Individually-Based Limitations: Process and Documentation
Individually-based limitations (IBLs) are addressed in the Individual Service Plan (ISP) to manage health and safety risks for individuals in provider-owned residential settings. The implementation process involves collaboration and documentation within the ISP planning process. IBLs can be initiated by the individual, their representative, or the Provider Services Coordinator. The need for an IBL is documented in the Risk Identification Tool and discussed during the ISP planning process.
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Process and Documentation INDIVIDUALLY-BASED LIMITATIONS
WHEN TO DO AN INDIVIDUALLY-BASED LIMITATION (IBL) Any time Individually-Based Limitations (IBL s) can be addressed at an Individual s annual ISP; OR In the course of a plan year when health and safety issues arise.
WHEN TO DO AN INDIVIDUALLY-BASED LIMITATION (IBL) If an identified support or strategy for an individual meets the criteria for an IBL, then the intervention must be addressed through the IBL process and form. Individually-Based Limitations will begin being implemented for ISP s effective March 1, 2017 or later. Once an individual has had their ISP developed and implemented between March 1, 2017 and February 28, 2018, then new strategies that meet the criteria for an IBL must be addressed and added to the plan as the need for a limitation arises. For existing supports, the IBL process must be applied as part of the ISP development for ISPs effective March 1, 2017 or later.
WHO MIGHT HAVE AN INDIVIDUALLY-BASED LIMITATION? Individuals residing in provider-owned, controlled or operated residential service settings who require a limitation to address significant health and safety risks. Individuals residing in other settings, such as in-home, should have risks and needed supports addressed in the ISP in the Risk Identification Tool and the Risk Management Plan. The formal Individually-Based Limitations process does not apply to in-home or non-residential settings for the six HCBS protections specific to residential service settings.
WHO CAN INITIATE AN INDIVIDUALLY-BASED LIMITATION? Most commonly an IBL will be suggested by the: Individual (or their representative) Provider Services Coordinator
HOW IS AN IBL IMPLEMENTED? Individually-Based Limitations are done collaboratively using the ISP planning process.
WHERE IN THE PLAN? The health and safety risks driving the need for an Individually- Based Limitation should be documented in the Risk Identification Tool. Discussion about health and safety should occur naturally during the ISP planning process. The Risk Management Plan should indicate the presence of an IBL.
WHERE IN THE PLAN? When an IBL has been identified in the Risk Management Plan, the limitation must be documented on the Department approved form. This form must be completed in full and attached to the ISP. The Individual Consent to HCBS Limitations form is the currently approved form required to document the presence of an IBL.
INDIVIDUALLY-BASED LIMITATIONS FORM A Consent to Individually-Based Limitations form must be completed for each limitation. This means using a separate form for each limitation. Each form must be completely filled out.
INDIVIDUALLY-BASED LIMITATIONS FORM Demographic Information:
INDIVIDUALLY-BASED LIMITATIONS FORM Indicate which Home and Community-Based Services (HCBS) protections is being limited: Access to personal food at any time; Choice of bedroom roommate; Control of personal schedule and activities; Furnish and decorate bedroom; Lockable bedroom doors; Visitors of the individual s choosing at any time.
INDIVIDUALLY-BASED LIMITATIONS FORM The Requested End Date may not be any later than the next ISP date or one year after the start date of the limitation. (Whichever is earliest) Indicate the start date and end date of the limitation.
INDIVIDUALLY-BASED LIMITATIONS FORM: COMPLETING THE QUESTIONS SECTIONS Each question section can be completed in a narrative format; OR The information can be provided by a cut and paste; OR This section can reference where the information can be found, such as: See Functional Behavioral Assessment dated 1/10/16 ; See ISP Risk Management Plan under Aspiration Risk . See Behavior Support Plan dated 3/30/16
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING THE LIMITATION Discuss what the limitation actually is. The description needs to answer the following information: What can be observed? How is it implemented? When? How often? By whom? How is it proportional to the risk?
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING THE NEED
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING THE NEED In this section, describe: What current health and safety need is addressed through the limitation; How and when was the need identified (including assessment tool used); What makes this a current need (i.e. What recent event occurred to drive the need for a limitation?)
