Restrictive Procedure Q&A

Restrictive Procedure Q&A

Presented By: Tara Viens

The Bureau of Supports for Autism & Special Populations

Office of Developmental Programs

17/30/2019

7/30/2019

Objective

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• Provide answers to frequently asked questions during

my VOH on restrictive procedures.

7/30/2019

Disclaimers

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• The answers provided are based on the context of the

example and cannot be generalized to all scenarios or

to all participants.

• This training is for educational purposes, all restrictive

procedure plans must be reviewed and approved by a

Human Rights Team.

• Remember just because a procedure is “allowable”

does not mean it’s appropriate for the participant.

Human Rights Team’s can disapprove recommended

procedures if there is not enough data to support the

need or if they feel there are other least restrictive

procedures that can be attempted.

7/30/2019

What is a Restrictive Procedure?

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A restrictive procedures is a practice that does one or

more of the following:

• Limits an individual’s movement, activity or function

• Interferes with an individual’s ability to acquire positive

reinforcement

• Results in the loss of objects or activities that an

individual values

• Requires an individual to engage in behavior that the

individual would not engage in given freedom of choice

Is this Restrictive?

QUESTION

• Are driver controlled locking

devices on cars restrictive?

ANSWER

• Cars that have an automatic

lock that engages when a

driver puts the car into drive

does not require a restrictive

procedure plan.

• If you engage the manual

locking device (ex child safety

lock on the side of a door) as a

strategy to manage behavior

then you must follow restrictive

procedure plan requirements.

Example:John is diagnosed with schizoaffective

disorder and suffers from hallucinations.

During times of high anxiety and when

experiencing hallucinations John has

attempted to open the car door while the

vehicle is in motion. Staff utilize a mini

van and the team has requested that he

sit in the back row to put space between

him and the door. He has continued to

attempt to exit the vehicle while moving.

The team is working with a behavioral

specialist and requesting to engage the

door locking device.

If you were reviewing this plan what

questions would you ask?

How would you vote?

ExampleBeth is diagnosed with IDD and ADHD

she has a hard time sitting for long

periods of time and on a trip to the

doctor she attempted to pull the van door

handle. She has never done this before.

One DSP was driving and one was

sitting in the back, Beth was able to be

redirected by staff. Beth is already

working with a behavior specialist and

staff requested that the door locking

device be engaged for Beth’s safety.

If you were reviewing this plan what

questions would you ask?

How would you vote?


QUESTION

• When a person is in crisis and

is physically aggressive toward

others can staff verbally

redirect them to exit the room

or is this now considered

seclusion?

ANSWER

• Verbal redirection to exit in this

example is not seclusion. It

doesn’t matter if staff are

redirecting the person in crisis

or other people in the room.

ExampleSam is having a bad day and when his

DSP asked him to get ready to go to the

store he hit his staff. Staff shut his door

and told him he cant go on his outing.

Staff stood in the doorway confining Sam

to his room until he calmed down in

order to maintain the safety of others in

the home.

Is this seclusion or verbal redirection?

How would you vote?


QUESTION

• Is locking up sharps and

hazardous products

restrictive?

ANSWER

• If a person is in a 6400 licensed setting and has been assessed to not be safe around sharps/hazardous products. The team can keep the assessment on file for licensing and securesharps/hazardous products without a restrictive procedure plan.

• If a person is not safe due to behaviors (attempting to hurt someone or themselves with a sharp object) then the team should implement a restrictive procedure plan and work with a behavioral specialist.

ExampleErin and Michelle are housemates with

different abilities and support needs.

Michelle lacks an understanding of the

dangers of poisons so staff have all the

cleaning supplies in a locked closet in

the home.

Erin understands the dangers of poisons

and enjoys cleaning her home.

Does Erin require a restrictive procedure

plan since poisons are locked in her

home?

How would you vote?


QUESTION

• If there is a court order that

prohibits a certain activity

and/or access to a certain

person does the court order

supersede the Human Rights

Team?

ANSWER

• If there is a court order there

should also be a restrictive

procedure plan. The Human

Rights Team should be

provided a copy of the court

order. The plan is important

because it will outline how staff

should respond if the

participant requests that

activity/access to the person.

ExampleAdam has a court order to not contact

his ex-girlfriend Sue due to repeated

calls he made after she broke up with

him. Adam has a cell phone and lives in

a supported living situation. He is not

supervised 24/7 should there be a

restrictive plan to remove his cell phone

due to the court order?

