Behavior Support Services

Frequently Asked B​ehavior Support Services Questions

Question
Answer
What are Behavior Support Services (BSS)?
Aging and People with Disabilities (APD) has permission from the federal government to provide Behavior Support Services as part of its Home and Community Based Care (HCBC) "K" Plan. Behavior Consultants will provide the service as employees or sub-contractors of agencies who have a contract with DHS to provide the service. APD case managers will refer clients to this contracted agency. Services cannot be provided without case manager authorization.

The goal of the Behavior Support Service is to reduce the frustration, injuries, stress, placement failures and crisis situations that result when people who have persistent and difficult behaviors are not provided with the support they and their caregivers need. Activities provided by the Behavior Consultants focus on assisting caregivers to change their behaviors and learn to use the client’s daily activities, schedules and interests to promote positive interactions, experiences and behaviors.
What is Positive Behavior Support?
This is an evidence-based set of practices developed over the years within the fields of special education and behavioral psychology. The practices are based on philosophies of person-centered care, self empowerment and autonomous decision-making.

The APD program Behavior Support Services was piloted for three years in Jackson and Josephine counties and is based on a curriculum developed especially for caregivers who work in APD settings.

An evaluation of these pilots indicated that caregivers and case managers found the service to be valuable and save time, and that placement changes decreased for clients receiving the service. More information on this approach can be found at www.otac.org.
Who can provide this service?
Agencies who are contracted as a provider of BSS must deliver the service only with Behavior Consultants who have passed the Competency Evaluation.

Contractors are selected based on experience with persons who use our services, familiarity with the APD delivery system including local office functions and their plans to hire and support persons who met Behavior Consultant qualifications.
How do I access a Behavior Consultant?
Local offices in these areas have developed a referral process with the contractor in their area. The referral process will include an internal system for local offices to prioritize clients, track referrals and ensure supervisor participation in referral decisions.
What will Behavior Consultants do?
The goal of the Behavior Consultant service is to focus on changes that can be made by the caregiver or within the person’s environment. Unlike traditional methods of behavior 'management,' this approach changes the caregivers and person's routines rather than expecting the person to change.

Using observation, interviews and environmental evaluations the Behavior Consultant will develop a Behavior Plan with ideas, strategies and practical approaches to help caregivers create or maintain a positive relationship with the person they serve.

The Behavior Consultant is expected to complete the assessment, behavior plan and provide onsite teaching/coaching and revisions within 120 days of referral acceptance.

The service can be repeated one time within 12 months or more often with central office authorization.
Who can receive Behavior Support Services?
Each local office will develop a priority system for identifying referrals with the contracting agency in their area. Persons must be Medicaid-eligible and receiving services in their home or a community-based care setting.
Who cannot receive BSS?
Right now the service cannot be provided to persons who are in nursing homes, hospitals or a Program for All-Inclusive Care for Elders (PACE).
Is this the same service provided to persons with Developmental Disabilities?
The training curriculum is based on a model of Positive Behavior Supports that is widely used in the field of Special Education and Developmental Disabilities.
Can a person receive mental health services and BSS?
Yes. Behavior Support Services do not duplicate services provided under a person's Medicaid Rehabilitation benefit.

In the rare instance when a person has a mental health provider who is delivering services at the person’s home and those services include the development of a behavior plan, then the case manager is advised to contact matthew.baldwin@state.or.us who will facilitate a review of the case to ensure that the services are not duplicative.
How do behavior consultants work with case managers?
Behavior consultants must provide the client's case managers with timely email and completed documentation of the work they are doing for the client.

Concerns about the person’s placement, healthcare, medications or a caregiver’s skill sets need to be communicated by the behavior consultant to the case manager and either the lead caregiver or licensed provider.

It is important for case managers to retain their leadership in managing these issues so that the behavior consultant can spend their limited service hours on creating an effective behavior plan, teaching all critical caregivers how to use the care plan and how to change it.
How do behavior consultants work with other professionals?
The services provided by a consultant are intended to complement but will not substitute for mental health, medical or nursing evaluations.

While the behavior consultant might alert a licensed provider or case manager to a health issue that may be impacting the behavior, they should not be the person who coordinates with the nurse or primary care provider.

The behavior consultant might work alongside a mental health professional but the service is not an alternative for either a mental health assessment or therapy. Participation in the client's formal care planning process is not a function for the behavior consultant, but if authorized by the case manager they might participate as a resource to the person's care planning team.

This service is designed to be proactive and is not to be used in a protective service or crisis management situation. However, it could be provided to support a post crisis plan.
What is the Behavior Plan?
The consultant will create written recommendations called a Behavior Plan within 30 days of the referral acceptance date. Copies of this plan are provided to both the case manager and the caregivers.

The plan is intended to be used by one or several caregivers while interacting with a specific resident. The caregivers and their employers will have the responsibility to decide how to incorporate this plan into whatever care planning process is required in their setting.

The behavior consultant is expected to provide both group teaching and individual coaching to caregivers on how to implement and revise the plan. The consultant must provide the case manager with progress notes on a mandatory form documenting all contacts with the client and his/her caregivers.
How are consultants reimbursed?
All services for Medicaid clients must be prior-authorized by the client’s case manager. Contracted BSS agencies have a Medicaid provider number. Local offices have a process using case managers to authorize client specific vouchers using the HATH screens and procedure code OR210.

Hourly rates for the service are established in contracts with each agency. Services are designed to be provided for up to four months at a time with a maximum of 40 hours per client. The four-month/40-hour service can be repeated in a 12 month period.

Consultants provide documentation to the case manager using the Progress Notes form at the time the agency submits their claim. Remittance or payment is provided to the contracted agency on a monthly basis.
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