Supports for Individuals with Complex Service Needs

Intent

To describe services available for Individuals with complex service needs.

Policy

Adults with complex service needs are defined as Individuals who are eligible for services from the PDD program and pose a significant risk, and/or are destructive to themselves, others or property. They require intensive services and have, or have had, a history of one or more of the following diagnoses or life experiences:

  • A mental health disorder;
  • Termination from services due to challenging behaviours;
  • Specialized treatment for psychiatric and/or behavioural issues;
  • Multi-system involvement;
  • Incarceration(s) or criminal justice involvement; and/or
  • Chronic substance abuse/dependency problems.

Individuals with complex service needs require specialized supports. Expertise is needed to support Individuals in a safe and secure manner through a continuum of services.

As described in the sections below, the PDD program provides resources to develop service provider and Family Managed Services (FMS) Administrator expertise in supporting Individuals with complex service needs. These resources include:

  • Access to specialized training;
  • Risk management; and
  • Behavioural support planning.

In addition, the PDD program provides other resources including:

  • Funding for respite services that provide a break for primary, non-paid, and paid caregivers on a temporary basis (see Home Living Supports); and
  • Funding for short-term specialized supports, such as behavioural and professional consultative services (see Specialized Community Supports).

Together, these resources enable Individuals with complex service needs to live as independently as possible and be included in their communities.

Specialized Training for Families and Service Providers

Individuals who have complex service needs require staff who are knowledgeable and have specialized expertise.

Community service providers and FMS Administrators must hire staff and caregivers who are knowledgeable and have the skills required to effectively support the Individual with complex needs. When required, community service providers and FMS Administrators will make available specialized training for staff, such as:

  • crisis intervention;
  • functional assessment;
  • risk assessment;
  • behavioural approaches; and/or
  • training on the specific strategies and techniques to be used with the Individual to address the issue(s) or behaviour(s) of concern.

The PDD program will make specialized training available to community service providers and FMS Administrators. Where there is an identified need, PDD regional staff will work with families, the service provider sector, and other ministries to facilitate access to specialized training.

PDD regional staff will monitor community service providers and FMS Administrators to confirm that staff assigned to work with the Individual have participated in specialized training as identified.

Risk Management

Risk management includes the identification, analysis and evaluation of risks and the process of taking steps to minimize the potential for risk of harm to the Individual, other people, property and the environment.

PDD regional staff will work with service providers and FMS Administrators to confirm that a risk management approach is being used for all Individuals who have complex service needs.

Engaging in risk management will assist community service providers and FMS Administrators to prioritize issues and make decisions. This will help to address the safety and security of the Individual and those around them.

PDD regional staff will participate in risk management as it relates to the coordination of services for the Individual, approval of funding and monitoring of services.

In situations where the community service provider or FMS Administrators are unable to lead the risk management process, PDD regional staff will facilitate the risk management process.

Service providers and FMS Administrators are responsible for implementing risk management strategies/processes in the provision of PDD funded services to the Individual.

Key elements of risk management include the following:

  1. Risk Assessment

    Formal risk assessment is the systematic identification, analysis and evaluation of risk. It leads to the development of plans to prevent and/or respond to potential incidents should they occur. Risk assessment includes evaluating the degree of potential harm or loss (to the Individual, the community and/or support system) and the likelihood of an Individual engaging in risk behaviour and/or the likelihood of an incident occurring.

    A comprehensive risk assessment requires access to current and accurate information about the support needs of the Individual (see Identification of Individual Support Needs and Service Design and Planning).

    In addition to engaging in a formal risk assessment, the assessment of risk may also form part of ongoing safety planning practices to address the acute safety and security needs of the Individual and others, including support staff and members of the community.

    PDD regional staff, community service providers and funds administrators will use the PDD Risk Assessment Guide and Risk Analysis Form in the completion of risk assessments.

