human rights and restrictive procedures: webcast 4: human

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Human Rights and Restrictive Procedures: Human Rights in Depth

Webcast 4: Human Rights Committees (HRC)

Course # - ID-2021-19

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Music only.

Course #: ID-2021-19 1

Human Rights and Restrictive Procedures: Webcast 4: Human Rights Committees (HRC)

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• Complete all listed course requirements based on your role• Open, save or print your certificate in order to receive credit for course

completion

Certificates of Achievement

Certificates of Achievement will be available to all staff of Direct Care Provider Agencies and Supports Coordination Organizations after completing all course requirements.

Please view and then save or print your certificate in order to receive credit for this course.

Course #: ID-2021-19 2


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Curriculum Outline


• Webcast #1 – Responsibility to Inform and Strategies to Support People to Exercise their Rights

• Webcast #2 – How to Make a Determination

• Webcast #3 – Human Rights Teams

• Webcast #4 – Human Rights Committees

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Hello, my name is Frank Schweigert from The Columbus Organization. This is the last of four webcasts developed for all stakeholders. The focus of this series is on standards for service provision and requirements for Human Rights Teams and Human Rights Committees as identified in the 55 PA Code 6100 Regulations and the Guidance for Human Rights Teams and Human Rights Committees Bulletin.

This training may be used to meet training requirements identified in the 55 PA Code 6100 Regulations.

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6100 RegulationsGuidance for Human Rights Teams and

Human Rights Committees Bulletin

This webcast series was produced in advance of the release of Guidance for Human Rights Teams and Human Rights Committees Bulletin (HRT/HRC Bulletin) and the new Incident Management Bulletin (targeted for implementation on 7/1/2021). The series is based on the most current draft versions and ODP does not anticipate any significant changes at this time. In this webcast we will highlight and explain many of the requirements and expectations for Human Rights Teams and Human Rights Committees included in the HRT/HRC Bulletin and we will be referencing it throughout this presentation. A copy of the 6100 Regulations, HRT/HRC Bulletin, and the Incident Management Bulletin will be included as a resource with this webcast.

This webcast series is not an acceptable alternative to fully reading the complete regulations and bulletins. You may want to print a copy of these resources and have them available as you complete this webcast series.

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Objectives of Training

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At the end of this webcast, participants will be able to describe:

• The goal of the Guidance for Human Rights Teams and Human Rights Committees Bulletin, the 6100 Regulations, and current AE Operating Agreement

• The function of the AE level Human Rights Committee (HRC)

Here are the objectives of this webcast. At the end of this webcast, participants will be able to describe:

* The goal of the Guidance for Human Rights Teams and Human Rights Committees Bulletin , the 6100 Regulations, and current AE Operating Agreement.

*The function of the AE level Human Rights Committee (HRC) based on the AE Operating Agreement and best practice standards.

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Goals of the HRT/HRC Bulletin

Modification of rights is a significant step taken

to protect a person’s health and safety and

as a last resort.

Human Rights Teams and Human Rights

Committees enhance the protection of people’s rights.

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In the first webcast we focused on identifying and describing the basic individual rights of everyone, including people with Intellectual Disabilities and/or Autism. The second webcast recognized that in order to protect the person’s health and safety, there may be times where a modification of these rights may be necessary. The second webcast stressed that actions taken by the teams to implement restrictive procedures and/or modify an individual’s rights in order to protect the person’s health and safety should only be a last resort, taken when all other less restrictive strategies and interventions have been exhausted. In addition, the second webcast stressed the need for teams to ensure that Behavior Support Plans also include strategies and opportunities for the person to continue to acquire the skills needed to minimize the length of time a restrictive procedure or modification of rights is needed.

Because of the significance of the actions to modify the rights of a person to protect their health and safety, the role of the Human Rights Team (HRT) and Human Rights Committee (HRC) is the focus of the third and fourth webcasts. The HRCs are meant to enhance the capabilities of agencies to protect the rights of the people they support. With the support of the HRC, the HRT helps to ensure any modification of those rights, including that the use of restrictive procedures are used only as a last resort and are applied only as long as necessary to protect the person’s health and safety.

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Goals of the HRT/HRC Bulletin

Minimum expectations:• Medicaid Waivers• Regulations (6100,

6400, 6500, etc…)• Federal Home and

Community-Based Services Rule

• ODP Bulletins• AE Operating

Agreement

Best practice strategies

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HRT/HRC Bulletin – pages 1and 2

The HRT/HRC Bulletin provides guidance on the purpose and function of the HRT/HRC and also provides best practice recommendations related to the review, implementation, and oversight of the use of restrictive procedures in order to meet the requirements of the Waivers, Regulations and Operating Agreement.

