1. Behavior Support and Management
Stephanie Pacinella
Standards Development and
Performance Measurement
April 2006
Hello, I am a Standards Associate at COA and have worked with advisory panel members and other members of the Standards Development group at the Council on Accreditation on developing the 8th Edition Accreditation Standards.  I would like to welcome you to this self-paced presentation, designed to let you view each section of the standards at your convenience, and move as quickly or slowly through the material as you like. 
The presentation time is listed in the upper left hand corner of your screen. When you are finished viewing the slide presentation, you will receive instructions for how to print the slide show, if desired.

2. Service Delivery Administration and Management
Administrative and Service Environment (ASE)
Client Rights (CR)
Training and Supervision (TS)
Behavior Support and Management (BSM)
7th Edition: G10 Behavior Management
Promote supportive culture
BSM addresses full continuum of behavior support interventions
(B) The section we will be discussing in this session is Behavior Support and Management or BSM. BSM is 1 of COA’s 4 Service Delivery Administration and Management sections. These four sections are a cluster of standards that focus on special considerations for the delivery of all services. These standards are implemented along with the services an agency provides. These standards used to be known as “G” standards, which stood for “generic” but that term is no longer used. They also used to carry a number, in this case, G10 but as you can see, that system has been replaced with an easy to remember abbreviation.
This section was previously titled Behavior Management. The title was changed to emphasize the use of these interventions to support an individual in managing their own behavior. The standards recognize the efforts in the field to minimize the use of restrictive behavior management interventions. BSM addresses the full continuum of interventions used to encourage a culture that emphasizes and supports positive behavior, beginning with leadership that supports a safe and therapeutic environment to restrictive behavior management interventions that may be used as a last resort when individuals are at risk of harming themselves or others.
May 19
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3. Behavior Support and Management (BSM) Purpose Standard
The organization’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.
(C) The stated purpose of the Behavior Support and Management standards is: “The organization’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.”
By stating this purpose, COA is guiding the organization to consider: How does it create and maintain a culture that encourages positive behavior? How does it keep staff, foster parents and service recipients safe? Are better program and service recipient outcomes associated with an environment where positive behavior is encouraged?
May 19
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4. © Council on Accreditation 2005 All Rights Reserved
What are Indicators of Strong Behavior Support and Management Practices?
Leadership that promotes and supports a well established philosophy and policy
A safe, therapeutic environment that promotes positive behavior
An ongoing, competency-based training program
A system to monitor incidents and make changes
Organizations with strong behavior support and management programs are able to demonstrate that their philosophy, polices and practices are supported by the leadership of the governing body and management. The environment is safe for staff and service recipients and reinforces positive behavior and healthy relationships. Training is provided on an ongoing basis to all staff and foster parents to prevent the need for restrictive interventions. And a system exits to monitor and review the use of interventions and individuals the involved in the incidents, and to make changes to practices to prevent future incidents.
May 19
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5. © Council on Accreditation 2005 All Rights Reserved
6 BSM Core Concepts
BSM 1. Philosophy and Organization Policy
BSM 2 . Behavior Support and Management Practices
BSM 3. Safety Training
(D) Core Concept standards in this section address:
1 – leadership promotion and support for a safe and therapeutic environment
2 – a positive culture and structure that prevents the need for restive interventions
3 – training that promotes a safe environment and a reduction in emergency situations
May 19
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6. © Council on Accreditation 2005 All Rights Reserved
6 BSM Core Concepts
BSM 4. Restrictive Behavior Management Intervention Training
BSM 5. Restrictive Behavior Management Interventions
BSM 6. Debriefing and Documentation
4 – annual training on the use of restrictive interventions.
5 – using restrictive interventions as a last resort in emergency or crisis situations to maintain safety of staff and service recipients; and
6 – documentation and assessment of incidents to prevent future occurrences.
Most of these important concepts have been brought forward from the 7th Edition standards, and will be familiar to you.
May 19
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7. Does Every Core Concept Apply to All Organizations?
