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On August 31,
2015, a new rule governing Positive Supports Strategies and Restrictive
Interventions went into effect. This rule is frequently referred to as the
Positive Supports Rule (PSR). The rule establishes training requirements, which
vary depending on a staff member’s position. This guidance illustrates who in your
organization needs training, and which training, to meet the requirements of
the rule. This guidance document is the second in a series of FAQs that DHS’
Licensing Division is developing on the Positive Supports Rule for license
holders. See, “Overview and
Frequently Asked Questions for DHS License Holders about the New Positive Supports Rule,” for general
questions and answers.
If you provide services under a DHS license and provide services for an adult or
child with a “developmental disability or related condition,” then the PSR
training requirements apply to you and the services you provide.
If you provide
services under a 245D Home and Community Based Service (HCBS) license, then the
PSR training requirements apply to you. This is because every individual who
receives your services is automatically covered by all the requirements of the
rule, regardless of their diagnosis.
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The Positive Supports Rule represents a significant change in policy
and, for some license holders, a significant shift in practice. Training is essential to ensuring that
all individuals who are involved in providing services have adequate skills and
knowledge to provide safe and effective services.
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The training requirements of the PSR will depend, based on the person’s level of responsibility and qualifications. If someone has multiple roles in the organization
as described below, then the person may have to take more than one training.
In
brief:
(a) Staff who provide direct services to a person/child with a
developmental disability or related condition and have responsibility for
developing, implementing, monitoring, supervising or evaluating: 1) positive support strategies; 2) a positive
support transition plan, or 3) the emergency use of manual restraint must
complete 8 hours of “core training” before assuming their responsibilities, and
4 hours of refresher training applicable to their responsibilities;
(b) Staff who develop positive support strategies for a
person/child with a developmental disability or related condition must complete
4 hours of “function specific training” in addition to the core training before
assuming their responsibilities and four hours refresher training applicable to
their responsibilities. License holders, executives, managers and owners may
also need to complete the 4 hours of function-specific training if their duties
involve the substance of the function specific training; and
(c) License holders, executives, managers, and owners in
nonclinical roles must complete 2 hours of management training before assuming
their responsibilities. At a minimum, all controlling individuals listed on your license with DHS
must complete this management training. A
license holder, executive, manager or owner in a nonclinical role may need to
complete “core training” and “function specific training” if s/he provides
direct services, or develops positive support strategies, to a person/child
with a developmental disability or related condition.
The
training requirements should be completed as soon as possible.
Core Training (8
hours) covers:
A. de-escalation
techniques and their value;
B. principles of person-centered service
planning and delivery, and how they apply to direct support services provided
by staff;
C. principles of positive support strategies, such as
positive behavior supports, the relationship between staff interactions with
the person and the person's behavior, and the relationship between the person's
environment and the person's behavior;
D. what constitutes the use of restraint, including chemical
restraint, time out, and seclusion;
E. the safe and correct use of manual restraint on an
emergency basis;
F. staff
responsibilities related to prohibited procedures; why the procedures are not
effective for reducing or eliminating symptoms or interfering behavior; and why
the procedures are not safe;
G. staff
responsibilities related to restricted and permitted actions and procedures;
H. the
situations in which staff must contact 911 services in response to an imminent
risk of harm to the person or others;
I. the procedures and forms staff must use to
monitor and report use of restrictive interventions that are part of a positive
support transition plan;
J. the procedures and requirements for notifying
members of the person's expanded support team after the use of a restrictive
intervention with the person;
K. understanding
of the person as a unique individual and how to implement treatment plans and
responsibilities assigned to the license holder;
L. cultural
competence; and
M. personal staff accountability and
staff self-care after emergencies.
Function-Specific
Training (4 hours)
covers:
A. functional
behavior assessments;
B. how to apply person-centered planning
C. how to design and use data systems to measure
effectiveness of care; and
D. supervision, including how to train, coach, and evaluate staff and
encourage effective communication with the person and the person's support
team.
Management Training (2 hours) covers:
A. how to include staff in organizational decisions;
B. management of
the organization based upon person-centered thinking and practices, and how to
address person-centered thinking and practices in the organization; and
C. evaluation of
organizational training as it applies to the measurement of behavior change and
improved outcomes for persons receiving services.
Annual
Refresher Training (4 hours)
Staff providing services to a person/child with a developmental
disability or related condition, which includes all staff working for a program
licensed under 245D, are required to complete four (4) hours of
refresher training on an annual basis. The Refresher Training covers topics
from the Core Training and Function-Specific Training. The rule requires staff
to complete trainings that are applicable to their responsibilities.
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Yes. The goal of the required training is to ensure competency of staff
in the knowledge and skills outlined in the PSR. However, you will want to
carefully document those equivalent hours of training and why you think they
meet the requirements of the new rule. For both the Function-Specific Training and
the Management Training, the rule allows for counting “equivalent training
approved by the commissioner” only if the equivalent training was completed
within the previous 12 months.
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The PSR requires that the license holder ensure that staff demonstrate
their competency, through testing or observation, to perform positive support
strategies that are "relevant to the primary disability, diagnosis or
interfering behavior of the person."
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The license holder is responsible for ensuring documentation of the completion
of the Core Training, additional trainings, and competency testing or
assessments. The following information
should be documented for each staff in the personnel record: (1) subject
area(s); (2) date(s) of training; (3) the number of training hours per subject
area; and (4) the name and qualifications of the trainer or instructor. A sample training documentation form is being
sent to the Authorized Agent.
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Each license holder is responsible for getting the training themselves. DHS
is working with the College of Direct Support at the University of
Minnesota to ensure appropriate and accessible training content is available to
license holders.
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“Qualified individual” (referenced in the training section of the PSR) is not defined in the rule, so the license holder
must determine who is a “qualified individual” for training purposes.
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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 prior to 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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The Department 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, including completing the required training.
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More information can be found at
these web sites:
DHS Partners and
Providers: Positive Support Web page
Positive Supports
Rule Web Page
To access DHS forms and instructions, visit DHS eDocs and enter the document number, below, in the search box:
- 6810 - DHS Positive Supports Transition Plan -
form
- 6810A - DHS Positive Supports Transition Plan
Review - form
- 6810B - DHS Positive Supports Transition Plan -
Instructions
- 6810C - Developing Positive Supports Transition
Plans: A Provider Guide for 245D-Licensed
Home and Community-Based Services in Minnesota (A good resource for ALL DHS
License Holders, not just 245D License Holders)
- 6810D - DHS Request for the Authorization of the
Emergency Use of Procedures - form
- 6810E - Positive Supports Rule Staff Training Record
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