DAR File No. 28210

Human Services, Services for People with Disabilities

R539-6

Purchase of Service Provider Requirements

NOTICE OF PROPOSED RULE

DAR File No.: 28210
Filed: 09/06/2005, 10:44
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The changes are proposed after a comprehensive revision and consolidation of the Division's rules.

Summary of the rule or change:

The changes involve repealing the current rule and replacing it with a new rule and moving some information into the Provider's service contract with the Division. This rule is repealed in its entirety.

State statutory or constitutional authorization for this rule:

Sections 62A-5-102 and 62A-5-103

Anticipated cost or savings to:

the state budget:

None--This revision does not alter the basic operations or functions of the Division and therefore, does not result in either a cost or savings to the state.

local governments:

None--Local government funding is not used. Therefore, there is no cost to local governments.

other persons:

None--This revision does not alter the basic operations or functions of the Division and therefore does not result in either a cost or savings to other persons.

Compliance costs for affected persons:

None--This revision does not alter the basic operations and functions of the Division. Provider requirements now appear in their current service contracts. This does not result in either a cost or savings to Providers or other affected persons.

Comments by the department head on the fiscal impact the rule may have on businesses:

None--This revision does not alter the basic operations of functions of the Division. Provider requirements now appear in their current service contracts. This does not change the fiscal impact on service providers. Lisa-Michelle Church, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Steven Bradford at the above address, by phone at 801-538-4197, by FAX at 801-538-4279, or by Internet E-mail at sbradford@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/31/2005

This rule may become effective on:

11/01/2005

Authorized by:

George Kelner, Director

RULE TEXT

R539. Human Services, Services for People with Disabilities.

[R539-6. Purchase of Service Provider Requirements.

R539-6-1. Personnel Requirements.

A. Policy.

The Provider shall ensure that trained program staff are responsible for the day-to-day supervision and operation of the program.

B. Procedures.

1. Each site shall have a direct program staff person responsible for the day-to-day supervision of individuals receiving services and the operation of the program. The responsibility of the direct program staff person shall be clearly defined. The Provider clearly defines supervisory responsibility during all hours of operation.

2. All direct program staff shall be at least 18 years of age.

3. The ratio of staff to recipient will be based upon the need of the individuals, and shall meet the minimum ratios identified in the contract for the program.

4. Students and volunteers may be used to augment, but not replace, regularly employed staff.

5. Each employee who works with children must undergo a Bureau of Criminal Investigation (BCI) screening in accordance with Section 62A-4-514. All persons living in the professional parent home over 18 must obtain fingerprints from their local law enforcement agency. (Section 62A-4-514.) Providers are encouraged to screen all employees working with Division of Services for People with Disabilities (DSPD) adults for a BCI check.

6. The Provider shall maintain personnel information on each employee.

a. Job descriptions and educational requirements will be maintained for each employed position.

b. Performance appraisals shall be conducted at least annually for all employees.

c. A health evaluation, including:

(1) The employee's statement of freedom from any communicable disease or other condition that might pose a health hazard to individuals receiving service.

(2) Within two weeks of employment all Direct Personnel shall be required to file a report that a negative TB screen for tuberculosis has been obtained, or a chest x-ray is negative if previous tuberculin test indicated positive results.

(3) If a staff member develops indications of a serious physical, emotional, or mental condition which could seriously jeopardize the well-being of any individual receiving services, or could prevent satisfactory performance of duties, that staff member shall be excluded from the program until the condition is resolved to the satisfaction of a licensed physician or other appropriate professional and until a written statement of such is presented and approval is given by the Provider.

7. All staff involved in food preparation shall have a current Food Handler's Permit obtained from the County Health Department.

R539-6-2. Personnel Respite.

A. Policy.

Respite Providers will ensure that all employees meet minimum criteria to ensure safety and services which offer the least disruption of the individual's life.

B. Procedures.

1. The Provider will interview each applicant and request written references which shall be verified and filed on all staff hired.

2. A BCI screening is required for all applicants working with children. If respite care is to be provided in a Provider's home all persons over 18 living in the home must obtain fingerprints from their local law enforcement agency. (Section 62A-4-514.) All providers working with adult recipients are encouraged to obtain a BCI screening.

