NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Behavioral Treatment Plan Review Committee Guidelines
PAGE: 1 of 4
MANUAL: Clinical
SECTION: Miscellaneous
ORIGINAL EFFECTIVE DATE: 10/2/95
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED ON DATE: 4/16/15
CURRENT EFFECTIVE DATE: 5/1/14
REVISIONS TO POLICY STATEMENT:
YES
NO
OTHER REVISIONS:
YES
NO
APPLIES TO:
All Northpointe Behavioral Healthcare services.
POLICY:
To establish and implement a Behavior Treatment Committee (BTC). Intrusive or restrictive techniques
shall only be used in emergency situations only and only after other approaches and methods have been
documented to have failed. When such techniques are considered for implementation, they must be used
in conjunction with an ongoing positive reinforcement procedure. In those cases where intrusive or
restrictive techniques are considered, the Behavioral Treatment Management Review Committee must
review and approve the procedure prior to its implementation.
PURPOSE:
In order to support the stated mission of Northpointe Behavioral Healthcare Systems and the principles
established to effect that end, the Board recognizes the rights of individuals, their family members, and/or
legal guardian/representative to participate in developing and determining the course of treatment including
any behavioral programs which consider the use of any restrictive or intrusive treatment decisions as
deemed appropriate by the Behavior Treatment Plan Review Committee (BTC).
DEFINITIONS:
A. Applied Behavioral Analysis -- means the organized field of study which has as its objective the
acquisition of knowledge about behavior using accepted principles of inquiry based on operant and
respondent conditioning. It also refers to a set of techniques for modifying behavior toward
socially meaningful ends on these conceptions of behavior.
B. Intrusive Techniques -- those techniques which impinge on the bodily integrity or the personal
space of a person to achieve therapeutic ends. Examples of such techniques include injections or
medications when the target behavior is not due to an active psychotic process or where the
medication approach is used to provide a reinforcing or negative consequence due to its side
effects as contrasted to its direct treatment effects, and the use of any direct observation
procedures during times which would otherwise be considered private, or may infringe on a
persons body or personal space.
C. Restrictive Techniques -- those techniques which, when implemented impact the environment.
Examples of such techniques include limiting communication with others to achieve therapeutic
objectives not directly related to the communication so limited, returning home from an outing,
prohibiting ordinary access to meals, scheduled snacks, scheduled smoking time(unless in
residential house rules), and any technique which can be described as an affront to the dignity of
the individual.
D. Behavioral Treatment Informed Consent -- means obtaining the prior written approval of the
individual or legal guardian specific to the use of a particular treatment approach which would
otherwise entail violating the individual's rights, even though general consent to treatment has been
obtained.
NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Behavioral Treatment Plan Review Committee Guidelines
PAGE: 2 of 4
MANUAL: Clinical
SECTION: Miscellaneous
ORIGINAL EFFECTIVE DATE: 10/2/95
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED ON DATE: 4/16/15
CURRENT EFFECTIVE DATE: 5/1/14
COMMITTEE COMPOSITION/RESPONSIBILITIES:
Behavioral Treatment Committee shall be comprised of a minimum of three individuals, at least two of who meet
the following criteria:
 One member must be a fully- or limited licensed psychologist with formal training or experience in applied
behavior analysis.
 One member must be a licensed physician or psychiatrist
In addition the committee is encouraged to have a representative from the Office of Recipient Rights in attendance
at all meetings.
Behavior intervention strategies are delineated from the least restrictive/intrusive to most restrictive/intrusive.
They are:
Level I:
Entirely positive and goal oriented without intrusive or restrictive components. Requires
Individual Plan of Service Team (Treatment Team) approval and review, does not require approval
from the Behavioral Treatment Committee.
Level II:
Some intrusive or restrictive components but short of manual, mechanical, or chemical control or
restraint. Requires Behavior Treatment Committee approval, approval of Treatment Team, and
Recipient/Guardian consent is required.
Level III:
Intrusive or restrictive component, whether manual, mechanical or chemical. Requires Behavior
Treatment Committee Approval, Treatment Team approval, and recipient/guardian consent. If the
prescription for a psychoactive medication is to address a diagnosed psychiatric illness, it does not
require BTC review. The agency, in every case, intends that the minimal dosage of psychoactive
medication is used in conjunction with a behavioral plan to address behaviors prompting
medication use. All treatment plans will be positively phrased and goal oriented. Under no
circumstances may seclusion (blocking of egress) be used. The use of medications in response to
any behavioral issue, either on an emergency or routine basis, is assumed to be simultaneously
guided by and consistent with any relevant Department of Community Health regulations and/or
medical standards of practice.
The Behavior Treatment Committee will:
A.
Review and approve (or disapprove), in light of current research and prevailing standards of
practice, all behavioral programs utilizing the generalized use of token economies if the removal of
tokens is a planned part of the program and those techniques requiring special consent by the
recipient (Level II and III); such reviews shall be completed as expeditiously as possible.
B.
Review and approve all program plans involving the use of psychoactive medications where they
are applied for behavior control purposes and where target behavior is not due to acute psychotic
process.
