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10602 — Behavior Intervention Services

Posted

Link to TCADD Policy 10601

SCOPE:

This procedure applies to all Service Coordinators, Services and Supports Managers, and Psychologists of Tri-Counties Regional Center. This procedure applies to all referrals for behavioral intervention or consultation for individuals with behavior challenges, both under California Early Intervention Services Act as well as the Lanterman Act.         

PROCEDURE:

Specialized Behavior Intervention Services

  1. Overview

TCRC’s policy on behavior intervention services (10600) reflects best practices and encourages parents/key social agents caring for children or adults to participate in the intervention plan. The behavior intervention specialist authorized by TCRC provides direct intervention services to the individual for purposes of demonstrating their use to promote positive social behaviors and ameliorate behaviors that interfere with learning and social interactions (WIC S 4686.2 (b)(1)(A). Behavioral services are designed to achieve IPP goals and objectives. Behavioral services achieve IPP goals by addressing two simultaneous needs.

The first need is to teach the child receiving services new skills that will be effective, socially acceptable, and will reduce undesirable behavior. TCRC supports the well-documented position that an individual will learn, generalize, and retain new skills most effectively when family members incorporate systemic behavior intervention procedures into the rhythm and flow of their daily routines.

The second need is to encourage parents to engage in effective teaching and reinforcement of skills needed by their child or adult. In accordance with the Lanterman Act (Section 4686.2 of the Welfare and Institutions Code), and The California Early Intervention Services Act (Section 95021 of the Government Code).

TCRC Purchase of Service (POS) shall not supplant the behavior services provided by a day program, a residential facility, or a generic agency such as a school district.  In addition, families will be expected to pursue private insurance coverage and follow their insurance company’s process for accessing services and provide a letter of denial from their insurance provider and/or proof of appeal, for the Service Coordinator to keep on file before TCRC funding can be approved.  

2. Statutory/Regulatory Considerations

The Lanterman Act, located within the Welfare and Institutions Code, defines a regional center’s statutory obligations for authorizing funding for a service.  Services funded by a regional center must be:

  1. Directed toward the alleviation of the developmental disability and/or the increased functioning of the individual 4512(b).
  2. Identified in the IPP and, therefore, service must be agreed to in advance by the planning team 4646 (d) (g).
  3. Denied or unavailable from a generic resource 4659 (a) (1); 4646.4
  4. Unavailable from private entities 4659(a)(2); 4646.4
  5. Beyond typical parental responsibility for a minor 4646.4(a) (4)

In developing an Individual Program Plan (IPP) goal related to Behavioral Services, the Lanterman Act requires that regional centers consider the effectiveness and the cost-effectiveness of each option (4512) (b); 4646 (a).  Behavioral treatment plans can be designed to achieve any of the following outcomes:

  1. Decrease behavior problems by teaching desired behavior to the person served and family.
  2. Address significant skill deficits interfering with the achievement of IPP goals.
  3. Ameliorate problem behaviors that pose a threat to health and safety.
  4. Enable parents to be more effective when teaching their children.
  5. Enable person served to be a fully functioning family member and to access the community.

Services and Supports Managers shall review to confirm that more intensive options will be accessed only after less intensive options have been considered by the Planning Team.

3. Process for Accessing Behavioral Services:

Aspart of a clinical review, matching person-centered services and supports, the team with TCRC staff (minimally including the Service Coordinator, Services & Supports Manager, Autism Coordinator and Psychologist),work to determine the appropriate need and level of behavior services based on the needs of the child, individual, and family. The consultation usually will occur in the course of intake assessments or planning meetings with the family.  

A.  Once the team determines that behavioral services are needed, families are recommended to attend a Parent Orientation to Behavioral Services. At the orientation, they will receive information about what to expect from behavioral services, including recommended parent participation. Families will also have access to the recommended ADEPT parent training modules through the TCRC learning platform; the modules include information on strategies for teaching functional skills and positive behavior strategies. The service coordinator will authorize an initial assessment from a vendored behavior provider.

B.   Parents will also be informed that ARCA provides an online platform for education in Applied Behavior Analysis (basic principles of behavior, reinforcement, and preventative strategies). The online modules will be shared with them, and they may complete the modules at their own pace.

C.   The planning team will determine which behavioral vendor agency is best suited to provide the behavioral assessment. Once the selection is made, an authorization will be completed by the Service Coordinator. The Service Coordinator will authorize an in-home behavior intervention assessment to address behavior problems of the person served, and to assess the teaching and environmental needs of the family. A formal teaching plan with measurable, time referenced goals and objectives will be sent to TCRC for review and approval within 30-45 days.

D.   Parent Participation Expectations – Participation by the parent is encouraged and helps in ensuring consistency in implementing the treatment plan and generalization of gains across all settings and individuals. It is generally recommended that at least one parent will be present when direct intervention for behavior management or intensive services are occurring at home or in the community.

Parent participation also encourages all the following:

  • Completion of the Online Parent Training Modules
  • Direct implementation of intervention strategies as described in the plan
  • The purchase of materials or community activities employed if a reward system is used.

4. Methods of Delivery

All TCRC Behavioral Services are individualized and tailored to the specific needs of the individual receiving services and their family. We utilize the Planning Team process to determine which services and providers are best suited to meet the unique personal, cultural and behavioral needs of the individual and family. The Service Coordinator may consider individual hardships when necessary to accommodate especially difficult circumstances which may require adjustments to the services being authorized as described below:

A.    Contracted In-Home Parent Training

       This service is available in all three counties, in English and Spanish, and is authorized on a “per contract” basis, with a flat monthly rate. Staff utilizes Applied Behavior Analysis methods and supports the family in learning how to implement strategies to manage difficult behaviors.

