A positive support transition plan is the tool 245D uses to phase out restrictive practices safely. License holders must develop one, on DHS forms, for a person who requires intervention to maintain safety when it is known the person's behavior poses an immediate risk of physical harm to self or others. For people admitted after the transition to the current rules, the plan must be developed and put in place within thirty calendar days of starting services and must phase out prohibited interventions no later than eleven months from when the plan starts. DHS notes that some providers need more time to phase out a procedure therapeutically and has a process for requesting approval.
The External Program Review Committee, set up under part 9544.0130, includes an expert in positive supports, a mental health professional, a licensed health professional and a representative of the Department of Health. It monitors how the rule is implemented, reviews requests for emergency use of procedures and requests to temporarily use a prohibited procedure, reviews emergency manual restraint reports and gives guidance to license holders. DHS will not grant a permanent variance to allow a prohibited procedure.
The content of a plan matters as much as the timeline. The rule calls for person-centered planning and functional behavior assessment, which asks what happens before a behavior, what the person gets or avoids through it, and what else is going on in their life. Positive Supports Minnesota describes positive behavior support as research-based work that improves quality of life and reduces challenging behavior by changing social interactions and settings, teaching communication and social skills, and staying person-centered and culturally responsive. A good plan changes the environment and the support around the person and teaches new ways to meet the same need. It does not only describe what staff will do when things go wrong.
Quality of life is the real measure. Alongside counts of incidents, track things the person cares about: time spent in activities they chose, relationships, sleep, health, work or school, and how often they say no and are listened to. A plan that reduces incidents while shrinking a person's life has not succeeded.
