Transition Planning: The Role of the CCBDD Behavior and Health Supports Department

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