Policy Manual


Behavior Management/Modification Intervention      

Type: Procedure                 Category: Service Delivery                 Level: Community Care 

Parties: Community Care employees and contractees

Printer Friendly Version: http://apps.comcareme.org/policymanual/default.aspx?code=3.MEP.37&nonav=yes

Supporting References: COA Standards BSM 1.02, 1.03, 2.03, 2.04, 3.02, 3.03, 4.01, 4.02, 4.03, 5.02, 5.06, 6.02

Parent Effective Date Approval Level Revision Dates Last Reviewed
N/A  1-1-2004  Management Team  1/2/09  2-1-2009
Related Document Code Related Document Name Type

Procedure:  1. Community Care utilizes the Mandt System, as approved and authorized by the State of Maine, for all behavioral interventions, both physical and non-physical. 2. All Community Care employees and contractees will be certified in the Mandt System, as required by their job description or contract prior to beginning direct services at Community Care and recertified at least yearly thereafter. Community Care employees and contractees must pass an initial course, ranging from 8 to 16 hours on behavioral interventions, as well as an annual 4 to 8 hour refresher course-the specific number of hours required are identified in each job description or contract. These courses are provided by Certified Mandt Instructors who teach both physical and non-physical interventions. Certificates are issued upon successful completion of the course, which includes written and physical post-testing. Mandt training certificates are kept on file for those who successfully complete the course. 3. Community Care follows the guidelines of both non-restrictive and restrictive procedures as authorized by the Mandt System. This system advocates for the use of a graded system of alternatives starting with the least restrictive and non-physical to the more restrictive physical aspects, including manual restraint, as individual circumstances warrant. 4. Community Care utilizes manual restraints only as a last resort, employing the techniques as taught by Certified Mandt Instructors. 5. Manual restraints are utilized solely to keep the person(s) served safe from harming themselves and/or others. Manual restraints will not be used as a form of discipline, or for the convenience of employees or contractees. 6. Any utilization of behavior management/modification interventions will be respectful of the client and will include every attempt to maintain their personal dignity. 7. When utilizing a physical intervention with a client, the employee or contractee must continually observe and assess the physical and mental status of the client and the readiness to discontinue use of the intervention as soon as it is safe to do so. The Mandt System clearly identifies this process within the training curriculum. 8. Uses of manual restraint will consider the following guidelines around time contraints: a. 15 minutes, or less, for children aged nine and younger; and b. 30 minutes, or less, for children aged ten and older. On a case-by-case basis, timeframes will be reviewed. Time frames may be extended when approved by a qualified person-one who is designated by the CEO with authority to make such a decision. 9. Any physical intervention will be discontinued if it produces adverse side effects such as illness, severe emotional or physical stress, or physical damage. 10. Any use of physical interventions/manual restraints must be documented in an incident report. This report must be called in immediately to the supervisor during business hours or to the emergency pager during after- hours and holidays. 11. The written report must be submitted to Community Care within 24 hours. All incident reports will be entered into the client's record and a copy of the report will be sent to the client's guardian. 12. The clincial supervisor will review each report to ensure the following: a. The utilization of physical intervention was necessary to ensure the safety of the client and/or others; b. The utilization of physical intervention was carried out appropriately; c. A debriefing of the incident occurs within 24 hours; d. The well-being of the client is considered throughout; e. Potential changes to the emergency plan are considered; and f. The agency's continuous quality improvement process tracks all uses of physical behavior management intervention practices, and addresses any need for change or improvement in such practices. 13. The Director of Quality Improvement will submit quarterly reports to the management team regarding the use of physical interventions, and annually the management team will evaluate the agency's practices compared with current best practice. 14. At the time of intake, the client and/or the legal guardian receive notification in writing that the Mandt System is employed by the agency. This notice is provided through the Notification of Rights form which is signed by the client and/or the legal guardian, and entered into the client's record. Notification of Rights is updated annually. A copy of the the Mandt System approach is made available for review. 15. To ensure that each client's individual behavioral needs are addressed, upon intake, an initial behavioral assessment is completed with an appropriate placement level determined. Included in this intake assessment are the following: a. an assessment of the potential for risk of harm to self or others; b. consideration of antecedents to past out-of-control behaviors; c. the effectiveness of past behavioral interventions; d. past history, including abuse history, psycho-social information, etc; and e. factors that might put the client, or others, at risk 16. Appropriate plans are identified and put in place at the time of intake, consistent with the level assessment of the client. A levels of care reassessment is made within 90 days of placement and at least yearly thereafter. Individual client treatment plans are completed with the client and/or guardian within 30 days (or less when required by service regulations) of placement identifying specific strategies to be employed in treatment and in crisis situations. The client and/or guardian participate in the formation of this plan and are required to sign off on it. This plan is modified, minimally, every 90 days thereafter. It should be noted that Community Care Policy does not permit the use of restrictive interventions such as isolation, mechanical or chemical restraint, or locked seclusion.