Services offered through the contracted in-home parent training vendor are available from the point of referral through the remainder of the fiscal year.   Once an assessment has been completed and a plan developed, the vendor and family agree upon the frequency and intensity of services, dependent upon the need being addressed.  These are not intended to be intensive services.  

This service is designed to teach the parent/family the function of the behavior challenges and quickly and effectively replace the aberrant behavior with socially desirable behavior, and /or shows significant delays of age-appropriate behaviors. Quarterly progress reports will include measurable progress toward goals established both for the parent and the individual served.

  1. The program should be authorized “per contract” for the remainder of the fiscal year.
  2. The vendor must submit quarterly progress reports including report of individual skill acquisition, behavior reduction, and the progress the parents and family are making toward independence in the achievement of their teaching goals and objectives.
  3. Parents/family would benefit from being involved and participating in the planning, teaching, and generalization of the skills acquired. Parent participation includes, but is not limited to, observing services modeled by vendor, with the expectation to practice and implement these behavior strategies independently outside of sessions.
  4.  Regional center will assure progress through utilization review of vendor progress reports, fading plans, parent reports, and reports of independent observation and interviews with staff and family.

B. Direct Behavior Intervention Services

These Applied Behavior Analysis services are provided in the home with the intent of supporting and training the parents and other household members how to implement strategies for the reduction of dangerous and/or challenging behaviors which result in extensive property damage or physical harm to the individual receiving services or others around him/her and to avoid the need for institutional placement. Intensive behavioral services are always individualized to meet the specific needs of the individual receiving services as well as the rest of the family. 

  1. The services should be authorized in 6 month increments or less.   Services for most children will fall within the guidelines outlined in section 5 below.  Any services beyond that level must be approved by the Director/Assistant Director as an exception prior to authorization.

2.   Quarterly progress reports must be submitted by the vendor agency including cumulative graphs of individual skill acquisition, behavior reduction, and the progress the parents and family are making toward the achievement of independence in their teaching goals and objectives.

3.   Parents/family would benefit from being involved and participating in the planning, teaching, and generalization of skills acquired and maintain data on behaviors to document active involvement in the intervention program. Parent participation includes, but is not limited to, observing services modeled by vendor, with the expectation to practice and implement these behavior strategies independently outside of sessions.

4.   Regional center will assure progress through the planning/clinical team, which will meet with the family and vendor at least every 6 months to review vendor progress reports, fading plans, on-going parent feedback, reports of independent observation and interviews with staff and family.       

5. Authorizing Behavior Services:

Behavioral Services are intended to be time limited. Research has indicated that most children benefit from an ABA program for a maximum average of 30 months and that the greatest benefit occurs before age 7. The Planning Team will reference the time limited nature of services and the need to fade the services out of the home as parents learn behavior management methods. Families can expect the Planning Team to begin to prepare for services to fade after 12 -18 months of services, unless there is an exceptional need to retain the intensity for a longer period.

For children up to 3 years of age, served under the California Early Intervention Services Act’s Early Start Program diagnosed with or suspected of having autism or other related developmental disabilities warranting intensive behavior services, TCRC may authorize, on average, up to 25 hours per week of intervention including supervision and training. The 25 hours per week of intervention includes all services provided including, but not limited to, Occupational Therapy, Speech Therapy, and Early Intervention Services.  Included in this total are services from all agencies, including TCRC as necessary, to address the core deficits.  Services may be authorized for a 6-month period and may be extended by the Planning Team when indicated.

For children 3 to 7 years of age, preschool children eligible for regional center services should have the school as their primary provider of educational intervention.   TCRC may authorize up to 15 hours per week of intervention. The total number of hours includes supervision and training. The Service may be authorized for a 6-month period and may be extended by the Planning Team in 6 month increments for a limited time. TCRC may authorize up to 10 hours per week for early elementary school children as part of the transition to school-based interventions. 

Individuals who are not in a school program (which includes adults) may also need behavior intervention and the Planning Team process should be utilized to identify services and supports necessary to achieve IPP goals regarding behavior issues.

WHO TO REFER: Individuals whose intensity, frequency or severity of behavior threatens the health and safety or placement of the child/individual. Individuals who are significantly delayed in development of age-appropriate behavior.

  1. Use of behavior intervention consultants is reviewed by Tri-Counties Regional Center Staff Psychologists, Autism Coordinator and Services and Supports Managers when an individual:
  2. Presents with challenging behaviors, or
  3. Is significantly delayed in development of age-appropriate behaviors
  4. TCRC core staff may recommend referral to behavioral services.
  5. If the TCRC staff Psychologist/Autism Coordinator approves of a behavior consultation, the Service Coordinator makes the recommendation for the parent training orientation and online parent training modules.
  6. The Service Coordinator will draft an IPP amendment and authorization can be made for behavioral services.
  7. Behavioral intervention service providers should document their treatment progress with quarterly reports including behaviors identified in the behavior assessment and treatment plan, with progress data relative to the targeted behaviors and measurement procedures.
  8. After the end of the initial six-month intervention period, the TCRC Psychologist/Autism Coordinator, the Service Coordinator and the Service and Supports Manager should be reconvened for the purpose of reviewing the intervention data and determining whether sufficient progress has been made to warrant continuation of the authorization for services for up to another 6 months. Planning team will meet to review progress at least once every 6 months if intensive services are being provided.
  9. Documentation: The IPP should identify goals to be met through the provision of the service, including recommendations for the parent to participate. Authorizations may be written for up to 6 months and may be extended in 6-month intervals, if the planning team agrees that treatment is effective and cost-effective progress is being made. The timelines should be explicit in the IPP. IPP should be reviewed annually and updated as appropriate. 

Revision Date: 12/9/2025