Required Behavior Support Plan (BSP Components)
In most cases, a BSP should be in place and implemented before the request for the Level of Need (LON) increase is submitted. The following should be included in the BSP:
- An operational definition for all targeted behavior.
- A baseline of the frequency and severity of the behavior that adequately reflects the individual's behavioral issues during a set time. There should be data sheets or observation notes documenting the frequency of targeted behaviors during the baseline period of at least one month, unless the behavior frequency is extremely high, thereby permitting a shorter baseline. Severity rankings should meet the criteria specified by the Texas Health and Human Services ICAP training materials. Note: DADS is now known as HHSC.
- A functional assessment (analysis) of the targeted behavior to identify the history of behavioral interventions that have been used, all attempts at less intrusive interventions, and when and under what conditions the behavior occurs. This assessment should describe the hypothesized function of the behavior, which is the basis for the BSP interventions.
- A specific objective to decrease or eliminate the targeted behavior or maintain replacement behavior must have been implemented, including a detailed description of specific interventions for the specific behavior. The BSP must clearly identify the undesirable behavior and target its decrease or elimination. Exactly how staff are to respond to the targeted behavior must be clear and simple enough that staff can verbally describe the procedure. Although positive reinforcement techniques are an essential component of all behavior programs, a program that focuses simply on teaching social behaviors is not sufficient if it does not give staff clear directions on what to do if the undesirable behavior occurs.
- Progress notes must be based on data recorded about the defined behaviors and the interventions used in the BSP. There must be data sheets or progress notes that document every occurrence of the target behavior, unless otherwise specified in the program. The specifics regarding the incidents should be recorded (i.e., if the planned intervention was carried out or not and why, the individual's actions and the staff actions).
- The Service Planning Team, including the individual or LAR must agree to the BSP.
- Any behavior management techniques involving intrusive interventions or restriction of the individual's rights are required to be developed by a behavioral support service provider with input from the individual, his or her legally authorized representative (LAR), the program provider and any actively involved persons.
- All appropriate consents must be obtained for restrictive practices. Texas Administrative Code (state.tx.us) Restrictive practices include 1:1 supervision as well as anything that impedes an individual from doing something they desire to do.
- For the Intermediate Care Facilities for Persons with an Intellectual Disability (ICF/IID) program only, the specially constituted committee must have approved the BSP.
- If the LON increase is requested for another year, there must be evidence of progress or program modification. If the program is effective, the rate and/or severity of the behavior should decrease over time. In cases where the intervention primarily involves preventive actions by staff, the frequency of these preventive actions also should decrease over time. Note: the actual frequency of the behavior may be low throughout because of successful prevention. If such decreases are not observed, the behavior needs to be re-analyzed through a functional assessment, and the BSP must be modified as indicated. Regular evaluation of the BSP's effectiveness should occur at intervals specified in the plan. This evaluation must be more frequent than annually and consistent with progress of the individual as well as problems in implementing the plan. This information is not required to be submitted to Utilization Review (IDD UR) staff annually for renewal, but it must be maintained by the program provider and be made available for review by IDD UR staff, upon request.
NOTE: Before implementing a plan designed to decrease undesirable behaviors, attempts should have been made to determine the effectiveness of other, less restrictive, less intrusive approaches. This could include such activities as modifying the environment, redirecting the behavior, ignoring the behavior (extinction), etc.
If such approaches prove ineffective, a functional assessment should be completed. This involves careful data collection and analysis of the conditions (time, location, during which activities, etc.) under which the targeted behavior occurs. Such an analysis might lead to a less intrusive method for managing the behavior. In addition, purely positive reinforcement techniques might be attempted. These activities are most effective if done under professional consultation from a psychologist or behavior analyst. However, the term consultation does not imply that a contract with an outside consultant is required. Agency staff, if properly qualified, can perform this function. Refer to the Home and Community-based Services (HCS) rules and principles regarding behavior management techniques involving restriction of individual rights or intrusive techniques [§Section 9.178 (v)].
Fading Plan Expectations
Each restrictive practice must have a fading plan, including 1:1 supervision. A fading plan must be specific, usually reflecting a step-by-step plan, which results in the individual no longer receiving the restrictive practice. Including a statement indicating the team will consider fading when "such and such" criteria are met is not a sufficient fading plan.
- HHSC expectations for a reasonable fading plan for restrictive practices includes:
- The plan to fade 1:1 should be part of the BSP. The fading plan is specific to the individual and based upon the life-threatening or dangerous behavior(s) for which the restrictive practice is in place.
- The fading plan should be a gradual process that gives the individual time to adjust to the changes in supervision and enables them to experience the success they are achieving. Alternatively, fading can be set to be attempted routinely at a specific time and/or place and then expanded to other times/places.
- Criteria are identified for expanding or generalizing fading to other times and or places. Once fading plan meets initial criteria, it should be expanded to other settings or times, continuing to fade restrictive practices.
- Criteria for abandoning the fading plan or going back one step also should be specified. The criteria for going back to a restrictive practice must also be operationally defined or identified (i.e., what constitutes failure on a specific fading attempt).
- The completion of the fading plan from a restrictive practice to a less restrictive level can be accomplished within the current BSP cycle.
At enrollment, submit a purpose code 2 Intellectual Disability/Related Condition Assessment and required supporting documents to HHSC Intellectual and Developmental Disability Program Eligibility and Support (IDD PES).
IDD PES Email for PC2 Submissions: Pc2Loc@hhs.texas.gov.
For renewal (purpose code 3) or mid-cycle requests (purpose code 4), submit to IDD UR. A "1" should be scored on at least one of the problem behavior areas (boxes 34-38) on Form 8578 ID/RC.
Health and Human Services
IDD Utilization Review
Mail Code W551
P. O. Box 149030
Austin, Texas 78714-9030
IDD UR Message Line: 512-438-5055