Presentation on theme: "DBHDS Presentation to TACIDD DOJ Settlement Agreement June 15, 2012"— Presentation transcript:
1DBHDS Presentation to TACIDD DOJ Settlement Agreement June 15, 2012
2Provider Information Session Agenda 10:00 – 10:45 a.m. – Overview of DOJ Settlement Agreement 10:45 – 11: 00 a.m. – Review of DBHDS and System Changes 11:00 – 12:00 a.m. – Overview of Provider Expectations, Measuring Quality, Case Management Expectations, and Discharges from Training Centers 12:30 – 1:15 a.m. – Review of New Training Center Discharge Process, Role of Community Integration Managers, and Post Move Monitoring 1:15 a.m. – 1:30 p.m. – Training Center Employees and Future Employment Opportunities
4Commonwealth’s Commitment to Community System Support and OversightIncreased number of community resource consultantsIncreased number of licensing specialistsIncreased number of human rights specialistsSTART (Systemic, Therapeutic, Assessment, Respite, and Treatment) Model of Community Crisis Stabilization ServicesServices beginning in most regions by July 1, 2012Designed to help keep individuals in their home communitiesUses both mobile crisis teams and center-based therapeutic respite
5Commonwealth’s Commitment to Community Training for Community ProvidersContinued emphasis on person-centered-thinking (PCT)/person-centered planning (PCP) processesCase management trainingProvide skills training for specialized needsContinued positive behavioral supports (PBS) training and endorsement through PPDWaiver Improvements and RenewalEnhanced rates for high medical and behavioral needsServices designed around needs and not disabilityStakeholder workgroups to begin this summer to review plansWill develop in phases beginning in July 2013Change process to be completed by 2015
6Commonwealth’s Commitment to Community Provider Selection Driven by Qualified Match and Individual ChoiceProvider profile under revision for brevity and essential informationWeb-posted information on CSB searches for providersAbility to meet needs must be documented before provider selectionIndividual/family choice of qualified provider is primary key to selectionQuality Improvement is GoalNational core indicators projectIndividual interviewsFamily and provider surveys
7Provider Responsibilities Use Available TrainingCheck ODS Web page at for training opportunitiesPerson-centered thinking is an ESSENTIAL core value for all providers – training is providedNew training opportunities are being developed for specialized skillsUnderstand Your Program’s Limitations As Well As AbilitiesMake the support coordinators aware of your capabilitiesDo not accept individuals with high risk needs before you are ready
8Overview of Provider Expectations, Measuring Quality, Case Management Expectations, and Discharges from Training Centers
9Quality and Risk Management System To ensure that all services for individuals receiving services under this Agreement are of good quality, meet individuals’ needs, and help individuals achieve positive outcomes, including avoidance of harms, stable community living, and increased integration, independence, and self-determination in life domains.
10Data Collections Areas Safety and freedom from harmPhysical, mental, and behavioral health and well being, timeliness and adequacy of interventionsAvoiding crisisStabilityChoice and self-determinationCommunity inclusionAccess to servicesProvider capacity
11Enhanced Oversight Categories Receive services from providers having conditional or provisional licenses;Have more intensive behavioral or medical needs as defined by the Supports Intensity Scale (“SIS”) category representing the highest level of risk to individuals;Have interruption of service greater than 30 daysEncounter the crisis system for a serious crisis or for multiple less serious crises within a three-month period;Have transitioned from a training center within the previous 12 months; orReside in congregate setting of 5 or more individuals
12Sources of Information Providers (outcomes/QI Programs/incident reports)System wide outcomesLicensing visits/ investigationsHuman rights investigationsCase management visitsService planningQuality service reviewsMortality reviews
13Case Management Role of case management Enhanced visits to targeted populationTransmission of key indicators to DBHDSCore competency training
14Review of New Training Center Discharge Process, Role of Community Integration Managers, and Post Move Monitoring
15Additional Training and Information Regional Trainings to Review Discharge ProcessCSBs and private providers, individuals and advocatesPresent the processBring team of people involved in this processCIMs (community integration manager),CRCs (community resource consultant),OL (Office of Licensing)OHR (Office of Human Rights)
16Community Integration Managers (CIMs) Provide leadership, direction, and support for transition/discharge operationsOversee quality and accuracy of the ongoing discharge processMonitor move targetsHelp maintain a list of families reluctant to consider community placement and steps taken to resolve concernsReview all situations that involve determination that an individual should remain in or move to a non-integrated settingProvide oversight and support for the training center post-move monitoring processAnalyze/trend discharge and post-move monitoring data
17Communication Plan Meeting with SW Team - Active Move Meeting CIM MeetingsWeeklyCoordination meetingsGround level meetingWeekly Planning meetingQuarterly CRC meetingsQuarterly CRC/CIM meeting
18SVTC/CVTC Initiative CVTC 20 18 17 11 SVTC 40 39 38 22 Training Center Target ByJuly 1, 2012Moves to dateNumber moved to Private Providers# of Providers chosenCVTC20181711SVTC40393822
19Census Reduction Goals Fiscal YearSVTCNVTCSWVTCCVTCIndividuals D/C**Waivers in SA20124006206060 201310356152519916020141055220220153957116902016968520175020183888201935202055**More individuals are anticipated to be discharged than waiver slots because some individuals choose MFP slots, some choose ICFs, and natural deaths occur over the period of the agreement.
