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Home and Community-based Services (HCS) & Texas Home Living (TxHmL) Quarterly Webinar April 27, 2018 1
Home and Community-based Services (HCS) & Texas Home Living (TxHmL)Quarterly WebinarApril 27, 2018
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Webinar Agenda• SB 2027, Section 1: Occupational Training
Program Survey • STAR Health in HCS/TxHmL • Behavioral Supports/Restraints
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85th Texas Legislature
Senate Bill 2027
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SB 2027, Section 1A Study on Training and Employment Opportunities for Individuals with an Intellectual DisabilityThe Health and Human Service Commission in conjunction with the Texas Workforce Commission shall conduct a study regarding occupational training programs available in this state for individuals with an intellectual disability.
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SB 2027, Section 1This study must:• Determine regions in this state where the training
programs should be improved or expanded; and
• Determine strategies for placing trained individuals with intellectual disabilities into fulfilling jobs using existing or improved training programs
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Workgroup• Workgroup established October 2017 consisting of:
• HHSC• TWC
• A diverse group from outside advocacy groups such as: • Arc of Texas• Texas Council of Community Centers• Providers Alliance for Community Services of Texas• D&S Community Services• Disability Rights Texas• LifePath Systems• Private Providers Association of Texas• Lakes Regional Center
Intellectual and Developmental Disability Occupational Training Program Survey
Intellectual and Developmental Disability Occupational Training Program Survey
Intellectual and Developmental Disability Occupational Training Program Survey
Intellectual and Developmental Disability Occupational Training Program Survey
Intellectual and Developmental Disability Occupational Training Program Survey
Intellectual and Developmental Disability Occupational Training Program Survey
Intellectual and Developmental Disability Occupational Training Program Survey
Intellectual and Developmental Disability Occupational Training Program Survey
Study of Texas to Evaluate by Region Occupational Training Opportunities
Study of Texas to Evaluate by Region Occupational Training OpportunitiesLIDDA regions established to be utilized for the study.
Texas Home Living Annual Survey, 650 x 509 jpeg, myays.net
Study of Texas to Evaluate by Region Occupational Training OpportunitiesCounty by County study will be performed using and in-depth internet search with follow up if needed.
Texas-county-map | “the weblog of Adam Moore”, 968 x 900 jpeg, transienttransient.wordpress.com
Study of Texas to Evaluate by Region Occupational Training Opportunities
• Job Corp in Texas • Regional LIDDA’s• TWC-Boards• Texas Association of
Regional Governments• TEA• Goodwill• Project Search
• Texas A&M PATHS Program,• Texas Tech CASE Program• Austin Community College
STEPS Program• Austin Community College-ARC• Houston Community College-
VAST Academy Program• Salvation Army• and more.
Specific entities within the state to be part ofstudy in each region.
Study of Texas to Evaluate by Region Occupational Training Opportunities• The Survey itself is expected to provide
recommendations from participants regarding occupational training programs.
• These recommendations will receive follow-up evaluation.
SB 2027, Section 1Not later than Dec. 1, 2018, the Health and Human Service Commission shall report the results of the study to the governor, the lieutenant governor, the speaker of the house of representatives, and the appropriate standing committee of the senate and the house of representatives.
85th Texas Legislature, Senate Bill 2027, An Act
To provide recommendations and feedback please [email protected]
Thank You
STAR HEALTH in HCS/TxHmL
Medicaid and CHIP Services Department
OverviewAt the end of this presentation, you will be able to answer the following questions:• What is STAR Health?• What services are available through STAR Health?• What is required of Home and Community-based
Services/Texas Home Living (HCS/TxHmL) providers?
• What is available to assist HCS/TxHmL providers in coordinating care for individuals who have STAR Health?
Background• STAR Health is the Medicaid managed care
program for children in state conservatorship (called foster care), and some other children who are transitioning out of foster care.
• STAR Health is a statewide program, and began April 1, 2008.