3. Respite providers shall be at least 18 years of age.

4. Respite Providers must provide the following information on all employees:

a. Name, address, and telephone number.

b. Training and experience in the area of developmental disabilities.

c. Physical problems that might limit their abilities to serve the specific kinds of disabilities.

d. Names, addresses, and telephone numbers for three non-family references.

R539-6-3. Training Requirements for Day and Residential Programs.

A. Policy.

In order to enhance the quality of services and to ensure reduced liability risk to the State and providers, all program staff in residential and day services shall receive training and demonstrate competency in the following areas. Specific training requirements under each area, if any, are listed in the Procedures section with the time-line in which that training is expected to occur. Specific requirements may vary according to the individuals served.

a. Division policies and procedures, philosophy, mission, and beliefs.

b. Provider policies, philosophy, and mission (R539-5-3, Provider Policy and Records).

c. Nutrition (R539-6-14, Nutrition Requirements).

d. Health (R539-6-10, Health/Medication Requirements).

e. Emergency procedures (as outlined in the provider's policy manual).

f. Behavior management (R539-6-12, Adaptive Behavior Development).

g. Crisis procedures (R539-6-13, Emergency Services Crisis Intervention).

h. Legal rights of individuals with disabilities (R539-2-1, Individual Rights, and R539-2-3, Human Rights Committee).

i. Abuse, neglect, and exploitation (R539-2-1, Individual Rights, and R539-6-8, Code of Conduct).

j. Department of Human Services Provider Code of Conduct (R539-6-8, Code of Conduct).

k. Confidentiality (R539-2-2, Human Subject Research).

l. Principles of community inclusion (R539-2-1, Individual Rights).

m. Americans with Disabilities Act (R539-2-1, Individual Rights).

n. Individual Program Plan development (R539-3-2, Individual Program Plan).

o. Disabling conditions.

p. Age appropriate recreation and leisure skills.

B. Procedures.

1. The provider will require all staff to pass a written examination, or by some other method, demonstrate competency. The measures shall be available for inspection by Division staff.

2. The provider will ensure that a pre-service manual is provided to all employees and that competency is demonstrated in the following areas prior to providing any direct services to people with disabilities:

a. Disabling conditions: Orientation to individuals receiving services in that specific location or work site.

b. Emergency procedures: Fire safety, as well as other disaster safety procedures.

c. Behavior management: General principles of behavior management.

d. Legal rights of persons with disabilities.

e. Confidentiality.

f. Abuse, exploitation and neglect.

g. The Department of Human Services Provider Code of Conduct.

h. Orientation to the provider's agency policies and mission.

i. Orientation to the Division's mission and beliefs.

3. Within the first 30 working days, the employee shall demonstrate competency in the following areas:

a. Emergency procedures: First aid (including the Heimlich Maneuver).

b. Health: Medication specific to the individuals receiving services, including self-medication administration and documentation. Illness symptom recognition specific to the individuals served.

c. Health: Prevention of communicable disease (Human Immunodeficiency Virus, Sexually Transmitted Diseases, Hepatitis, etc.).

d. Nutrition: Specific dietary issues of the individual's receiving services.

e. Behavior management: Behavioral intervention programs specific to the individuals receiving services.

4. Within the first six months, the employee shall demonstrate competency in the following areas:

a. Principles of community inclusion.

b. Health: Self-medication administration and identification of common medications; and Cardiopulmonary Resuscitation (CPR) Certification.

c. Provider agency policies, philosophy, and mission.

d. Division policies and procedures, philosophy, mission, and beliefs.

e. Individual Program Plan development: Teaching methods, data collection, and documentation.

f. Behavior management: The use of non-aversive techniques in behavioral crisis prevention and intervention. Mandt, Professional Assault Response Training, or other Division approved training programs will only be required of those employees working with individuals who are highly likely to become aggressive. Providers are encouraged to provide this training to their staff as appropriate and as determined necessary.

g. Individual rights: Human Rights committees policies and procedures.

h. Americans with Disabilities Act.

i. Age appropriate recreation and leisure skills.

j. Nutrition: Mealtime procedures and nutritional needs of individuals served.

k. Health: Exercise and weight control.

l. Orientation to individuals with mental retardation and developmental disabilities, as well as to the disabling conditions specific to the individuals served by the provider.

5. After the first year of employment a minimum of 12 hours of additional training per year related to services for individuals with disabilities is required and must include Cardiopulmonary Resuscitation and First Aid certification or recertification.

