340:100-5-57. Protective intervention protocol (PIP)
(a) Purpose.The purpose of a PIP is to ensure the service recipient's safety, when physical, emotional, medical, financial, legal, or community participation issues place him or her at risk.
(b) PIP elements.The PIP is part of the Individual Plan (Plan) developed with the participation of the service recipient and Personal Support Team (Team).The PIP:
(1) uses the least restrictive approaches necessary to address safety risks identified in the safety risk assessment per Oklahoma Administrative Code (OAC) 340:100-5-56;
(2) identifies the early signs, clues, or other indicators of potential safety risks;
(3) describes preventative supports, services, and actions to take in order to reduce or eliminate safety risks;
(4) describes detailed instructions and procedures taken by staff and Team members during a situation that places the safety of the service recipient or others at risk, including procedures to:
(A) keep the service recipient and others as safe as possible;
(B) defuse, reduce, or eliminate harm or injury; and
(C) secure Team or provider agency staff assistance;
(5) includes outcomes targeting skill enhancement, health improvement, choice making, meaningful relationship development, and community participation;
(6) describes teaching methods in sufficient detail to provide clear direction to provider agency support staff to assist the service recipient to learn relevant skills;
(7) identifies methods and time frames to evaluate the PIP's effectiveness;
(8) is revised when circumstances change or the PIP is no longer effective;
(9) treats the service recipient with dignity and is reasonable, humane, practical, not controlling, and the least restrictive alternative; and
(10) is reviewed by the Team to determine if the PIP meets OAC 340:100-5-57 requirements.Team review and approval is documented in the Plan.
(c) Serious risk or dangerous behavior.When a PIP addresses challenging behaviors that create serious risk of physical injury or harm to the service recipient or others, risk of involvement in civil or criminal processes, or places the service recipient's physical safety, environment, relationships, or community participation at serious risk, the PIP must be developed and overseen by the Team and an appropriately-licensed professional or a family trainer approved by Developmental Disabilities Services (DDS) with the assistance of the positive support field specialist.
(d) Restrictive or intrusive procedures.When the Team determines restrictive or intrusive procedures, per OAC 340:100-1-2 are essential for safety, the Team must develop a PIP with a DDS positive support field specialist's assistance.In addition to the requirements in (b) of this Section, the Team must:
(1) describe the severity and frequency of the risk or dangerous behavior;
(2) address any limitations placed on the service recipient's access to goods, services, and activities and document the Team's plan to restore access to such;
(3) identify positive approaches used prior to implementing the restrictive or intrusive procedure;
(4) ensure the procedure does not harm the service recipient;
(5) describe methods to help the service recipient develop skills that serve the same function as, or reduce or eliminate the possibility of, the dangerous behavior or serious risk.These methods must be individualized and provide clear direction to provider agency support staff to develop the service recipient's pro-social and coping skills;
(6) submit the protocol to the Statewide Human Rights Behavior Review Committee (SHRBRC) per OAC OAC 340:100-3-14 for initial approval and any time additional restrictive or intrusive procedures are requested; and
(7) document annual review and continued PIP approval.
(e) Physical management.A physical management hold per OAC 340:100-1-2 is only used to prevent physical injury.Physical management holds are allowed when supported by a specific assessed need and are documented in the person-centered Plan.Person-centered Plan documentation includes requirements per OAC 317:40-1-3(b)(8)(A) through (H).Prompting that does not restrict the service recipient's movement or choice is not considered physical management. Any PIP that includes a physical management hold requires the Team, to:
(1) ask the service recipient's physician to assess whether the service recipient has any health concerns related to the use of the physical management procedure;
(2) ask the service recipient's physician to assess whether the current medication regimen poses any risk for the service recipient due to the stress of the physical management procedure;
(3) include a DDS approved trainer of physical management procedures in the planning sessions.
(A) The trainer:
(i) makes recommendations about the effectiveness and safety of the physical management procedure in particular environments;
(ii) assists the Team in identifying alternative approaches when standard procedures do not appear appropriate for the service recipient or the situation; and
(iii) identifies existing physical obstacles to the implementation of the procedure for particular staff.
(B) The Team includes the trainer's recommendations in the development of the PIP;
(4) identify any situation in which physical management procedures cannot be used because they are unsafe or ineffective per this subsection; and
(5) comply with (f) of this Section.
