If you have implemented a positive support transition plan (PSTP) (PDF) and the team does not believe it can phase out a prohibited procedure by the 11-month deadline because of a safety concern, you may request approval from the commissioner to extend the use of a procedure. You may also request approval for the use of a prohibited procedure that is not specifically permitted by Minn. R. 9544.0050, nor specifically prohibited by Minn. R. 9544.0060. To request an approval for the use of a prohibited procedure, follow these steps:
Carefully review all of the information on this page.
Email to DHS the signed (by all parties) request form and all other required documentation (see below) or fax it to (651) 431-7612.
This must be done three weeks before the deadline. The deadline is 11 months past the original implementation date written on the signed PSTP or the date indicated on your most recent approval letter.
When DHS receives your information, the EPRC coordinator will forward it to the EPRC . The EPRC will thoroughly review the information provided and recommend that the commissioner approve or deny the request. At times, the EPRC may ask for more information. Once the commissioner makes a decision, DHS will inform your team whether you may continue to use the prohibited procedure.
Read the notification letter in detail. Most letters contain recommendations or suggestions on how to improve the care provided to the person served. The EPRC may also request a phone conference or in-person meeting. Failure to comply with the instructions and recommendations in the letter may result in the commissioner denying future extension requests.
Respond to any additional inquiries or requests made by the commissioner, EPRC members or DHS Positive Supports staff.
Please identify and describe the specific, interfering self-injurious behavior your care team is attempting to prevent, such as exiting a moving vehicle, head-banging, biting, etc.
Why is it happening?
Please make sure the application identifies and describes the possible functions of a person’s self-injurious behavior: What is the person trying to say when engaging in the self-injurious behavior? What is the purpose of the self-injurious behavior? For example, a young man might hit his head to show staff that pain medication is needed.
This information should be available within the FBA. If providers have not identified the function of the self-injurious behavior, they must consult with a qualified professional to update the FBA.
How are you going to prevent self-injurious behavior?
Please explain how your team will help the person learn about socially acceptable behaviors that are not self-injurious and that help the person achieve the same outcome. The socially acceptable behaviors being taught are often referred to as replacement behaviors or functionally equivalent behaviors. A visualization of these terms and concepts can be seen below:
Also, please identify what the care team will do to address contextual variables, antecedent variables or triggers and responses following the self-injurious behavior. Contextual variables are situations where the interfering behavior is likely to occur. Antecedent variables are triggers that lead to a behavior, such as situations, words, people, decisions, biological event or conditions, etc. The response to a behavior will depend on whether it is a desired, replacement or interfering behavior. Providers should reinforce desired and replacement behaviors; they should not reinforce interfering behaviors. A maintaining consequence is a response to a behavior that makes the behavior more likely to reoccur. A visualization of these terms and concepts can be seen below:
Make sure your PSTP identifies any other strategies your team will use to prevent injury. There are a number of strategies you may attempt to prevent injury, but some ideas may include a plan for how to speak to an individual, a routine that will be established or a home modification.
We recommend that your team outline a plan to collect information so you can make data-driven decisions. The plan needs to be useful for the team and paint a picture of what is happening. For example, you may want to collect information about how often the target behavior occurs, under what circumstances the behavior is most and least likely to occur, information about related behaviors and the acquisition of replacement behaviors. See the positive supports manual (PDF) for more details. Data will give your team the opportunity to find solutions and alternatives to prohibited procedures that you might not have tried previously.
Actively pursue other strategies to replace or eliminate the need for the prohibited procedure. Remember, the commissioner’s approval is only a temporary solution
Provide updates that accurately address and report on the information requested from the EPRC, DHS staff or the commissioner. For example, if asked to collect data on the self-injurious behavior:
Do not simply state how often the self-injurious behavior occurred
Provide information about variables surrounding the behavior. For example, what happened before the behavior occurred? How did staff respond to the behavior? Describe the setting. By looking at trends, you will be better equipped to determine what works and what might need to be changed.