6. During the first month of employment the relief and substitute staff will meet the pre-service requirement (2 above). Additionally, during the next 12 months they will complete items 3 and 4 above. Relief and substitute staff are those which work 10 or less hours per week.

R539-6-4. Training Requirements for Family Support and Respite Care Provider Agencies.

A. Policy.

All persons contracted or employed under a provider agency to provide family support or respite services to individuals with disabilities or their families with Division funding, will meet the following criteria to ensure safety, quality, competency, and flexibility in the supports and services they provide:

1. All persons contracted or employed under a provider agency to provide family support or respite services shall receive training and demonstrate competency in the following areas related to serving the person with disabilities. Training may be waived by the provider agency if the person's education or experience meets this criterion and competency is demonstrated. Verification of such education or experience must be documented and maintained in the person's provider file. The person shall receive the following training prior to providing services and supports:

a. The Philosophy of the Division of Services for People with Disabilities, including the Division Mission Statement, and Keys to Successful Family Support.

b. The Philosophy of supporting the family (as opposed to supplanting the family) and how to maintain positive interactions with the family.

c. Emergency first aid, Emergency Policies and Procedures (as outlined in the provider's policy manual according to R539-5-3, Provider Policy and Records), Fire Safety (Persons providing respite services must have a written fire evacuation plan).

d. General principles of behavior management, as well as legal rights of persons with disabilities.

e. Confidentiality.

f. The Department of Human Services Provider Code of Conduct (R539-6-8, Code of Conduct), including what constitutes abuse, neglect, and exploitation.

g. A general review of the causes of developmental disabilities and the more common types of disabilities. Specific emphasis may be given to the types of disabilities the provider may encounter with selected individuals.

2. Persons providing direct services and supports must be knowledgeable about the disabilities, required support, and strengths of the individual(s) they are to serve.

This policy does not apply to persons hired directly by individuals with disabilities or their families to provide family support or respite services under the Purchase of Individual Family Support Agreement, form 945 (Parent Choice Model).

B. Procedures.

1. Each provider agency will have a written statement of operation and the following information in each person's file with whom they employ or contract to provide direct services and supports:

a. An application.

b. At least three references (with verification of those references by the provider agency).

c. Bureau of Criminal Identification release forms (if applicable) in accordance with R539-6-1, Personnel Requirements.

d. Child/Adult Abuse Screening forms in accordance with R539-6-1.

e. A copy of the person's drivers license and evidence of insurance coverage if they will be transporting the individual. The provider must also annually check the person's driving record.

f. A copy of the person's social security card.

g. The Department of Human Services Provider Code of Conduct signature sheet signed by the person providing direct services and supports.

h. Persons providing respite services in their own home will complete a self certification form annually and will be subject to a random sample audit.

2. Training shall be conducted by a person with professional experience (at least two years) and knowledge in providing services and supports to persons with developmental disabilities.

3. All persons contracted or employed under a provider agency to provide family support or respite services will maintain records for individuals served according to R539-5-1, Provider Records for Individuals.

R539-6-5. Provider Board.

A. Policy.

To ensure oversight of Division programs, each non-profit Provider serving more than six individuals and having contracts exceeding $35,000 shall have a board to assure a high quality of program standards, effective program administration, and continuing program development. For-profit agencies are excluded from this requirement, but shall authorize their Human Rights Committee (R539-2-3) program oversight responsibilities in order to assure the public trust in state funding of service.

B. Procedures.

1. The Provider shall have bylaws which dictate the size of the board, constitution of membership, terms of membership, and method of selecting officers and new board members. The Board of Directors for non-profit agencies shall establish bylaws consistent with the following:

a. The board membership reflects the range of community people with interest or background in the program area. At least one member shall be a representative of the individuals served in the program.

b. Boards shall have term membership and shall rotate replacement of new members. Selection of officers and new members shall be made by a committee of the board and appointments made by a vote of the full board. Officers shall be elected annually.

c. To the extent they are not a majority of the membership or Board quorum, provider staff and/or their relatives may serve on the Board.

d. The Board of Directors for for-profit agencies shall comply with the Governing Body policy in the Department of Human Services' Rule (R501-2-3).

2. The Provider shall supply secretarial and staff support as requested by the board. The board agenda shall be established as a cooperative effort between the agency director or designee and the board chair.