20Identifying Individuals for Discharge Some of the factors considered when prioritizing individuals for moving :Individuals expressed a desire or do not oppose community placement and their personal support team (PST) feels there are supports already available in the communityCommunity options are available to meet the needs of individuals and allow an individual to be near natural supports, particularly family and friendsIndividuals have already begun the transition to the community by participating in a higher level of community integration activities, e.g., paid employment off groundsIndividuals have expressed interest in remaining together and there are providers willing and able to serve the identified group of individualsProviders are willing and able to develop specialized programs to meet needs of individuals
21Assurances Some individuals may request to move more quickly and some Individuals may take longer due to unforeseen occurrences or otherfactors that must be addressed. DBHDS is committed to ensuring aconsistent discharge process which includes:Ensuring all essential support needs will be met in the community;Providing reasonable time to plan for and prepare the individual and AR for the discharge;Developing a discharge plan that addresses what is important to/for individual;Sharing the appropriate information with provider agencies to assure a successful transition;Providing a post-move plan of care that will assist the individual to adjust successfully to his or her new supports; andProviding post-move monitoring to ensure the continuation of supports and services as identified in the pre and post-move process.
22Initial Pre Move Meeting Discussion should includeReview of personal profileAssessmentsImportant to/forProtection from harm, rights restrictionsEssential and non-essential supportsThe individual’s vision of an optimal living environment.Education of the individual or AR,Preference of the individual or AR,Major barriers to the individual’s movementStrategies intended to overcome identified barriers.Objections/agreements
23Choices & Pre-Move Monitoring CSB, Individual, and AR Identify PotentialProvidersResidential, Employment, and Day SupportCSB will notify the Discharge Coordinator of viable options chosen to tourOLS, OHR, and CRCs are notified of choices of potential providers for follow-up and feedbackOHR, OLS, CRC – share concerns directly with providerOHR, OLS, CRC – share any concerns regarding providers with members on this . Lee and I are passing on this information to CRCs and CIMsCIMs should share this information in a timely manner with the CSB and the SW teams, particularly as it relates to individuals who are identified to go to providers where concerns have developedCRCs should also share this information with SCs at the CSBs, in a timely manner and as appropriateOHR, OLS, CRC – update status of providers as concerns have been resolved so this information can be passed along using above process.
24Active Move Process Continued Initial pre-move meetingChoosing possible support optionsPre-Move Monitoring VisitsToursVisitsTraining
25Post-Move Monitoring ~3 day ~7 day ~10 ~17 day ~1 mo ~2 mo ~3 mo ~4 mo ~5mo~6 mo~7 mo~8 mo~9 mo~10 mo~11 mo~12 moTCxOLCSBCRCOHRPRN*** Additional visits may occur based on needs of individual or provider
26Training Center Employees Total number of employees impacted by closure of the 4 DD facilities (Petersburg, Fairfax, Hillsville, Lynchburg)Approximately 3,185 employeesOccupations: buildings and grounds, food services, housekeeping, direct support staff, administrative staff, to therapists, psychologists, social workers, nurses, and physicians.Direct Support Staff (front-line) 1,856NursingClinicalAdministrative
27Southside Virginia Training Center – Petersburg, VA Total Number of Staff: 937Direct Support StaffHigh school graduate or GEDPredominately femaleNursingLPN’s & RN’sClinicalPsychologist, SW, OT, PT, & Speech TherapistAdministrativeOffice specialists, fiscal, procurement, environmental services, human resources
28Northern Virginia Training Center Fairfax, VA Total Number of Staff: 503Direct Support Staff 288High school graduate or GEDPredominately female, multi-cultural workforceNursingLPN’s & RN’sClinicalPsychologist, SW, OT, PT, & Speech TherapistAdministrativeOffice specialists, fiscal, procurement, all environmental services (B&G to food and housekeeping services), human resources
29Employee Competencies Direct Support StaffHighly trained staff; person-centered planning, positive behavior supports; up-to-date mandated training--CPR/First Aid, TOVA, etc.Community based training through the College of Direct Support.Community College coursework through the Direct Support Professional Career Pathway Program; Career Studies Certificate in Developmental Disabilities and Career Studies Certificate in Human Services.Direct Support Professional Designation
30Employee Competencies NursingLicensed Practical Nurses & Registered NursesUp-to-date nursing skills with DD populationsCliniciansLicensed professionals, such as psychologists, social workers, OT, PT, and Speech Pathologists (dysphasia)Working experience with an interdisciplinary team focused on person-centered planning.AdministrativeHighly skilled techniciansSeasoned healthcare professional staff