  2. Action Planning

    Action planning includes the development of a plan that identifies the actions to be taken to address the identified risks. Typically the action plan will include agreed to tasks, persons responsible for completing the tasks, and the associated timelines for completion.

  3. Monitoring

    Community service providers, funds administrators and PDD regional staff will jointly monitor plans to ensure that specified actions are implemented and that the plan is addressing the identified risks.

  4. Documentation

    Risk assessments, action plans and evidence of monitoring will be retained on the Individual’s file in Part II according to the Individual File Standard.

    PDD regional staff will provide all available information relating to current and/or previous risk assessments, action plans and monitoring to the community service provider or funds administrator during the planning process, prior to the Individual’s receipt of services (see Service Design and Planning). This includes when Individuals with complex service needs transition from one community service provider to another.

Behavioural Support Planning

Behavioural supports are a set of interventions that have been tailored to support an Individual within his or her lifestyle. Behavioural supports reinforce positive social skills and modify an Individual’s environment to strengthen positive behaviour. Effective delivery of behavioural supports requires an understanding of the context, triggers and outcomes of behaviour for an Individual.

Responding to Unanticipated Situations or Behaviours of Concern

When unanticipated situations or behaviours of concern occur, the focus is on people’s safety and bringing the situation or behaviour under control. Service provider staff and staff of family managed services must immediately respond to the situation. Positive approaches are preferred ways of addressing unanticipated situations or behaviours of concern. Positive approaches may include simple changes to an Individual’s environment, or role modeling.

In emergencies, staff may need to immediately use a restrictive approach to protect Individuals or others from harm or to prevent major property damage. Examples of restrictive approaches include physically holding, restraining, or removing Individuals to prevent an altercation, and preventing an Individual from harming another.

When responding to unanticipated situations or behaviours of concern, service providers and FMS Administrators are required to:

  • have written emergency procedures in place including positive and restrictive approaches that may be used in addressing unanticipated situations or behaviours of concern;
  • ensure staff are trained and deemed competent in addressing unanticipated situations or behaviours of concern;
  • document and review within a specified timeline the use of restrictive approaches in addressing unanticipated situations or behaviours of concern;
  • document the review of the incident that includes decisions made, follow up action, and strategy to address any future incidents;
  • provide a copy of the incident report to PDD for review and possible follow-up with the service provider or funds administrator (see Critical Incident Reporting).

Responding to Anticipated Situations or Behaviours of Concern

Planned Positive Procedures

A situation and/or behaviour of concern becomes anticipated when staff can recognize that the behaviour of concern is likely to happen again. A planned positive procedure is preferred when responding to anticipated behaviours of concern. Examples of planned positive procedures include expanding an Individual’s choices in a situation, and teaching appropriate skills or behaviours.

Planned Restrictive Procedures

When a positive procedure cannot be implemented successfully by itself, a planned restrictive procedure may be implemented at the same time as the planned positive procedure to address the behaviour of concern.

Planned restrictive procedures are used for the safety or well-being of Individuals or others, or to prevent major damage to property.

Planned restrictive procedures (a) restrict an Individual’s rights, freedoms, choices or self-determination such as physical interventions, body boundaries, accessing external assistance (e.g. police), or (b) may involve the use of medications to influence/alter behaviour, but not for treating a medical or psychiatric diagnosis. When a staff is responsible for determining when to administer medication, a restrictive plan must be in place.

Behavioural Support Planning

  1. Functional Assessment
    Prior to the development of a behavioural support plan for an Individual, a functional assessment must be completed. A functional assessment is conducted to determine the function or purpose of behaviour(s) of concern and the conditions that maintain such behaviours. Results of the functional assessment are used to design interventions in an Individual’s behavioural support plan.
     
