Instructions: Plan Review and Process
INSTRUCTIONS: PLAN REVIEW FORMS & PROCESS
-
Plans are submitted no less than 14 days prior to the date of the IASC meeting
-
Informed consent is mandatory
-
Completed Cover Sheet and relevant Sections required or will be declined
-
One of three decisions will be made:
-
Approved as presented
-
Approved conditionally – pending additional information or clarification
-
Not approved
-
-
Signed Cover Sheet is the record for decision
-
Approval is effective as of meeting date
-
Behavior Plan Checklist is available for guidance
-
Agency documents turned over to the presenter after review
PLAN REVIEW – ATTACHMENT A
RESTRICTIVE TECHNIQUE
➢ Level of participation in plan development
➢ List each restrictive technique and the corresponding challenging behavior(s)
➢ List each behavioral objective with criteria for fading the restrictive measure
➢ Explain the adaptive alternative behavior/skills to be introduced
➢ What is the potential outcome if the restrictive measure(s) is not used/Risk to person or others
➢What are potential risks incurred by use of technique used/Risk to person or others
PLAN REVIEW – ATTACHMENT B
BEHAVIOR MODIFYING DRUGS
➢ Level of participation in plan development
➢ List each psychoactive drug prescribed and the corresponding challenging behavior(s)
➢ List each behavioral objective with criteria for fading the medication
➢ Explain the adaptive alternative behavior/skills to be introduced
➢ What is the potential outcome if the medication(s) is not used/Risk to person or others
➢ What are the potential risks for the person as a result of the use of each medication
PLAN REVIEW – ATTACHMENT B
BEHAVIOR MODIFYING DRUGS > PHYSICIAN’S STATEMENT
➢ Medication/Dose
➢ Behavior(s) targeted by this medication
➢ Possible side effects and/or potential risks associated with this medication
➢ How is effectiveness of medication determined
➢ Conditions under which you would consider decreasing this dose
➢ Conditions under which you would discontinue this medication
➢ Recommended frequency of medication review
➢ Special concerns or notes
PLAN REVIEW – ATTACHMENT C
RESTITUTION
➢ Agency affirms compliance w/COMAR 10.22.02.10A(11)
➢ Regional Director notification date
➢ Level of participation in plan development
➢ Describe the specific nature and history of all challenging behavior(s) that may result in property damage
➢ How is the person’s ability to pay for damages determined, including the cap on amount
➢ List each behavioral objective with criteria for fading use of this measure
➢ Explain the adaptive alternative behavior/skills to be introduced
➢ What is the potential outcome if this measure(s) is not used/Risk to person or others
➢ What are potential risks incurred by use of this measure/Risk to person or