• Superior Health Plan is the single managed care organization (MCO) serving all children in STAR Health.
What does STAR Health provide?• STAR Health provides medical (physical, dental, and
eye care) and mental health (psychological and therapy services), and MDCP for those who qualify.
• STAR Health provides service coordination and service management services.
• STAR Health provides a medical record for the child• The Health Passport.
What are the Goals of Managed Care?• Emphasize preventive care.
• Establish a medical home through a primary care provider, such as a doctor, nurse or clinic.
• Improve access to care.
• Make sure people get the right amount of services.
• Improve client and provider satisfaction.
• Promote care in least restrictive, most appropriate setting.
• Improve health outcomes, quality of care and cost-effectiveness.
Continuity of Care• Continuity of care means care provided to a
member by the same PCP or specialty provider to ensure that the delivery of care to the member remains stable, and services are consistent and unduplicated.
• It is provided when a member changes providers or programs to ensure that all referrals and services remain in place for the member during the transition.
Continuity of Care The state requires STAR Health to provide “continuity of care.” • Authorizations for basic care such as specialist
visits and medical supplies are honored for 90 days, until the authorization expires or until the health plan issues a new one.
• Authorizations for long-term services and supports are honored for six months or until a new assessment is completed.
• During the transition period, members can keep seeing current providers, even if they are out of the health plan’s network.
Service Coordination• Service Coordination means assisting members,
caregivers, and medical consenters with coordination or care needs to include scheduling of appointments and transportation
• Superior provides service coordination to children who qualify through an initial member outreach call based on their needs.
• Service Coordinators contact members, guardians, or DFPS caseworkers to determine the child’s needs and works to provide referrals for those needed services.
Service Management• Service Management is a clinical service
performed by the MCO for Members with Special Health Care Needs and others when appropriate to facilitate development of a healthcare service plan and coordination of clinical services among a member’s PCP and specialty providers.
• Service Management is provided by a licensed Superior employee to members who qualify during the initial welcome call and health screening.
Service Management• Service Management is also available upon
request of the member, guardian, DFPS caseworker, or medical consenter.
• Service Management assists with coordinating care and making needed referrals for children in STAR Health.
Who to contact• If a child living in an HCS group home requires
any non-waiver Medicaid services, Superior can assist in accessing those services as well as providing referrals for non-Medicaid services.
• To request services, Superior must verify the person they are speaking to is the DFPS caseworker, Ad Litem, member, or medical consenter.
• Superior can be reached at 1-866-912-6283.
Complaint Contacts for Providers
HHSCHPM Complaints
P.O. Box 85200, MC H-320Austin, TX 78758
Remember to follow HIPAA guidelines and always send patient information securely.
Place STAR Health in the subject line
If a Member has Problems with Medicaid Services • Call the HHS Office of the Ombudsman:
1-866-566-8989• Call the number on the health plan ID card.
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Thank You
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HCS and TxHmL Behavioral Support Program Policies
Nova EvansSenior Behavioral Health Policy Analyst
Outline• Behavior and Communication• IDD waiver behavior support policy
• Behavioral supports policies • Behavior support plans• Restraint and restrictive interventions
• Community and state-wide resources
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What makes us behave?
Function of behavior and co-occurring dynamics
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ReframeBehavior Management Plan Positive Behavior Support PlanPeople with IDD sometimes have challenging behavior.
IDD does not cause challenging behavior. Everyone sometimes has “challenging” behavior.People with IDD can have challenges with effective verbal communication and may use behavior to express themselves.
Behavior management plans are for the person with IDD.
Behavior support plans are for the support staff / caregiver.
Behavior management plans help the person change their negative behavior
Behavior support plans support the person gain skills and improve mental wellness.
The only way to help a person with IDD who has challenging behavior is with a behavior plan and medication.
People with IDD can participate in many therapeutic and wellness activities just like anyone else.
