1. Transition Planning: The Role of the CCBDD Behavior and Health Supports Department Richard Cirillo, Ph.D. Chief Clinical Officer Cuyahoga County Board of Developmental Disabilities

2. Composition of the Department  Behavior and Health Supports consists of two basic service areas: Behavioral Support and Nursing  Current staff consists of approximately 55 professional, paraprofessional, and support staff  Behavioral staff include licensed psychologists, professional counselors, social workers, behavior support specialists, forensic system liaisons, and a human sexuality educator with a scope of practice clearly focused on individuals with developmental disabilities  We do not provide psychiatric/pharmacological therapies

3. BHS Role in Transition Planning  Assessment of behavioral needs Generally includes behavioral and related information collected from parents, consumer, teachers  Team consultation on preparing for and implementing a successful transition  Development of an individual specific behavior support plan if needed  Training staff on the behavior support plan  Resource for future consultation regarding behavioral issues

4. Getting a Referral  Referrals for Behavioral Services are taken through the student’s SSA  Ideally referral comes six months to a year prior to the anticipated transition to an adult service or job to allow for appropriate assessment, planning, and transition  A longer period may be needed if a particularly difficult and/or gradual transition is anticipated.

5. What to expect  The assessment is an important first step in planning  Expect a review of past behavioral, educational, mental health and to a lesser extent medical history  Allowing access to past providers of service can be particularly helpful in some cases  Participation of parents and teachers in the assessment process is sought and valued

6. Results  Written recommendations will be provided in most cases, and for any case if requested.  Communication of results with SSA, family, and other stakeholders  Training of staff as needed  A continued relationship with the team until a the individual has been transitioned and/or there is no longer a need for behavior support

7. Philosophy of Behavioral Care  A primary emphasis placed on maintaining health and safety  Strong Protection of individual rights Any restriction that is to be placed on the individual’s rights must have a clear relationship to health and safety, must be documented, and must first clear a Human Rights Committee A strength of the DD system, but in some cases can be difficult for families to understand.

8. A Least Restrictive Approach to Behavioral Supports  Behavior planning must rely first and foremost on positive and preventative strategies Are expectations of the individual appropriate? Is there a fit between the person’s preferences, temperament, and abilities and the environment? Are staff appropriately trained and responding in line with the individuals needs?  Seclusion or restraint are avoided and can be used only after positive methods have failed and there is a clear health and safety threat involved.  Any plan with such aversive interventions in place must go through a formal planning and review process (two separate committee reviews before approval).  In some cases, part of our transition planning may involve having the individual weaned off the use of seclusion or restraint as it may have been applied in a school setting

9. Remember  Consultation with the Behavior and Health Supports Department can be requested at any time  There is no charge to you for our services

10. Questions and Comments