Common use of BEHAVIOR TREATMENT PLAN STANDARDS Clause in Contracts

BEHAVIOR TREATMENT PLAN STANDARDS. A. The person-centered planning process used in the development of an individualized written plan of services will identify when a behavior treatment plan needs to be developed and where there is documentation that functional behavioral assessments have been conducted to rule out physical, medical or environmental causes of the behavior; and that there have been unsuccessful attempts, using positive behavioral supports and interventions, to prevent or address the behavior. B. Behavior treatment plans must be developed through the person-centered planning process and written special consent must be given by the individual, or his/her guardian on his/her behalf if one has been appointed, or the parent with legal custody of a minor prior to the implementation of the behavior treatment plan that includes intrusive or restrictive interventions. C. Behavior treatment plans that propose to use physical management and/or involvement of law enforcement in a non-emergent situation; aversive techniques; or seclusion or restraint in a setting where it is prohibited by law shall be disapproved by the Committee. Utilization of physical management or requesting law enforcement may be evidence of treatment/supports failure. Should use occur more than 3 times within a 30 day period the individual’s written individual plan of service must be revisited through the person-centered planning process and modified accordingly, if needed. MDCH and DHS Administrative Rules prohibit emergency interventions from inclusion as a component or step in any behavior plan. The plan may note, however, that should interventions outlined in the plan fail to reduce the imminent risk of serious or non-serious physical harm to the individual or others, approved emergency interventions may be implemented. D. Behavior treatment plans that propose to use restrictive or intrusive techniques as defined by this policy shall be reviewed and approved (or disapproved) by the Committee. E. Plans that are forwarded to the Committee for review shall be accompanied by: 1. Results of assessments performed to rule out relevant physical, medical and environmental causes of the challenging behavior. 2. A functional behavioral assessment. 3. Results of inquiries about any medical, psychological or other factors that might put the individual subjected to intrusive or restrictive techniques at high risk of death, injury or trauma. 4. Evidence of the kinds of positive behavioral supports or interventions, including their amount, scope and duration that have been used to ameliorate the behavior and have proved to be unsuccessful. 5. Evidence of continued efforts to find other options. 6. Peer reviewed literature or practice guidelines that support the proposed restrictive or intrusive intervention. 7. References to the literature should be included on new procedures, and where the intervention has limited or no support in the literature, why the plan is the best option available. Citing of common procedures that are well researched and utilized within most behavior treatment plans is not required. 8. The plan for monitoring and staff training to assure consistent implementation and documentation of the intervention(s). 1997 federal Balanced Budget Act at 42 CFR 438.100 MCL 330.1712, Michigan Mental Health Code MCL 330.1740, Michigan Mental Health Code MCL 330.1742, Michigan Mental Health Code MDCH Administrative Rule 7001(l) MDCH Administrative Rule 7001(r) Department of Community Health Administrative Rule 330.7199(2)(g) It is the expectation of the Michigan Department of Community Health (MDCH) that Prepaid Inpatient Health Plans’ (PIHPs) and Community Mental Health Services Programs’ (CMHSPs) access systems function not only as the front doors for obtaining services from their helping systems but that they provide an opportunity for residents with perceived problems resulting from trauma, crisis, or problems with functioning to be heard, understood and provided with options. The Access System is expected to be available and accessible to all individuals on a telephone and a walk-in basis. Rather than screening individuals “in” or “out” of services, it is expected that access systems first provide the person “air time,” and express the message: “How may I help you?” This means that individuals who seek assistance are provided with guidance and support in describing their experiences and identifying their needs in their own terms, then assistance with linking them to available resources. CMHSPs and PIHPs are also expected to conduct active outreach efforts throughout their communities to assure that those in need of mental health services are aware of service entry options and encouraged to make contact. In order to be welcoming to all who present for services, the access systems must be staffed by workers who are skilled in listening and assisting the person with trauma, crisis or functioning difficulties to sort through their experience and to determine a range of options that are, in practical terms, available to that individual. Access Systems are expected to be capable of responding to all local resident groups within their services area, including being culturally-competent, able to address the needs of persons with co-occurring mental illness and substance use disorders. Furthermore, it is expected that the practices of access systems and conduct of their staff reflect the philosophies of support and care that MDCH promotes and requires through policy and contract, including person-centered, self-determined, recovery-oriented, trauma- informed, and least restrictive environments.

