Functional Assessment & Positive Support Planning

1. Functional Assessment & Positive Support Planning

2. Who do the regulations apply to? Maine citizens with Intellectual Disabilities or Autism who are age eighteen or older Receives services that are provided, licensed, or funded in whole or in part, directly or through a contractor, by the Department of Health and Human Services Unless otherwise specified, these regulations apply in all circumstances where a Person who receives services is experiencing Challenging Behaviors*

3. Challenging Behavior Presents an Imminent Risk to the health and safety of the Person or the community; or Presents serious and Imminent Risk of damage to property of the community; or Seriously interferes with a Person’s ability to have positive life experiences and maintain relationships. 

4. Positive Supports Must Be the First Approach When a Person is exhibiting Challenging Behavior, the Planning Team must design Positive Supports to help: Assist the person to live in a home which is safe, in their community, with access to friends & family Develop positive skills and techniques that empower the Person to demonstrate positive, Prosocial Behavior

5. Positive Support Plan A component of the Personal Plan that supports Individual growth Enhances quality of life Attempts to decrease or eliminate the need for more restrictive measures

6. Functional Assessment A systematic analysis of factors, both internal and external to the person, which may be contributing to his/her Challenging Behavior

7. Where do we start?? • 1. Defining the behavior – objective, factual, understandable to all. • 2. Track the incidents • A-B-C Data • Intensity, frequency and duration • 3. Complete the Functional Assessment • 4. Development of the Positive Support Plan including all of the necessary components • 5. Acquire team approval, train staff and implement • 6. Monitor and modify the plan

8. Define the Challenging Behavior Objective Measurable Specific Understandable to all including the Person

9. Track the incidents • Intensity, Frequency & Duration • A-B-C Data • Antecedent (Setting Event) – What happens just before the behavior occurs • Behavior (Challenging / Problem) – What did the person do? How long did the behavior last? • Consequence – What happened, or what did staff do, right after the behavior occurred?

10. Purpose of Behavior Escape/Avoidance of Task or Request Obtain Attention / Tangibles Communication Alleviation of Pain, Stress or Frustration Self-Stimulation or Sensory Stimulation

11. Basic Requirements for Functional Assessment (See Appendix 1 for complete list) 1. completed by or under the supervision of a person who has been designated by the Planning Team and who has training and experience in behavior analysis and Positive Supports; 2. based on direct observation of the Person, interviews with the Person and significant others, including family where appropriate, caregivers and team members; 3. based on review of available information such as assessments and reportable events

12. Functional AssessmentSources of Data • Observation of the Person • Interview with the Person • Interview with significant others • Family, where appropriate • Care givers • Team members • Natural supports • Review of available information • Assessments • Reportable events

13. Challenging Behavior • Factors increase Challenging Behavior • When does the behavior occur • Where does the behavior occur • With whom does the behavior occur • Frequency, Intensity, Duration of the behavior • Factors increase the desirable behavior • Proactive/Preventative measures being used • With or without success

14. Quality of Life Communication Relationships Environmental Conditions/Sensory Factors Daily Activities Communicative Intent of the Behavior Unmet Needs

15. Medical, Mental Illness & Neurological Symptoms of diagnosed condition Recommended treatment Medications Potential side effects of treatment

16. Functional Assessment Summary • Hypothesis • Prediction or “best guess” about of the function or the reason the challenging behavior occurs • When people she doesn’t know come within arm’s length of Paula, she starts screaming and thrashing her arms. When she does this, people move away from her. People getting too close is the antecedent. Screaming and thrashing her arms is the behavior. Getting people to move away is the function the behavior serves for Paula. It gets her space back.

17. Medical & Mental Health Assessment Physical Health Psychosocial Issues Trauma history How will these be addressed?

18. Psychiatric Medication Support Plan If a Psychiatric Medication is used for a Challenging Behavior, the plan must be completed

19. Positive Support Planning • Level 1 • No restriction of rights • Non-coercive intervention with voluntary participation by the person • Level 2 • Non-coercive intervention with voluntary participation by the person • Some programs which restrict a person’s activities or rights for safety reasons • Preservation of personal property and safety measures involving fire-starting material or sharps • Positive Behavior Modification Techniques • All interventions require that the person does not communicate an objection to the intervention

20. Positive Supports Environmental Modifications Communication Support Teaching of Skills Physical Prompts for teaching or personal support without coercion In-Home Stabilization for less than one hour Verbal re-direction or verbal prompting to redirect the behavior

21. Positive Supports Securing of personal property and safety measures with problematic misuse or safety concern Voluntary Timeout Locks the person is able to unlock Restriction of food or liquid (with doctor’s health or safety concern) Token Economy or Reward System

22. In-Home Stabilization Limited period of time for which a person whose challenging behavior has placed that person or the community in imminent risk of harm may be denied access to the community for safety and assessment The functional assessment must address the Challenging Behavior and justify the use of the In-Home Stabilization Justification must include the history of the Challenging Behavior, the types of problems it poses and how the In-Home Stabilization will address those problems

23. Transition Plan A transition plan is for the reduction of the restriction of Rights, and transition to more Positive Supports, naturally occurring reinforcements and personal control

24. Discontinuation Plan • What will it look like when the plan is no longer necessary? • Objective & measurable • What is the plan to evaluate and modify the Positive Support Plan? • Tracking techniques • Ongoing data collection • A minimum of annual review by the Planning Team

25. Approval The Planning Team comes together to review the Positive Support Plan The Planning Team including the Guardian and Case Manager must approve the plan. What happens if the Guardian objects to the plan? What happens if the client communicates an objection to the intervention or the plan?

26. Training All DPSs working with the Person must be trained in the Positive Support Plan All others who support the client should be offered the opportunity to be trained in the Plan for consistency.

27. At least Annually Review the Positive Support Plan for necessity and effectiveness Make modifications as appropriate

28. Objection You can’t make me. I want it now How to address the Person’s objection during the life of the plan?

29. Emergency Interventions • You have a requirement to keep a person safe • If there is a situation in which there is Imminent Risk of harm or danger to the Person or Community or a risk of criminal detention or arrest, you may: • Utilize Emergency Intervention including Emergency Restraint or Removal of Personal Property • Intervention must be the least restrictive necessary to keep the person safe and must be ended as soon as it is safe to do so • File a Reportable Event

30. Help??? Your supervisor is your first step for questions and clarifications If there are additional questions or the need for clarification, please email: OADS@maine.gov