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Why do we behave?• All behavior is a means of communication
• Many things influence the way we behave: • Limited ability to verbally communicate (or
communicate at all)• Medical conditions / Pain• Genetic conditions / Behavioral Phenotypes• Anxiety and Impulsivity• Mental Health Issues• Antecedents, Consequences, and Setting Events• Trauma
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Function of behavior• These are some reasons we behave the way we do to
get our needs met everyday:• Escape / Avoidance• Attention• Obtaining Tangible / Activity• Self stimulation• Pain attenuation (an individual is experiencing pain)
• What are the interactions between a person and their environment? • Antecedents – Behavior – Consequences• Setting events
• What is person trying to communicate? 43
Whole Person
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• All aspects of life impact each other
• Consider every aspect of the person’s life
• Overlap in biological, psychological and social factors, and strengths that contribute to a person’s overall mental health
Intellectual and Developmental Disability (IDD) Waivers and Services
Behavioral Support Program Policies
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HCS40 TAC Chapter 9, Subchapter D- Program Service Requirements• §9.153, Definitions
• Behavioral Emergency, Restraint, Seclusion• §9.177, Training / Provider Qualifications• §9.178, Quality Assurance
• Rules governing use of behavior support plan • §9.179, Restraint
• Rules governing use of Restraint
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TxHmL40 TAC Chapter 9, Subchapter N- Program Service Requirements• §9.579 Qualified Personnel
• Rules governing use of Provider Qualifications, Provider Training
• §9.580 Quality Assurance• Rules governing use of Behavioral Support Plan,
Restraint
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What are Behavioral Supports?Waiver Service Definition:Behavioral support provides specialized interventions that assist an individual to increase adaptive behaviors to replace or modify maladaptive or socially unacceptable behaviors that prevent or interfere with the individual’s inclusion in home and family life or community life.
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Providers of Behavioral Support• Qualified providers must be one of the following:
• Licensed psychologist• Licensed psychological associate • Issued a provisional license to practice psychology • Licensed clinical social worker• Licensed professional counselor• Certified authorized provider • Certified behavior analyst
• Certified by the Behavior Analyst Certification Board, Inc.
• Must have completed HHSC-approved training.49
Behavioral Support ServicesBehavioral Supports include:• Screening and assessment (FBA) and analysis• Development and implementation of BSP • Training of and consultation with family members,
other support providers, and individual• Ongoing training of staff may be necessary if
there are staff changes or the BSP changes. • Is it best if the behavioral support providers
conducts the training directly when possible to ensure proficiency
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Behavioral Support ServicesBehavioral Supports include:• Monitoring and evaluation of BSP, and modification
as necessary• BSP may need to be changed as more
information is gathered, if needs change, or if progress is made
• Participating on Service Planning Team• A vital role of the behavioral support providers
are to participate as a member on the person’s service planning team to provide ongoing insight, training and support
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Fostering Principles for Behavioral SupportWhat are the fostering principals that drive HHSC Behavioral Support services?• Person Centeredness• Person Directed Planning (PDP)• Positive Relationships and Interactions• Integrity, respect, and accepting differences • Supportive Environments• Supporting and Reinforcing Positive Behavior
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Fostering Principles for Behavioral SupportWhat are the fostering principals that drive HHSC Behavioral Support services?• Self Determination • Promoting Independence & Community Living• Team Collaboration• Trauma Informed Care• Behavioral and Mental Wellness
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What is a Behavior Support Plan?Behavior Support Plan (BSP) • A BSP is a comprehensive, individualized written
plan that is based on a current functional behavior assessment.
• Goal is to:• Modifying the individual’s environment in
order to teach or increase adaptive skills and build on an individual’s strengths and preferences; and
• Eliminating or reducing frequency, severity, and duration of challenging behavior.
