Question: Identify to whom Article 9 applies

Answer: Article 9 was written to address both individual rights and the use of behavioral methods within DDD services

Question: who must follow Article 9?

Answer: HCBS Providers Day Program ProvidersWork Program Providers Therapists funded by DDD Group Home ProvidersDevelopmental Home ProvidersIntermediate Care Facilities funded by DDD Division Employees HCBS Providers Day Program ProvidersWork Program Providers Therapists funded by DDD Group Home ProvidersDevelopmental Home ProvidersIntermediate Care Facilities funded by DDD Division Employees

Question: Identify 5 positive teaching techniques and strategies

Answer: Positive Behavior Support (PBS)1) active listening2) applied behavior analysis3) chaining 4) cues/prompts5) differential reinforcement6) discrimination training 7) fading of cues/prompts8) graduated guidance9) generalization training 10) incidental teaching11) modeling12) redirection13) reinforcement14) relaxation training 15) shaping16) token economics17) voluntary time out18) environmental manipulation

Question: What is PBS?

Answer: Seek to support, not controlBehavior = Communication Get to know the person and apply what you knowCommit to motivating the individual without using negative consequences

Question: Rights that A9 supports?

Answer: confidentiality, consent, presumption of legal competency, right to participate in the planning process, right to live in the least restrictive environment, right to withdraw from services

Question: define implicit rights

Answer: assumed for each person and aren't usually written. We are all born with "implicit" rights.

Question: define explicit rights

Answer: Ones that have been clearly spelled out (in other words, "explained") in writing or granted specifically. They are laws.

Question: define abuse

Answer: Doing something that you are not supposed to doPhysical (including sexual):-Emotional -Programmatic-Using a prohibited "red light" technique -Using a "yellow light" technique without approval of the Program Review Committee (PRC)

Question: define neglect

Answer: NOT doing something that you are supposed to do Lack of attention to physical needs:-Failure to report medical problems or change in health -Sleeping on duty or abandoning shift -Failure to follow prescribed treatment plan

Question: Green Light positive techniques

Answer: No approval neededThey do not need to be written in an ISP or IFSP. They are all "green light" techniques that are "good to go." If you are working with someone or getting a call from a frantic family member, these are all suggestions you can make. And chances are, you have probably used these techniques are various times, because these are things that work. They can work with friends and family members, they work with the people you run into in the store, they work with co-workers or children

Question: what is a behavior plan?

Answer: An "instruction manual" written by the persons or people that know the individual best. A working document that assists providers in identifying when a targeted behavior occurs and how to support the individual in replacing it with a more effective and safe behavior

Question: Identify when a team should consider developing a behavior plan?

Answer: The team must write a plan: for anyone prescribed a behavior modifying medication (except if living in their own or family home); or upon team decision to use any technique that requires approval, which includes any of the following:-techniques that require the use of force-programs involving the use of response cost-programs which might infringe upon the rights of the individual-protective devices used to prevent self-injury

Question: when they must meet to consider developing a behavior plan?

Answer: The team may consider developing a plan when the individual is displaying an inappropriate behavior that interferes with the individual's learning or participation in his/her community or places the individual or others at risk of harm-Use of force-Rights' Infringement-Living in licensed setting and taking behavior modifying medication-Protective devices to prevent self-injury

Question: when they must develop a behavior plan?

Answer: The team must meet and consider writing a behavior plan when an emergency measure is used two or more times in a 30-day period or with any identifiable pattern

Question: behavior plans must include:

Answer: 1) Description of the target behavior2) Data collected 3) Environmental considerations4) Reason for the target behavior5) Description of the alternative behavior

Question: Yellow Light teaching techniques

Answer: These are all techniques we might use in certain situations where someone's behavior is impacting their day to day functioning and ability to live the life they want to liveLooking at these techniques, one can see that they can be restrictive and alternatives must be considered first if possible. Remember, to use these techniques they MUST be part of a person's behavior plan that is submitted to PRC/IOC for approval prior to use. In other words, we must have the techniques approved first! If we do not get this approval first, what type of abuse is it considered?

