BEHAVIOR SERVICES
STATEMENT OF PURPOSE
Positive Behavior Support Plans (PBSP) are designed to address areas of unmet needs and teach relevant
social skills to replace interfering behaviors through use of teaching techniques and reinforcement
strategies in natural environments.
In the event that interfering behaviors present imminent physical danger and less restrictive interventions
have failed, procedures are in place for implementation of safe emergency intervention techniques to
protect for the safety of everyone involved.
INFORMED CONSENT
Chileda's behavior policies and procedures promote proactive approaches and a continuum of
interventions which emphasize the least restrictive treatment approach. However emergency situations of
severe acting out behavior(s) may arise during the early stages of behavior assessment and treatment
and/or without prior predisposition. In an effort to offer a secure and safe environment for all residents,
informed consent by parents/guardian for use of emergency intervention procedures is secured at the time
of admission.
Parents/guardians receive a copy of the Behavior Services Policies and Procedures along with the
Behavioral Support Consent Form to be signed at the time of enrollment.
Prior to enrollment a PBSP is developed and included as a component in the initial Treatment Plan and
Individual Education Plan (IEP). If the PBSP includes a restrictive intervention (see Behavior
Interventions Hierarchy), the PBSP and the Behavioral Support Program Consent Form are sent to
parents/guardian for review. By signing and returning the Behavioral Support Program Consent Form, the
parent/guardian is providing consent for the specific behavior program.
The current PBSP will be included and sent to the parent/guardian with the quarterly Treatment Plan.
Parents/guardians can revoke consent for the PBSP at any time by contacting the Behavior Specialist or
their child’s Case Manager.
BEHAVIORAL ASSESSMENT
Behavioral assessment may include any or all of the following in the determination of an appropriate
PBSP:
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Review of history, case records;
Interview of parents, teachers, and/or primary caregivers;
Direct observation of student across environments;
Direct observation of the behavior as it occurs;
Probes or time-limited interventions; and/or
Analysis of data.
DEVELOPING POSITIVE BEHAVIOR SUPPORT PLANS (PBSP)
All PBSP will be based on behavioral assessment and consist of:
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identification, description, and frequency of interfering behavior(s);
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identified antecedents and anxiety level behaviors;
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proactive techniques including reinforcement plan designed to support appropriate behaviors;
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least restrictive interventions (see Behavior Interventions Hierarchy) to support decreases of and
maintain safety during episodes of interfering behaviors;
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procedures to reduce reliance on emergency intervention techniques (if applicable);
data collection to monitor progress of intervention plan; and
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data collection to monitor frequency and duration of emergency intervention techniques (if
applicable).
All individuals will be given the opportunity to participate in the development of his or her PBSP.
Individuals can request changes to his or her plan by notifying any staff member who will report the
request to Behavior Services or a representative of Core Team.
Prior to implementation of any PBSP, a staff member who is familiar with the individual will be
designated by the assigned Case Manager to explain the plan to the individual to the fullest extent
possible.
PBSP development for any individual will utilize the least intrusive means possible to affect behavior
change as established in the Behavior Interventions Hierarchy (see below), by current professional
literature, and as determined by the behavioral assessment.
BEHAVIOR INTERVENTIONS HIERARCHY
Nonrestrictive Interventions:
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Positive procedures for increasing appropriate behaviors:
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Environmental enrichment/Non-contingent reinforcement: the ready availability for
interesting and stimulating activities for each individual as an appropriate alternative to
any maladaptive behavior. A basic need for any person after adequate food, water, sleep,
and good health, is the need for a stimulating environment. The absence or deprivation
of any of these necessary elements will increase the likelihood that problem behaviors
will occur. Daily participation in interesting, meaningful, and diversified activities that
are tailored to the needs, preferences, and abilities of each individual lessens the chances
an individual will engage in problem behaviors. A warm and positive environment
creates opportunities for learning and social interactions.