The HRT/HRC Bulletin identifies the minimum expectations for the HRTs and HRCs; what must be done to be in compliance. The HRT/HRC Bulletin also identifies best practice strategies; what should be done that exceeds the minimum requirements to promote the high‐quality services and supports we should all strive for.

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Human Rights Committees(HRC)

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Let’s now take a look at the expectations and purpose of the Human Rights Committees or HRCs and their role in enhancing the rights and safety of the individuals being supported.

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Summary of HRC Expectations

AE Role: Human Rights Committee (HRC)

• Oversight

• Systemic review of restraint and restrictive interventions

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HRT/HRC Bulletin – page 3

Per the AE Operating Agreement, each AE is responsible to develop and maintain a Human Rights Committee (HRC) to safeguard the human, civil, and legal rights of individuals receiving services and supports. For agencies supporting individuals through the Bureau of Supports for Autism and Special Populations (BSASP), BSASP fills the role of the HRC. The AE and BSASP, through the work of the Human Rights Committee, maintain a key role in overseeing the utilization of restrictive procedures within the service system.

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HRC Scope of Work

• Monitors outcomes of HRTs

• Systemic review of: – Restraints and restrictive

procedures used– Data related to frequency

of restrictive procedures– Data regarding rights

related issues

• Drives processes for improvement

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HRT/HRC Bulletin – page 11-12

The HRC does not have a role in approving the use of restrictive procedures, unless the AE has agreed to act as the HRT for a provider or in other special circumstances. But instead, the HRCs provide a consistent process for monitoring and oversight of the approval and use of restrictive procedures approved by the HRTs.

The scope of work for the HRC can be very diverse. The HRC provides a mechanism for the systemic review of incidents that involve the use of restraint and rights violations. Through the systemic analysis completed by the HRC, the AEs (or BSASP) will be able to recognize and address trends, facilitate activities to reduce the use of unnecessary restrictive procedures, improve practices associated with the use of restrictive procedures, and ultimately provide recommendations to the AE and agencies for improving the service system.

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The systemic reviews completed by the HRC help to ensure that the use of restraints and restrictive procedures is appropriate and necessary, include best practices regarding the protection of individual rights, and are the least restrictive interventions. Review by the HRC also helps to ensure that when restrictive procedures are utilized, the plan also includes effective strategies to reduce or eliminate the need for those restrictive procedures in the future. In this way, the HRC supports the AE’s oversight role in the use of restrictive procedures. The HRC also provides support and oversight to HRTs by tracking, monitoring, and reviewing the use of restrictive procedures and the process by which they are authorized.

HRCs are not required by the Bulletin to fully review all plans that include the use of restrictive procedures, but the HRCs should review a representative sample of agency plans. The methodology used to identify this sample is to be determined by the AE and must be described in the AE’s HRC policy. This is especially important where one agency is responsible for multiple restrictive plans or where similar restrictive procedures are being implemented across providers.

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HRC Responsibility

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• Systemic reviews

• Sample of behavior support plans with restrictive procedures

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HRCs Collect, Maintain, and Analyze Data

• Types of interventions implemented

• Trends of incidents including abuse, neglect and exploitation

• Trends and patterns related to rights violations

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While HRCs are not required by the HRT/HRC Bulletin to complete detailed reviews of all behavior support plans, they are responsible to collect and maintain data from all of the behavior support plans that contain restrictive components. The HRCs are expected to review policies, incidents, and plans that authorize the use of interventions that have the potential to impact individuals’ rights and analyze the data to identify and address any potential systemic concerns.

At a minimum, the HRC should:* Monitor and track the types of interventions being implemented in plans.

* Monitor incidents and conduct trend analysis of incidents, including those alleging abuse, neglect or exploitation.

* Monitor and identify trends and patterns contained in incident data and any other available data sources related to rights violations.

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The sample spreadsheet on this slide includes the minimum information requirements identified in the Bulletin that should be collected, maintained, and used by the HRC in their analysis. This sample layout is not a required format. Based on the unique needs and priorities of each HRC, additional information may need to be collected and the layout can vary. However, each HRC should be sure that the information they collect includes at minimum all the elements identified in the Bulletin.

