Definitions

For purposes of 115 CMR 5.00, the following terms shall have the following meanings: Behavior Safety Plan. A document, prepared by a Positive Behavior Support (PBS) Qualified Clinician, describing the plan for a rapid response to the challenging behavior of an individual. The Behavior Safety Plan must be a separate document from the Intensive Positive Behavior Support Plan (PBSP) document. Chemical Restraint. The non-consensual use of medication, not for treatment, but for the purpose of impairing the individual's freedom of movement. Chemical restraint does not include medication administered subject to the provisions of 115 CMR 5.15. Corporal Punishment. The application of painful stimuli to the body as a punishment for certain behavior and includes, but is not limited to, hitting, pinching, the use of electric contingent skin shock or infliction of other pain. Crisis Prevention, Response and Restraint (CPRR) Curriculum. A standard, Department approved curriculum which includes training on de-escalation using Positive Behavior Supports, debriefing requirements and the monitoring of persons subject to a restraint. Each Department vendor may select from the list of Department qualified CPRR Curriculum providers and shall only use the procedures contained in the specific selected curriculum. (Mass. Register #1411 2/21/20) Crisis Prevention, Response and Restraint Individual Modification Plan (CPRR Individual Modification Plan). A document providers must use to modify a restraint technique contained in a Department approved CPRR curriculum, where use is contraindicated due to a medical or psychological condition of an individual. A CPRR Individual Modification Plan must describe the reason the approved restraint is contraindicated, including the specific condition and how the modification will address the condition. A CPRR Individual Modification Plan developed due to a medical condition must be supported by an order from a physician, dentist, physician's assistant or nurse practitioner. A CPRR Individual Modification Plan developed in response to a psychological condition must be supported by an order from a PBS Qualified Clinician. Individual modifications of restraint techniques must be approved by the Department CPPR Curriculum Review Committee prior to implementation. The Department CPRR Curriculum Review Committee shall not approve any modification which is identified at 115 CMR 5.14(15) including, but not limited to, physical restraint in a prone position. Emergency: (a) the occurrence of serious self-injurious behavior. (b) the occurrence of serious physical assault; (c) the substantial risk of serious self-injurious behavior; or (d) the substantial risk of serious physical assault. Environmental Modification. Alterations or changes to the physical environment, such as altering lighting, sound, colors, or temperatures, to lessen an individual's responsiveness which may trigger challenging behavior. Evidence-based Practice. Strategies based on procedures, assessments and interventions validated through peer-reviewed research. Informed Consent. The knowing consent voluntarily given by an individual (or by the individual's guardian, if applicable) who can understand and weigh the risks and benefits involved in the particular decision or matter. Mechanical Restraint. Any limitation of movement achieved by means of a physical device. Mechanical restraint does not include devices utilized in accordance with 115 CMR 5.12 or 5.13. Positive Behavior Support (PBS). A systematic, person centered approach to understanding the reasons for behavior and applying evidence-based practices for prevention, proactive intervention, teaching and responding to behavior, with the goal of achieving meaningful social outcomes, increasing learning and enhancing the quality of life across the lifespan. PBS is a three-tiered system that includes Universal Supports, Targeted Supports, and Intensive Supports, as defined in 115 CMR 5.14(5). Response Blocking. A procedure in which staff physically intervene as soon as the individual begins to emit a challenging behavior in order to prevent the completion of the targeted behavior. Response blocking is used mostly as a treatment to manage self-injurious behavior; however, it also is used as a defensive procedure when an individual is aggressing toward a staff person. Response blocking as described in CPRR-approved curricula (used defensively or to block self-injury) is not a restrictive procedure. Restraint. Any method used to limit an individual's freedom of movement over the individual’s active resistance. Restraint of individuals with intellectual or developmental disability may only be used in cases of emergency. Restraint does not include hand-over-hand assistance with activities of daily living or skill acquisition. Restrictive Procedure. A procedure that restricts an individual's freedom of movement or requires an individual, through coercion, to perform a task which is non-scheduled, not essential for acquiring a skill or learned task, or not essential for his or her health and well-being, or removes something an individual owns or has earned. Restrictive procedures do not include hand-over-hand assistance with activities of daily living or skill acquisition. Seclusion. Any act which involuntarily places an individual alone in a locked room or other area from which there is no egress. Substantial Risk. A serious, imminent threat of bodily harm, where this is the present ability to enact such harm. Time Out from Positive Reinforcement. The contingent withdrawal of the opportunity to earn positive reinforcement or the loss of access to a form of positive reinforcement for a specified time. Time out from positive reinforcement is limited to a period not to exceed 15 minutes. Physical removal over active resistance to a time out is a restraint.