Section 2
Intervention Procedures and Client Rights Committee
2.1 Employment of Interventions
The following procedures shall only be employed when clinically or medically indicated as a
method of therapeutic treatment
 Planned non-attention to specific undesirable behaviors when those behaviors are
health threatening
 Contingent deprivation of any basic necessity
 Other professionally acceptable behavior medication procedures that are not
prohibited
The determination that a procedure is clinically or medically indicated and the authorization for the
use of such treatment for a specific client shall only be made by either a physician or a licensed
practicing psychologist who has been formally trained and privileged in the use of the procedure.
2.2 Least Restrictive Alternative
The goal of Lindley Habilitation Services is to use the least restrictive, most appropriate and
effective positive treatment modality. The use of a restrictive intervention procedure designed to
reduce a behavior shall always be accompanied by positive treatment or habilitation methods
which shall include:
 The deliberate teaching and reinforcement of behaviors which are non-injurious
 The improvement of conditions associated with non-injurious behaviors which as an
enriched educational and social environment
 The alterations or elimination of environmental conditions which are reliably correlated with
self injury
2.3 Prohibited Interventions
The following interventions will be prohibited:
 Isolation time out: time out in a room with the door closed
 Corporal punishment (spanking/hitting): it is against the law to punish consumers
 Seclusion: placing a consumer in a locked room
 Chemical restraint: sedating or medicating a consumer w/o authorization as a medical
intervention
 Taking away basic rights: overcorrecting efforts, physical intervention,(except in emergency to
prevent injury to consumer or others)
 Taking away basic rights: taking away meals, bathroom, well ventilated rooms, lights or other
basic needs of daily living
 Abusive verbalization: staff do not tease, ridicule or swear at clients
 Contingent medical restraint: any object used to restrict movement, seatbelt, helmet, gloves,
or tight clothing to restrict movement to client’s body
 Planned ignoring of threatening behaviors: SIB’s (self injurious behavior), that may cause
injury to client’s self
Physical restraints or seclusion of client shall be employed only when there is imminent danger
abuse or injury to self or others, when substantial property damage is occurring, or when the
restraint or seclusion is necessary as a measure of therapeutic treatment. All instances of restraint
or seclusion and the detailed reasons for such action shall be documented on an incident/accident
report form and kept in the Human Rights Committee file. Each client who is restrained or
secluded shall be observed frequently, and written notation of the observation shall be made by the
supervisor and kept in the client’s file.
LINDLEY HABILITATION SERVICES may adopt additional rules to implement this section.
2.4 Rules for Physical Restriction for Behavioral Control
The use of restrictive interventions shall be limited to emergency situations, in order to terminate a
behavior or action in which a client is in imminent danger of abuse or injury to self or other persons
or when property damage is occurring that poses imminent risk of danger of injury or harm to self
or others; or as a planned measure of therapeutic treatment as specified.
Restrictive interventions shall not be employed as a means of coercion, punishment or retaliation
by staff or for the convenience of staff or due to inadequacy of staffing. Restrictive interventions
shall not be used in a manner that causes harm or abuse.
2.5 Staff Training for Physical Restraint
Lindley Habilitation Services staff will be certified in NCI standards for restraint policies. The trainer
will be responsible to LHS to provide the structure for the class and to certify or not any staff
trained in their classes. All LHS staff will attend part A of the NCI standards for prevention
techniques. To remain or become eligible for employment under CAP MR/DD regulation,
successful completion of part A is mandatory for all staff. To begin a permanent or fill-in position
NCI part A must be completed during the training period. Core or Core Plus of NCI standards is
required for all direct care staff who work with clients that may become aggressive. The core or
Core Plus techniques for NCI will be taught and reported to LHS, Inc. and QPs (Qualified
Professional. Records of staff participation shall be maintained for five years. Each staff must pass
all NCI testing requirements annually to maintain certification
2.6 Consent for Restrictive Interventions
The use of physical interventions may be planned, as written in a behavior plan, or used in an
emergency situation to protect a client from hurting themselves or others. Each client regardless,
of a history of aggressive behaviors or the presence of a behavior plan with planned physical
interventions shall be notified of possible interventions that have been approved for use. This
notification shall be in writing and shall be signed by the client and/or legally responsible party at
the time the Consent Packet is completed by the Qualified Professional or other designated party.
This signature shall be considered consent given for use of approved interventions. If the client is
known to have aggressive behaviors or a behavior plan which may require the use of restrictive
interventions and the client and/or legally responsible party refuses consent, the admission of the
client or continuation of services shall be reviewed by the NCI instructor, Qualified Professional and
Regional Director to make a decision if the client can be admitted or continue services due to
safety and liability issues for the client and the agency. If there is a medical reason a physical
intervention cannot be used, a doctor’s note shall be given to the agency and kept in the client’s
permanent file as well as the staff file kept in the client’s home. All staff will be notified and
required to sign a statement of understanding that restrictive interventions shall not be used.