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HRC Responsibility

Collecting, maintaining and analyzing data from all plans that contain restrictive components.

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As a result of the HRC’s review and analysis of this information, the HRC is better equipped to provide agencies with the necessary technical assistance to support the promotion of individual rights. The HRC can also support development of positive intervention strategies that can eliminate or reduce the need for restraints and restrictive procedures. This support includes but is not limited to providing information and training related to Human Rights, Restrictive Procedures, and other topics requested by agencies.

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HRC – Best Practice Considerations

HRC review and analysis can:

• Provide technical assistance

• Support positive interventions

• Provide information and training

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HRT/HRC Bulletin – pages 13-14

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The Bulletin also identifies a number of areas where the HRC may consider engaging in other activities as part of their responsibility. These activities can be coordinated with the existing AE Incident Management and Quality Management requirements to support the promotion of individual rights.

Included in this list for consideration are:

* Reviewing and approving restrictive procedures when they are complex in nature, a potential HRT conflict of interest exists, or when there is a question if a procedure is allowable or prohibited.

* Evaluating individual incidents of restraint or restrictive procedures and providing recommendations for improvement. The goal here is to ensure that the intervention was necessary for the health, safety, and welfare of the individual and others, and was consistent with the philosophy of least restrictive intervention.

* Coordinating activities between multiple service system stakeholders to support human rights.

* Conducting a comprehensive review of complex or systemic issues and concerns that involve human, civil and legal rights violations brought by individuals, families, guardians, advocates, agency staff and administrators, or any other service system stakeholders.

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HRC – Best Practice Considerations

• Review and approve restrictive procedures:– that are complex.– where potential HRT conflicts of

interest exist.– to determine if a restrictive

procedure is allowable or prohibited.

• Evaluate incidents and provide recommendations for improvement

• Coordinate activities between stakeholders

• Review complex or systemic issues and concerns

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HRT/HRC Bulletin – pages 13-14

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HRC Membership

• Provides recommendations related to human rights issues, including the approval of restrictive interventions

• At least one member of the HRC should not be employed by the AE

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In order to support best practices and effective analysis of the information presented, the HRC must be comprised of members that are able to review and provide recommendations related to human rights issues up to and including approval of plans related to the modification of rights. All members of the HRC should have an opportunity to receive training on human rights and freedoms, applicable policies and interventions, and other topics related to their responsibility to protect and promote rights. The Bulletin also recommends that at least one member of the HRC should not be employed by the AE.

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HRC Membership

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Individuals

Family Members

Experienced Direct Care

Workers

Other Agency Staff

Outside Stakeholders

Advocacy Groups

Supports Coordination Organizations

Similar to the HRTs, HRC membership can include representatives from a variety of groups, with no one group constituting a majority, if possible. Each member of the HRC should be able to commit to regular meeting attendance, to objectively review and provide feedback on behavior support plans including those with restrictive procedures, and participate in other rights related discussions.

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HRC Roles and Responsibilities

• Chairperson– Group leader

– Resolve disputes

– Meet the qualification requirements related to Behavior Support.

– Qualify as voting member

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The role of the HRC Chairperson is to ensure consistency to the process and resolve any disputes that may arise. Given the nature of the position and the anticipated scope of work, including the possibility of the HRC functioning at times as a HRT, the chairperson should meet the qualification requirements for Behavior Support set forth in § 6100.344(b).

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The AE also needs to develop and implement a written policy that establishes HRC operating procedures including membership roles and responsibilities; data collection and sampling methodology; conflict of interest; frequency, structure, and documentation of meetings; alerting the AE of discovered concerns; and communication with stakeholders. The policy must also establish the protocols and training to ensure the confidentiality of information reviewed by the HRC is understood and followed. The HRT/HRC Bulletin provides additional details regarding the procedures to be included.

In the event the HRC chooses to fulfill the responsibilities of an HRT for an agency, the HRC operating procedures must also include methods to meet the standards established for an HRT in the HRT/HRC Bulletin. It is important to understand that each AE’s HRC is only eligible to act in the scope of the HRT to review plans for individuals that are registered with that AE, regardless of the AE of residence.

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General Guidelines for AEs

Develop policies describing operating procedures to support the work of the HRC.

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At a minimum, each HRC meeting needs to include a sample review of behavior support plans that contain restrictive procedures and were approved by the HRT. This review should be intended to ensure the plans include all the required components and determine the appropriateness of the approaches identified. To further protect the human rights of the people being served, each HRC meeting also needs to include trend analysis of incident and other available data in order to provide recommendations for policy changes and strategies.