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What is a Behavior Support Plan?Behavior Support Plan (BSP) • Development of a BSP must include:
• Input from the individual• Their LAR• Program provider and • Other actively involved persons
• Including the service coordinator for TxHmL
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Key Components of a BSP• Identifying information/demographics• Based on a functional behavioral assessment• Include target and replacement behaviors• Baseline severity, frequency, and duration of each
target behavior• Goals and written, measurable objectives• Behavioral techniques
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Key Components of a BSP• Data collection / evaluation of effectiveness • Fading plan for restrictive interventions • Team approval• Consents• Monitoring and revision
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Identifying Information / DemographicsWhat identifying information about the individual needs to be included?• Name and age of the individual• Diagnoses• Where the individual lives- home / residential setting• Primary language or way of communicating• List psych medications and all medications used to control
behavior • Additional: informal supports; allergies, etc.The intent of having this information is to encourage communication among all healthcare professionals to coordinate services and improve behavioral health outcomes.
Functional Behavioral AssessmentWhat is a Functional Behavioral Assessment (FBA)?• A FBA is a process of collecting information through:
• Observation with the individual in settings where the behavior is most likely to occur
• Interview (with individual, LAR, may include friends, family, co-workers, school teachers, other professionals, etc.)
• Record review • Baseline data collection to determine the rate of the
target behavior• A FBA should have a conclusion pertaining to the
function of each behavior. 59
Defining Target and Replacement BehaviorsTarget and replacement behaviors must be observable, measurable, and clearly defined.• A target behavior is a behavior that have a negative
impact of the person’s quality of life, that you want to reduce.
• A functional replacement behavior (FRB) serves the same function as the target behavior but is a more socially acceptable behavior and less harmful.
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Defining Target and Replacement BehaviorsWhen there is a goal to decrease/eliminate a target behavior, there should also be a FRB being taught, so the person can learn to have their needs met in a positive way. • This may involve building on a person’s existing
skills or teaching new skills.
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Javier:Replacement BehaviorTargetBehavior Javier slaps his head he hears loud noises.
Environmental antecedent
He is in the living room where the TV is put on at a loud volume (environmental antecedent)
Function Javier slaps his head he hears loud noises because he wants to get away from the noise (communicating escape)
Replacement Behavior
• Encourage Javier to communicate with staff that he would like to go to his room and provide positive reinforcement.
• Teach Javier to use headphones when he feels overwhelmed with loud noises.
Intervention
• Avoid the living room when Javier’s roommate’s are watching TV.
• Provide Javier headphones to wear with preferred soothing music.
• Allow him to be alone in his room, with activities he enjoys.
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Javier: Without Replacement BehaviorTargetBehavior Javier slaps his head he hears loud noises.
Environmental antecedent
He is in the living room where the TV is put on at a loud volume (environmental antecedent)
Function Javier slaps his head he hears loud noises because her wants to get away from the noise (escape)
Intervention
• When Javier slaps his head, tell him to stop one time. • If he does not stop in one minute tell him if he does not
stop he will not get to go to the store later. • If he continues to slap his head hold his hands by his
down so he is not able to hurt himself. • When Javier has had one minute of not resisting release
Javier’s hands.63
Baseline DataHaving baseline data of the target behavior, when possible, prior to implementing a BSP:• Assists in development of BSP• Helps to determines effectiveness of interventions
after implementationBaseline data includes:• Type and frequency of the behavior • Severity and duration of the behavior is also be
considered.
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Goals and ObjectivesGoals must be observable, measureable, and outcome-oriented and reflect:• An acquisition of or increase in replacement
behaviors • A reduction in target behaviors.Objectives are steps to meet a goal and should:• Be reasonable / achievable by the individual.• Describe a specific observable behavior that
contains criteria for success.
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Behavioral Techniques: Elements in a BSPA BSP should contain:• Preventative strategies for reducing events that
are likely to provoke challenging behavior:• Modifying the person’s environment• Teaching and/or building on skills
• Methods to teach positive alternative behaviors that will achieve the same results as the challenging behavior: • Functional replacement behaviors
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Behavioral Techniques: Elements in a BSPA BSP should contain:• Methods to reduce the effectiveness of the challenging
behavior: • Alternative desired reinforces• Target behavior not being reinforced• Positive reinforcement• Including meaningful activities; staff training
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Jose• Jose is a 32 year old man who has mild ID
paranoid schizophrenia, seizure disorder, and speech impediment.
