DBHDS Presentation to TACIDD DOJ Settlement Agreement June 15, 2012

1. DBHDS Presentation to TACIDD DOJ Settlement Agreement June 15, 2012

2. Provider 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

3. Review of DBHDS and System Changes

4. Commonwealth’s Commitment to Community • System Support and Oversight • Increased number of community resource consultants • Increased number of licensing specialists • Increased number of human rights specialists • START (Systemic, Therapeutic, Assessment, Respite, and Treatment) Model of Community Crisis Stabilization Services • Services beginning in most regions by July 1, 2012 • Designed to help keep individuals in their home communities • Uses both mobile crisis teams and center-based therapeutic respite

5. Commonwealth’s Commitment to Community • Training for Community Providers • Continued emphasis on person-centered-thinking (PCT)/person-centered planning (PCP) processes • Case management training • Provide skills training for specialized needs • Continued positive behavioral supports (PBS) training and endorsement through PPD • Waiver Improvements and Renewal • Enhanced rates for high medical and behavioral needs • Services designed around needs and not disability • Stakeholder workgroups to begin this summer to review plans • Will develop in phases beginning in July 2013 • Change process to be completed by 2015

6. Commonwealth’s Commitment to Community • Provider Selection Driven by Qualified Match and Individual Choice • Provider profile under revision for brevity and essential information • Web-posted information on CSB searches for providers • Ability to meet needs must be documented before provider selection • Individual/family choice of qualified provider is primary key to selection • Quality Improvement is Goal • National core indicators project • Individual interviews • Family and provider surveys

7. Provider Responsibilities • Use Available Training • Check ODS Web page at www.dbhds.virginia.gov/ODS-PersonCenteredPractices.htm#training for training opportunities • Person-centered thinking is an ESSENTIAL core value for all providers – training is provided • New training opportunities are being developed for specialized skills • Understand Your Program’s Limitations As Well As Abilities • Make the support coordinators aware of your capabilities • Do not accept individuals with high risk needs before you are ready

8. Overview of Provider Expectations, Measuring Quality, Case Management Expectations, and Discharges from Training Centers

9. Quality 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.

10. Data Collections Areas • Safety and freedom from harm • Physical, mental, and behavioral health and well being, timeliness and adequacy of interventions • Avoiding crisis • Stability • Choice and self-determination • Community inclusion • Access to services • Provider capacity

11. Enhanced 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 days • Encounter 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; or • Reside in congregate setting of 5 or more individuals

12. Sources of Information • Providers (outcomes/QI Programs/incident reports) • System wide outcomes • Licensing visits/ investigations • Human rights investigations • Case management visits • Service planning • Quality service reviews • Mortality reviews

13. Case Management • Role of case management • Enhanced visits to targeted population • Transmission of key indicators to DBHDS • Core competency training

14. Review of New Training Center Discharge Process, Role of Community Integration Managers, and Post Move Monitoring

15. Additional Training and Information • Regional Trainings to Review Discharge Process • CSBs and private providers, individuals and advocates • Present the process • Bring team of people involved in this process • CIMs (community integration manager), • CRCs (community resource consultant), • OL (Office of Licensing) • OHR (Office of Human Rights) 

16. Community Integration Managers (CIMs) • Provide leadership, direction, and support for transition/discharge operations • Oversee quality and accuracy of the ongoing discharge process • Monitor move targets • Help maintain a list of families reluctant to consider community placement and steps taken to resolve concerns • Review all situations that involve determination that an individual should remain in or move to a non-integrated setting • Provide oversight and support for the training center post-move monitoring process • Analyze/trend discharge and post-move monitoring data

17. Communication Plan Meeting with SW Team - Active Move Meeting CIM Meetings • Weekly Coordination meetings • Ground level meeting • Weekly Planning meeting • Quarterly CRC meetings • Quarterly CRC/CIM meeting

18. SVTC/CVTC Initiative

19. Census Reduction Goals **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.

20. Identifying 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 community • Community options are available to meet the needs of individuals and allow an individual to be near natural supports, particularly family and friends • Individuals have already begun the transition to the community by participating in a higher level of community integration activities, e.g., paid employment off grounds • Individuals have expressed interest in remaining together and there are providers willing and able to serve the identified group of individuals • Providers are willing and able to develop specialized programs to meet needs of individuals

21. Some individuals may request to move more quickly and some Individuals may take longer due to unforeseen occurrences or other factors that must be addressed. DBHDS is committed to ensuring a consistent 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; and Providing post-move monitoring to ensure the continuation of supports and services as identified in the pre and post-move process. Assurances

22. Discussion should include Review of personal profile Assessments Important to/for Protection from harm, rights restrictions Essential and non-essential supports The 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 movement Strategies intended to overcome identified barriers. Objections/agreements Initial Pre Move Meeting

23. CSB, Individual, and AR Identify Potential Providers Residential, Employment, and Day Support CSB will notify the Discharge Coordinator of viable options chosen to tour OLS, OHR, and CRCs are notified of choices of potential providers for follow-up and feedback Choices & Pre-Move Monitoring

24. Active Move Process Continued • Initial pre-move meeting • Choosing possible support options • Pre-Move Monitoring Visits • Tours • Visits • Training

25. Post-Move Monitoring

26. Training Center Employees • Total number of employees impacted by closure of the 4 DD facilities (Petersburg, Fairfax, Hillsville, Lynchburg) • Approximately 3,185 employees • Occupations: buildings and grounds, food services, housekeeping, direct support staff, administrative staff, to therapists, psychologists, social workers, nurses, and physicians. • Direct Support Staff (front-line) 1,856 • Nursing 258 • Clinical 189 • Administrative 882

27. Southside Virginia Training Center – Petersburg, VA • Total Number of Staff: 937 • Direct Support Staff 550 • High school graduate or GED • Predominately female • Nursing 91 • LPN’s & RN’s • Clinical 46 • Psychologist, SW, OT, PT, & Speech Therapist • Administrative 250 • Office specialists, fiscal, procurement, environmental services, human resources

28. Northern Virginia Training Center Fairfax, VA • Total Number of Staff: 503 • Direct Support Staff 288 • High school graduate or GED • Predominately female, multi-cultural workforce • Nursing 21 • LPN’s & RN’s • Clinical 45 • Psychologist, SW, OT, PT, & Speech Therapist • Administrative 149 • Office specialists, fiscal, procurement, all environmental services (B&G to food and housekeeping services), human resources

29. Employee Competencies • Direct Support Staff • Highly 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

30. Employee Competencies • Nursing • Licensed Practical Nurses & Registered Nurses • Up-to-date nursing skills with DD populations • Clinicians • Licensed professionals, such as psychologists, social workers, OT, PT, and Speech Pathologists (dysphasia) • Working experience with an interdisciplinary team focused on person-centered planning. • Administrative • Highly skilled technicians • Seasoned healthcare professional staff

31. Employee Concerns • Compensation • Fringe Benefits (Health) • Retirement • Job Security • Work Environment