Behavior Management

BEHAVIOR MANAGEMENT

In accordance with Recovery Works development and implementation of its policies and procedures on behavior management, policies and procedures are set forth describing the types of clients served in accordance with its program purpose, the anticipated behavioral problems of the clients, and appropriate techniques of behavior management for dealing with such behaviors.

ANTICIPATED PROBLEMS AND TECHNIQUES

  1. Behavior Management

    1. Recovery Works policies and procedures describe the types of clients served in accordance with the program purpose:

Program Description & Services Provided….. 111.8.19.09.2a

The types of clients are additionally detailed according to the criteria for client admission:

Admissions Criteria 111.8.19.13.1a

As discussed in these above sections, Recovery Works serves clients with anticipated behavioral problems.

Unanticipated behavioral problems may also emerge. These may be indicative of a subsequent need for a higher level of care, or otherwise indicative of a client being unsuitable for the program.

All clients must agree to the program’s rules, in writing, prior to admission, and, the program maintains contingency management techniques for behavioral problems that may include violations of its rules.

Examples of behavioral problems that can require management:

  • Property Violations (e.g., property damage, theft, shoplifting, intrusion, trespassing)

  • Hostile Behavior (e.g., abusive comments, intrusion, trespassing, offensive language, behavioral agitation, or inappropriately aggressive domination of meetings)

  • Violent Behavior (e.g., assault, injury or threat of injury to others, property damage, threatening statements)

  • Self-Harm (e.g., overdose, behavioral dyscontrol, impulsive, reckless behaviors, intentional self-harm, cutting, suicidal behavior)

  • Addictive Behaviors (e.g., acute intoxication, drug-seeking behavior, unintentional overdose)

  • Disruptive Behaviors (e.g., disorganized agitation, psychotic disorganization, paranoid behavior, inappropriate sexual behavior, sexual harassment, behaviors disrupting others’ recovery)

The appropriate techniques of behavior management for needed intervention of such behaviors are outlined in the section:

Interventions: Behavioral & Emergency Safety….. 111.8.19.09.2e

Individuals who are unable to adequately control their behavior are, ultimately, not suitable for continued inclusion in the Recovery Works program. The Behavior Management & Emergency Safety techniques only provide management strategies for either:

the transition of the individual off-site (e.g., higher level of care, criminal justice custody, discharge, etc.), or

the transition of the individual to achieving appropriate behavioral control, within a time-frame acceptable to the program for continuation in the program.

REQUIREMENTS

Program staff shall be made aware of each client’s known or apparent medical and psychological conditions and family history, as evidenced by written acknowledgement of such awareness, to ensure that the staff have adequate knowledge to deliver safe and healthy care to the client.

Behavior management procedures must incorporate principles and techniques in accord with the individual treatment plan, and these policies and procedures governing service expectations, treatment goals, safety, security, as well as applicable rules and regulations.

Behavior management shall be limited to the least restrictive appropriate method as described in the client's treatment plan pursuant to 111.8.19.14a, and 111.8.19.14b.1-5, and in accordance with the prohibitions as specified in these policies and procedures.

Behavior management techniques shall be administered by trained staff and shall be appropriate for the client’s age, intelligence, emotional makeup and past experience.

PROHIBITIONS

The following forms of behavior management shall not be used by Recovery Works program staff with any of its clients receiving services through the program:

  • Assignment of excessive or unreasonable work tasks;

  • Denial of meals and hydration;

  • Denial of sleep;

  • Denial of shelter, clothing, or essential personal needs;

  • Denial of essential program services;

  • Verbal abuse, ridicule, or humiliation;

  • Manual holds, chemical restraints, or mechanical restraints not used appropriately as emergency safety interventions;

  • Denial of communication and visits;

  • Corporal punishment;

  • Seclusion or confinement of a client in a room or area which may reasonably be expected to cause physical or emotional damage to the client; or not used appropriately as an emergency safety intervention; and

  • Seclusion or confinement of a client to a room or area for periods longer than those appropriate to the client’s age, intelligence, emotional make up and previous experience, or confinement to a room or area without the supervision or monitoring necessary to ensure the client’s safety and well-being.

    CLIENT-CLIENT PARTICIPATION

    Clients shall not be permitted to participate in the behavior management of other clients or to discipline other clients.

    The only exceptions would be where such activity were

    1. part of an organized therapeutic self-governing program, and

    2. in accordance with accepted standards of clinical practice, and

    3. conducted in accordance with written policy and

    4. supervised directly by designated staff.

    DOCUMENTATION

    1. Programs shall submit to the department electronically or by facsimile a report within 24 hours whenever the program becomes aware of an incident which results in any injury to a client requiring medical treatment beyond first aid that is received by a client as a result of or in connection with any behavior management.

    2. All forms of behavior management or emergency safety interventions used by staff shall also be documented in case records in order to ensure that such records reflect behavior management problems.

    3. The program shall take appropriate corrective action when the program staff become aware of or observe the use of prohibited forms of behavior management, as specified in section 111.8.19.26.1d. Documentation of the incident and the corrective action taken by the program shall be maintained in the case records of the client.