    For the PDD program, the core requirements of a functional assessment for Individuals with complex service needs include the following:
    • a risk assessment (see Risk Management of 2.4.1 Supports for Individuals with Complex Service Needs);
    • a medical assessment that may include a physical exam, a psychiatric exam, or both;
    • a review of the Individual’s past history as it relates to the behaviour of concern;
    • a review of previous strategies used to address the behaviour of concern;
    • consultations with relevant professionals (such as physician, orthodontist, denturist, surgeon, psychiatrist, psychologist, behavioural specialist, speech language pathologist, occupational therapist, physiotherapist, dietician);
    • an environmental assessment that examines how an Individual feels about the different programs and environments and how well-adapted those programs and environments are to the Individual, and;
    • a communication assessment that explores how an Individual communicates and how well their caregivers understand the Individual.
       
  2. Behavioural Support Plan
    Following the initial functional assessment, each service provider and/or funds administrator shall develop and implement a behavioural support plan for each Individual who has a behaviour(s) of concern. The behavioural support plan is in addition to any other plans in place (such as a risk management plan, transition plan, etc.) and must be developed with the involvement of the Individual/guardian and their family, whenever appropriate. The plan should focus on the development of positive behaviour, communication and adaptive skills to enable the person to reduce, change, and overcome the behaviour(s) of concern that limits their potential for inclusion in the community.
     
    For Individuals with complex service needs, a behavioural support plan must include the following:
    • a description of the situation or behaviour(s) of concern;
    • an outline of desirable behaviours and overall objectives;
    • planned positive procedures to support behaviour change, and where applicable, planned restrictive procedures that will be used to address the behaviour;
    • an implementation plan;
    • a strategy to decrease or eliminate as much as possible the need for the planned restrictive procedure;
    • termination criteria for the planned restrictive procedure;
    • necessary training requirements for staff to carry out the plan;
    • timelines for reviewing the plan;
    • methods to gather and report data and to evaluate the effectiveness of the plan.
       
    In the development of behavioural support plans, service providers and/or funds administrators are required to:
    • obtain documented consent from the Individual/guardian and/or family in the development of a behavioural support plan, including the use of planned positive and restrictive procedures;
    • have all behavioural support plans that include the use of restrictive procedures be developed in consultation with a qualified person and approved by a committee or qualified person;
    • train staff in the use of planned positive and restrictive procedures specific to the behavioural support plan;
    • review the effectiveness of planned positive procedures or determine whether they need to continue, be discontinued, or change;
    • review and reduce the use of restrictive procedures as much as possible;
    • review all behavioural support plans to ensure they are working well and resulting in positive outcomes for the Individual. These reviews will occur as specified in the behavioral support plan or at a minimum of twice in a 12 month period;
    • include the Individual/guardian and/or family in the review process and obtain documented consent for any changes to the behavioural support plan;
    • ensure consistent feedback and ongoing communication with the Individual/guardian, family and support staff;
    • provide a copy of the behavioural support plan to PDD to keep on file;
    • upon request, provide PDD with any written documentation pertaining to a behavioural support plan to keep on file.

Prohibited Procedures

Prohibited procedures can never be used as behavioural techniques, even in an emergency.

Prohibited procedures include inappropriate use of restrictive procedures, physical acts that cause pain, or other inappropriate actions defined as “abuse” in the Abuse Prevention and Response Protocol and the Protection for Persons in Care Act.

Service providers and FMS Administrators are expected to take all necessary steps to ensure that prohibited procedures are never used.

If any prohibited procedures are used, they are considered abuse and service providers and FMS Administrators are to ensure that:

  • the use of the prohibited procedure stops immediately,
  • the Individual is safe, and
  • the incident is reported immediately as per the Abuse Prevention Response Protocol and/or Protection for Persons in Care Act (see Safeguards and Standards), and
  • a copy of the incident report is submitted to PDD for review and any necessary follow-up (see Critical Incident Reporting).

Services Provided by the PDD Program

The PDD program will make behavioural support services available to assist families and service providers who support Individuals with complex service needs (see Specialized Community Supports).

Legislative Authority

Created: 2013-08-16
Modified: 2016-06-08
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