In order to facilitate the effective use of time and thoughtful consideration of the information discussed at these meetings, an agenda and the supporting documents to be reviewed, such as Individual Support Plans, Behavior Support Plans, data, incident reports, and policies/procedures, are to be provided in advance to the HRC members.

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Meeting Structure

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Random sample of plans

Appropriateness of restrictions

Trend analysis

Technical Assistance/ Oversight

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Now let’s go back to John’s story and the role of the HRC. The HRT has approved John’s plan for 3 months, with monthly reviews by the ISP team to monitor the effectiveness of the plan and explore some of the unanswered questions the team had identified. During this time an HRC meeting is held and John’s plan is randomly selected for review. The data provided continues to show that while John is generally cooperative with the plan and has not called the police, he is still struggling with keeping his phone in his locker at work and wants to call his friends late at night. The staff supporting him have so far been unable to identify any specific reason for the other changes in his behavior that were identified in the plan.

What are some of the questions you would have as member of the HRC? Some of their questions should be:

* Are the current interventions allowable?

* Does the plan contain all the required components?

* Does the behavioral data support the interventions included in the plan?

* Was the plan approved appropriately through the Human Rights Team?

* Has it been reviewed by the HRT within the minimum time requirements?

* Do the current efforts to support John appear to be the least restrictive interventions to protect John’s health and safety?

* Is there an appropriate plan to fade the need for the restrictive procedure?

And then on the systemic level the HRC would also need to consider:

* How does this situation compare to other situations within the agency or within the AE?

* Are there unmet needs (individual or systemic) such as staff training, individual education, availability of technology or community supports and capacity?

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The Plan

Random Plan Review

• Is there an appropriate fade plan?

• Are the current efforts the least restrictive interventions?

The System:

• How does this situation compare to other situations?

• Are there unmet needs (individual or systemic)?

• Are the interventions allowable?

• Does the data support the intervention plan?

• Does the plan contain all the required components?

• Was it approved appropriately by the HRT?

• Were the HRT review requirements met?

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Understanding and Protecting Everyone’s Rights

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As we conclude this webcast series, let me reinforce the importance of all stakeholders to understand and protect the rights afforded to everyone.

It is our responsibility to use strategies that promote the individual’s ability to be supported in the most proactive, least restrictive environment possible. It is also our responsibility to promote effective interventions and ensure behavior support plans with restrictive procedures are not developed, approved and implemented unless all other less intrusive strategies have proven unsuccessful.

The requirements of Human Rights Teams and Human Rights Committees through the HRT/HRC Bulletin are designed to promote and ensure that the rights of every person served through the Office of Developmental Programs are protected. If or when it is necessary to modify any of these rights to protect the person’s health and safety, these requirements ensure that proactive supports, intended to minimize the duration and need for these modifications, are provided.

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Questions

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• Human Rights• Restrictive Procedures

• 55 PA Code 6100 Regulations • Guidelines for Human Rights

Teams and Human Rights Committees Bulletin

Contact your ODP Regional Clinical Staff

This webcast highlighted many of the requirements and expectations for Human Rights Committees included in the HRT/HRC Bulletin. However, this webcast should not be considered as an acceptable alternative to reading the complete Bulletin.

Additional questions regarding Human Rights and Restrictive Procedures or the requirements within the 55 PA Code 6100 Regulations and HRT/HRC Bulletin can be directed to the ODP Regional Clinical Staff in your region. Contact information for the Clinical Staff is available as a handout in the resources section where you accessed this webcast.

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Curriculum Outline


• Webcast #1 – Responsibility to Inform and Strategies to Support People to Exercise their Rights

• Webcast #2 – How to Make a Determination

• Webcast #3 – Human Rights Teams

• Webcast 4 – Human Rights Committee

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This concludes the fourth and final webcast in this series on Human Rights and Restrictive Procedures: Human Rights in Depth, Human Rights Committees.

Please be sure to watch all four webcasts and complete all the course requirements in order to obtain your Certificate of Achievement and training credit.

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Developed and produced by

Pennsylvania Department of Human ServicesOffice of Developmental Programs

in partnership with

Music courtesy of www.essasmusic.com

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This webcast has been developed and produced by the Pennsylvania Department of Human Services, Office of Developmental Programs in partnership with The Columbus Organization.

Thank you for participating in this lesson.

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human rights and restrictive procedures: webcast 4: human

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