BEHAVIOR TREATMENT PLAN STANDARDS. A. The person-centered planning process used in the development of an individualized written plan of services will identify when a behavior treatment plan needs to be developed and where there is documentation that functional behavioral assessments have been conducted to rule out physical, medical or environmental causes of the behavior; and that there have been unsuccessful attempts, using positive behavioral supports and interventions, to prevent or address the behavior. B. Behavior treatment plans must be developed through the person-centered planning process and written special consent must be given by the individual, or his/her guardian on his/her behalf if one has been appointed, or the parent with legal custody of a minor prior to the implementation of the behavior treatment plan that includes intrusive or restrictive interventions. C. Behavior treatment plans that propose to use physical management and/or involvement of law enforcement in a non-emergent situation; aversive techniques; or seclusion or restraint in a setting where it is prohibited by law shall be disapproved by the Committee. Utilization of physical management or requesting law enforcement may be evidence of treatment/supports failure. Should use occur more than 3 times within a 30 day period the individual’s written individual plan of service must be revisited through the person-centered planning process and modified accordingly, if needed. MDCH and DHS Administrative Rules prohibit emergency interventions from inclusion as a component or step in any behavior plan. The plan may note, however, that should interventions outlined in the plan fail to reduce the imminent risk of serious or non-serious physical harm to the individual or others, approved emergency interventions may be implemented. D. Behavior treatment plans that propose to use restrictive or intrusive techniques as defined by this policy shall be reviewed and approved (or disapproved) by the Committee. E. Plans that are forwarded to the Committee for review shall be accompanied by: 1. Results of assessments performed to rule out relevant physical, medical and environmental causes of the challenging behavior. 2. A functional behavioral assessment. 3. Results of inquiries about any medical, psychological or other factors that might put the individual subjected to intrusive or restrictive techniques at high risk of death, injury or trauma. 4. Evidence of the kinds of positive behavioral supports or interventions, including their amount, scope and duration that have been used to ameliorate the behavior and have proved to be unsuccessful. 5. Evidence of continued efforts to find other options. 6. Peer reviewed literature or practice guidelines that support the proposed restrictive or intrusive intervention. 7. References to the literature should be included on new procedures, and where the intervention has limited or no support in the literature, why the plan is the best option available. Citing of common procedures that are well researched and utilized within most behavior treatment plans is not required. 8. The plan for monitoring and staff training to assure consistent implementation and documentation of the intervention(s). 1997 federal Balanced Budget Act at 42 CFR 438.100 MCL 330.1712, Michigan Mental Health Code MCL 330.1740, Michigan Mental Health Code MCL 330.1742, Michigan Mental Health Code MDCH Administrative Rule 7001(l) MDCH Administrative Rule 7001(r) Department of Community Health Administrative Rule 330.7199(2)(g) It is the expectation of the 2013 Application for Participation For Specialty Prepaid Inpatient Health Plans Michigan Department of Community Health (MDCH) that Prepaid Inpatient Behavioral Health Plans’ (PIHPs) & Developmental Disabilities Administration 1. Governance Page 13 2. Administrative Functions 2.1. General Management Page 19 2.2. Financial Management Page 23 2.3. Information Systems Management Page 24 2.4. Provider Network Management Page 28 2.5. Utilization Management Page 30 2.6. Customer Services Page 31 2.7. Quality Management Page 32 3. Accreditation Status Page 33 4. External Quality Review Page 34 5. Public Policy Initiatives 5.1. Regional Crisis Response Capacity Page 35 5.2. Health and Community Mental Health Services Programs’ (CMHSPs) access systems function not only as the front doors for obtaining services from their helping systems but that they provide an opportunity for residents with perceived problems resulting from trauma, crisis, or problems with functioning to be heard, understood and provided with optionsWelfare Page 38 5.3. The Access System is expected to be available and accessible to all individuals on a telephone and a walk-in basisXxxxxxxx Compliance Page 41 5.4. Rather than screening individuals “in” or “out” of services, it is expected that access systems first provide the person “air time,” and express the message: “How may I help you?” This means that individuals who seek assistance are provided with guidance and support in describing their experiences and identifying their needs in their own terms, then assistance with linking them to available resources. CMHSPs and PIHPs are also expected to conduct active outreach efforts throughout their communities to assure that those in need of mental health services are aware of service entry options and encouraged to make contact. In order to be welcoming to all who present for services, the access systems must be staffed by workers who are skilled in listening and assisting the person with trauma, crisis or functioning difficulties to sort through their experience and to determine a range of options that are, in practical terms, available to that individual. Access Systems are expected to be capable of responding to all local resident groups within their services area, including being culturally-competent, able to address the needs of persons with co-occurring mental illness and substance use disorders. Furthermore, it is expected that the practices of access systems and conduct of their staff reflect the philosophies of support and care that MDCH promotes and requires through policy and contract, including person-centered, self-determined, recovery-oriented, trauma- informed, and least restrictive environments.Substance Use Disorder Prevention & Treatment Page 48