3. The responsibilities of the Board shall include the following:

a. Meet with a frequency sufficient to carry out its responsibility, but not less than quarterly.

b. Review and up-date the bylaws outlining the power and responsibility of the board.

c. Review and approve all program policies, standards, budgets, and administrative practices, including employee job descriptions, hiring and firing practices, salary levels, and other personnel issues. They shall also review and make decisions on any unresolved employee grievances.

d. Non-profit boards shall conduct an annual review of the agency director's performance and submit a written appraisal to the director.

e. Review individual and parent grievances when not resolved by staff or administration. Issue recommendations to the agency director for resolution of the grievance.

f. Hold meetings with individuals and parent groups or conduct surveys as needed to determine program satisfaction.

g. Record minutes of meetings and document all actions taken by the board.

h. Perform other oversight responsibilities as the board sees fit in order to maintain the public trust in the state-funded service.

4. For non-profit agencies, either in the bylaws or agency policy, there shall be provision guarding against conflict of interest between a board member and the Provider organization. This does not rule out a business relationship with the Provider, but does require a disclosure of the interest and the limits or exclusions required for a member's participation in discussions and voting on the matters in which there are conflicts.

R539-6-6. Use of Volunteers.

A. Policy.

Purchase of Service Providers may use volunteers who have been trained to augment or deliver service designed for individuals with disabilities. Volunteers shall not replace minimum ratios for staff.

B. Procedures.

1. A volunteer will complete an application, including references, and have a screening interview. If the volunteer is to work with children with disabilities, they must be approved through a BCI check (Section 62A-4-514). Volunteers working with adults with disabilities are encouraged to be approved with a BCI check.

2. Providers will ensure that volunteers complete an orientation and training program which will include at a minimum:

a. Provider policies and procedures.

b. DSPD policies and procedures for reporting client abuse and client rights.

c. Confidential nature of information on individuals with disabilities.

d. Emergency procedures to follow when working with the individual.

e. Documentation of training and proficiency of the individual to carry out the assigned tasks.

f. Orientation to the individual with disabilities.

3. Providers will document the number of hours the volunteer works and provide supervision to comply with federal wage laws.

4. The Provider will have adequate insurance to protect both the volunteer and the individual with disabilities.

5. The legal guardian must provide written permission for the volunteer to take an individual from the program or overnight.

R539-6-7. Licensing and Certification.

A. Policy.

The purpose of licensing or certification is to authorize a public or private agency, or individual to provide services for DSPD. The license or certification designates that the program has the capacity to provide the service and indicates that the governing body of the program has demonstrated or has provided assurance that services shall be provided in accordance with DSPD and Office of Licensing (OL) rules.

B. Procedures.

1. A program and Provider will comply with licensing regulations regarding the application process and shall apply through the Department of Humans Services (DHS) Office of Licensing. Programs requiring licensing include day training, pre-vocational, large group-homes (four or more persons), supervised apartments (four or more persons), and foster care.

2. A program or Provider seeking certification shall apply through DSPD. Programs requiring certification include: small group homes (three or less persons), supervised apartments (three or less persons), living support and training, respite care, family support, supported employment, and socialization/recreation.

a. The certification application shall be completed by the provider and submitted to the DSPD contract administrator.

b. The on-site inspection certification shall be completed by the DSPD regions for out-of-home programs. The certification check-list for facility requirements is completed for all supervised apartments, small group-homes, out-of-home respite, and Professional Parent homes. (See R539-6-11)

c. Certificates shall be issued by DSPD to providers annually.

d. A self-certification form will be completed for family support programs, in-home respite and living support and training programs, supported employment, and socialization/recreation.

(1) Family support - Provider managed.

(a) Provider certifies to abide by the terms and conditions of the DSPD policies and procedures.

(b) Maintain documentation that training requirements are met for each employee.

(c) Written references shall be verified and filed for each employee.

(d) Medicaid application on file if required.

(2) Respite - In-home.

(a) Provider certifies to abide by the terms and conditions of the DSPD policies and procedures.

(b) Maintain documentation that training requirements are met for each employee.

(c) Written references shall be verified and filed for each employee.

(d) Medicaid application on file if required.

(3) Family support - Family managed.

(a) Application and references for an employee shall be on file.

(b) Maintain documentation that the family has selected the service provider.

(c) Family provides a statement which includes the following:

(i) The individual demonstrates competency to provide the service(s).

