(a) When a behavior therapy program must be developed. An individual's treating psychologist, with input from the individual's interdisciplinary team (IDT), must develop a written behavior therapy program for the individual if:
(1) the IDT recommends the use of a highly restrictive procedure or other restriction of the individual's rights or privileges to modify or replace a targeted behavior; or
(2) the individual is receiving medications intended primarily for the treatment of a psychiatric disorder.
(b) Functional analysis.
(1) The individual's treating psychologist must implement a functional analysis before developing a behavior therapy program.
(2) If an individual participates in a program outside the state MR facility (e.g., attending public school or working), the functional analysis must involve the outside program. The state MR facility must invite staff of the outside program to participate in the functional analysis.
(3) The individual's treating psychologist must develop a written protocol if the functional analysis will involve any of the following:
(4) A written protocol, as required in paragraph (3) of this subsection, must:
(5) Before implementing a functional analysis that requires a written protocol a state MR facility must ensure that staff:
(c) Development of behavior therapy program.
(1) If an individual participates in a program outside the state MR facility (e.g., attending public school or working), the individual's IDT must invite staff of the outside program to participate in the development of a behavior therapy program that will be implemented while the individual is on the state MR facility campus.
(2) If the individual's treating psychologist and IDT determine that an individual's behavior therapy program should include a highly restrictive procedure, then the determination of which procedure to use must be based on:
(3) As required by 40 TAC §90.42(e)(4)(A) (relating to Standards for Facilities Serving Persons with Mental Retardation or Related Conditions), if restraint is the highly restrictive procedure being considered by the individual's IDT as an intervention in a behavior therapy program, a physician must participate on the IDT concur with the IDT's recommendation concerning the use of restraint.
(4) An individual's behavior therapy program must be developed and implemented as described in this subchapter and 42 CFR §483.450 (Condition of Participation: Client Behavior and Facility Practices).
(5) The written behavior therapy program must:
(d) Review and approval of and consent to a behavior therapy program. Prior to implementation of a behavior therapy program, the state MR facility must ensure that:
(1) the behavior therapy program is reviewed and approved by:
(2) staff obtain legally adequate consent, consent, or authorization in accordance with §415.407(a) or (b) of this title (relating to Requirement to Obtain Legally Adequate Consent, Consent, or Authorization); and
(3) staff document the legally adequate consent, consent, or authorization in the individual's record.
(e) Use of a highly restrictive procedure.
(1) Except as described in paragraph (2) of this subsection, a behavior therapy program utilizing a highly restrictive procedure will not be approved by an individual's IDT, the state MR facility's HRC, or the state MR facility's behavior therapy committee unless a behavior therapy program that utilizes less restrictive procedures has been systematically attempted and failed to modify or replace the targeted behavior. Procedures for teaching replacement behaviors must be implemented simultaneously.
(2) If an individual's inappropriate behavior is so severe (i.e., life threatening) or of such duration that other therapeutic approaches are currently precluded, the individual's IDT, the HRC, and the behavior therapy committee may approve and the state MR facility may implement a behavior therapy program that utilizes a highly restrictive procedure without first attempting a behavior therapy program that utilizes less restrictive procedures.
(f) Monitoring by qualified mental retardation professional (QMRP).
(1) The individual's QMRP, as defined in 42 CFR §483.430(a), concerning qualified mental retardation professional, must review the behavior therapy program to assess whether the specified behavioral objectives are being met:
(2) If the individual's QMRP determines that the behavioral objectives specified in the program are not being met, or that significant changes in the individual's behavior, functioning level, or physical or medical condition have occurred, the QMRP must notify the individual's treating psychologist.
Source Note: The provisions of this §5.406 adopted to be effective June 23, 2004, 29 TexReg 5939; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841