How would you respond if you were on

Adam’s team? What questions do you

have?

How would you vote?

ExampleChris lives in a home with 24/7 support

he has a court order that states he is not

allowed to have any access to the

internet due to pending charges for

watching child pornography.

How would you respond if you were on

Chris’s team? What questions do you

have?

How would you vote?


QUESTION

• Is it restrictive for a company to

have a policy on certain types

of pets in a 6400 licensed

home?

ANSWER

• Providers should not have

“blanket policies” that will

restrict an individual's rights.

ExampleBecky really wants a cat but her

residential provider has a landlord that

does not allow cats or dogs at her home.

It’s not restrictive for the provider to

uphold this agreement with the landlord

however what can the team do to

support Becky?


QUESTION

• Is 1:1 or 2:1 staffing

restrictive?

ANSWER

• 1:1 or 2:1 staffing for

behavioral reasons is listed as

restrictive in the current

waivers and requires a

restrictive procedure plan.

• It’s not the staffing level that is

restrictive as much as

maintaining this level of

supervision in certain

situations will infringe on the

rights of the participant.

ExampleJan lives alone by choice with staff

support so she has 1:1 staffing by

default, does the team need a restrictive

procedure plan?

NO

Larry has 1:1 staffing while at day

program due to wandering out of the

program area on several occasions,

does the team need a restrictive

procedure plan?

YES


QUESTION

• Is a gait belt ordered by a

medical processional

restrictive?

ANSWER

• No

ExampleDan’s doctor has ordered the use of a

gait belt for staff to assist him when he is

unsteady. There are times when Dan

refuses to put the belt on, he may hit

staff or take the belt off.

How should staff proceed? Is it

restrictive to continue to put the belt on

Dan?

How would you vote?


QUESTION

• Can a rep payee withholds SSI

funds if the participant

engages in undesired

behavior?

ANSWER

• This is a prohibited procedure

and is considered abuse. A

incident report should be filed

and APS contacted if it

continues.


QUESTION

• Are doctor’s orders to follow

specific diet or fluid restriction

considered a restrictive

procedure?

ANSWER

• If the team is working with a participant to follow a diet or fluid restriction and the participant is accepting of the support/plan then it does not require a plan.

• If at any time staff refuse food/ drink OR take away food/drink in order to implement the plan then that is a rights violation. If the risk level is immediate and severe then a restrictive procedure plan can be implemented with HRT approval.

ExampleDeb is non-verbal and has been

diagnosed with Type 2 diabetes. Her

doctor prescribes insulin and diet to

manage her sugar level. Staff begin to

assist Deb with following her new diet.

Her portions are now smaller than her

housemates and she is redirected from

getting a second helping. Deb doesn’t

resist this redirection from staff but does

continuously try to access food. Staff are

redirecting Deb with increased frequency

and observe Deb getting frustrated.

How should staff proceed? Is it

restrictive if they continue to redirect

Deb?

How would you vote?

Is This Restrictive?

QUESTION

• Are door alarms restrictive?

ANSWER

• Door alarms or automatic lights

that do not inhibit movement

are not considered restrictive.


QUESTION

• Is an Evacuation Slide Sheet

for overnight fire drills and/or to

use in an emergency

restrictive? The person utilizes

a wheel chair and requires

assistance to exit during

emergencies.

ANSWER

• This is a medical device for

use in an emergency situation,

it is allowable and would not

require a restrictive procedure

plan. However, a plan that

outlines how it can be used

and under what circumstances

should exist and staff should

be trained on implementation.


QUESTION

• Can families use restrictive

procedures in the home?

ANSWER

• If the family member is a paid

caregiver and/or paid staff are

providing service in the home

then any restrictive procedures

utilized during that time must

be reviewed and approved by

a HRT.

ExampleCassidy lives at home with her family

and utilizes community support and

behavior support services. When staff

arrive to pick up Cassidy the family lets

them know that they started a

reinforcement plan. The family would like

the CS and BSS to keep track of

Cassidy’s behavior while in the

community. If she is able to manage her

aggressive behaviors they want staff to

give her $5 to spend at the store. The

family has used this strategy and have

found it to be helpful when they are out

with Cassidy.

How should the staff respond?

How would you vote?

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Documents

Restrictive Procedure Q&A