(ii) The individual will be trained by the parent(s) to provide the service(s).

(d) Medicaid application on file if required.

(4) Living Support and Training.

(a) Provider certifies to abide by the terms and conditions of the DSPD policies and procedures.

(b) Maintain documentation that training is implemented according to the IPP.

(c) Medicaid application on file if required.

(5) Supported Employment.

(a) Provider certifies to abide by the terms and conditions of the DSPD policies and procedures.

(b) Maintain documentation that training is implemented according to the IPP.

(c) Provider certifies that employer facilities will comply with Federal and State life safety requirements.

(d) Provisions of direct services in a facility requires providers to meet standards of physical accessibility.

(e) Medicaid application on file if required.

(6) Socialization/Recreation (State and Federal).

(a) Provider certifies to abide by health and safety requirements.

(b) Provision of direct services in a facility based program requires the provider to meet physical accessibility standards.

e. If the provider has a medicaid application and provider agreement on file they are not required for recertification.

3. A program or Provider seeking licensure or certification to provide direct service to children shall submit fingerprints and accompanying information to the DSPD region through the BCI check. Providers are encouraged to ensure that all employees working with adult recipients also complete the BCI screen.

4. Each program and Provider shall permit representatives of the Office or Agency to conduct on-site reviews, announced or unannounced, of the physical facility, program operation, individual records, and to interview staff and recipients to determine compliance.

R539-6-8. Code of Conduct.

A. Policy.

It is the policy of DSPD to have rules of conduct apply to any employee of any contracted service. The contractor must enforce and ensure that all employees sign and understand the Code of Conduct.

B. Procedures.

1. All employees will sign and state that they understand the code of conduct prior to beginning employment and annually review the statements to include at a minimum the following:

a. Use of alcoholic beverages, or controlled substances without medical prescription, by an employee while on the job, or being under the influence while on the job, is prohibited.

b. Cruel and abusing treatment is strictly prohibited, which includes mental as well as physical maltreatment. Employees are not allowed to strike recipients with any object, including their hands. When aversive procedures are recommended or prescribed, the Provider must have the procedure approved by the Provider Human Rights Committee and Division Human Rights Committee.

c. Recipient-employee sexual relationships are prohibited and will be reported to the Department officials as abuse.

d. Errors of omission and neglect in performing duties, as sleeping on duty, will be viewed as an overt abusive act.

e. Use of a recipient's resources for private or personal gain by an employee is prohibited.

f. No firearms are allowed in residential or day training facilities. Specialized foster homes, Professional Parents, and Respite providers must follow the licensing standards for Foster Care in regard to storage of firearms. (R501-12-9)

2. Employees that witness or are aware of a violation have the responsibility to report verbally such violations immediately to the appropriate authorities. Following this oral report, a written report should be given to the supervisor. If the employee witnessing the violation fails to report, the employee is subject to the same corrective action as applies to the offender.

3. All providers will comply with the DHS Code of Conduct. (R495-876)

R539-6-9. Facility Requirements.

A. Policy.

1. Residential facilities shall be maintained in a manner which is safe, attractive, and healthy for the individuals who reside in them. Each individual receiving services shall receive training, support, and opportunities to furnish and maintain the home in which the individual resides, as determined by the IPP team. Each individual receiving services shall receive training, support, and opportunities to decorate and personalize the home or apartment in an age-appropriate manner, with respect shown to roommates and to property.

2. Policies regarding facilities do not apply to individuals receiving Living Support and Training (LST) services. However, the Provider shall provide training, support, and assistance as requested by the individual to enable the individual to have a healthy, safe, and pleasant residence.

B. Procedures.

1. Each facility shall be maintained in good condition with regard to:

a. Exterior of building in good repair. Well groomed and maintained lawn, shrubs, and trees (if appropriate).

b. Interior of building in good repair.

(1) Equipment and furnishings are sufficient, comfortable and in good repair.

(2) No more than two persons shall be housed in a single bedroom.

(a) Minimum of 60 feet per occupant is provided in a bedroom with two persons.

(b) Minimum of 100 square feet for one individual is provided.

(c) Sleeping areas shall have a source of natural light, and be ventilated by mechanical means or equipped with a screened window.

(d) Sleeping areas serving male and female persons shall be structurally separated.

(e) No adult shall share a room with a child without permission from the IPP team.