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Environmental accommodations: modifications made to surrounding environments to
support an individual to minimize interfering behaviors. Examples include: window
shades, placement of furniture, alternatives to fluorescent lighting.
o
Contingent positive reinforcers:
 primary reinforcers;
BEHAVIOR SERVICES
 secondary or paired reinforcers;
 social reinforcers; and
 activity/item reinforcer.
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Teaching new behaviors
 task analysis;
 shaping;
 discrete trial;
 chaining;
 prompts: gestural, visual; verbal; and physical
 prompt fading; and
 generalization.
Procedures for decreasing interfering behaviors:
o
Positive programming methods:
 differential reinforcement of incompatible behaviors (DRI): the contingent
presentation of a stimulus that increases a behavior which, by its occurrence,
precludes the occurrence of an inappropriate target behavior.
 differential reinforcement of alternative behaviors (Alt-R): the contingent
presentation of a stimulus that increases a behavior that competes functionally
and topographically with an
 inappropriate target behavior.
 differential reinforcement of other behaviors (DRO): the contingent presentation
of a stimulus that increases the occurrence of any other behavior but the
inappropriate target behaviors, as a result reinforcing the nonoccurrence of the
inappropriate target behavior.
 differential reinforcement of low rates of occurrence (DRL): the contingent
presentation of a stimulus following a specified lower occurrence of the
inappropriate target behavior.
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Ignoring: the elimination of attention to a specified behavior. Ignoring is almost
always used in conjunction with redirection.
o
Stimulus change: the sudden introduction of a new stimulus or an alteration of
environmental/ stimulus conditions that results in a temporary decrease in a specified
behavior.
o
Redirection: the presentation of a stimulus or use of a prompt which encourages a
behavior or provides a diversion that should or could normally be occurring for
that time and place, and is a functional alternative to the inappropriate behavior
that is occurring.
Restrictive Interventions:
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Physical crisis intervention:
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Physical escort as taught in Nonviolent Crisis Intervention course;
Physical restraint as taught in Nonviolent Crisis Intervention course
 Children's (basket) Hold;
 Team Control; and
 CPI Vehicle Restraint.
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Use of psychotropic medications as prescribed by physician.
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Seclusionary Time-out.
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Secured Seclusionary Time-out.
CRITERIA FOR IMPLEMENTING EMERGENCY (RESTRICTIVE) INTERVENTIONS:
Rationale for use of an Emergency Intervention must be that imminent physical danger and risk of injury
is present, less restrictive interventions have failed, and use of an emergency intervention is necessary to
protect for the safety of everyone involved. The risks associated with allowing the interfering behavior to
continue without Emergency Intervention must be more than the risks associated with use of the
Emergency Intervention.
If extenuating circumstances dictate the use of an Emergency Intervention the Supervisor on duty or
administrative designee may approve the use of the intervention.
Emergency Interventions may be implemented only with the approval of the Supervisor on duty or
administrative designee. The only exception is due to extenuating circumstances which may occur in a
community setting or while in a vehicle where immediate use of an Emergency Intervention is necessary
to provide for safety (see Emergency Intervention in a Community Setting or Vehicle).
Implementation of Emergency Interventions will be designed for safety and in the best interest of the
individual and shall never be used as punishment, for staff convenience, or as a substitute for positive
programming.
Notes:
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Emergency Interventions are not implemented based on the length of time a particular behavior
has been occurring. In fact, the longer the behavior occurs the more likely the cycle is nearing an
end.
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At times, a severe behavior may occur but not be sustained at a level which is continuing to pose
imminent danger. For example, a student may be successful in punching a window. If it breaks,
they are often scared by it or just stop. It is very rare for a student to go from window to window
breaking them.
Examples of behaviors which may require the use of Emergency Intervention include:
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non-redirectable, repetitive biting
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non-redirectable, repetitive self-injurious behaviors which are resulting in injury (this may often
be head banging or biting)
non-redirectable attempts to bolt into traffic
non-redirectable, repetitive property damage in a community setting
non-redirectable, repetitive physical aggression in a vehicle
Emergency Intervention in a Community Setting or Vehicle:
At times, behaviors may escalate while in vehicles or on a community outing. In such cases, staff will
intervene immediately following the CPI Crisis Development model (see steps below). If least restrictive
interventions are unsuccessful to provide for the immediate safety of everyone involved, Emergency
Intervention may be necessary as a last resort.
