Request prohibited procedure extension

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:

1. The procedure is necessary to protect the person’s health and safety for a limited time while positive support strategies are developed and implemented
2. The procedure is part of a positive support transition plan, which must be informed by a functional behavior assessment (FBA) and person-centered plan or description
3. The person’s expanded support team approves of the use of the procedure
4. The EPRC recommends that the commissioner approve the procedure.

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), starting on page 11. 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 an FBA are available in the positive-supports manual, Guidelines for Positive Supports in DHS-Licensed Settings, DHS-6810C (PDF), starting on page 32.

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.

PSTPs that are submitted to the EPRC must include relevant content from the person-centered plan or description, information from the FBA, the required components below, material associated with the topics to emphasize and any recent changes. You can find more details about the development of a PSTP in the positive-supports manual, Guidelines for Positive Supports in DHS-Licensed Settings, DHS-6810C (PDF), starting on page 35. Resources and additional information are also on the Positive supports webpage.

Required components

• Data on the interfering behavior
• 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. Service providers may also fax their forms to (651) 431-7612.

• 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.

Service providers must:

• Complete a Behavioral Intervention Report Form (BIRF) every time they use the procedure (or in aggregate)
• 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.

Please note that the following list of resources is not comprehensive. Additional resources are available through other agencies or companies.

• Guidelines for Positive Supports in DHS-Licensed Settings (PDF): DHS developed this manual to provide guidelines for positive supports in DHS-licensed settings. DHS recommends that all providers read and use this manual.
• Home and Community Positive Behavior Support Network: This website includes resources, literature and links aimed at expanding and enhancing the application of positive behavior support principles across home and community settings, contexts and the lifespan for people with behavioral challenges.
• Person-centered practices: This DHS webpage contains a variety of resources and links for finding regional planning facilitators who are qualified to write person-centered plans or descriptions.
• Positive Supports Minnesota: This webpage was developed through a collaboration with the Research and Training Center on Community Living and DHS. It provides examples of positive-support practices, a calendar of events, links to new information and a variety of other resources.
• Positive supports: DHS developed this webpage to provide information about prohibited procedures and provider responsibilities.
• STAR Device Database: Use this webpage to browse devices that can assist with speech/communication, mobility, recreation, etc. People may use many of the devices at home before purchasing.
• Training news and information webpage: DHS provides links to a variety of training opportunities related to disability services.
• Sensible strategies for supporting people - Person-Centered Thinking Initiatives: Use this webpage to register for person-centered thinking and person-centered planning courses offered by the University of Minnesota.
• College of Direct Support online training courses: This webpage is maintained by DirectCourse, which provides a variety of free or low-cost competency-based trainings for direct support staff. The Research and Training Center on Community Living developed the courses. Read more about other DirectCourse classes on the DHS Training and conferences webpage.
• DHS eList announcements: Use this link to subscribe to email notifications about topics of interest.
• Rules and Statutes:
  • Minnesota Rules, Chapter 9544
  • Minnesota Statutes, Chapter 245D
• Forms:
  • Searchable document library (eDocs)
  • Positive Support Transition Plan, DHS-6810 (PDF)
  • Positive Support Transition Plan Instructions, DHS-6810B (PDF)
  • Positive Support Transition Plan Review, DHS-6810A (PDF)
  • Request for Authorization for the Emergency Use of Procedures, DHS-6810D (PDF)

We hope you find this webpage and supporting information helpful. If you have questions, contact the EPRC coordinator by phone at (651) 431-4974 or secure fax (651) 431-7612. You may also send an email to positivesupports@state.mn.us and request a secure email string. The process is as follows:

1. Send a blank email to positivesupports@state.mn.us with the title: Requesting a secure email string
2. The Minnesota Department of Human Services (DHS) will reply with the subject: [SECURE]
3. 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
4. Send the reply
5. Save the [SECURE] email for future use