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Jonathan Graf

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Jonathan Graf
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Understanding Professional Behavior Services

The need for Professional Behavior Services is determined through a Functional Needs Assessment in combination with the Individual’s goals identified through the person-centered planning process e.g. Individual Support Plan (ISP).

All Professional Behavior Service activities must be for the direct benefit of the Medicaid beneficiary and intended to determine if formal supports are needed; develop a Positive Behavior Support Plan (PBSP); and offer training to the providers assisting the individual who is at risk for engaging in challenging, dangerous, or unsafe behaviors, which may impede activities of daily living (ADL) or instrumental activities of daily living (IADL) or health related tasks.

Please answer the following questions to be considered for Graf Consulting services:

 
Individual's name *
Individual's address *
Individual's phone number
Parent / guardian *
Parent / guardian phone number *
Provider phone number
Case manager (SC/PA)
Please select all that apply
Consultation expectations
The relationship with the behavior consultant is professional, not therapeutic. Consultation is short in nature and limited in scope. Consultation offers guidance utilizing evidence-based practices; however, consultation does not diagnose any medical or psychological condition, nor offer any treatment, nor is a substitute for counseling, psychotherapy, mental health care, or substance abuse treatment. Behavior Professional follows Positive Behavior Supports and Interventions (PBIS) by developing: A Functional Behavior Assessment (FBA) based on the following: file review, direct observations of the individual; review of historical behavior data; interviews with the ISP team and others as applicable; an assessment of the environment germane to the individual. The written FBA includes description of challenging behavior(s); a clear justification for the need to alter behavior; current abilities and skills; identifies the function of behavior; and offers a hypothesis regarding the underlying causes. HCBS guidelines authorize up to 15 hours to complete FBA. A Positive Behavior Support Plan (PBSP) based on the FBA is designed to render the individual’s challenging behaviors irrelevant, inefficient, or ineffective while reinforcing alternative behavior that achieves and satisfies the same need as the challenging behavior. The written PBSP should contain positive behavior interventions and supports to help the designated persons deescalate, or tolerate challenging behavior when they occur. Included is a description of challenging behaviors exhibited by the individual; the individual’s baseline behavior; setting events and antecedents; proactive, reactive, emergency/crisis, and recovery strategies; consideration of biopsychosocial factors which may influence behavior; person-centered thinking; functional alternatives; things that are important to be avoided in the person’s life so the person may accomplish attendant care skills e.g. ADL/IADL, health-related tasks; and develop a behavior data collection. HCBS guidelines authorize up to 12 hours to complete and train the PBSP. In very limited situations, the use of restrictive interventions may be added to an individual’s PBSP including the use of Safeguarding Interventions or Safeguarding Equipment. Only Behavior Professionals authorized through the Oregon Intervention System (OIS) may author any OIS maneuver. This includes writing appropriate Protective Physical Interventions (PPIs) into the PBSP as an Emergency Crisis Strategy (last resort) only; OIS training of providers paid and unpaid; reviewing the staff’s and providers’ continued demonstration of physical techniques for applicable PPIs. HCBS guidelines authorize up to 3 additional hours to complete additional requirements. In the event Safeguarding Interventions are necessary strategies, a formal HCBS Individually-Based Limitations (IBL) must be completed by the ISP team. Ongoing Behavior Consultation Services can be approved by the Case Management Entity for individuals requiring maintenance of the PBSP. Ongoing Maintenance of the PSBSP may be authorized for up to 18 hours per plan year.
Individual and provider expectations
The individual and providers apply the strategies outlined in the PSBP and are responsible for collecting behavior data for effectiveness. Sustainable application of the PBSP requires continuous maintenance through accurate practice, up-to-date trainings e.g. OIS, and ongoing measurements and goals, implemented by the individual, providers, and ISP team.
Confidentiality
Confidentiality is protected by law. The Individual/Medicaid recipient’s identity and personal information will be kept strictly confidential. There may be circumstances, such as medical emergencies or behavioral crisis, when it is necessary to share specific information to prevent a serious threat to health and safety of the individual. Information may be released with expressed written permission from the Individual, guardian, and/or case manager, or required by Court Order. All personal information must be sent electronically via secured email or redacted. Packets can be mailed to Graf Consulting or hand-delivered. The Individual/Medicaid recipient, (and/or) parent, (and/or) guardian must sign the Release of Information form prior to any services rendered.
Mandatory reporter
Behavior consultants are mandatory reporters and must report suspected abuse and suspected neglect in good faith. This includes but not limited to: physical mistreatment, financial exploitation or theft, psychological or emotional harassment, physical or chemical restraint, involuntary seclusion, sexual abuse, neglect, self-neglect, abandonment.
File review
If available, the following information should be made available for review: - Personal information sheet or contact list - Functional needs assessment(s) e.g. ONA, CNA/ANA, SNAP, SIS - Eligibility determination documentation e.g. psychological evaluations and assessments - Behavior data and history of behavioral challenges - Medical history, relevant medical records, current medication list, MAR/TAR - Individual Education Plan (IEP), school BSP, or vocational BSP - Person-centered planning e.g. ISP and supporting documents - Former FBA/BSP or mental health guidelines - Legal status e.g. probation restrictions or conditions of release - Residential placement history - Relevant incident reports, progress notes, and case notes
Behavior data tracking
Behavior must to be tracked regardless of the Service Element. Common methods of behavior tracking includes daily: journaling, progress notes, incident reports (as needed), tally sheet, task analysis sheet, or a Likert scale. Behaviors should be tracked beginning the time the request is made in order for the Behavioral Consultant/Behavior Professional to complete the Functional Behavior Assessment.
Fees, payment schedule, and services
Professional Behavior Services fees, payment schedule, and services are outlined in the Oregon DHS/ODDS Expenditure Guidelines. Graf Consulting will invoice for payment after each service is delivered.
Additional information
Jonathan Graf, Behavioral Consultant at Graf Consulting, is an OIS Mentor Instructor. He is a Behavior Professional Medicaid Provider through Oregon DHS/ODDS and operates within the State of Oregon. Qualification and references are available upon request.
Acknowledgment and release of liability:
There are risks associated with Professional Behavior Services including social, emotional, or physical, depending on the Individual’s challenging behavior and environment. I fully acknowledge there may be risks not known or foreseen at this time. Services are requested at the Individual’s, and if applicable, the parent/guardian’s own choice and with inherent singular responsibility. By signing this disclosure and consent statement, I acknowledge that I understand using any Professional Behavior Services with Graf Consulting is without warranty of any kind and “as is,” either expressed or implied, including but not limited to: guidance, technical assistance, information, interventions, strategies and supports, products, materials or equipment in connection with Professional Behavior Services, OIS maneuvers, or training. I am fully responsible for implementing the supports and strategies outlined in the services e.g. FBA/BSP; and it is my responsibility to make informed decision about the accuracy of the information provided. A written plan and training cannot replace sound judgment. I agree to hold harmless Graf Consulting, Jonathan Graf, any Behavioral Consultant/Behavior Professional associated with the behavioral consultation, from all liabilities and claims which may arise as a result of my participating in Professional Behavior Services. Behavioral Consultant/Behavior Professional may choose at any time to end services. Timelines and services are subject to change without notice.
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- Jonathan Graf

 

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