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Leading Practice Guidelines
Medication for Behaviour Support
Guideline: The organization has a formal, rights based approach for the use of medication for behaviour support that ensures there is formal consent and review, monitoring and evaluation and required partnership with positive behaviour support strategies.
What does this look like?
The organization has a policy that outlines the values, expectations and parameters related to use of medication for behaviour support. This policy should include:
- Clear definitions and parameters related to psychotropic medication, chemical restraint and treatment of psychiatric conditions.
- Psychotropic medication is any medication that alters the chemicals in the brain and consequently impacts a person’s emotions and behaviours. Psychotropic medications treat a variety of psychiatric conditions including depression, bipolar disorder, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and psychosis. They can also be used to modify someone’s state in order to change their behaviour in the absence of a diagnosed psychiatric condition. At times, medications that have psychoactive effects but are not considered psychotropic medication can also be used to alter behaviour (i.e. anti-convulsants).
- Sets out requirements for:
- Psychotropic medication in the absence of a psychiatric condition is only used following a Functional Assessment and in partnership with a positive Behaviour Support Plan (BSP) that may include changes to the environments, relationships, skill building opportunities, and the activities available to a person rather than targeting problem behaviours exclusively through medication.
- Regular review by senior leadership of the organization, the prescribing physician along with the person and their support network.
- All opportunities to reduce or eliminate medication will be sought and evaluated with an aim to achieve a balance between the person’s optimum quality of life and the use of medication as required. The review includes an evaluation of whether the potential benefits of using the psychiatric medications outweigh the risks of not using these medications.
- Ongoing monitoring for impact, side effects and effectiveness to ensure that the desired outcomes are being achieved, changes can be evaluated objectively and accurate information is provided to the person, their support network and their prescribing physician.
- People served and their families and SDMs are informed of the risks associated with medication for behaviour support prior to its implementation.
- Prohibits use of psychotropic medication when:
- It is administered at a dose or frequency to intentionally limit behaviour without identifying an underlying anxiety, fear, severe emotional distress or other symptom of psychiatric or emotional disturbance that needs to be eased, managed or treated.
- It is a substitute for adequate and meaningful support services
- It is utilized in the absence of any positive behaviour support strategies
Staff are oriented and trained to understand the behaviour expected surrounding the usage of medications for behaviour support. They are aware of and understand the purpose of all medications that people they support are taking.
How would you know this is happening? (Evidence)
What you see in systems:
- Clear, comprehensive policy is in place and shared with all stakeholders
- Training or orientation records exist as evidence of staff knowledge
- BSPs are in place wherever medications are being used to alter behaviour in the absence of a psychiatric diagnosis.
What you see in actions:
- Staff are aware of and understand the medications that people they support are using and how they may impact behaviour. Staff are knowledgeable of the person’s BSPand the plan to reduce medication over time.
- People served and their support networks are aware of the purpose and reasons for medications that they take and how they relate to BSPs. People are supported to be actively involved in decision making and planning surrounding their behaviour needs according to their wishes and abilities.
Resources to support achieving guideline:
- Sample Policy – Medication for Behaviour Support – [to be added soon]
- Psychotropic Medication Issues – Surrey Place (PDF)
- Auditing Psychotropic Medication Therapy – Surrey Place (PDF)