Question: Use of force

Answer: Forced complianceForced exclusion time outContingent observation-if force is requiredLogical Consequences-if force is usedUse of Force is very rarely approvedThis could mean physical force, or it may mean forcing something be done through a lack of choice. Any time we are using force, we would need an approved behavior plan

Question: rights infringement

Answer: 1) Exclusion from daily routine: If someone is attending a program, it's their right to participate in the activities and any exclusion would need to be pre-approved in a behavior plan2) Restitution (Adm. Directive 119): is paying for the repairs or replacement for property damage3) Earning basic necessities or personal possessions: such as shampoo or clothing, or has to earn their own belongings, the team would need an approved behavior plan. 4) Response cost: giving up something that has already been earned. Please note, response cost is in the law but is basically never approved across the state5) Limitations: Limitations often happen around the implicit rights that we talked about earlier- telling someone they have to turn the TV off or that they cannot be friends with someone on Facebook, or that someone has to go to bed at a particular time. We all have the right to chose to stay up late and have the natural consequence of being tired the next day. If we're restricting someone's rights, we need an approved behavior plan

Question: behavior modifying medications

Answer: This is the only technique that applies to where the individual livesSpecifically looking at people living in DDD-licensed situationsThere is one situation where someone may take behavior modifying medications in a licensed residential setting without having a plan, and that's for a necessary medical or dental procedure

Question: use of protective devices

Answer: helmets, arm splints, etc.

Question: Determine when a strategy or technique must be reviewed and approved prior to use

Answer: ...

Question: Identify and give examples of prohibited techniques

Answer: The use of seclusion (locked time out) rooms: Defined as placing an individual in a room and locking or holding the door shut, thus preventing egress. (Includes the use of force to place or maintain an individual in a confined area, alone and/or without interaction)The use of overcorrection: Defined as a group of procedures used as a consequence to an individual's behavior, which involve either:-requiring an individual to restore an environment to a state vastly improved from that which existed prior to the behavior-or, requiring an individual to repeatedly practice a behaviorThe application of noxious stimuli: Defined as the utilization of a stimulus that is considered to be highly unpleasant to the individual, including, but not limited to:-Offensive tastes-Loud, high-pitched, or otherwise unpleasant noises-Offensive odors-Offensive tactile stimuli-Offensive visual stimuliPhysical restraints, including mechanical restraints, when used as a negative consequence to a behavior:-Physical restraints are defined as, but not limited to, full body restraints, basket weave/standing restraints, and seated restraint procedures. -Mechanical restraints are defined as a device utilized to limit "freedom of movement"

Question: Identify the monitoring requirements for the implementation of a behavior plan

Answer: Monitoring Behavior Plans:Each planning team shall specifically designate and record in the plan (ISP/ IFSP) the name of a member of the team, excluding those direct service staff responsible for implementing the approved behavior plan, who shall:a. Ensure that the behavior plan is implemented as approved.b. Ensure that all persons implementing the behavior plan have received appropriate training as specified in R6-6-906.c. Ensure that accurate data on the learning objective and the target behavior(s) are maintained in the individual's record.d. Evaluate, at least monthly, collected data and other relevant information as a measure of the effectiveness of the behavior plan.e. Conduct on-site observations not less than twice per month and prepare, sign, and place in the individual's record a report of all observations

Question: Identify who must review and who must approve those behavior plans including techniques that require review and approval

Answer: ...

Question: Define an emergency, an emergency measure and describe when an emergency measure can be used

Answer: Definition of an "Emergency Measure" in the event that an individual engages in a sudden, intense, out of control behavior endangering the health or safety of the individual or another person, the use of emergency physical intervention techniques and/or behavior modifying medication with a physician's order for specific one time emergency useThe team must meet and consider writing a behavior plan when an emergency measure is used two or more times in a 30 day period or any identifiable pattern

Question: Identify the reporting requirements for an emergency measure

Answer: When a physical management technique is employed to manage a sudden, intense behavior, the person employing that measure shall:-Immediately (The Division interprets "immediately", as the first allowable opportunity that does not place the individual or staff at undue risk, as applicable to the situation, and not to exceed 24 hours) report the circumstances of the emergency measure to the following:***The person designated by the Division***The responsible person-After calling the above individuals, a full and complete written report of the circumstances of the emergency measures needs to be submitted within one working day to the support coordinator and the district central reporting site