(f) Emergency intervention.Emergency intervention is the use of a restrictive or intrusive procedure not included in a PIP, in response to an unanticipated and unpredictable situation or event or the sudden occurrence of an event so severe and dangerous urgent action precludes less restrictive measures.Physical management per OAC 340:100-1-2 is only used during emergencies to ensure physical safety and prevent injury.
(1) Emergency intervention:
(A) cannot be used as a substitute for positive approaches or a PIP; and
(B) is used for no longer than necessary to eliminate the clear and present danger of serious physical harm to the service recipient or others.
(2) Physical management must be terminated as soon as the service recipient is calm or the threat ended with attempts to release every two minutes to ensure the safety of the service recipient.
(3) When responding to an emergency, no one may authorize or use an amount of force that exceeds what is reasonable and necessary under the circumstances to protect the service recipient or others.
(4) Any person who has reason to believe abuse occurred is responsible to contact the appropriate authorities.
(g) Temporary approval of restrictive or intrusive procedures.After the first use of an emergency restrictive or intrusive procedure, when the Team in consultation with the positive support field specialist determine the use of a restrictive or intrusive procedure must be continued to ensure the safety of the service recipient or others, the positive support field specialist or DDS director of psychological and behavioral supports may provide temporary immediate approval for continued use of restrictive or intrusive procedures.
(1) The DDS case manager contacts the positive support field specialist to request temporary approval of restrictive or intrusive procedures to protect the service recipient or others from serious physical harm.
(2) The positive support field specialist approves or denies the request for use of emergency interventions using Form 06MP042E, Request for Temporary Approval of Restrictive or Intrusive Procedures.
(A) When the temporary request is approved, the positive support field specialist assists the Team in ensuring needed structure and training are in place for safe and proper implementation of the emergency interventions.
(B) Temporary approval lasts no longer than 60-calendar days.
(3) Form 06MP042E must be completed and sufficient information provided to demonstrate positive supports were attempted, and that the danger of severe harm still exists.
(4) When physical management procedures are authorized, training is obtained from an approved or certified trainer.
(5) To continue using the temporarily-approved restrictive or intrusive procedure, the Team must submit within 60-calendar days following approval, a PIP that incorporates the requested procedures to SHRBRC.When the submitted PIP does not receive SHRBRC approval, SHRBRC may extend the temporary approval for a maximum of an additional 60-calendar days.
(h) Review and revision of the Plan.The Plan is reviewed and, as necessary, revised when an unexpected high risk event occurs.
(1) Review and revision to the Plan is appropriate, when the:
(A) service recipient was recently seen in a hospital emergency room due to a behavioral crisis;
(B) service recipient was recently admitted to a psychiatric facility for stabilization;
(C) police were called to intervene because the service recipient is displaying challenging behavior; or
(D) service recipient was placed in police custody as the result of his or her challenging behavior.
(2) Team planning must include, at a minimum:
(A) consultation with the positive support field specialist;
(B) a review of recent events, including challenging behaviors;
(C) identification of the signs or behaviors indicating the event may reoccur;
(D) assisting the service recipient to develop an individualized safety plan;
(E) detailed action steps for provider agency support staff to follow to reduce reoccurrence; and
(F) consultation with other professional services, when appropriate.
(3) When a high risk event occurs, the Team reviews the event to determine if additional action is needed to prevent further occurrence.
(4) When psychiatric hospital admission occurs, the Team begins planning upon notification of a discharge date.A review is held within five-business days following discharge to meet the requirements of this Section, and address medication changes per OAC 340:100-5-26.1(d)(2).
(i) Mechanical restraint in a medical context.Restraints and mechanical supports used in a medical context are exempt from (d) of this Section.These exemptions include, but are not limited to:
(1) sedation prescribed by a physician or dentist prior to a medical or dental procedure;
(2) restraints used to control the movement of the service recipient during a time sensitive and necessary medical or dental procedure;
(3) time-limited restraints to promote healing following a medical procedure or injury;
(4) devices prescribed by a physician, physical therapist, or an occupational therapist to maintain body alignment or otherwise support or position a service recipient;
(5) devices normally used for safety reasons, such as car seats or seat belts;
(6) helmets used to protect a service recipient from injury during or following a seizure;
(7) bed rails used to keep a service recipient from falling out of bed; or
(8) wheelchair brakes, unless used for the purpose of restricting mobility.