Lindley Habilitation Services reserves the right to refuse treatment to any client whose behaviors
are deemed to be a threat to staff and/or themselves and consent is not given for use of restrictive
interventions. This determination shall be made by the NCI instructor after review of the case and
history of behaviors.
If a client has a physical disability or surgery that would make affected nerves/bones sensitive to
injury, Lindley Habilitation Services may choose not to serve these clients. If Lindley Habilitation
Services assesses that the client’s safety and health cannot be adequately maintained, the client
will be discharged. Any surgery or physical disability will be documented in the client’s record.
Reporting of any change in health status is the responsibility of the Legally Responsible Party or
Client. Possibilities of limits which would warrant not serving a client are but not limited to:
 Breathing difficulties
 Heart related issues
 Fragile bones
 Size of client, related to staff size
2.7 Notification of Restrictive Interventions
In the event a restrictive intervention is required, either as a planned intervention or used in an
emergency situation to protect the client or others, the legally responsible person of a minor or
incompetent adult client will be notified after the occurrence and before the staff leaves the shift.
Proper documentation will be completed by the staff involved in the intervention and submitted to
the agency within 24 hours. The agency will submit the documentation to the LME as directed.
2.8 Monitoring of Client during Intervention
Consideration will be given to the client’s physical and psychological well-being before, during and
after utilization of a restrictive intervention. This will include: review of the client’s health history or
the client’s annual physical received by the agency and reviewed by the agency nurse upon
admission to services. The history or physical shall include the identification of pre-existing
medical conditions or any disabilities and limitations that would place the client at greater risk
during the use of restrictive interventions; continuous assessment and monitoring of the physical
and psychological well being of the client and the safe use of restraint throughout the duration of
the restrictive intervention by staff who are physically present and trained in the use of emergency
safety interventions; continuous monitoring by an individual trained in the use of cardiopulmonary
resuscitation of the client’s physical and psychological well being during the use of ,manual
restraint; and continued monitoring following the restrictive intervention by an individual trained in
the use of cardiopulmonary resuscitation of the client’s physical and psychological well being for a
minimum of 30 minutes subsequent to the termination of a restrictive intervention.
2.9 Documentation of Restrictive Interventions
Whenever a restrictive intervention is utilized, the correct documentation from the State will be
completed and sent to the appropriate LME(s) within the timeframe required by the State.
Documentation shall be made in the client record to include: notation of the client’s physical and
psychological well being; notation of the frequency, intensity and duration of the behavior which led
to the intervention, and any precipitating circumstance contributing to the onset of the behavior; the
rationale for the use of the intervention the positive or less restrictive interventions considered and
used and he inadequacy of less restrictive intervention techniques that were used; a description of
the intervention and the date, time and duration of its use; a description of accompanying positive
methods of intervention; a description of the debriefing and planning with the client and legally
responsible person if applicable, for the emergency use of seclusion, physical restraint or isolation
time out to eliminate or reduce the probability of future use of restrictive interventions; a description
of the debriefing and planning w/ the client and the legally responsible person if applicable, for the
planned use of seclusion, physical restraint or isolation time out if determined to be clinically
necessary; and signature and title of the agency employee who initiated and the of the employee
who further authorized the use of the intervention.
2.10 Emergency Restrictive Interventions
The use of a restrictive intervention in the case of an emergency shall be limited as follows:
 An employee approved to administer emergency interventions may employ such
procedures for up to 15 minutes without further
 The continued use of such interventions shall be authorized only by the
responsible professional or another qualified professional who is approved to use
and to authorize the use of the restrictive intervention based on experience and
training; the responsible professional shall meet with and conduct an assessment
that includes the physical and psychological well being of the client and write a
continuation authorization as soon as possible after the time of initial employment
of the intervention. If the responsible professional or qualified professional is not
immediately available to conduct an assessment of the client, but concurs with the
intervention is justified after discussion with the employee, continuation of the
intervention may be verbally authorized until an on-site assessment of the client
can be made;
 A verbal authorization shall not exceed three hours after the time of the initial
employment of the intervention; and
 Each written order for seclusion, physical restraint or isolation time out is limited to
four hours for each adult client; two hours for children and adolescent clients ages
9-17; or one hour for clients under the age of nine. The original order shall only be
renewed in accordance with these time limits or up to a total of 24 hours.
The use of restrictive interventions shall be discontinued immediately at any indication of risk to the
client’ health or safety or immediately after the client gains behavioral control.