(f) Beds shall be solidly constructed.

(g) Each individual shall have a bed.

(h) There shall be sufficient storage place for the clothing and personal items for each person.

(3) Bathrooms shall meet a minimum ratio of one toilet, one lavatory, one tub or shower for every four individuals.

(a) Toilets and baths or showers shall allow for individual privacy.

(b) Mirrors shall be secured to the walls at a convenient height; other furnishings or equipment shall be appropriate to meet the individual's needs.

(c) Bathrooms shall be so placed as to allow access without disturbing other persons during sleeping hours.

(d) Toilet paper and towels shall be readily accessible.

(4) Window coverings shall assure privacy and shall be in good repair.

(5) Lighting in all rooms shall be adequate for individual needs.

(6) Coverings shall be placed on all electric outlets.

(7) Laundry facilities shall be conveniently located.

(8) Basic first aid kit shall be kept in accessible location.

(9) Fire extinguisher and smoke detector shall be in working order and shall be serviced regularly.

c. Facility shall be located in an area with access to stores, churches, recreation facilities, and public transportation (if available).

d. Potentially hazardous substances shall be stored in a safe and secure manner.

e. Group homes and supervised apartment programs shall have a pest control program, which includes a professional or equal inspection as needed to assure premises are kept free of rodents and other pests.

2. Facilities licensed by DHS/OL shall comply with any additional licensing standards.

R539-6-10. Health/Medication Requirements.

A. Policy.

Each individual receiving services shall receive training, support, and opportunities to seek and obtain routine and acute medical, dental, psychiatric, or other health-related services, as determined by the IPP team. The Provider shall have policies and procedures available to safeguard the health and well-being of individuals receiving services. Providers providing Living Support and Training services shall have policies and procedures for addressing the health and safety of individuals receiving services with regard to the right of self-determination on the part of individuals, and will have emergency procedures developed in the event an individual's life-style becomes health- or life-threatening.

B. Procedures.

1. The Provider for residential services shall assure that the following things are done:

a. Individuals will be assisted to identify a primary health care provider.

b. Individuals shall receive training and assistance to obtain annual dental and physical examinations.

c. Individuals who have prescribed medication will receive training and assistance to obtain and self-administer medications to the maximum extent possible, as determined by the IPP team.

2. The Provider shall develop policies to govern administration, handling, storage, disposal of medication, and supervision by program staff.

3. All medication taken by individuals receiving services shall be documented by staff as to frequency, dosage, and type of medication.

4. Any medication received and kept for an individual shall be locked.

5. Health care services shall be delivered by professionals licensed in the field for which they are providing services.

6. Children will have monthly weights and quarterly heights documented as requested by the primary care physician.

R539-6-11. Use of Psychotropic Medications.

A. Policy.

1. The purpose of this policy is to assure that the most effective, least intrusive treatment strategy shall be provided to individuals with disabilities to assist in coping, controlling, replacing, or modifying inappropriate behaviors.

2. Psychotropic medication for persons receiving services funded by DSPD shall be used primarily for the treatment of psychiatric symptoms. Behavior interventions shall be implemented prior to consideration of psychotropic medication, except when the individual has a diagnosis of schizophrenia, major depressive disorder, bi-polar affective disorder, or obsessive compulsive disorder at which time behavior interventions may be initiated concurrently. Psychotropic medications for behavioral treatment shall be prescribed in consultation with a psychiatrist.

3. Psychotropic medications shall not be used as a form of punishment, in lieu of behavioral programming, as a convenience for staff, or in doses which exceed dosages manufacturers recommended.

4. The use of psychotropic medications shall require periodic review for effectiveness, monitoring for adverse reactions, and assurance of informed consent.

B. Procedures.

1. Each provider will be required to inform the Division Human Rights Committee (DHRC) annually of the recipients' names, psychiatric diagnoses or challenging behaviors, types of medications and dosages, and the review dates by prescribing physician, of individuals receiving psychiatric medication.

R539-6-12. Adaptive Behavior Development.

A. Policy.

1. All behavioral development techniques shall emphasize a positive approach with effective treatment alternatives designed to acquire and maintain adaptive behaviors. The primary purpose of behavior development techniques shall be to meet individual behavioral needs so that persons may develop to their fullest potential and enjoy satisfying lives.