• He enjoys his job at the auto parts store, likes to hang out with his friends and his girlfriend, and listen to music on his boom box.
• At times he will fight with his girlfriend and will come home and listen to music.
• When he plays loud heavy metal music after fighting with his girlfriend he often becomes agitated and he can become aggressive and punch walls and others that come near him.
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Jose 1TargetBehavior
Property destruction and aggression: Punching walls and others.
Antecedent When Jose listens to loud heavy metal music after fighting with his girlfriend.
Function Avoidance.
Intervention
• When Jose begins punching walls tell him to stop. • If Jose’s behavior escalates to property destruction or
physical aggression, utilize personal restraint. • Only use restraint if he is dangerous to himself or others. • Do not give him any unnecessary attention such as talking
to him, reacting to or reprimanding him about his behavior, or giving him direct eye contact.
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Jose 2Target Behavior Property destruction and physical aggression: Punching walls and others.
Antecedent When Jose listens to loud heavy metal music after fighting with his girlfriend.
Function Avoidance- Keep away negative feelings. Negative coping.
Replacement Behavior
• Jose sees a therapist once a week to work on his issues with abandonment as a child and conflict in his current relationship.
• Throughout the day provide positive messaging to Jose. • Jose is able to go to yoga twice a week. • He is also afforded opportunities to engage in community activities with his peers
throughout the week. • Jose works with a speech therapist twice a week.
Intervention
• Allow Jose to call his therapist when he has a fight with his girlfriend. • If he remains agitated after the phone call, remind him of his positive qualities
and try to engage him in yoga or another redirect him to another activity that he enjoys.
• If Jose starts to get agitated while in the community remind him of his positive qualities and try and redirect him to an activity that he enjoys.
• If his agitation escalates allow him to call his therapist and the behavior escalates to property destruction or physical aggression, utilize personal restraint.
• Only use restraint if he is dangerous to himself or others. • Do not respond by reprimanding him or trying to reason with him. • Release him immediately when he is no longer a threat to himself or others.
Jose 3TargetBehavior Property destruction and physical aggression: Punching walls and others.
Antecedent When Jose listens to loud heavy metal music after fighting with his girlfriend.
Function Avoidance- Keep away negative feelings. Negative coping.
Replacement Behavior
• Jose sees a therapist once a week to work on his issues with abandonment as a child and conflict in his current relationship.
• Throughout the day provide positive messaging to Jose. • Jose is able to go to yoga twice a week. • He is also afforded opportunities to engage in community activities
with his peers throughout the week. • Jose works with a speech therapist twice a week.
Intervention
• Allow Jose to call his therapist when he has a fight with his girlfriend. • If he remains agitated after the phone call, remind him of his positive
qualities and try to engage him in yoga or another redirect him to another activity that he enjoys.
• If Jose starts to get agitated while in the community remind him of his positive qualities and try and redirect him to an activity that he enjoys.
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Behavioral TechniquesThe BSP must:• Include the use of techniques appropriate to the
level and severity of the behavior; and • Consider the effects of the techniques on the
individual's physical and psychological well-being • HCS: §9.178 (v)(1)(B)• TxHmL: §9.580 (p)(10)
• The focus should be to enhance a person’s quality of life by decreasing target behavior.
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When is a BSP Required? • There are two times a BSP is required:
• If an individual’s behavior requires behavior management techniques which include intrusive interventions or restriction of an individual’s rights
• If a behavior on the Inventory for Client and Agency Planning (ICAP) Maladaptive Behavior Scale is listed as “very serious” or “extremely serious”, the individual must have a BSP that meet DADS guidelines.
