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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.
The Department of
Human Services (DHS) is issuing a series of guidance documents about the
Positive Supports Rule to DHS license holders. This document is written
specifically for DHS-licensed child care
providers (includes both child care centers and family child care
providers).
The General FAQ on
Positive Supports Rule
addresses
the following questions:
- Do child care
providers have to meet the requirements of the PSR?
- If we
don’t have a child with developmental disability or a related condition now in our setting, but might someday,
what do we have to do to get ready?
- How would I know that a child in my care has a "developmental disability or related condition" and the PSR applies?
- I currently have children with
developmental disabilities and related conditions in my child care program.
Will Licensing give me a citation or correction order if I’m not yet following
the requirements of the PSR?
- Who has
to get the training?
- What is
in the training?
- Will all
our personnel/caregivers have to take the training even if we only have one
child with a developmental disability or related condition?
- Etc.
A1. No.
The Rule makes a distinction between “permitted procedures,” “restricted
procedures,” and prohibited procedures.” The Rule does not prohibit all physical contact
or redirecting. You should read the full rule and relevant statutes to
understand what is permissible. Positive Supports Rule
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A2. “Permitted Procedures” are those actions that your staff are
allowed to take when providing services to a child with a developmental
disability or related condition.
There
are many “Permitted Procedures” described in the Positive Supports Rule Permitted
Procedures in Positive Supports Rule
and in Minnesota Statute, section 245D.06, subdivision 7: Permitted Procedures in 245D
The
following is a list from each:
- Positive verbal
correction that is specifically focused on the behavior being addressed;
- Temporary withholding or
removal of objects being used to hurt self or others;
-
Use of the instructional
techniques and intervention procedures listed below are also permitted. They
may be used on an intermittent or continuous basis. When used on a continuous
basis, they must be addressed in a child's plan. Physical contact or instructional
techniques must use the least restrictive alternative possible to meet the needs
of the person and may be used:
1) to calm or comfort a child by holding that child with no resistance from that child;
(2) to protect a child known to be at risk of injury due to
frequent falls as a result of a medical condition;
(3) to facilitate the child 's completion of a task or response when
the child does not resist or the child 's resistance is minimal in intensity and
duration;
(4) to block or redirect
a child 's limbs or body without holding the child or limiting the child 's movement to interrupt the child 's behavior that may result in injury to
self or others with less than 60 seconds of physical contact by staff; or
(5) to redirect a child 's behavior when the behavior does not
pose a serious threat to the child or others and the
behavior is effectively redirected with less than 60 seconds of physical
contact by staff.
- There are times when
restraint is allowed in the PSR. Restraint may be used as an intervention
procedure to:
1) allow a licensed
health care professional to safely conduct a medical examination or to provide
medical treatment ordered by a licensed health care professional;
2) assist in the safe
evacuation or redirection of a child in the event of an
emergency and the child is at imminent risk of
harm; or
3) position a child with physical disabilities in a manner
specified in the child's coordinated service and support plan
addendum or other individualized plan.
- Use of adaptive aids or
equipment, orthotic devices, or other medical equipment ordered by a licensed
health professional solely to treat a diagnosed medical condition is allowed under the PSR. The use of
such equipment or devices would not, in and of themselves, be considered a
mechanical restraint. Their use would also not require submission of a report
via the Behavior Intervention Report Form.
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A3. “Restricted
procedures” are specific procedures that are allowed when they are implemented
in compliance with standards governing their use, as identified in statute.
“Prohibited
procedures” are procedures or interventions that restrict a child’s autonomy in
some manner used
as a substitute for adequate staffing, for a behavioral or therapeutic program
to reduce or eliminate behavior, as punishment, or for staff convenience.
Some examples, in the broadest sense, include:
- chemical
restraints,
- mechanical
restraints,
- manual
restraints,
- time
out,
- seclusion,
or
- any
other aversive or deprivation procedure
See the list of
prohibited and restricted procedures in rule and statute at:
Prohibitions in
the Positive Supports Rule
Prohibited Procedures in 245D
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A4. It is
important to understand how the Rule defines “time out.” Under the Rule, “time out” is defined as “the
involuntary removal of a person for a period of time to a designated area from
which the person is not prevented from leaving.” The Rule also states that “time out does not
mean the voluntary removal or self-removal for the purpose of calming,
prevention of escalation, or de-escalation of behavior; nor does it mean taking
a brief break or rest from an activity for the purpose of providing the person
an opportunity to regain self-control.” For example, a ‘chair time out’,
requiring someone to sit on a chair for a specified amount of time but not
physically forcing them to stay in the chair would be prohibited. Asking
someone to ‘take a break’ to ‘cool down’ – but not requiring them to do so -
would not be considered a form of time out.
-
“Time
out” is prohibited for a child with a developmental disability or related
condition when used as a “substitute for adequate staffing, for
a behavioral or therapeutic program to reduce or eliminate behavior, as
punishment, or for staff convenience.”
Family
child care providers have been able to
use time outs, or separation of the child from the group, under Rule 2 for
behavior guidance purposes, as long as: “The separation of a child
from a group to guide behavior must be appropriate to the age of the child and
circumstances requiring the separation….and for not longer than ten minutes.”
Child
care centers have had a prohibition on the use of time outs and
separation of the child under Rule 3, unless:
“the license holder has tried less intrusive
methods of guiding the child's behavior which have been ineffective and the
child's behavior threatens the well-being of the child or other children in the
center.”
Bottom
line: The PSR is newer law and is intended to update and
take precedence over previous rule and practice for those license holders
providing care to children with a developmental disability or related
condition.
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A5. Yes. The Rule allows for the "emergency use of
manual restraint" under certain conditions. This is a key phrase that you will have to
learn more about and about which DHS will be sending further guidance. Emergency Use of Manual Restraints
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A6. Yes, if a child in your care is
developmentally disabled or has a related condition, then you must have a
written policy that addresses when and under what circumstances you would approve
the emergency use of manual restraint by yourself or your staff. Only parents
or legal representatives of a child who has been determined to be
developmentally disabled or with a related condition would receive the policy
on EUMR.
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A7. The license
holder must retain documentation of emergency use of manual restraint in the
person's permanent record for at least five years after creation of the
documentation or other documents. There are other documentation and reporting requirements you must
follow when you have to use physical
contact or emergency use of manual restraints (at links below).
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A8. Yes. You will have
to provide documentation, as the rule section positive supports documentation states
for all children with developmental disabilities or a related condition, of the
following:
1. Document
general positive support strategies and activities for your setting*;
2. Incorporate
positive support strategies into an existing treatment, care, or other
individual plan (e.g. ICCPP, or Individual Child Care Program Plan);
3. Maintain policy on the Emergency use of Manual Restraint
(EUMR);
4. Report incidents via Behavior Intervention Report Form
(BIRF)**;
5. Positive Support Transition Plans (PSTP).
*Please note that if you are a Family Child Care provider,
you do not have to document general
positive support strategies and activities for your setting. Family Child Care
providers must still report required incidents via the Behavior Intervention
Report Form and create Positive Support Transition Plans, if required.
**Please note that further guidance for child care
providers on the use of the BIRF is forthcoming from DHS.
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NOTE: You are receiving this notice because you are listed as an Authorized Agent for a child care center licensed by the Minnesota Department of Human Services (DHS). If you believe you have received this notice in error, please ask the license holder to contact their DHS licensor, or contact the DHS Licensing Division via email at DHS.LicensingSupp@state.mn.us.
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