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includes aggressive, consistent implementation of a program of specialized and generic

training, treatment, health services and related services described in this subpart, that is

directed toward-

(i) The acquisition of the behaviors necessary for the client to function with as much self-determination and independence as possible; and

(ii) The prevention or deceleration of regression or loss of current optimal functional

status.

Active treatment embodies an individually- tailored series of daily life and living experiences

that serve as the primary opportunity for the acquisition, development and expression of

functional skills and adaptive behaviors necessary for the client to experience optimal

independence and promote purposeful “self-expression”.

The uniqueness of each client is a core consideration in the design of active treatment

programs. It is expected that individual clients are given the opportunity to provide input into

the content of their day-to-day living experiences.

An active treatment program includes the following elements as substantiated through

observation, interview and record review:

a) Each client's needs and strengths have been accurately assessed and relevant input has

been obtained from team members; (Observations and interviews with the client by the

surveyor should be consistent with the current assessment information. Interview the

QIDP regarding any needs observed but not addressed through

assessment/programming by the facility).

b) Each client's IPP is based on assessed needs and strengths, and addresses major life

areas such as personal skills, home living skills, community living skills, employment

skills, etc., essential to increasing independence and ensuring rights;

c) Needs identified as a priority are addressed formally and through activities which are

relevant and responsive to client need, interest and choice;

d) Active treatment is consistently implemented in all relevant settings both formally and

informally as the need arises or opportunities present themselves. It should not be

limited to specific periods of time during the day or environments. Each client should

receive aggressive and consistent training, treatments and supports in accordance with

their needs and IPP. New skills and appropriate behaviors are encouraged and

reinforced across environments and times of day. Each client has the adaptive

equipment and environmental adaptations necessary for him/her to progress toward

heightened independence as recommended and contained in their IPP. Active

treatment means taking advantage of opportunities for the practice of new skills and the

use of other skills during the normal rhythm of each client’s day.

e) Each client's performance related to IPP objectives is accurately and consistently

measured and documented and programs are modified on an ongoing basis based on

data and major life changes; and

i. Clients with degenerative conditions receive training, treatment and services

designed to retain skills and functioning and to prevent further regression to the

extent possible.

ii. Clients may need adjustments to their active treatment programs as functional or

endurance limitations are identified associated with the aging process. In such

cases, there may be more of an emphasis on the retention of skills already attained

and reducing the rate of loss of skills, than on the acquisition of new skills.

In large part, it is this pervasive and continuous reinforcement of “formal” training through

“informal” routine daily living experiences and interactions with staff and others that makes

active treatment programs effective. Formal settings are those that are planned and specifically

structured for training on objectives and interventions. Informal settings are times that are not

anticipated or planned but that offer the opportunity for training.

Active treatment programs mirror normal living experiences such as leisure activities and social

conversation at the dinner table. It must be clear that active treatment programs are far more

than implementation of discreet formal training sessions or programs that are conducted at

prescribed times by defined personnel. Learning occurs in the process of the normal rhythm of

life and life experiences.