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Restrictive InterventionsWhat is a restrictive intervention in an BSP?• According to the Centers for Medicare and
Medicaid Services (CMS) Technical Guide, “a restrictive intervention is an action or procedure that limits an individual’s movement, a person’s access to other individuals, locations or activities, or restricts an individual’s rights.” • Restraints and seclusion are a subset of
restrictive interventions.• Seclusion is prohibited.
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Restrictive InterventionsWhat is a restrictive intervention in an BSP?• BSPs containing restrictive interventions and
restraints are the least desirable approach to supporting individuals. • Restrictive interventions should be used only
with those individuals presenting challenging behaviors for which documented evidence verifies non-restrictive BSPs are ineffective.
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Requirements for Restrictive Interventions• If the program provider identifies the need for an
intrusive / restrictive intervention due to a person’s behavior they must:• Obtain a behavioral evaluation and have a
provider of behavioral supports develop a BSP• Ensure staff are trained on an individual’s BSP,
special needs, restraint risks, and limitations on restraint use
• Before implementing a plan designed to decrease behaviors by using restrictive interventions, attempts should have been made to determine the effectiveness of other, less restrictive methods
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Less Restrictive AlternativesWhat are some less restrictive alternatives?• This may include, and are not limited to:
• Modifying the environment• Redirecting the behavior• Ignoring the behavior
• Different than ignoring the person!
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Data Collection, Monitoring, and RevisionHow is data collected?• Data sheets• Progress or service notes• Incident reportsThe BSP should:• Include a description of how and what behavioral
data are collected and monitored• Allow for a decrease in the use of techniques
based on the behavioral data• Allow for the revision of the plan when the
behavior is not displayed or the techniques are not effective
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Fading PlansWhat are fading plans?• A plan to gradually reduce and ultimately phase
out restrictive interventions• Must be included in the BSP• Should include generalizing fading to other
times and/or places• Will depend on the type, severity, frequency, and
duration of the behavior• Must take into account risk to the person’s health,
safety, and welfare
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Fading PlansWhy is it important to fade restrictive interventions in HCS and TxHmL BSPs?• The goal of a BSP is to improve the individual’s
QOL by increasing FRBs and decreasing challenging behaviors
• While not always possible, an ultimate goal would be for an individual to no longer need any restrictive intervention
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ConsentsWhat about consents and notification?• Before implementing the BSP or any modifications to the
BSP:• Written consents must be obtained from the individual or
LAR; and• Written notification to the individual or LAR of the right to
discontinue implementation of the plan at any time must be provided; and
• The individual's service coordinator or SPT must be notified
• Consent is needed annually; if adding a target/ replacement behavior; or prior to adding a new restriction/restrictive intervention 81
Monitoring and RevisionThe BSP should be reviewed by the provider of BS services with sufficient frequency to monitor progress or lack of progress and address any changes needed. • A BSP dated two years ago, with no evidence of
team review, revision, effectiveness, etc. does not meet standards
• BSP may need to be changed as more information is gathered, if needs change, or if progress is made.
• A provider of behavioral supports must document the frequency of monitoring required to justify the necessary services.
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IDD Program Policies
Restraint and Restrictive Interventions
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When is Restraint Allowed?Restraint is allowed: • In a behavioral emergency; • As part of a BSP that addresses inappropriate
behavior exhibited voluntarily by an individual• During a medical or dental procedure if necessary or
following an injury to promote the healing of wounds (prescribed by physician)
• To protect the individual from involuntary self-injury• To provide postural support to the individual or to
assist the individual in obtaining and maintaining normative bodily functioning
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What is a Behavioral Emergency?Behavioral emergency• A situation in which an individual's severely aggressive,
destructive, violent, or self-injurious behavior: • Poses a substantial risk of imminent probable death of,
or substantial bodily harm to, the individual or others• Has not abated in response to attempted preventive
de-escalatory or redirection techniques• Is not addressed in a written behavior support plan• Does not occur during a medical or dental procedure
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Emergency Safety Situation• Emergency safety situation
• Unanticipated resident behavior that places the resident or others at serious threat of violence or injury if no intervention occurs and that calls for an emergency safety intervention as defined in this section.
