DBHDS Virginia Department of Behavioral Health and Developmental Services DBHDS Presentation to TACIDD DOJ Settlement Agreement June 15, 2012

DBHDSVirginia Department of

Behavioral Health andDevelopmental Services

DBHDS Presentation to

TACIDD

DOJ Settlement Agreement

June 15, 2012

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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



Review of

DBHDS and System Changes

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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

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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

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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

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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

http://www.dbhds.virginia.gov/ODS-PersonCenteredPractices.htm

http://www.dbhds.virginia.gov/ODS-PersonCenteredPractices.htm



Overview of Provider Expectations, Measuring Quality, Case Management Expectations,

and Discharges from Training Centers

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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.

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Data Collections Areas

1. Safety and freedom from harm

2. Physical, mental, and behavioral health and well being, timeliness and adequacy of interventions

3. Avoiding crisis

4. Stability

5. Choice and self-determination

6. Community inclusion

7. Access to services

8. Provider capacity

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Enhanced Oversight Categories

1. Receive services from providers having conditional or provisional licenses;

2. Have more intensive behavioral or medical needs as defined by the Supports Intensity Scale (“SIS”) category representing the highest level of risk to individuals;

3. Have interruption of service greater than 30 days

4. Encounter the crisis system for a serious crisis or for multiple less serious crises within a three-month period;

5. Have transitioned from a training center within the previous 12 months; or

6. Reside in congregate setting of 5 or more individuals

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Sources of Information

1. Providers (outcomes/QI Programs/incident reports)

2. System wide outcomes

3. Licensing visits/ investigations

4. Human rights investigations

5. Case management visits

6. Service planning

7. Quality service reviews

8. Mortality reviews

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Case Management

1. Role of case management

2. Enhanced visits to targeted population

3. Transmission of key indicators to DBHDS

4. Core competency training

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Review of New Training Center Discharge Process, Role of

Community Integration Managers, and Post Move Monitoring

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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)

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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

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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

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SVTC/CVTC Initiative

Training Center

Target By July 1, 2012

Moves to date

Number moved to Private Providers

# of Providers chosen

CVTC 20 18 17 11

SVTC 40 39 38 22

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Census Reduction Goals

Fiscal Year SVTC NVTC SWVTC CVTC

Individuals D/C**

Waivers in SA

2012 40 06 20 60 60 2013 103 56 15 25 199 160

2014 105 52 20 25 202 1602015 39 20 57 116 902016 40 56 96 852017 40 50 90 902018 38 50 88 902019 35 50 352020 35 55 35

**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.

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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

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Assurances

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.

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Initial Pre Move Meeting

Discussion should includeReview 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

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Choices & Pre-Move Monitoring

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

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Active Move Process Continued

• Initial pre-move meeting• Choosing possible support options• Pre-Move Monitoring Visits• Tours• Visits• Training

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Post-Move Monitoring

~3 day

~7day

~10day

~17 day

~1 mo

~2 mo

~3 mo

~4 mo

~5mo

~6 mo

~7 mo

~8 mo

~9 mo

~10 mo

~11 mo

~12 mo

TC x x x

OL x x x x x x x x x x x x x x

CSB x x x x x x x x x x x x x

CRC x

OHR PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN

*** Additional visits may occur based on needs of individual or provider

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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

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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

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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

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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

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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

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Employee Concerns

• Compensation• Fringe Benefits (Health)• Retirement• Job Security• Work Environment

Documents

DBHDS Virginia Department of Behavioral Health and Developmental Services DBHDS Presentation to TACIDD DOJ Settlement Agreement June 15, 2012