From: Chris Sullivan, Sarah Pope

Memo to: All Therapists

From: Chris Sullivan, Sarah Pope

Date: February 7, 2011

RE: Policies and Practices – Physical Assistance

Cc: Jay Cole

S.O.S. Health Care Inc.’s policies and practices regarding Physical Assistanceare as follows –

POLICY STATEMENT

The Building Futures Autism Clinic believes that the use of physical assistance is a last resort.

Procedures for physical assistance are employed only after exhausting all avenues of prevention, including shaping, and extinction and differential reinforcement. In addition, their use may only follow parent involvement in the development of an individualized behavioral intervention treatment plan, which documents the physical assistance and the conditions under which they are to be implemented. Also, the physical assistance procedures must meet requirements and policies set by clients’ funding partners. For example, the PDD Waiver Program does not permit use of physical restraint.

Signatures by caregivers, Clinic management, and Board-certified Behavior Analysts (BCBAs) are required in a behavioral intervention treatment plan that includes use of physical assistance. Documentation should follow each instance of physical assistance. Caregiver communications should follow each physical assistance procedure, and meet guidelines documented in the behavior intervention plan or in this policy.

Communications to caregivers about use of such physical assistance procedures are made only by Board Certified Behavior Analysts or their designates, per the plan or this policy. Notes about such communications also are required by Clinic Management, under guidelines stated in the Treatment Plan.

PRACTICES

1)All therapists must ensure their knowledge of constraints levied by clients’ funding partners. One current partner, the SC Dept. of Disabilities and Special Needs (DDSN), does not allow physical restraint for their clients. PCM Personal Safety procedures are permitted.

2)Level 1 Procedures, defined as personal safety techniques, PCM transportation procedures that include independent walk, single/double back, single wrist-tricep, do not require signature from caregivers, or notification of their use to caregivers, the BCBA or management.

3)Level 2 Procedures, defined as PCM transportation procedures that include double wrist tricep, single/double Sunday stroll, one-arm wraparound, and any vertical immobilization procedure do not require signature from caregivers, the BCBA or management upon their first use for clients for which their funding allows. However, Clinic management and the BCBA must receive notification of first use of these techniques by the end of the client’s therapy session. (Appendix O of the PCM Manual, ie. PCM Physical Assistance Log, is used. A single running list is kept for each client.)

4)Use of any PCM Level 2 Procedure will result in a called meeting by Clinic Management. Attendees will include Clinic Management, the therapist(s), the Board-Certified Behavior Analyst, and caregivers to discuss the Physical Assistance procedures(s) and the use. Caregiver input may result in decisions to a) terminate their use; b) continue their use; c) specify specific conditions of use. Other prevention-based behavioral interventions, techniques, and practices will be discussed as well (e.g., functional analysis of problem behavior). The meeting will include discussion of PCM physical assistance and the hierarchy of least-to-most interventions. Medical status will be discussed and appropriate medical clearances received. A documented plan, or update to an existing plan, will result from this meeting.

5)PCM Level 3 Procedures, defined as two or three person prone immobilizations, require funding review, prior notification, caregiver input, caregiver signature, and medical clearance. In addition, all PCM prone immobilization procedures must occur under direct supervision and observation of the Board-Certified Behavior Analyst or his/her designate. Clinic management may also request to be on site during implementation of these procedures.

IN THE CASE OF “CASH” WITHOUT FUNDING, A PLAN, SIGNATURES AND CLEARANCES…

If a client’s problem behavior in a session rises to the level of continuous aggression, self-injury and/or high magnitude disruption (CASH), therapists immediately should call for help and observation by colleagues and management.

The therapist will keep the client, other clients and therapists safe during the episode by-

-using PCM Personal Safety procedures, ie. Blocking, etc.

-employing principles of shaping, extinction and reinforcement, if possible, to reduce or eliminate the behavior;

-allowing the child to move to another location, de-escalate, contact the antecedent in the new location, and exhibit the target behavior; then, returning the child to the setting, if possible.

-transporting the child to a new location via PCM Transportation Procedures (ONLY IF THE CLIENT’S FUNDING ALLOWS). Documenting the transport via the Physical Assistance Log. Notifying the Board-Certified Behavior Analyst and Management, with anticipation of a called meeting notification.

-At the therapist’s discretion, caregivers are called to pick up the client and end the session. Management may end the session at any time.

The therapist will then document the episode (in writing), copying Clinic management, lead therapists and the Board-certified Behavior Analyst (BCBA). The BCBA, or his/her designate, and clinic management will then share the documentation with caregivers. A follow-up meeting to discuss steps toward an individualized behavior intervention plan will be scheduled with the BCBA, his designate, and/or management, before the client’s next session.

EXCEPTIONS TO CONSTRAINTS BY FUNDING PARTNERS ARE RARE BUT POSSIBLE

The Board-Certified Behavior Analyst does have the ability to request an exception for Physical Assistance e for clients whose funding is the DDSN PPD Waiver Program. The need to make this request will be considered at the called meeting.

REVIEW AND SIGN

After review of this policy, please direct any questions to the Clinic Manager or the Board-certified Behavior Analyst. Then, sign below to indicate your understanding and acceptance of this Policy. You will receive a signed copy of this document for your files.

Employee Signature: ______Date: ______

Clinic Manager: ______Date: ______

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