105.C.3 This regulation does not differentiate between types of behavioral treatment plans (those that contain restrictive practices and those that do not) and requires review and approval by the independent review committee prior to implementation of all plans.

To require this review for all plans (even when only positive reinforcement/support is included) is not a reasonable expectation for an agency that develops a high number of behavioral treatment plans. (Our organization develops over 300 such plans annually, with frequent monitoring/amendments, as needed.)  In addition, requiring such review prior to implementation (for plans without restrictive elements) hinders a person's timely access to sound therapeutic treatment which needs to begin the day of admission.

A proposed alternative is to require all restrictive plans be reviewed by the committee prior to implementation and a percentage of positive plans be reviewed within 30 days of implementation.

105.E  Again, this regulation does not differentiate between plans, whether all-positive or containing restrictive elements, requiring LHRC determination prior to implementation.

Consistent with best practices, and in compliance with other external requirements, our agency develops positive behavioral treatment plans to begin the day of admission. These initial plans are assessed for efficacy with revisions made promptly to assure responsiveness to changing needs of individuals.

If only positive practices are used, this regulation is not reasonable and would clearly have a negative impact on timely access to sound therapeutic treatment.