2.11 Notification of Restrictive Intervention
When any restrictive intervention is utilized for a client, notification of others shall occur as follows:
 The on-call supervisor or the Qualified Professional supervising the case shall be
notified within 24 hours
 The Regional Director or other designee of the agency shall be notified within 24
hours of the next working day after each use of the intervention
 The legally responsible person of a minor child or an incompetent adult client shall
be notified immediately unless she/he has requested not to be notified.
Proper documentation shall be completed within 24 hours of the intervention and sent to the LME
within 72 hours of the intervention.
2.12 Planned Interventions
A restrictive intervention shall be considered a planned intervention and shall be included in the
client’s treatment/habilitation plan whenever it is used:
 More than four times, or for more than 40 hours, in a calendar month
 In a single episode in which the original order is renewed for up to a total of 24
hours in accordance with the limit specified; or
 As a measure of therapeutic treatment designed to reduce dangerous, aggressive,
self injurious or undesirable behaviors to a level which will allow the use of less
restrictive treatment or habilitation procedures.
When a restrictive intervention is used as a planned intervention a consent or approval shall be
considered valid for no more than 6 months and the decision to continue the specific intervention
shall be based on clear and recent behavioral evidence that the intervention is having a positive
impact and continues to be needed. Plans will be reviewed as the client’s POC is reviewed every
six months.
Prior to the initiation or continued use of any planned intervention the following written notifications,
consents and approvals shall be obtained and documented in the client record:
 Approval of the plan by the responsible professional and the treatment and
habilitation team, based on an assessment of the client and a review of the
documentation
 Consent of the client or legally responsible party, after participation in treatment
planning and after the specific intervention and the reason for it have been
explained
 Notification of an advocate/client rights representative that the specific intervention
has been planned for the client and the rationale for utilization of the intervention;
and
 Physician approval, after an initial medical examination, when the plan includes a
specific intervention with reasonably foreseeable physical consequences. In such
cases, periodic planned monitoring by a physician shall be incorporated in the
plan.
Within 30 days of initiation of the use of a planned intervention, the Client Rights
Committee/Intervention Advisory Committee, by majority vote, may recommend approval or
disapproval of the plan or may abstain from making a recommendation. The CRC/IAC, shall be
given the opportunity to review the treatment/habilitation plan any time during the use of a planned
intervention. If any of the persons or committee do not approve the initial use or continued use of a
planned intervention, the intervention shall not be initiated or continued. Appeals regarding the
resolution of any disagreement over the use of the planned intervention shall be handled by the
Vice Presidents and CEO. Documentation in the client record regarding the use of a planned
intervention shall indicate:
 Description and frequency of debriefing with the client, legally responsible person,
if applicable, and staff if determined to be clinically necessary. Debriefing shall be
conducted as to the level of cognitive functioning of the client;
 Bi-monthly evaluation of the planned intervention by the responsible professional
who approved the planned intervention; and

Review, at least monthly, by the treatment/habilitation team that approved the
planned intervention.
2.13 Protective Devices
If a protective device is utilized for a client it shall be reviewed by the Client Rights Committee to
ensure the necessity for the protective device has been assessed as well as the consideration for
the use of positive and less restrictive alternatives have been examined and documented.
Any staff using the protective device will have documentation stating they have been trained and
have demonstrated competence in the utilization of the device. The staff will assure the client is
frequently observed and provided opportunities for toileting, exercise, etc. as needed. When the
device limit’s the client’s freedom of movement, the client shall be observed at least every hour.
Whenever the client is restrained by the device and subject to injury by another client, the staff
shall remain present with the client continuously.
The use of any protective device for the purpose or with the intent of controlling unacceptable
behavior shall comply with the policy on Behavior Control in this section.
2.14
Client Rights Committee
The Client Rights Committee shall also serve as the Intervention Advisory Committee for Lindley
Habilitation Services. The membership of this committee shall include at least one person who is
or has been a consumer of direct services provided by the governing body or who is a close
relative of a consumer and at least three citizens who are not employees of this agency. The
committee shall have a member or a regular independent consultant who is a professional, an NCI
trainer and has expertise in the use of the type of interventions being utilized and who is not
directly involved in the treatment or habilitation of the client.
The Intervention Advisory Committee will review planned intervention plans.
The Client Rights Committee shall have access to client information only when necessary for
committee members to perform their duties. In addition, members shall have access to client
records on a need to know basis only upon the written consent of the client or his legally
responsible party. Information in the client record shall be treated as confidential.
Members of the Client Rights Committee shall be trained on agency policy as well as Client Rights
Training. They shall be provided with copies of Client Rights Rules and have access to agency
policies and procedures. When reviewing interventions, they shall be provided with information
about proposed interventions and alternatives. Minutes shall be maintained by the committee and
they shall make an annual written report to the agency on the activities the committee reviewed
each quarter of the fiscal year.