It is very important that behaviors are identified and addressed at the earliest level possible to avoid
escalation to physical acting out.
In the event of any behavioral episode in the community, the following steps will be taken:
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As soon as behavioral escalation is noted (escalating anxiety behaviors, non-redirectable verbal
acting out, property damage, etc.), an available staff will phone Chileda to notify the Supervisor
on duty of potential problems. The Supervisor may choose to immediately send additional staff to
assist in de-escalation and/or transportation.
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If behaviors meet the criteria under “Examples of behaviors which may require the use of
Emergency Intervention" or otherwise pose imminent danger, staff will implement approved
Emergency Intervention procedures as a last resort to provide for the immediate safety of all
individuals involved.
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After returning to Chileda, the Supervisor on duty must be notified as soon as possible of the use
of an Emergency Intervention in the community. The Supervisor will notify the designated oncall staff.
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Appropriate documentation of the incident will occur and the Supervisor and assigned staff will
review the incident and document it on the Emergency Intervention Form.
Additional Considerations while in a Vehicle:
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If behaviors escalate to the physical level of acting out, the vehicle driver will pull over to the
side of the road at the next available turn off. This can be a parking lot or side street. If, for
example, the van is driving over the causeway between La Crosse St. and Menard Plaza, the
driver will need to continue driving to either the Subway or Menards parking lot. The driver will
use the emergency blinkers, turn off the motor, remove the keys and assess the situation:
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If the situation is not posing a continued safety risk to staff or students and the acting out person
is no longer physically acting out or being restrained, the driver may choose to drive the
individual back to Chileda. The individual should be returned to Chileda for his/her and others’
safety.
BEHAVIOR SERVICES
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If the situation is continuing to pose a safety risk to staff or students and the acting out person is
continuing to physically act out or continues to require restraint after two minutes time, staff
member should assess the need to call 9-1-1. Chileda will also be called to send assistance. It is
very important that the driver clearly state the location they are at and the name of the student
experiencing difficulties. Chileda will send a second vehicle and additional staff support. The
students who are not experiencing acting out behaviors will be transferred to the second vehicle
rather than risk moving the acting out person. The vehicle with the acting out person will not
drive back to Chileda until the acting out person is no longer physically acting out or is no longer
being restrained.
Definition of Emergency Interventions
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Physical Escort (Forward Escort or Basket hold Escort): anytime a student is physically escorted
against his or her will.
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Team Carry: anytime a student is physically carried.
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Physical Restraint (Basket hold Restraint, Team Control Restraint, CPI Vehicle Restraint, or
Supine Restraint): Anytime a restraint procedure is used with the intention of restraining a person
based on safety because of his or her behavior, it needs to be documented regardless of how short
of a time period the intervention occurred.
Under any other circumstance, if a staff restricts an individual from moving his or her limb(s) for
60 seconds or longer, it is considered a restraint (for example, directing someone’s hands to his or
her lap and holding them there for 60 seconds or longer).
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Seclusionary Time-out; Secured Seclusionary Time-out: anytime a student is physically escorted
to a designated time-out room. If the secured, locking feature is initiated, it is considered a
Secured Seclusionary Time-out
An Emergency Intervention Report must be completed anytime any of the above criteria is met.
Emergency Interventions may only be implemented by staff meeting criteria.
Only physical restraint and escort procedures taught during CPI's Nonviolent Crisis Intervention course
may be utilized by staff. These are the two-person forward escort, Children's (Basket) Hold escort or
restraint, the Team Control, and the restraint taught for use in a vehicle. Staff are also instructed in use of
an approved Team Carry and Supine Restraint.
