DEVELOPMENTAL CENTER UPDATE Presented to the RCOC Board of Directors By Randy Laya March 4, 2010

Historical Perspective of the Developmental Center System 1960s – At its peak, California had seven “state hospitals” serving 13,400 people 1969 – Lanterman Mental Retardation Act signed by Governor Reagan 1976 – Lanterman Act was amended affirming the right to treatment to people with developmental disabilities 1978 – “state hospitals” renamed “developmental centers” 2010 – 5 DCs serve ~2,200 people

System Overview of Developmental Centers The Department of Developmental Services (DDS) is the independent State agency that oversees the regional center system and state developmental centers ~243,000 people are served by 21 regional centers – RCOC ~17,000 people (~7% of total) ~2,200 people still reside in state developmental centers – RCOC ~140 people (~6% of total)

WHAT IS A DEVELOPMENTAL CENTER? Requires an annual court commitment Most restrictive environment Locked facilities Large campus Institutional/hospital-like setting

MANY LEVELS OF CARE Intermediate Care Facility (ICF) Skilled Nursing Facility (SNF) Short-term Acute Care Use of restrictive devices/procedures Locked helmets, restraints, contingent seclusion, emergency medication as needed for dangerous behavior

HOW MANY RCOC CONSUMERS LIVE IN DEVELOPMENTAL CENTERS? Fairview = 124 Lanterman = 12 Porterville* = 5 (+ 2) Total = 141 (+ 2) * RCOC placements at Porterville are ordered through criminal court due to crimes such as fire setting, murder, pedophilia.

WHY DO SOME CONSUMERS LIVE IN DEVELOPMENTAL CENTERS? Intellectual Disability (Mental Retardation) Judicial commitments: In re HOP, 29 Cal. 3d 82 (1981) Gravely disabled Welfare & Institutions Code (WIC) §6500 Danger to self and/or others California Penal Code §1370.1.(a)(1)(B) Incompetent to stand trial

In re HOP, 29 Cal. 3d 82 (1981) Gravely Disabled 24-hour Nursing Sensory Deprived Gastrostomy Tube (G-Tube) Severe uncontrolled seizure disorder Oxygen, PRN (as needed) Diabetes/IM (injections) Multiple diagnoses

WIC §6500 – Danger to Self/Others Self Injury/Pica/Locked Helmet Violent/Injury to others/Property destruction Verbal abuse Elopement Severe behavior plans Multiple diagnoses Multiple failure with community placements Multiple failure with treatment

California Penal Code §1370.1. (a)(1)(B) Incompetent to Stand Trial Person accused of a criminal act Unable to understand or aid in own defense Requires ongoing competency training Porterville Secure Treatment Area Competency training

Community Placement Options Licensed Community Care Facilities (CCF) Intermediate Care Facilities (ICF) Congregate Living Health Facility (CLHF) Unlicensed Supported Living (SL) Due to unique needs that cannot be met in licensed settings because of licensing restrictions

Developmental Center v. Community Placement Cost Comparison Average annual cost for persons living in DCs $275,970* Average annual cost for persons who moved from DCs into the community since July 1992 $60,068** *Controlling Regional Center Costs: Report to the Legislature, December 2007 ** “Components Contributing to Expenditure Growth – 2001-00 to 2007-08,” Department of Developmental Services, Budget Analysis, presented to the California Senate Budget Subcommittee #3 during a May 7, 2007 hearing.

RCOC COMMUNITY PLACEMENTS * FY10-to-date: 5 additional consumers are in active placement activities

BARRIERS TO COMMUNITY PLACEMENT Long-term institutional behavior Reluctant parents/families Reluctant Interdisciplinary Teams at DCs Process for transition six months to two or more years (reluctant providers) Court involvement

PLANNED CLOSURE OF LANTERMAN DEVELOPMENTAL CENTER DC closure outlined in WIC §4474.1 Meeting w/ Lanterman Family Group – 2/20/10 Public meeting at Lanterman DC – 2/24/10 Written input can be submitted to DDS on or before 3/5/10 Closure plans to be presented to the Legislature by 4/1/10 Closure activities to take place in FY 2010-11 More information at www.rcocdd.com

IMPACT OF LANTERMAN DC CLOSURE ON RCOC Business as usual 12 RCOC consumers at Lanterman DC RCOC staff have met with Lanterman staff to preliminarily assess needs and identify supports Formal meeting on 3/10/10

EXISTING CHALLENGES WIC §6500 Danger to Self/Others Including 2 at Lanterman DC Some people have difficulty with moves/ transition Self Injurious Behavior (SIB) Cannot use restrictive devices/procedures in the community Long-term institutional behavior Family opposition DC staff opposition

QUESTIONS?