3.13 – Human Rights-Behavior Support Committee

Reference:      Medicaid Tabs W 260-W317

Purpose

The purpose of the Human Rights – Behavior Support Committee (HRC-BSC) is to provide direction to persons and entities responsible for developing or implementing specialized services for individual with developmental disabilities to ensure that individuals are supported in a positive and responsive manner with respectful solutions that recognize individuals rights, promote individuals personal growth and emotional well-being, and ensure individuals health and welfare. 

Procedure

The HR/BSC committee is to approve, review, and monitor all behavior support plans, including those which may involve risks to residents’ rights and insure that these plans are implemented only with the informed consent of the individual/guardian. 

This committee will also review facility policies/procedures related to control of inappropriate behavior, protection of residents rights and funds, and any other areas the committee believes need to be addressed.   

The committee will review and approve all medications used for behavioral support.  The committee will review and approve medication used for behavioral support for any at the ICF.  This committee will oversee that titration plans are listed for these medications and make recommendations based on records/data from QIDP, nursing, psych professionals, and pharmacy.  Each titration plan must include direct analysis of all factors involved including behavioral interventions and progress, medication, treatment strategies, professional recommendations, and team reviews.  The tracking methods to monitor strategies utilized should be included in the person centered planning process.

All doctor orders that include an aversive/restraint for safety will be reviewed through the Balancing Rights and Safety Review.  These recommendations will be noted on meeting documentation for each individual.

(At all Open Door ICF and Waiver residential sites) For medications given prior to medical treatments/appointments to reduce trauma or anxiety, Open Door will ensure that the following are in place:

1. Medical record reflects history anxiety related to specific appointments, treatments (this should remain in individual’s medical chart)
2. The medication order is one that is similarly prescribed for general patients who experience anxiety even outside of the DD population
3. The prescription order clearly identifies the medication name, route, dosage, time to be administered, and any other instructions
4. The guardian/individual provides prior consent for the medication to be given

Membership/Membership Commitments

The Human Rights –Behavior Support committee shall be comprised of no less than four members and shall include:

• Residential Services Director, or designee
• Medical Services Manager or designee
• QIDP(s)
• At least one individual who receives or is eligible to receive specialized services
• Two External members from County boards or other providers
• At least two Guardians or family members
• Psychologist, Pharmacy, or other guests, as appropriate

All committee members will receive department approved training within three months of appointment to the committee in the following topics:

• Rights of individuals as enumerated in section 5123.62 of the Revised Code
• Positive culture
• Informed consent
• Confidentiality
• Behavior Support Rule

Members of the Human Rights-Behavior Support Committee shall annually receive department-approved training in relative topics which may include but are not limited to:

• Self-advocacy and self determination
• Role of guardians and section 5126.043 of the Revised Code
• Effect of traumatic experiences on behavior
• Court ordered community controls and the role of the court, the county board and the human rights committee

No committee member will receive any monetary remuneration for his/her participation on this committee.

At least 7 committee members must be in attendance in order to review the Behavior Support Plans. 

Operations

The committee will meet monthly to conduct timely reviews of all behavior support plans prior to implementation.

The committee will ensure that a thorough assessment has been completed to identify target behaviors to be addressed, medical, social, or environmental factors contributing to these behaviors, alternative behaviors to be trained, and appropriate reinforcement strategies.  The HR/BSC will also ensure that the strategies proposed in the plans are the least restrictive/intrusive and the most effective means of reducing the target behaviors, while promoting acquisition of the alternative behaviors.  When limited or restricted methods are employed, the plan must also contain a strategy for reducing or eliminating their use.  Once a plan is approved, the HR/BSC will ensure that informed consent has been provided prior to implementation. 

The committee will review all existing plans, guidelines and Balancing Rights and Safety Review at least annually.

The committee will also review and approve all medications used for behavioral support during any medical procedure and medications used to manage behavior.  

The committee will see that appropriate staff training is in place for staff responsible for implementing limited or restricted methods.  The QIDP will be responsible for the Behavior Support training for all staff.

In addition to review of formal behavior support strategies, the HR/BSC will also review incident logs at least annually.    The committee will review the prevention plan by the facility in regards to each incident, as well as make suggestion for general facility practices.

The committee may also serve in an advisory capacity for the use of research proposals involving individuals residing at the facility and for the protection of resident funds.

When adjustments (current plan, possible resident restraint physical or chemical, etc) are required prior to or after a regularly schedule HRC/BSC meeting, the QIDP, nurse  or other Administrative staff will in writing (via email, fax, or scan) at least two (2) members of the external members of the HRC.  This request for emergency approval must include justification for the restrictive measure, the nature and degree of risk to individual if the restrictive measure is implemented. If manual, mechanical, or time-out is proposed, risk of harm. If chemical restraint is proposed, risk of harm and how the engagement in a precisely-defined pattern of behavior is likely to result in harm. When rights restriction is proposed, the risk of harm or how the individual’s actions are likely being subject to legal sanctions. The HRC must provide a written explanation of the rejection or approval for the restrictive strategy proposed to the HRC chair.

The PWCA HR/BSC approval poll form will be completed and will be presented for written approval at the next scheduled HR/BSC meeting. 

Review

Sample of behavior support strategies will be made available to the Department upon request for review to ensure that behavior support strategies are developed, implemented, and monitored in accordance with this rule.

Last Revised: 9/21/2022