• Emergency safety intervention • The use of restraint or seclusion as an immediate
response to an emergency safety situation.
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When is Restraint Not Allowed?A program provider / facility must not use restraint:• For disciplinary purposes, as retaliation or retribution • For the convenience of a staff member or service
provider or other individuals • As a substitute for effective treatment or habilitation
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Restraint Use in an EmergencyWhat is an emergency restraint?• A restraint that is a applied due to unforeseen
circumstances and would not be in a BSP • Used when someone puts themselves or someone
else in imminent danger
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Restraint Rules: SafetyA program provider must:• Consider conditions, factors, and limitations on a
specific restraint technique• Use minimal force or pressure• Safeguard dignity, privacy, and well-being• Not secure the person to a stationary object while
in standing position• Only use a restraint hold in which a person’s limbs
are held close to the body
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Restraint Rules: SafetyThe individual MUST be released from restraint:• When no longer a risk of imminent physical harm
to self or others• If the individual experiences a medical emergency• As soon as the individual who moves toward the
floor reaches the floor
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Restrictions on RestraintRestraint can never be used in a manner that: • Uses hyperextension of joints• Uses pressure points or pain • For disciplinary purposes, retaliation, coercion, or
retribution; • For the convenience of a staff person, service
provider, or other persons• As a substitute for an effective treatment or
habilitationThese practices have led to injury and death for individuals and must never be used!
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Restrictions on RestraintRestraint can never be used in a manner that:
• Obstructs the individual's airway, including the placement of anything in, on, or over the individual's mouth or nose
• Impairs the individual's breathing by putting pressure on the individual's torso;
• Interferes with the individual's ability to communicate
• Places the individual in a prone (lying face down) or supine (lying face up) position;
• Extends muscle groups away from each other
These practices have led to injury and death for individuals and must never be used! 92
Prohibitions• Prone and Supine restraints are prohibited.
• Prone - lying face-down• Supine - lying face-up
• Restraints on the floor are prohibited.• Seclusion is Prohibited
• Seclusion is the involuntary separation of an individual away from other individuals and the placement of the individual alone in an area from which the individual is prevented from leaving.
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Prohibitions• If you suspect abuse, neglect, or exploitation
you must report it to the Department of Family and Protective Services (DFPS) within 1 hour:
1-800-647-7418• If you wish to file a complaint, contact consumer
rights and services (CRS):1-800-458-9858
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Program Provider’s Responsibilities• Documentation• Notifications
• RN or LVN must be notified as soon as possible but no later than one hour after the use of restraint
• Medical services must be obtained for the individual as necessary
• LAR and SC are notified• Restraints must be reported as a Critical
Incident in Care
Program Provider’s Responsibilities• Training
• Must conduct initial and periodic competency-based training on the current needs and characteristics of the individual they support, including the use of restraint
• Supporting the Rights of Individuals • Providers must promote and protect the rights
of individuals.
TAC ReferencesHCS Program and Community First Choice (CFC)• Title 40 Texas Administrative Code (TAC) Chapter 9,
Subchapter D:https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=1&ch=9&sch=D&rl=Y
TxHmL Program and CFC• 40 TAC, Chapter 9, Subchapter N.
http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=1&ch=9&sch=N&rl
• 42 Code of Federal Regulations, Parts 440, 441, 442, 455, 456, and 483http://www.ecfr.gov/cgi-bin/text-idx?gp=&SID=ac49f6a6f1a77f5d759f3878d12e9ec0&mc=true&tpl=/ecfrbrowse/Title42/42tab_02.tpl 97
More Resources• The Department of Aging and
Disabilities Behavioral Support Service Provider Policy (BSSPP) Training for Home and Community-based Services (HCS) and Texas Home Living (TxHmL)
http://www.dads.state.tx.us/business/cbt/
• Mental Health Wellness for Individuals with IDD web-based training
www.mhwidd.com