Philosophy and Organization Policy
Behavior Support and Management Practices
Safety Training
Using the 7th edition standards, organizations who maintained a policy that prohibited the use of behavior management interventions could apply for a “not applicable” or NA rating for G10 and would not need to demonstrate implementation of those standards. Although there still exist some NA ratings at the practice standard level, all organizations are required to demonstrate implementation of the first three core concepts - Philosophy and Organization Policy, Behavior Support and Management Practices, and Safety Training. These core concepts focus on creating and maintaining a positive culture and structure that promotes respect, healing and positive behavior – an essential for any service providing organization. The remainder of the section will be reviewed only for organizations that use more restrictive interventions, including isolation, locked seclusion, and manual and mechanical restraint.. In the rare instance when an organization does not provide any services in a face to face context the organization may receive an NA rating for the entire section.
May 19
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8. Noteworthy Core Concepts
Restrictive Behavior Management Interventions combines four sections from the 7th edition – G10.4, G10.5, G10.6, G10.7
Debriefing and Documentation
The majority of the changes in this section were the result of reorganizing standards to achieve increased clarity and focus.
For example, while Restrictive Behavior Management Interventions and Debriefing and Documentation are new concepts in the 8th edition, the requirements are not. The standards in Restrictive Behavior Management Interventions combines requirements from four 7th Edition standards: G10.4, G10.5, G10.6, and G Debriefing and Documentation combines standards from those same four sections to provide increased focus on the importance of the debriefing process in preventing future incidents.
May 19
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9. Essential Life and Safety
A total of 10 essential life and safety standards in BSM
Fundamental to practice
Must be implemented to achieve accreditation
Due to the nature of the section, there are a significant number of essential life and safety standards focused on protecting the health and safety of the organization’s staff and service recipients. These standards are fundamental to practice and must be implemented to achieve accreditation.
May 19
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10. Essential Life and Safety
BSM 2.03
Interpretation: Chemical restraints do not include situations when a psychopharmacological drug: (1) is used according to the requirements for treatment authorized by a court; nor (2) is administered in an emergency to prevent immediate, substantial, and irreversible deterioration of a person's mental status when prescribed by a physician or other qualified medical practitioner.
Note: Refer to COA's glossary for a definition of chemical restraint.
BSM 2.03 is an Essential Life and Safety standard that prohibits the use of chemical restraints. This standard, brought forward from the 7th edition, has been updated to include an interpretation that provides further clarification of chemical restraints. Additionally a note was included that refers to the updated glossary definition of Chemical Restraints that reads:
The use of a psychopharmacological drug as a restraint to control behavior or restrict freedom of movement that is not a standard treatment for the person's medical or psychiatric condition.
May 19
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11. Other Noteworthy Revisions
Foster parent language added
Risk management training incorporated
Debriefing for staff and service recipients
Other helpful additions to the 8th edition include incorporation of the term “foster parents” in standards as well as specific foster parent related notes and interpretations to help clarify relevant foster parent practices.
Additionally, Standards that were previously located under Risk Management training were moved into BSM to further acknowledge and support behavior support and management as a full continuum.
And practice standards were enhanced to include in the debriefing process both staff and other service recipients that may have witnessed a restrictive intervention to help assess injuries and reactions, resume the normal program routine, and return the environment to pre-incident condition.
May 19
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12. Standards Implementation
Evidence of Implementation
Pre-site
Procedures
Training Documents
On-site
Case Records
Behavior Management Logs
Interviews
(G) Once you have familiarized yourself with the content of the Behavior Support and Management standards, you will begin to focus on standards implementation. Some examples of important evidence that the organization will need to demonstrate implementation include: a BSM policy and philosophy document; criteria used to assess an individuals potential risk of harm; training curriculum; debriefing protocols; and procedures for incident review.
When the peer site team visits the organization they will be interested in looking at case records, documentation of training, incident reports and behavior management logs. They will also be interested in talking to service recipients, foster parents and personnel at all levels about behavior support and management practices, polices, and procedures. Full information about pre-site documents and onsite activities is contained in the evidence chart at the end of every section of standards.
May 19
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13. © Council on Accreditation 2005 All Rights Reserved
Thank you!
Council on Accreditation
120 Wall Street, 11th Floor
New York, NY 10005
Stephanie Pacinella,
( )
Melissa Lavigne, (ext. 239)
I would like to welcome you to any questions you may have to Stephanie Pacinella or to Melissa LaVigne at the addresses shown. If you would like to print the slide show, click on the word attachments in the upper right hand corner and select the slide presentation.  Thank you again for your interest in the new 8th Edition Behavior Support and Management standards.
May 19
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