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On August 31, 2015, a new rule governing Positive Support Strategies and Restrictive Interventions went into effect. The new Rule is frequently referred to as “the Positive Supports Rule.” The purpose of the Positive Supports Rule is to improve the quality of life for individuals, including children, who receive DHS licensed services by requiring the use of person-centered principles and positive support strategies in the services provided for each person to whom the rule applies.
The Department of Human Services (DHS) will be issuing a series of guidance documents about the Positive Supports Rule to DHS license holders. You can access the complete rule at Positive Supports Rule.
The Positive Supports Rule is a new Minnesota rule that requires all DHS license holders to use person-centered principles and positive support strategies when they are providing services for persons or children with developmental disabilities or related conditions. In addition, the rule both prohibits and limits certain restrictive interventions.
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A “positive support strategy” is a strengths-based strategy based on an individualized assessment that emphasizes teaching a person productive and self-determined skills or alternative strategies and behaviors without the use of restrictive interventions.
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The PSR supports several goals that represent the latest developments in the field of disability services. These goals include:
• Promote community participation, person-centeredness & inclusion in the most integrated setting
• Focus on creating quality environments
• Ensure collaborative development of positive support strategies
• Increase skills and self-determination of people receiving services
• Improve the quality of life of people receiving services
• Ensure people are free from humiliating and demeaning procedures
• Eliminate the use of aversive and deprivation procedures
• Create a consistent set of standards for providers across service settings
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The rule became effective on August 31, 2015.
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The rule applies to all DHS license holders who provide services to a person or child with a “developmental disability or related condition”.
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The PSR uses the definitions for these terms that are found in Rule 9525.0016, subpart 2, governing case management services to persons with disabilities. Please read those definitions to become familiar with what health conditions are covered by the PSR.
In general, for a person to have a “developmental disability,” they must be diagnosed as having an intellectual disability that substantially limits their cognitive functioning and other skills, including communication and self-care, prior to their 22nd birthday.
In general, for a person to have a “related condition,” they must have a condition that closely resembles a “developmental disability” and requires treatments or services similar to those required for persons with developmental disabilities. Examples of closely related conditions include: cerebral palsy, Prader-Willi syndrome, and autism spectrum disorder.
Mental illness as defined under Minnesota Statutes, section 245.462, subdivision 20, or an emotional disturbance, as defined under Minnesota Statutes, section 245.4871, subdivision 15, are not “related conditions.” For example, attention deficit hyperactivity disorder (ADHD) is not a “related condition.”
However, an individual might have multiple diagnoses (chronic mental illness and autism) and so the rule would apply.
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If you are providing services to someone under a 245D or Home and Community Based Services (HCBS) license, then that person is automatically covered by the PSR, regardless of their diagnosis, and all services your program provides to that person must comply with the PSR.
If you are delivering services to someone under any other DHS license, there are several possible ways you might know if he/she meets the definition:
i. The person, or their legal guardian, may have told you. If you are providing services to a child, the parent or legal guardian may have told you.
ii. You know that the adult or child receiving services from you is on a Developmental Disability (DD) waiver or has a DD case manager.
iii. There may be medical or health information in the adult or child’s client/service file, treatment plan, Individual Service Plan, or Individualized Education Plan (IEP) that indicates the adult or child may have a “developmental disability or related condition.”
In general, if you have information that suggests a person you are serving meets the definition of “developmental disability or related condition,” as defined in the PSR, you should follow up with the person (or their legal guardian) and discuss the PSR rule and definitions with them. You should then document the outcome of that follow up, including whether the person meets the definition of “developmental disability or related condition.”
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Yes. The staff person should also document whether, as a result of the assessment, the person meets the definition of “developmental disability or related condition” so that your program can comply with the PSR if applicable.
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If you are serving a person/child with developmental disabilities or a related condition, then there are requirements for your program for staff training, for documentation, for interactions with the person/child, and for compliance and reporting. The requirements of the PSR can be found at: www.revisor.leg.state.mn.us.
In general, there are seven key requirements that license holders must follow:
- Maintain a Policy on the Emergency Use of Manual Restraint
- Develop and Document Positive Support Strategies For Every Person to Whom the PSR Applies
- Prohibit the Use of Restrictive Interventions
- Conduct Functional Behavior Assessments
- Develop Positive Support Transition Plans
- Report Certain Incidents Using the Behavior Intervention Report Form
- Ensure certain Staff Qualifications & Training Are Met
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The Department of Human Services recognizes that license holders will need time to learn about the PSR and to develop a plan for complying with the PSR as soon as possible.
If you are currently serving someone with a “developmental disability or related condition,” then the PSR applies to your service to that person/child and you must comply with the PSR in its entirety and as soon as is practically feasible.
If you are not currently serving someone with a “developmental disability or related condition,” you must come into compliance with the PSR before you begin providing services to them.
Remember, if you are providing services under a 245D HCBS license, then each person you provide services to is covered by the PSR and you must comply with the PSR in its entirety and as soon as is practically feasible.
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Yes.
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As stated above, DHS recognizes that license holders will need time to learn about the PSR and to develop a plan for complying with the PSR as soon as possible. DHS Licensing staff will be reviewing license holder records for evidence that the program has a plan in place to comply with the training, documentation and programming requirements of the PSR and that reasonable progress is being made.
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The Department of Human Services will not grant a variance to allow the use of a prohibited procedure as defined in the PSR. Other variances will be considered on an individualized basis and consistent with DHS authority and guidance provided in statute. (e.g. Pursuant to Minnesota Statutes, Section 245A.04, subdivision 9, Human Services Licensing Act, the commissioner may grant variances to rules that do not affect the health or safety of persons in a licensed program if certain conditions are met). www.revisor.mn.gov/statutes.
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You may submit your variance to your DHS licensor using the approved variance request form.
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For information on the DHS Positive Supports Rule webpages, go to: mn.gov/dhs/partners-and-providers.
To read and print out Chapter 9544, Positive Support Strategies and Restrictive Interventions, go to: www.revisor.leg.state.mn.us/rules
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