Behavioral Support Services

DDA is committed to providing positive behavioral supports (PBS) to individuals requiring behavioral support both programmatically and in emergency situations. This approach includes an emphasis upon the use of non-restrictive behavioral procedures and the reduction of physical restraints. Positive behavior interventions include key elements which include collaborative team-based decision-making, person-centered decision-making, self-determination and functional assessment of behavior

Staff observations of problem behavior are an important point of entry. These observations may require that an incident report be written. Staff may be advised to begin to collect behavioral data (ABC- antecedent-behavior-consequence) including the date and time of the incident/behavior, duration, frequency and intensity as well as identifiable antecedents and consequences.

Incident Reports available through the DDA PORII system provide a source of initial potential data requiring further evaluation. Behavioral incidents may include physical and verbal aggression, self -injurious behaviors, property destruction, pica and elopement.

A pattern of behavior (typically three or more behaviors either the same or different) and/or one or two high intensity (severe) behaviors need to be discussed by the individual’s interdisciplinary team (treatment team) and may precipitate a referral for behavior consultation.

How do I access behavioral services?

Behavioral Services are provided by Humanim Maryland Behavioral Support Services Partnership is available 24/7 by calling 888-374-3276. www.bss4md.com

Humanim (serving the Central Region) functions as the lead agency in collaboration with The Arc of Southern Maryland (serving the Southern Region), The Arc of Washington County (serving the Western Region), and Somerset Community Services (serving the Eastern Shore). Humanim provides comprehensive Statewide Behavioral Support Services to Maryland residents with intellectual and developmental disabilities.

Types of Services available include the following:

  1. Behavioral Assessments:

    In most cases Behavioral Assessments are the beginning point of entry (the first step in developing behavioral support strategies for the individual in need). These comprehensive assessments are conducted by trained clinical professional staff, typically a licensed psychologist. psychology associate under the supervision of a licensed psychologist or a licensed professional counselor (all of whom are required by COMAR to have training and experience in applied behavior analysis- usually referred to as ABA). This comprehensive assessment will always include a functional assessment/functional analysis of the problem behavior (s) in the individual’s primary environments (i.e. home, work, school etc.) as well as an environmental assessment (s), direct observation (including an ABC analysis), record review, development of specific behavioral objectives (including a data base) and hypotheses for each problem behavior. A comprehensive written report will always be generated for the caregiver and/or provider. The behavior assessment will conclude with a recommendation for one of the following tiers of behavioral support:

    Tier 1 (positive interactions, choice making, predictable/proactive setting/environment);
    Tier 2 (social, communication, emotional, physiological intervention/therapy; or
    Tier 3 (individual behavior plan)
  2. Behavioral Consultation:

    Behavioral Consultation primarily involves the development of Tier 1, Tier 2, and Tier 3 behavioral intervention strategies working in conjunction with the interdisciplinary team. This may involve collaboration with other treatment professionals as well as family members. The next steps are training (family and staff) on the implementation of the strategies, development of data collection procedures, as well as monitoring , review and data based evaluation.
  3. Behavioral Support:

    Behavioral Support is then provided typically by behavioral technicians as a follow-up activity, complimenting and ensuring that strategies and recommendations are being implemented consistently/correctly and that expected behavioral outcomes are being achieved.
  4. Mobil Crisis Intervention Services:

    MCIS services are available 24/7/365 Statewide (accessed by calling 1-888-374- 3276. The call center is answered by a trained crisis intervention staff. The MCIS Team will present on site to a crisis within 1-3 hours.

    Mobile crisis intervention services should be used in response to a behavioral, acute psychiatric or situational emergency that may result or has resulted in a harmful or potentially harmful outcome to a person who has been found eligible for DDA services and is currently receiving DDA services. MCIS will include expedited on-site evaluation/consultation, completion of an Initial Crisis Behavioral Assessment (within 24 hours of the intervention), coordination of services with locally based Emergency Departments, psychiatric units, acute care hospitals, state psychiatric hospitals, DDA licensed providers, Core Services Agencies, and other locally-based human and generic agencies. The goal of these services is to reduce harm to self or others, minimize emergency hospital admissions, limit police/legal involvement, and/or facilitate placement at the appropriate level of care.
  5. Behavioral Respite:
    Access to this service is contingent upon referral/authorization from the appropriate DDA Regional Office. DDA has developed a list of criteria for appropriate referrals.

    Behavioral Respite is a highly structured intervention that provides intensive behavioral services in a well- controlled, behaviorally managed residential environment with the primary purpose of reducing the frequency, intensity, and duration of problem behaviors and/or manage co-occurring mental health issues so that the individual is able to return to a community-based placement either through a DDA provider or family/caregiver. Access to this service is contingent upon referral/authorization from the appropriate DDA Regional Office. DDA has developed specific behavioral criteria for appropriate referrals.
  • Please note that a number of licensed DDA provider agencies and also families have made the decision to use behavior support providers working outside of the Humanim network. In some cases these providers may provide a different service delivery model. This choice is acceptable given that the providers meet all applicable COMAR standards. On the Eastern Shore it may also be possible to receive behavior support services from State employed psychology associates working under the supervision of a licensed psychologist.

 

For questions and/or additional information contact Michael A. Bluestone, Ph.D., BCBA-D, DDA Headquarters at 410-767-5803, michael.bluestone@maryland.gov