12VAC35-105-20. Definitions
1. “Behavior intervention” means those principles and methods employed by a provider to help an individual receiving services to achieve a positive outcome and to address challenging behavior in a constructive and safe manner. Behavior intervention principles and methods must be employed in accordance with the individualized services plan and written policies and procedures governing service expectations, treatment goals, safety, and security.
“Behavioral treatment plan,” “functional plan,” or “behavioral support plan” means any set of documented procedures that are an integral part of the individualized services plan and are developed on the basis of a systematic data collection, such as a functional assessment, for the purpose of assisting individuals to achieve the following:
1. Improved behavioral functioning and effectiveness;
2. Alleviation of symptoms of psychopathology; or
3. Reduction of challenging behaviors.

Comment:
Behavioral assessments and behavior interventions need to be developed by licensed professionals operating within their scope of practice in accordance with Department of Health (DHP) professions regulations. Implementation of these interventions can only be done under delegation. These definitions should be changed to clarify the process by which they can be developed and implemented.

2. Comment:
Throughout the document all uses of the term mental retardation should be changed from this derogatory term to Developmental Disability. This has been the generally accepted standard nationwide for many years

3. “Licensed mental health professional (LMHP)” means a physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, or certified psychiatric clinical nurse specialist.

Comment:
These regulations were last updated long before the Board of Medicine began licensing Behavior Analysts (LBA) and Assistant Behavior Analysts (LABA). Given that Applied Behavior Analysis (ABA) services can provide a highly effective and efficient service to support recovery and independence, DBHDS should include LBA and LABA in this category to allow them to be contained in DBHDS regulations such as human right regulations and allow for their use in conducting behavioral assessments and developing behavior intervention plans

4. “Time out” means the involuntary removal of an individual by a staff person from a source of reinforcement to a different, open location for a specified period of time or until the problem behavior has subsided to discontinue or reduce the frequency of problematic behavior.

Comment:
Time out is a punishment procedure and its use should be severely limited. DBHDS should specify that its use is allowed only after assessment and development of an intervention plan by a licenses professional operating within their scope of practice and training. DBHDS should further specify that any person subjected to time out must be evaluated by a licensed professional with specific trauma-informed care competency. This type of procedure can easily result in trauma for the person placed in time out. DBHDS should consider moving this to the seclusion and restraint section with similarly limited use, required reporting of each use and a required debriefing process after each use which includes participation of the licensed professional who assessed and developed the plan that uses time out.

12VAC35-105-800. Policies and Procedures on Behavior Interventions and Supports.

5. Article 6. Behavior Interventions
A. The provider shall implement written policies and procedures that describe the use of behavior interventions, including seclusion, restraint, and time out. The policies and procedures shall:
1. Be consistent with applicable federal and state laws and regulations;
2. Emphasize positive approaches to behavior interventions;
3. List and define behavior interventions in the order of their relative degree of intrusiveness or restrictiveness and the conditions under which they may be used in each
service for each individual;
4. Protect the safety and well-being of the individual at all times, including during fire and other emergencies;
5. Specify the mechanism for monitoring the use of behavior interventions; and
6. Specify the methods for documenting the use of behavior interventions.
B. Employees and contractors trained in behavior support interventions shall implement and monitor all behavior interventions.

Comment:
Now that Commonwealth has moved behavioral services to a licensed status these regs are not compliant with DHP regulations.
DBHDS should change this section regarding behavioral assessment and plan development to specify that they are to be completed by a VA licensed professional operating within his/her scope of practice and training.

6. 12VAC35-105-810. Behavioral Treatment Plan.
A written behavioral treatment plan may be developed as part of the individualized services plan in response to behavioral needs identified through the assessment process. A behavioral treatment plan may include restrictions only if the plan has been developed according to procedures outlined in the human rights regulations. A behavioral treatment plan shall be developed, implemented, and monitored by employees or contractors trained in behavioral treatment.

Comment:
Now that Commonwealth has moved behavioral services to a licensed status these regs are not compliant with DHP regulations.
DBHDS should change this section regarding behavioral assessment and plan development to specify that they are to be completed by a VA licensed professional operating within his/her scope of practice and training.

12VAC35-105-830. Seclusion, Restraint, and Time Out

7. C. Application of time out, seclusion, or restraint shall be documented in the individual’s record and include the following:
Physician’s order for seclusion or mechanical restraint or chemical restraint;

Comment:
Given the potential for misuse and overuse of timeout and the high likelihood of the traumatic effects of timeout when misused, time out should require an order by a licensed clinician. Similar to seclusion and restraint any use of time out should require a formal debriefing procedure which includes an assessment of the individual as well as the effectiveness and appropriateness of the intervention.