Any use of the following procedures beyond the initial 11-month phase-out period must be reviewed by the External Program Review Committee (EPRC) and approved by the commissioner. Please note, this is not a comprehensive list:
Chemical restraint
Mechanical restraint
Manual restraint, except in an emergency
Time out
Seclusion
Aversive procedures
Deprivation procedures
If you would like to request approval from the commissioner to extend the use of a prohibited procedure beyond the initial 11-month phase-out period, please review the following information:
If you have implemented a Positive Support Transition Plan, DHS-6810 (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 procedure that is not specifically permitted by Minn. R. 9544.0050, nor specifically prohibited by Minn. R. 9544.0060. The commissioner has limited authority to approve an extension for the use of a procedure when all of the following conditions are met:
The procedure is necessary to protect the person’s health and safety for a limited time while positive support strategies are developed and implemented
To request approval for the use of a procedure, follow these steps:
1. Update or complete a person-centered plan or description
Person-centered planning is a collection of models that provide a way to get to know a person and his or her “story.” This helps you know what the person wants in life, where he or she prefers to live, what makes him or her happy and how to balance what is important for the person with what is important to him or her. Person-centered planning is useful for all people, regardless of ability. Person-centered planning addresses all areas of the person’s life, including community participation, relationships, work and aspirations. It is a collaborative process to help people identify the supports and services they need to live a high quality life based on their preferences and values. The person served drives the planning process and those who know the person best are important supporters in the process.
A person-centered plan or description and functional behavior assessment should guide the development of a positive support transition plan. More information and tools related to the development of a person-centered plan or description are available in the positive-supports manual, Guidelines for Positive Supports in DHS-Licensed Settings, DHS-6810C (PDF). You can find related Minnesota guidelines about person-centered planning in Minn. Stat. 245D.07 and Minn. R. 9544.0030.
Scroll down to the Planning facilitators section on the Minnesota Department of Human Resources (DHS) Person-centered practices webpage to find a qualified person-centered plan author in your area.
2. Update or complete a functional behavioral assessment
Information and tools related to the development of a functional behavioral assessment are available within the Resources tab on the Positive Supports webpage. See “Guides and templates for developing functional behavior assessments.”
3. Update the positive support transition plan
A PSTP directs the actions of a service provider; it outlines the support and procedures providers will use with the people they serve. Goals of the PSTP include decreasing target behaviors, phasing out of prohibited procedures, decreasing the emergency use of manual restraint (EUMR), and increasing the quality of life of the person.
Documentation of methods the provider has tried unsuccessfully to eliminate the interfering behavior
Documentation of the assessments performed to determine the function of the behavior
Documentation of a good-faith effort to eliminate the use of restrictive interventions
Documentation that a reasonable increase in staffing or the provision of other positive supports is unlikely to prevent the interfering behavior in the immediate future
Justification for the use of the procedure that identifies the imminent risk of serious injury if the team did not use the procedure
Documentation of the people consulted in creating and maintaining the current PSTP
Additional documentation as requested by the EPRC
Topics to emphasize
Please describe the possible functions of the 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? Is the person trying to avoid or obtain something? For example, a young man might hit his head to show staff that he needs pain medication. This information should be available within the FBA. If it is not, consult with a qualified professional to update the FBA.
Please explain how your team will help the person learn about socially acceptable behaviors that are not self-injurious and achieve the same outcome. The socially acceptable behaviors you are teaching are often referred to as replacement behaviors or functionally equivalent behaviors. You can see a visualization of these terms and concepts below:
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 events 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. You can find a visualization of these terms and concepts below:
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.
Identify any other strategies your team will use to prevent target behaviors and eliminate the use of a prohibited procedure. You may attempt a number of strategies, but some ideas include a plan for how to speak to an individual, a routine that will be established or a home modification.
4. Complete the request form
DHS intends for the request form, Request for the Authorization of the Emergency Use of Procedures (DHS-6810D) (PDF), to be a summary that highlights important factors the provider would like the EPRC to consider. If you cannot summarize the information, you may refer to another document by providing the document’s title and page numbers where the information can be found.
5. Submit the required documentation
Email the request form signed by all parties, an updated PSTP, any PSTP reviews, the person-centered plan or description, the most recent FBA and any other requested documentation to DHS. See instructions for how to request a secure email string in the Contact information section below.
You must do this three weeks before the deadline. The deadline is 11 months after the original implementation date 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 committee. The EPRC members will review the information thoroughly and recommend that the commissioner approve or deny the request. At times, the EPRC might ask for more information. Once the commissioner makes a decision, DHS will inform your team whether you may continue to use the prohibited procedure.
6. 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 might result in the commissioner denying future extension requests.
7. Follow-up
Respond to any additional inquiries or requests made by the commissioner, EPRC members or DHS Positive Supports staff.
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 by the EPRC, DHS staff or the commissioner.
We hope you find this webpage and supporting information helpful. If you have questions, contact the EPRC coordinator by phone at (651) 431-4974. You may also send an email to positivesupports@state.mn.us and request a secure email string. The process is as follows:
The Minnesota Department of Human Services (DHS) will reply with the subject: [SECURE]
Open the “message.html” with a one-time passcode and hit reply, then attach your messages and the private information. Make sure to keep [SECURE] in the subject line, which will automatically prompt DHS’s system to password protect the documents
