures below provide definitions and examples of what we can’t do, what we can do and what we should do when it comes to intervening in someone else’s behavior. Let’s start with the bad and end with the good.
The things we cannot do (also known as prohibited procedures)
The following are not allowed as a replacement for proper supervision or staffing, to reduce or stop a behavior, as punishment, or for staff convenience:
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In summary, we do not do these things. Not only do they make people unhappy, they generally do not work well to help people appropriately get their wants and needs met. Prohibited procedures may stop a behavior, but they do not teach a person what to do differently the next time. Prohibited procedures may also make a behavior worse. In addition, prohibited procedures can result in mental or physical injuries.
We have better options for you, so please keep reading. We will cover the things you can’t do first and end with the good stuff, positive supports.
Here are the simplified and technical definitions of prohibited procedures along with some and examples.
- Chemical restraint:
A chemical restraint is giving someone a drug or medication that has not been prescribed by their doctor to treat the behavior you are trying to avoid.
An example of chemical restraint is giving a person Xanax when they start yelling so they don’t become physically aggressive but Xanax is prescribed for the person to take when they have panic attacks. If Xanax is given for physical aggression and not a panic attack, this would be a chemical restraint.
Technical definition: The administration of a drug or medication to control the person’s behavior or restrict the person’s freedom of movement and is not a standard treatment or dosage for the person’s medical or psychological condition.
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Mechanical restraint:
A mechanical restraint is using an object to limit or stop a person from freely moving a part of their body or have access to a part of their body
An example of a mechanical restraint is taping gloves onto a person’s hands so they cannot scratch themselves, but they would not choose to wear the gloves on their own.
Mechanical restraint does not include the following: (1) devices worn by the person that trigger electronic alarms to warn staff that a person is leaving a room or area, which do not, in and of themselves, restrict freedom of movement; or (2) the use of adaptive aids or equipment or orthotic devices ordered by a health care professional used to treat or manage a medical condition.
Technical definition: The use of devices, materials or equipment attached or adjacent to the person’s body, or the use of practices that are intended to restrict freedom of movement or normal access to one’s body, to prevent injury with a person who engages in self-injurious behaviors, such as head-banging, gouging, or other actions resulting in tissue damage that have or could cause medical problems resulting from the self-injury. Mechanical restraint also includes the use of practices that are intended to restrict freedom of movement or normal access to one’s body or body parts, or limits a person’s voluntary movement or holds a person immobile as an intervention precipitated by a person’s behavior.
- Manual restraint:
A manual restraint is using your body to limit another person’s ability to move their own body.
An example of a manual restraint is pinning someone to the ground to stop them from going somewhere.
Technical definition: Physical intervention intended to hold a person immobile or limit a person’s voluntary movement by using body contact as the only source of physical restraint.
- Seclusion:
Basically, seclusion is making a person go somewhere or leave somewhere against their wishes and then not allowing them to leave.
An example of seclusion is forcing a person to be separated because they were pinching the staff by putting them in a locked room while attending a birthday party.
Technical definition: Removing a person involuntarily to a room from which exit is prohibited by a staff person or a mechanism such as a lock, a device, or an object positioned to hold the door closed or otherwise prevent the person from leaving the room; or otherwise involuntarily separating a person from an area, activity, situation, or social contact with others and blocking or preventing the person’s return.
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Time out:
A time out is making someone go to an area and it is experienced as a negative consequence. It differs from seclusion in that the person is not stopped from leaving the area they were sent to, but it is still not allowable for a staff to tell a person receiving services that a consequence of their behavior/actions is that they have to go to a designated area.
Time out does not mean voluntary removal or self-removal for the purpose of calming, prevention of escalation, or de-escalation of behavior; nor does it mean taking a brief break or rest from an activity for the purpose of providing the person an opportunity to regain self-control.
An example of a time out is sending a person to their bedroom after an argument, when they do not want to go. Another example is requiring someone to sit on a chair for a specified amount of time, but not physically forcing them to stay in the chair.
Asking someone to ‘take a break’ to ‘cool down’, but not requiring them to do so, is not considered a time out.
Technical definition: The involuntary removal of a person for a period of time to a designated area from which the person is not prevented from leaving.
- Any other aversive or deprivation procedure:
- Aversive procedure: An aversive procedure is doing or saying something during or right after a behavior that will cause a strong feeling of stress, anxiety, dislike or disgust in order to get the person to stop or reduce the behavior.
An example of an aversive procedure is to wash someone’s mouth out with soap if they swear in the hope that they will not swear again.
Technical definition: The application of an aversive stimulus based upon the occurrence of a behavior for the purposes of reducing or eliminating the behavior.
- Aversive stimulus: Typically, an aversive stimulus is an unpleasant thing that punishes or limits a person. The thing that is used to try to stop the behavior is the aversive stimulus. The thing or situation itself does not have to be aversive on its own. It can be how it is used that it becomes aversive to the person.
Examples of aversive stimulus are heat, cold, noise, a food or an event that is unwanted or unpleasant that is presented to stop someone or suppress a behavior.
Technical definition: An object, event, or situation that is presented immediately following a behavior in an attempt to suppress the behavior.