2. All Providers must ensure that persons receiving behavioral training services have an opportunity to participate in their environment, to become engaged in meaningful activities, and to interact with peers, family, and staff when behavior development programs are utilized.

3. The use of the following procedures is prohibited:

a. Corporal punishment; examples: slapping, hitting, and pinching;

b. Demeaning speech to a person which ridicules or is abusive;

c. Seclusion, defined as locked confinement in a room;

d. Use of electric devices or other painful stimuli used to manage behavior; and

e. Denial or restriction of access to personal equipment or assistive technology, except where removal prevents injury to self, others, or property.

f. Meals shall not be withheld or denied contingent upon misbehaviors the individual might exhibit.

B. Procedures.

1. Interventions to address challenging behaviors are classified into three levels. The three levels are: Level 1- positive intervention procedures and withholding reinforcement; Level 2- mildly intrusive procedures; and Level 3- moderately and highly intrusive procedures. Behavioral development programs which utilize Level II and III interventions shall have prior approval from the PHRC, and Level III interventions shall also receive prior approval from the DHRC (see R539-2-3, Human Rights Committee).

2. The Adaptive Behavior Development policy is augmented by specific information found in the Division of Services for People with Disabilities Habilitation and Adaptive Behavior Guidelines and the By-Laws for the Division Human Rights Committee. The reader is referred to these two documents, available from the State or Regional DSPD office, for additional information and definitions.

3. Prior to the use and approval of any restrictive techniques, the prior use of non-restrictive procedures shall be documented. Level of interventions are defined to be:

a. Level I- Positive intervention procedures and withholding reinforcement which may include: teaching adaptive behaviors, positive reinforcement, reinforcement for alternative behavior, differential reinforcement, modeling, shaping, chaining, prompting, fading, graduated guidance, group reinforcement response contingency, token economy, environmental engineering, and extinction.

b. Level II- Mildly intrusive procedures which may include: response cost, exclusionary time out from reinforcement, satiation, application of mildly noxious stimuli, and overcorrection which is under verbal control and does not allow physical contact with the individual.

c. Level III-

(1) Moderately intrusive procedures which may include: overcorrection which requires physical contact to gain compliance, enforced compliance, forced relaxation, and manual restraint.

(2) Highly intrusive procedures which may include: isolationary time out, application of a highly noxious stimuli, deprivation of sensory stimuli, mechanical restraint, and psychotropic medications (see R539-6-11, Use of Psychotropic Medications).

NOTE: Refer to R539-6-13, Emergency Services Crisis Intervention for use of Levels II and III interventions in emergency situations.

4. Each provider agency shall develop written policies and procedures regarding behavioral programs which comply with DSPD guidelines regarding behavior programs. Written behavioral programs shall include:

a. Description of the specific target behaviors.

b. A functional analysis of the circumstances under which the behavior occurs;

(1) Relevant medical, ecological, and social factors which may contribute to the behavior.

(2) An investigation of environmental deficiencies.

(3) Program staff and medical staff consultation that states there is not a potential medical condition which may be contributing to the identified behavior.

c. Baseline data.

d. Behavioral objective written in measurable and observable terms.

e. Procedures for implementing the programs.

(1) Generalization.

(2) Maintenance.

(3) Emergency procedures.

(4) Reinforcement.

(5) Prompts.

(6) Corrective procedures.

(7) Rationale for aversives.

(a) Identification of review and approval.

(b) When and where intervention will occur.

f. Name and title of the person(s) responsible for supervising the program.

g. Data collection which measures progress toward the objective.

h. Dates for review and program revisions.

5. A request to the DSPD case manager shall be made for a legal representative if the interdisciplinary team recommends a behavioral intervention program and they feel the individual could not participate with informed consent.

6. A behavioral development plan shall address the inappropriate behaviors emphasizing a positive approach and within 30 days be included in the IPP.

7. Programs shall make a reasonable effort to include for example, external behavioral consultation, physical restraint, manual blocking, and environmental change, to ensure that recipients of services are prevented from self-injury.

8. At the request of the recipient or legal representative, the Utah Legal Center for People with Disabilities may be consulted to represent the desires of the recipient prior to the approval of the Level III intervention.

9. The written approved program shall be available to all staff involved in implementing or supervising the programs. All staff shall demonstrate competency prior to the implementation of the program.

R539-6-13. Emergency Services Crisis Intervention.