Emergency Interventions may be implemented for no longer than the period of time necessary for a
student to calm. Physical restraint may not exceed 15 minutes; Seclusionary Time-out may not exceed 30
minutes. After the designated time limit has been reached, the individual must be released from any hold
or time-out area. If behaviors are still occurring at a level where Emergency Intervention is necessary and
less restrictive interventions are not feasible, staff may need to initiate a second intervention. Consultation
with Behavior Services or the Supervisor on duty is necessary whenever an Emergency Intervention
needs to be reinitiated.
Emergency Interventions are used to maintain safety and not for staff convenience or as punishment.
BEHAVIOR SERVICES
Use of Seclusionary Time-out and Secured Seclusionary Time-out
The only room which may be used for seclusionary time out procedures is identified as a Time out Room.
The room is well lit, ventilated, used only for the purposes of seclusionary time out, and designed to
minimize the risk of injury.
Use of secured feature on the time-out room in an must be approved by the supervisor on duty or by an
administrative designee unless it is included as part of the child’s written behavior plan. The secured
feature is engaged only when direct manual pressure is placed on the feature's button. It is not feasible for
an individual to be secured in the room without a staff member actively engaging the button and
supervising the situation within the time-out room.
During the implementation of a seclusionary time-out procedure, CPI certified staff shall be present and
in direct supervision of the individual at all times. Staff is not permitted to be seated outside of the timeout room. The time out room is equipped with direct observation video camera monitoring capabilities
from which staff will observe the individual at all times during the time out procedure. Time-out rooms
may not be used if both video viewing monitors are inactive.
If at any time, the individual within the time-out room is posing a risk to him or herself, the staff will
immediately enter the room.
If at any time during a seclusionary time out procedure the certified staff member determines that there is
a significant risk for injury to the individual or another person, staff may interrupt the time out procedure.
If time out needs to be interrupted prior to the individual demonstrating calm behavior, staff will consult
with the Supervisor on duty or administrative designee and may:
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utilize blocking techniques to prevent injury; and/or
utilize approved physical restraint techniques to prevent injury.
Use of Mechanical Restraints
Mechanical restraints include any article, device or garment used primarily to modify resident behavior
by interfering with the free movement of the resident or normal functioning of a portion of the body, and
which the resident is unable to easily remove.
Chileda does not initiate the use of mechanical restraints unless they are medically indicated and ordered
by a physician (ex: use of helmet to protect an individual with a seizure disorder). However, if an
individual when admitted to Chileda has mechanical restraint procedures in place or ordered these
restraints will continue to be employed only to the extent necessary if individual safety is in jeopardy. A
behavior program will be developed to support successful and safe fading of mechanical restraint use as
quickly as possible.
Meals and Snacks
Emergency interventions may be continued through meal or snack times. However an appropriate meal or
snack will be offered after the individual has calmed.
Meals and snacks are not contingent on behaviors.
BEHAVIOR SERVICES
Use of Relaxation Room
Chileda has two rooms designated as "Relaxation Rooms". These rooms are designed to be comfortable,
pleasant environments for student self-removal.
1. The Relaxation Room is an area where students can choose to go in order to calm or relax. A
student may also choose to talk to staff within the Relaxation Room to problem solve an issue
which is causing him or her stress.
This room may also be used as an area to complete school or vocational work if a student is
unable to complete that work in the original environment. This measure will require approval by
Supervisor on duty or administrative designee.
2. Staff can suggest or recommend that a student go to the Relaxation Room although students will
not be escorted to the room.
3. A time limit guide of 15 minutes should be used to assure the room can be used by other students
although students will not be escorted from the room.
4. If a student is not respecting the property in the room they may be asked to leave. Items can be
removed from the room if a student is attempting to damage or destroy the items or using the
items as weapons against self or others. Under these circumstances, it is important to assess if this
is the most appropriate area to the child to be to calm down.
Staff Training:
Prior to implementing an Emergency Intervention, staff must successfully complete an 8-12 hour course
in Nonviolent Crisis Intervention (as developed by the Crisis Prevention Institute-CPI). Certification of
staff in the implementation of Emergency Intervention techniques may be rescinded at any time by the
staff member’s direct Supervisor or an administrative designee. Staff are required to participate in recertification on an annual basis.
