Why Minnesota moved to positive supports

Minnesota's Positive Supports Rule, Minnesota Rules chapter 9544, works together with Minnesota Statutes chapter 245D to govern how licensed providers respond to behavior that concerns them. The rule applies to providers of home and community-based services governed by chapter 245D, which serve people with disabilities and people sixty-five and older, and to other settings licensed under chapter 245A that serve people with a developmental disability or related condition. DHS describes the rule's purpose as improving the quality of life for people, including children, who receive DHS-licensed services, by requiring person-centered principles and positive support strategies.

The core prohibition sits in 245D. A license holder may not use chemical restraint, mechanical restraint, manual restraint, time out, seclusion, or any other aversive or deprivation procedure as a substitute for adequate staffing, as a behavioral or therapeutic program to reduce or eliminate behavior, as punishment, or for staff convenience. Those four purposes are worth memorizing, because they describe the reasons restrictive practices have historically crept into services. When you review a plan or a report, ask whether a restriction is really serving one of those purposes, even if no one would say so out loud.

DHS lists the goals behind the rule: community participation and inclusion in the most integrated setting, high-quality environments, positive support strategies developed together with the person, growth in skills and self-determination, better quality of life, freedom from humiliating and demeaning procedures, and an end to aversive and deprivation procedures, with consistent standards across settings. Notice that most of these are about what should be present in a person's life, not only what should be absent.

That difference shapes oversight. A compliance-only reading asks whether prohibited procedures were avoided and reports were filed on time. A quality-of-life reading also asks whether the person is doing more of what they enjoy, has more control and more relationships, and is less often in situations that lead to distress. Both readings matter. Formal licensing findings belong to DHS Licensing and the processes that govern them, but anyone who touches a person's plan can ask the quality-of-life questions.

Tamsin is a DSD program consultant reviewing provider quality data. One provider has had no restraint reports for a year and all paperwork on time. In site visit notes, however, she reads that residents are rarely out in the community, several people spend most evenings in their rooms, and staff describe a 'quiet house' as the goal. Another provider has filed several reports but shows steady growth in outings, jobs and friendships for the people it serves.

Add two quality-of-life questions, such as how often the person chose an activity this month and how often they were in the community, to the checklist or template you use for your next plan review or site visit.

When you review a provider or a plan, which questions come to you first: compliance questions or quality-of-life questions? What would it take to ask both?