C.
Categorize behavioral treatment techniques approved by NBHS into a hierarchy along the
parameters of intrusiveness and restrictiveness. When either a component of an individual
behavior plan, the plan itself is will reflect when the proposed component will be decreased or
released. Using this hierarchy, the committee shall determine the frequency of review necessary
for program plans using approved behavior treatment techniques.
D.
Set a specific date for each approved program when it will re-examine the continuing need for
approved procedures, such a time should be a minimum of quarterly or as deemed clinically
necessary.
NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Behavioral Treatment Plan Review Committee Guidelines
PAGE: 3 of 4
MANUAL: Clinical
SECTION: Miscellaneous
ORIGINAL EFFECTIVE DATE: 10/2/95
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED ON DATE: 4/16/15
CURRENT EFFECTIVE DATE: 5/1/14
E.
Be familiar with all litigation involving the use of behavior modification at the agency and to the
extent it is commonly made available by the Michigan Department of Community Health.
F.
Keep all Behavior Treatment Committee Meeting Forms and/or minutes and clearly delineate the
actions of the Committee.
G.
Provide decisions, in writing, to the responsible staff person and a copy to the individual’s file,
with an indication of appropriate appeal process of the agency in the event of continuing dispute.
H.
BTC member should abstain from decision making with respect to programs prepared by them or
under their specific direction.
Program data should be reviewed by care manager and psychologist monthly, BTC will review at
least quarterly.
I.
In addition, the Behavior Treatment Committee may:
A.
Advise and recommend to the CEO the need for specific training in behavior modification and
behavior analysis for staff.
B.
At its discretion or upon request, review all other behavior modification programs if such reviews
are consistent with the agency's needs and approved in advance by the CEO.
C.
Advise the CEO regarding administrative and other policies affecting behavior modification
practices.
D.
Provide specific case consultation as requested by professional staff of the agency.
E.
Serve another service entity, i.e., smaller CMH Board, if agreeable between the involved
responsible mental health agencies.
PROCEDURES:
1.
The Treatment Team convenes to discuss individual treatment recommendations.
2.
The Treatment Team utilizes and exhausts positive and least restrictive behavioral treatment
options and collects data on these methods.
3.
The Treatment Team may choose to obtain information and/or consultation from an external
resource, i.e., psychologist, psychiatrist, literature review to aid in determining the course of
treatment.
4.
If a program that includes the use of intrusive or restrictive measures is recommended, the provider/clinician
will present copies of the proposed new or altered program to the BTC Chair within 10 working days
prior to the scheduled meeting for distribution to all members.
5.
As part of the initial program plan submission, the provider will prepare a packet of information
to assist the BTC of the case. The packet will include:
a. Signed Behavior Treatment Consent (NBHS Form cl.122).
b. A copy of the proposed behavioral plan, including rationale, baseline, or monitoring
behavior, etc. when initial approval is requested.
NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Behavioral Treatment Plan Review Committee Guidelines
PAGE: 4 of 4
MANUAL: Clinical
SECTION: Miscellaneous
ORIGINAL EFFECTIVE DATE: 10/2/95
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED ON DATE: 4/16/15
CURRENT EFFECTIVE DATE: 5/1/14
c. Review summary of part of an ongoing plan.
d. A copy of the IPOS if a copy has not been previously reviewed or has been changed
substantially since last review.
e. Medication history of an individual if taking psychoactive medication for behavioral
control. The long term medication history is only required with initial presentation.
6.
For ongoing review, a summary of the individual’s course during the current plan is sufficient. A copy
of the BTC Review Form (NBHS Form cl.123) should be submitted (instead of the copy of the
Behavioral Plan) when an ongoing plan review is requested.
7.
The BTC Facilitator is responsible for returning plans, reviews, etc., to the provider with
appropriate review form. The provider is then responsible for submitting documents for filing in
appropriate BTC sections of the file
8.
BTC will meet within ten (10) working days of the plan's submission or as scheduled by the BTC
Facilitator. The provider or designated team member will be present.
9.
After review of the new treatment program, the BTC can do one of the following:
10.
a. Approve the plan as submitted and return to the provider.
b. Approve the plan following BTC recommended revisions and return to the provider.
c. Reject the plan as submitted and return to provider with appeal process outlined.
d. Decision to discontinue is made and progress note entered into ELMER
A plan is considered approved when a consensus of committee members and the guardian have
signed the BTC Review Form (NBHS Form Cl.123).
11.
Emergent individual needs that arise may require review by BTC at an unscheduled meeting date
in order to address safety restrictions or other measures to assist in addressing behaviors of harm
to self or others (NBHS form cl.172).
12.
Other recipients of the organization's services are prohibited from implementing an individual's
behavior treatment program.
CROSS REFERENCE:
Michigan Medicaid Managed Care Specialty Services & Supports Contract
Medicaid Provider Manual
CARF Standards
Michigan Mental Health Code, Public Act 258, of 1974
NBHS Form Cl.122.
NBHS Form Cl.123