A. Policy.

1. The purpose of this policy is to outline procedures to prevent injury to individuals with disabilities, other people, and property destruction during a behavioral crisis in which an individual may be aggressive or assaultive.

2. Emergency behavioral control procedures shall not be employed as punishment, for the convenience of staff, or as a substitute for programming.

B. Procedures.

1. Behaviors which may require emergency interventions are those which constitute:

a. Danger to others: Physical violence toward others with sufficient force to cause bodily harm.

b. Danger to self: Self abuse of sufficient force to cause bodily harm.

c. Danger to property: Physical abuse or destruction of property.

d. Threatened abuse toward others, self, or property: may, with an evidence of past threats, result in any of the items listed in a-c.

2. Examples of emergency procedures are use of physical restraints, manual restraints, and exclusion.

3. The individual record shall document all periods of emergency behavior control, with justification and authorization for each period.

4. The PHRC shall review all uses of emergency control procedures (R539-2-3) quarterly. When emergency control procedures are used either in excess of five times in a 30 day period or a cumulative total in excess of 25 minutes in a 30 day period the procedure must be reviewed by the PHRC who may refer cases to the DHRC.

5. Within 24 hours after the use of an emergency procedure, the staff person who implemented the procedure shall report, in writing, to the designated individual program coordinator, or appropriate program supervisor, and guardian or authorized representative, the information required as follows:

a. Description of the intervention employed, including the beginning and ending times.

b. Why the procedure was judged necessary.

c. An assessment of the likelihood the behavior necessitating emergency intervention will reoccur.

6. Within 14 days of the date of the emergency intervention, the DSPD service coordinator case manager shall be notified by the provider agency using an incident report form.

7. Following the review of the report, the DSPD case manager shall determine whether to convene members of the interdisciplinary team.

8. DSPD sanctions the use of either the Professional Assault Response training (PART) or the Mandt System for Managing Non-Aggressive and Aggressive People. Other crisis management procedures require Division approval prior to implementation.

R539-6-14. Nutrition Requirements.

A. Policy.

Each individual receiving services shall receive training, support, and opportunities to plan, shop for, and prepare a variety of nutritious meals in a safe and sanitary manner, according to individual preference and special diet, as determined by the IPP team.

B. Procedures.

1. The Provider shall make assurances that individuals receiving services have nutritious meals.

2. Providers providing LST services shall develop policies and procedures regarding the nutrition of individuals receiving services and the right to self-determination of the individual.

3. The Provider shall develop emergency policies and procedures in the event the individual's life-style becomes health- or life-threatening.

4. Providers for group home and supervised apartment programs shall adhere to the following additional standards:

a. Menus will be planned to meet basic nutritional standards, special diets, food preferences, customs, and appetites of individuals receiving services.

b. Individuals receiving services shall have kitchen privileges.

c. Documentation of meals served shall be kept for six months.

5. The kitchen area shall be maintained in a safe and sanitary manner. All food and drink shall be safe for human consumption and prepared and served in a sanitary manner.

R539-6-15. Leisure and Recreation Requirements.

A. Policy.

Recreation and leisure activities shall involve the use of generic services available in the community, public transportation, and opportunities for interaction and integration with disabled and non-disabled peers. The Provider shall provide training, support, assistance, and opportunities to each individual receiving services to plan and implement age-appropriate daily living, personal management, community access, and social and leisure activities.

B. Procedures.

1. Activities shall be identified as desired by the individual, shall be functional for the individual, and shall occur in the natural routine of daily living.

2. Activities shall accommodate any medical or physical considerations of the individual.

3. Activities for individuals receiving group home or supervised apartment services shall be implemented individually or in small groups (preferably three or less).

4. The Provider providing group home or supervised apartment services shall post a monthly schedule of individual and group activities in a manner which is easily accessible to individuals receiving services.

5. The Provider providing group home or supervised apartment services shall document individual and group participation in scheduled activities in the individual's record (see R539-5-1).

6. Examples of activities should include personal money management, shopping, access to community resources, use of public transportation, meal preparation, social skills, interpersonal relationships, communication, and sexuality training.

KEY: disabled persons*, social services

August 14, 1995

Notice of Continuation December 18, 2002

62A-5-103]

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Steven Bradford at the above address, by phone at 801-538-4197, by FAX at 801-538-4279, or by Internet E-mail at sbradford@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.