Effective Date
Instructions
Updated: 5/2025
Note: The term person when used in this form refers to an individual per 26 Texas Administrative Code (TAC) Section 260.5.
Purpose
To provide a standardized record of completion for DBMD person-specific training.
Procedure
When to Prepare
The DBMD program provider completes Form 6518 when providing specific training on a person’s needs. Training must occur before providing services to the person, at least annually, and if the person’s needs change.
Form Retention and Submission
Keep this form per record retention requirements outlined in the Texas Administrative Code. The DBMD program provider is not required to submit the forms to HHSC on completion but must maintain the forms in personnel records and provide a copy to HHSC on request.
Detailed Instructions
Person’s Name — Enter or print the person’s name.
Date Training Completed — Enter month, day and year the service provider completed the training.
Service Provider’s Name — Enter or print the name of the service provider who completed the training.
Trainer’s Name — Enter or print the name of the DBMD program provider staff member who provided the training.
Service Provider Type, check one or more —Indicate which service provider type is receiving the training. Specific training is required for all program provider staff, including subcontractors, who provide:
- Community First Choice Personal Assistance Services Habilitation (PAS/Hab)
- Employment Assistance
- Employment Readiness
- Individualized Skills and Socialization
- Intervener, I, II, III
- Licensed Assisted Living, 18 and 24 Hour
- Licensed Home Health Assisted Living
- Respite, In-Home and Out-of-Home
- Supported Employment
- Transportation – Residential Habilitation
Completed in the Person’s Home — Mark Yes or No to indicate training was or was not provided in the person’s home.
Complete Physical Address of the Training Site — Provide the complete physical address where the specific training was conducted, including city, state and ZIP Code.
Reason for Training — Mark to indicate the reason for the training:
- Initial Training – Select this option when the:
- person is new to the contract.
- service provider is a new employee.
- service provider will be providing services to the person for the first time.
- Annual Renewal – Select this option when the service provider is completing their required annual training.
- Person’s Needs Changed – Select this option any time during the plan year when the person’s needs change.
Examples of changes to the person’s needs:
- sustained injuries,
- health deterioration,
- diet changes,
- new physical diagnosis, and
- new adaptive equipment.
Training included the full participation of the – Mark to indicate who participated during the service provider training:
- Person
- Person’s Legally Authorized Representative
- Actively Involved Person
Section 1: Specific Needs – Complete all items in this section.
Methods of communication — Mark to indicate instruction has been provided to the service provider that details the person’s methods of communication. Describe if the person uses American Sign Language, gestures, a communication board, etc.
Specific visual and audiological loss — Mark to indicate instruction has been provided to the service provider that details the person’s specific visual and audiological loss. Describe if the person has cochlear implants, needs staff to speak into one specific ear, needs tactile stimulation or uses Braille, etc.
Adaptive aids, if applicable — Mark to indicate instruction has been provided to the service provider that details the person’s use of adaptive aids. List the adaptive aids the person uses and refer to Section 1000, Adaptive Aids/Vehicle Modification Services, of the DBMD Program Manual.
Managing challenging behavior
De-escalation techniques — Mark to indicate instruction has been provided to the service provider that details the methods used to address and de-escalate a challenging behavior when prevention has failed.
Prevention of aggressive behavior — Mark to indicate instruction has been provided to the service provider that details the person’s aggressive behavior and preventative methods used to address the specific behavior.
Person has a Behavioral Support Plan (BSP) — Mark Yes or No to indicate the person does or does not have an active BSP.
Section 2: Protective Devices — Complete the appropriate items in this section.
Training on the person’s protective device(s), if any, has been completed — Mark to indicate instruction has been provided to the service provider that details use of the person’s protective device(s).
List the protective device — List the protective item or device the person uses. Refer to 26 TAC 260.5 Definitions for a list of protective devices.
Protective device use must be reported to — List the name of the DBMD program provider staff member who must be notified of protective device(s) use. Notification must occur per 26 TAC 260.215 Protective Devices.
I understand that protective devices must not be used to modify or control a person’s behavior or for disciplinary purposes or for convenience or as a substitute for an effective, less restrictive method. — Mark to indicate understanding of the statement.
Not Applicable, check if the person does not use a protective device — Mark to indicate the person does not use a protective device.
Section 3: Restraints — Complete the appropriate items in this section.
Training on restraints has been completed, including use and reporting requirements — Mark to indicate instruction has been provided to the service provider that details the use of a physician-authorized restraint.
List the authorized restraint(s) — List the allowable restraint authorized by the physician.
Use of a restraint must be reported to — List the name of the DBMD program provider’s registered nurse (RN). Notification must occur per 26 TAC 260.217 Restraints. Program providers who provide licensed assisted living must comply with 26 TAC 553.267 Rights. Program providers must make sure a six-bed ICF/IID that provides out-of-home respite services complies with 26 TAC 551.42 Standards for a Facility.
Training includes the following documentation requirements: — Mark to indicate documentation and reporting requirements were explained to the service provider. This training must be completed even if the person does not have a physician’s order for restraint usage. Training must occur to make sure the service provider understands that if a restraint must be used during a behavioral emergency the restraint is only used to protect the person’s health and safety.
Documentation requirements include:
- The use of the restraint. Document in the person’s record that a restraint was used.
- Time and date the restraint was used. Enter the time and month, day and year.
- Name of the person who administered the restraint. Enter the name of the service provider who administered the restraint.
- Type of restraint and duration used. Enter the actual restraint type and duration of the restraint.
- If used in a behavioral emergency:
- Events preceding the use of the restraint. Enter the events or actions that led up to the necessary use of a restraint.
- Actions taken after use of the restraint. Enter what the service provider did after they administered the restraint.
- Types of interventions attempted before use of the restraint. Enter the actions the service provider took to prevent or de-escalate the situation.
I understand that restraints must not be used for disciplinary purposes, retaliation, coercion, retribution, for the convenience of myself or another service provider or as a substitute for an effective, less restrictive method. — Mark to indicate understanding of the statement.
Not Applicable, check if the person does not have a physician’s order for a restraint. — Mark to indicate the person does not have a physician’s order for a restraint.
Section 4: Delegated Tasks — Complete this section as applicable.
Delegated training and competency verification must be provided by a physician or nurse. Documentation of delegated training must be maintained in the person’s record and available for review on request per 26 TAC 260.205 Training.
MoTraining on delegated tasks has been completed by (enter the name of the appropriate licensed medical professional who provided delegation training) on (enter the date of the delegated training) and competency was verified.
Section 5: Reporting Changes — Complete this section as applicable.
The following changes must be reported as soon as possible —Change(s) include:
- Person is hospitalized.
- Changes in the person’s needs or behavior.
- Person is absent from the home or has moved.
Report these changes to — List the name of the DBMD program provider staff member who must be notified when the person’s needs change.
Section 6: Additional Information — Complete this section as applicable.
If this training is being conducted because of a change in the person’s needs, document the change(s) — Provide documentation of changes to the person’s needs that required a training update.
Additional concerns if any — Provide any additional concerns as necessary.
Additional comments if any — Provide any additional comments as necessary.
Signature of Service Provider and Date — The service provider signs and dates the form. The service provider’s signature confirms they have received training on the person’s specific needs and can demonstrate competency.
Signature of Trainer and Date — The trainer signs and dates the form. The trainer’s signature confirms that instruction has been provided to the service provider on the person’s specific needs.
Contact Program Staff
Email the CLASS/DBMD Provider Monitoring team for questions about the form or instructions.
Email the Long Term Services and Support (LTSS) Policy team for questions about DBMD program policies.