Positive Behavior Support Plan Inservices:
Staff are required to be inserviced on a student's PBSP prior to working with him or her. All direct care
staff are required to attend the PBSP inservices for all students in their assigned house(s). The PBSPs
must be reviewed with staff through the PBSP inservices each quarter (every three months). These
inservices are mandatory.
Documentation of Emergency Interventions
Documentation for any Emergency Intervention procedure shall be reliable and accurate. Data collection
will include the following:
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Date;
Name of individual;
Procedure(s) implemented;
Time procedure(s) began and ended;
Antecedent(s) and/or circumstances preceding behavioral occurrence;
BEHAVIOR SERVICES
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Least restrictive procedures attempted prior to use of emergency intervention;
Interfering behavior which necessitated use of emergency intervention;
Reaction of the individual to the procedure (in 5-10 minute intervals);
Documentation of student or staff injuries;
CPI certified staff member(s) involved.
Documentation of Emergency Interventions are reviewed within 2 hours by Supervisor on duty. The
Behavioral Specialist or appropriate designee reviews documentation of emergency interventions on the
following business day.
The Behavior Specialist is responsible for the supervision of all restrictive procedures and shall regularly
review data on behavior frequency as well as frequency of use of restrictive procedures.
PBSP Monitoring
All PBSPs will be reviewed quarterly during the Individual Education Plan (IEP) review or more
frequently as needed. PBSPs may be discussed and reviewed at weekly Core Team meetings and/or a
Case Conference may be held to address issues relating to an individual’s PBSP. A Case Conference may
be requested by staff at any level through notifying the assigned Case Manager.
Internal and External Monitoring of Emergency Interventions
On-Call: The COO and/or an administrative designee is available on premise or on-call 24 hours per day.
Supervisory staff are encouraged to contact the administrative designee for consultation and support
during early levels of behavioral escalation. The administrative designee will assist in providing
techniques for de-escalation and prevention of implementation of an Emergency Intervention. All
episodes of emergency intervention need to be reported as soon as possible to the on-call administrative
designee.
Emergency Intervention Debriefing/Supervisory Review: The Supervisor on duty will review each
individual episode of Emergency Intervention with the team leader (typically the staff assigned to work
with the involved student). When appropriate, the student will also participate in debriefing (typically,
this is very informal).
Behavior Services Review: The Behavior Specialist will review each individual episode of Emergency
Intervention.
Core Teams: The Core Team will be responsible for reviewing frequency and trends in use of Emergency
Interventions for all students living in a particular living unit.
Best Practice Committee (internal): The Best Practice Committee will be responsible for reviewing and
monitoring frequency and trends in use of Emergency Interventions specific to individual living units or
shift, as well as the agency as a whole. Minutes will be distributed to Core Teams for review.
Human Rights and Research Committee (external):
The Human Rights and Research Committee
(HRRC) will be responsible for reviewing individual frequency and trends in use of Emergency
Interventions as well as use of psychotropic medications.
BEHAVIOR SERVICES
Regular reports summarizing the use of Emergency Interventions and subsequent outcomes including
supporting documentation are provided to Core Teams, Best Practice Committee, and the Human Rights
and Research Committee. A record of data shall be presented in an objective form permitting evaluation
by any pertinent, interested party.
The Best Practice Committee and the HRRC shall have access to all data, records, and reports relating to
the use of Emergency Interventions.
Core Teams, Best Practice Committee and the HRRC will keep written minutes of all meetings and
provide the COO and President/CEO with a copy of those deliberations.
House Rules
Residents work with the Case Managers and house staff to create agreeable house rules specifying social
and behavioral expectations. These rules are posted in the living unit for resident and staff reference.
Off Campus Privileges
Chileda sends no less than two staff members out into the community with resident(s). Residents are
supervised at all times while in the community. Residents are required to have safe behaviors for a
minimum of 3 hours prior to an off campus activity.
Shift Managers are responsible for documenting off campus activities in the Recreation Office and
include resident and staff names, location and duration of activity, and the assigned cell phone number.
Home visits are recorded in medical office and treatment record by the Case Manager.