BEHAVIOR TREATMENT PLAN STANDARDS. A. The person-centered planning process used in the development of an individualized written plan of services will identify when a behavior treatment plan needs to be developed and where there is documentation that functional behavioral assessments have been conducted to rule out physical, medical or environmental causes of the behavior; and that there have been unsuccessful attempts, using positive behavioral supports and interventions, to prevent or address the behavior. B. Behavior treatment plans must be developed through the person-centered planning process and written special consent must be given by the individual, or his/her guardian on his/her behalf if one has been appointed, or the parent with legal custody of a minor prior to the implementation of the behavior treatment plan that includes intrusive or restrictive interventions. C. Behavior treatment plans that propose to use physical management and/or involvement of law enforcement in a non-emergent situation; aversive techniques; or seclusion or restraint in a setting where it is prohibited by law shall be disapproved by the Committee. Utilization of physical management or requesting law enforcement may be evidence of treatment/supports failure. Should use occur more than 3 times within a 30 day period the individual’s written individual plan of service must be revisited through the person-centered planning process and modified accordingly, if needed. MDCH and DHS Administrative Rules prohibit emergency interventions from inclusion as a component or step in any behavior plan. The plan may note, however, that should interventions outlined in the plan fail to reduce the imminent risk of serious or non-serious physical harm to the individual or others, approved emergency interventions may be implemented. D. Behavior treatment plans that propose to use restrictive or intrusive techniques as defined by this policy shall be reviewed and approved (or disapproved) by the Committee. E. Plans that are forwarded to the Committee for review shall be accompanied by: 1. Results of assessments performed to rule out relevant physical, medical and environmental causes of the challenging behavior. 2. A functional behavioral assessment. 3. Results of inquiries about any medical, psychological or other factors that might put the individual subjected to intrusive or restrictive techniques at high risk of death, injury or trauma. 4. Evidence of the kinds of positive behavioral supports or interventions, including their amount, scope and duration that have been used to ameliorate the behavior and have proved to be unsuccessful. 5. Evidence of continued efforts to find other options. 6. Peer reviewed literature or practice guidelines that support the proposed restrictive or intrusive intervention. 7. References to the literature should be included on new procedures, and where the intervention has limited or no support in the literature, why the plan is the best option available. Citing of common procedures that are well researched and utilized within most behavior treatment plans is not required. 8. The plan for monitoring and staff training to assure consistent implementation and documentation of the intervention(s). 1997 federal Balanced Budget Act at 42 CFR 438.100 MCL 330.1712, Michigan Mental Health Code MCL 330.1740, Michigan Mental Health Code MCL 330.1742, Michigan Mental Health Code MDCH Administrative Rule 7001(l) MDCH Administrative Rule 7001(r) Department of Community Health Administrative Rule 330.7199(2)(g) It is the expectation of the Michigan Department of Community Health (MDCH) that Prepaid Inpatient Health Plans’ (PIHPs) and Community Mental Health Services Programs’ (CMHSPs) access systems function not only as the front doors for obtaining services from their helping systems but that they provide an opportunity for residents with perceived problems resulting from trauma, crisis, or problems with functioning to be heard, understood and provided with options. The Access System is expected to be available and accessible to all individuals on a telephone and a walk-in basis. Rather than screening individuals “in” or “out” of services, it is expected that access systems first provide the person “air time,” and express the message: “How may I help you?” This means that individuals who seek assistance are provided with guidance and support in describing their experiences and identifying their needs in their own terms, then assistance with linking them to available resources. CMHSPs and PIHPs are also expected to conduct active outreach efforts throughout their communities to assure that those in need of mental health services are aware of service entry options and encouraged to make contact. In order to be welcoming to all who present for services, the access systems must be staffed by workers who are skilled in listening and assisting the person with trauma, crisis or functioning difficulties to sort through their experience and to determine a range of options that are, in practical terms, available to that individual. Access Systems are expected to be capable of responding to all local resident groups within their services area, including being culturally-competent, able to address the needs of persons with co-occurring mental illness and substance use disorders. Furthermore, it is expected that the practices of access systems and conduct of their staff reflect the philosophies of support and care that MDCH promotes and requires through policy and contract, including person-centered, self-determined, recovery-oriented, trauma- informed, and least restrictive environments.)