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Deprivation procedure: A deprivation procedure involves taking away or not allowing someone to have something or do something they like, want, or need in order to get the person to stop or reduce the behavior.
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An example of a deprivation procedure is to take away someone’s dinner because they hit someone or not allow the person to go to the dance because they hit themselves.
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Technical definition: The removal of a positive reinforcer following a response resulting in, or intended to result in, a decrease in the frequency, duration, or intensity of that response. Often times the positive reinforcer available is goods, services, or activities to which the person is normally entitled. The removal is often in the form of a delay or postponement of the positive reinforcer.
The things we can only do in certain circumstance ( also known as restricted procedures)
A restricted procedure is something that should not normally be done, but may be allowed in very specific circumstances if it is done properly and for acceptable reasons. Some restricted procedures include:
- Procedures identified in a positive support transition plan
- Emergency use of manual restraint
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- Procedures identified in a positive support transition plan A positive support transition plan is developed by the person’s expanded support team to implement positive support strategies to:
- Eliminate the use of prohibited procedures
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Avoid the emergency use of manual restraint and
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Prevent the person from physically harming self or others
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Phase out any existing plans for the emergency or programmatic use of restrictive interventions that are prohibited.
Employees working with a person who has a positive support transition plan receive training before working unsupervised. In Minnesota, Mains’l develops a positive support transition plan on the forms and in the manner prescribed by the commissioner of DHS for a person who requires intervention in order to maintain safety when it is known that the person’s behavior poses an immediate risk of physical harm to self or others. The positive support transition plan forms and instructions will supersede the requirements in Minnesota Rules, parts 9525.2750; 9525.2760; and 9525.2780.
2. Emergency Use of a Manual Restraint:
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Emergency physical intervention intended to hold a person immobile or limit a person’s voluntary movement by using body contact as the only source of physical restraint.
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This means using a part of your body, such as your arms, hands, legs, or your entire body to stop the movement of another person.
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An example of an emergency use of a manual restraint is to use a wrist side hug procedure to move a person away from someone they are trying to assault.
At Mainsl, we do not allow the emergency
use of a manual restraint (EUMR) to be done to most people.
Employees who work with someone who has a support plan that allows EUMR are required to complete Behavior Basics and Emergency Use of Manual Restraint training before they can perform an emergency manual restraint.
A restricted procedure (one approved in a positive support transition plan or an emergency use of a manual restraint) cannot:
- Be implemented with a person in a manner that is sexual abuse, neglect, physical abuse, or mental injury.
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Be implemented in a manner that violates a person's rights.
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Restrict a person's normal access to a nutritious diet, drinking water, adequate ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping conditions, necessary clothing, or any protection required by state licensing standards or federal regulations governing the program;
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Deny the person visitation or ordinary contact with legal counsel, a legal representative, or next of kin;
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Be used for the convenience of staff, as punishment, as a substitute for adequate staffing, or as a consequence if the person refuses to participate in the treatment or services provided by the program;
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Use prone restraint, which means the use of manual restraint that places a person in a face-down position. Prone restraint does not include brief physical holding of a person who, during an emergency use of manual restraint, rolls into a prone position, if the person is restored to a standing, sitting, or side-lying position as quickly as possible;
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Apply back or chest pressure while a person is in a prone position;
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Be implemented in a manner that should not be used (contraindicated) for any of the person's known medical or psychological limitations;
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Be implemented by a staff that has not completed training on the proper techniques to do an emergency manual restraint.
The things that we can do (also known as permitted actions and procedures)
While these are not the first choice, or what we want to regularly have happen, the following can be used on an intermittent basis. Additionally, if addressed in a person service and support plan, these things can be done on a continuous basis. The reason for continuous use is to be included.
Physical contact
- Allowable restraint
- Adaptive aids and equipment and devices
- Physical contact or instructional techniques must use the least restrictive alternative possible to meet the needs of the person and may be used:
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To calm or comfort a person by holding that person when they show no resistance to being held.
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To protect a person known to be at risk of injury due to frequent falls as a result of a medical condition;
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To facilitate the person's completion of a task or response when the person does not resist or the person's resistance is minimal in intensity and duration;
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To block or redirect a person's limbs or body without holding the person or limiting the person's movement to interrupt the person's behavior that may result in injury to self or others with less than 60 seconds of physical contact by staff; or
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To redirect a person's behavior when the behavior does not pose a serious threat to the person or others and the behavior is effectively redirected with less than 60 seconds of physical contact by staff.
2. Restraint may be used as an intervention procedure to:
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To position a person with a physical disability in a manner specified in the person’s service and support plan.
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Assist in the safe evacuation or redirection of a person in the event of an emergency and the person is at imminent risk of harm.
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Allow a licensed health care professional to safely conduct a medical examination or to provide medical treatment ordered by a licensed health care professional that is necessary to promote healing or recovery from an acute, meaning short-term, medical condition.
3. Use of adaptive aids or equipment, orthotic devices, or other medical equipment ordered by a licensed health professional to treat a diagnosed medical condition do not in and of themselves constitute the use of mechanical restraint.
The things that you should do (positive supports)
Positive approaches should be used first and be the most commonly used approached to intervening in another person’s behavior. Positive support approaches include:
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