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING THE NEED There must be a current health and safety risk and active need for support to mitigate the risk for a limitation to be valid. Historical references, including identification of past events or practices applied are not sufficient to justify a need for an IBL. However, a past event (or series of events) coupled with an identification of current, active supports to address or avoid future events, may be used to make a case to support the need for an IBL.
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING WHAT HAS ALREADY BEEN TRIED
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING WHAT HAS ALREADY BEEN TRIED This section is to be used to describe past attempts to address the behavior or safety risk. What are other strategies, including proactive approaches, have been tried to address the health and safety risk? Include a description of what has actually been attempted and did not work.
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING OTHER OPTIONS Describe approaches that were considered and ruled out. Explain why such approaches were ruled out as options.
INDIVIDUALLY-BASED LIMITATIONS FORM: HOW DOES THE LIMITATION BENEFIT THE INDIVIDUAL
INDIVIDUALLY-BASED LIMITATIONS FORM: HOW DOES THE LIMITATION BENEFIT THE INDIVIDUAL Provide supporting information to make a case for the Individually-Based Limitation as the most appropriate intervention for the individual. Describe how the use of the Individually-Based Limitation will benefit the individual.
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING HOW THE LIMITATION WILL BE MEASURED
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING HOW THE LIMITATION WILL BE MEASURED This section identifies how the effectiveness of the limitation will be measured. Measurement, such as data collection, should be customized to the individual. This section can apply data tracking already designated in a Behavior Support Plan or can be created to include tracking of new information. Simple Functional Sufficient to make a case for the use of a limitation Measures should be:
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING HOW THE LIMITATION WILL BE MONITORED
INDIVIDUALLY-BASED LIMITATIONS FORM: DESCRIBING HOW THE LIMITATION WILL BE MONITORED In this section identify: Who is responsible (in addition to the Services Coordinator) for monitoring the limitation (including review of data and analysis of individual s current situation/need); How often the monitoring must occur; How will a determination be made that there continues to be a need for the limitation. The data collection is a key component to this section. This monitoring can align with other monitoring activities such as service and site monitoring.
DOCUMENTATION OF MONITORING ACTVITIES The progress note should specifically indicate that the monitoring activity occurred and how it was completed. Progress notes must reflect the specific monitoring activity that occurred. For example, an Individually- Based Limitation identifies that the Services Coordinator will monitor by reviewing incident reports on a monthly basis. In the example situation, the progress note may state: On 8/16/17, SC completed monitoring of John Smith s IBL by reviewing incident reports. Four IR s in the last month related to food safety and aspiration affirm that the IBL limiting food access is still necessary and appropriate.
INDIVIDUALLY-BASED LIMITATIONS FORM: INDIVIDUAL STATEMENT
INDIVIDUALLY-BASED LIMITATIONS FORM: INDIVIDUAL RIGHTS AND CONSENT The feedback section may be used to indicate that the individual (or representative) does not consent. This documents that risks were discussed with the individual, supports were offered, and the individual has chosen not to accept the identified support. This section must indicate if the individual or guardian is the party consenting.
INDIVIDUALLY-BASED LIMITATIONS FORM: INDIVIDUAL STATEMENT This section includes a narrative section to document feedback from the individual. This area can be used to document the individual s (or representative s) concerns or conditions for providing consent. This narrative may also be used to describe the individual s expression of disagreement to a proposed limitation.
INDIVIDUALLY-BASED LIMITATIONS FORM: STATEMENT BY THE SERVICES COORDINATOR
ASSURANCES INCLUDED IN THE SERVICE COORDINATOR STATEMENT SECTION The Services Coordinator Statement section provides the following assurances: The individual was supported in understanding the information. The individual had the opportunity to ask questions. The individual was not coerced. The strategies or structures proposed as the limitation are non- aversive and will not cause harm to the individual.
INDIVIDUALLY-BASED LIMITATIONS FORM Provide a copy of this form to: The individual The individual s representative (if applicable) The provider responsible to implement or monitor the limitation A copy of the limitations form must be kept in the individual s case file attached to the ISP.
INDIVIDUALLY-BASED LIMITATIONS FORM Questions? Contact us at the HCBS email box. Please be sure to identify if you are affiliated with DD services. HCBS.Oregon@state.or.us HCBS.Oregon@state.or.us
