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Positive supports

Page posted: 1/20/15

Page reviewed:

Page updated:

Legal authority

Minn. Stat. §245D.06, subd. 5 - 8; Minn. Stat. §245.91; Minn. Stat. §245D.04, subd. 3(c)

Background

Beginning Jan. 1, 2014, Minnesota Statute, chapter 245D, required all providers to transition away from use of punitive practices and procedures such as seclusion and restraint. DHS now prohibits these.

Providers must use positive supports instead. More information is available on the DHS Jensen Settlement Web page.

Applicability

This applies to organizations that provide services and supports to people with disabilities and people over the age of 65 who receive services licensed under Minnesota Statutes, §245D.

Definition

Positive supports: Strategies used to increase quality of life and decrease challenging behavior. These strategies teach new skills and change a person's environment.

Approved procedures

Minnesota requires the use of positive supports. Providers must use strategies that encourage a person to use productive, alternative ways to deal with stress without the use of aversive or punishing procedures. Examples of positive supports strategies may include:

  • • Modifying the environment to the individual’s behavior and routine
  • • Positive reinforcement
  • • Providing alternatives to undesired behaviors
  • • Teaching the individual new skills.
  • Prohibited procedures

    Minnesota law prohibits the following procedures:

  • • Chemical restraint
  • • Mechanical restraint
  • • Programmatic use of manual restraint
  • • Seclusion
  • • Time out
  • • Any other aversive or deprivation procedure.
  • DHS determined these procedures should be prohibited when working with all people. This includes people with:

  • • Brain injuries
  • • Dementia
  • • Development disabilities
  • • Mental illness
  • • Physical disabilities
  • • Other acquired conditions that were not previously subject to Rule 40.
  • Examples of prohibited procedures

  • • Containing, restricting, isolating, secluding or otherwise removing a person from normal activities without monitoring the person
  • • Denying or restricting a person's access to equipment and devices such as assistive mobility and communicative devices that facilitate the person's ability to function. When the temporary removal of the equipment or device is necessary to prevent injury to the person or others or serious damage to the equipment or device, the equipment or device must be returned to the person as soon as possible
  • • Depriving a person of or restricting access to goods and services or requiring a person to earn goods and services that are otherwise available, or using token reinforcement programs or level programs that include a response cost procedure or negative punishment component
  • • Interacting with a person or others in a manner that ridicules, demeans, threatens, or is abusive to the person
  • • Interfering with protections established through state licensing standards or federal regulations governing the program
  • • Using any action or procedure as punishment
  • • Using any action or procedure which is medically or psychologically contraindicated
  • • Using any other interventions or procedures that may constitute an aversive or deprivation procedure (e.g., use of metallic handcuffs or leg hobbles; faradic shock; totally or partially restricting a person’s senses; using a noxious smell, taste, substance, spray, or water mist; and presenting intense sounds, lights, or other sensory stimuli).
  • • Using painful techniques, including intentional infliction of pain or injury, intentional infliction of fear of pain or injury, dehumanization and degradation;
  • • Using physical intimidation or a show of force
  • • Using prone restraint
  • Provider responsibility

    On and after Jan. 1, 2014, certain organizations may no longer use prohibited procedures. Providers licensed under Chapter 245D also must:

    1. Base service planning and delivery for people on positive support strategies. Their goal should be to meet and achieve the person’s needs, interests, preferences and desired outcomes.

    2. Support the person’s preferences, goals, service outcomes, daily needs and activities. To accomplish that, providers should use the principles of:

  • • Person-centered service planning and delivery
  • • Integrated settings and inclusive service delivery
  • • Self-determination
  • 3. Develop a Positive Support Transition Plan, DHS-6810 (PDF) for people who require intervention to maintain safety when their known behavior poses an immediate risk of physical harm to self or others.

    4. Report the emergency use of manual restraint and any procedure identified in a positive support transition plan to the Department of Human Services and the Office of the Ombudsman for Mental Health and Developmental Disabilities using the Behavior Intervention Report Form, DHS-5148 (electronic form)

    Paying for extraordinary needs

    If the rate determined through the statewide disability waiver rates system is not sufficient to meet the person’s extraordinary need, the lead agency may request a rate exception.

    The lead agency may be eligible for a disability waiver budget adjustment if the person meets eligibility criteria. If the lead agency has concerns about ability to manage the cost of the person’s support plan within its budget, the lead agency should contact its assigned regional resource specialist.

    Positive supports

    consultation

    A 245D-licensed provider can provide individual consultation on positive support practices and/or person-centered planning. Typically, a consultant in that role would work with other providers who have requested help to serve people with highly complex behavioral and/or medical support needs.

    Qualifications

    To qualify to consult, potential providers must have:

  • • The ability to provide individual consultation on positive support practices and/or person-centered planning to current providers of waiver recipients with highly complex needs within 30 days
  • • Current employees who have training and experience necessary to provide the consultation.
  • Paying for the consultation

    To cover the cost of the consultation, the county of financial responsibility could authorize one of the following services:

    Positive supports consultation

  • Behavioral support services for people on the BI, CAC and CADI waivers
  • Specialist services for people on the DD Waiver
  • Person-centered planning consultation

  • Family training and counseling for people on the BI, CAC and CADI waivers
  • Consumer training and education for people on the DD Waiver
  • Request for authorization of emergency use of prohibited procedures

    To protect a person from imminent risk of serious injury due to self-injurious behavior, DHS may grant limited approval for the emergency use of procedures. These procedures would otherwise be prohibited after the 11-month reduction and elimination period, if those procedures had been part of the person’s approved Positive Support Transition Plan. Definitions - Minn. Stat. §245.91

    Submitting a request

    A designated coordinator or manager from a 245D-licensed provider along with the person’s expanded support team must complete the Request for the Authorization of the Emergency Use of Procedures, DHS-6810D (PDF) form. To protect the privacy of the person involved, providers must use secure fax or secure email (PDF) to return the form to DHS.

    Additional

    resources

    Training

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