dbhds virginia department of behavioral health and developmental services dbhds presentation to...
TRANSCRIPT
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
DBHDS Presentation to
TACIDD
DOJ Settlement Agreement
June 15, 2012
Page 2
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Review of
DBHDS and System Changes
Page 4
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 5
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 6
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 7
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Overview of Provider Expectations, Measuring Quality, Case Management Expectations,
and Discharges from Training Centers
Page 9
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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.
9
Page 10
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
10
Page 11
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
11
Page 12
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
12
Page 13
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Case Management
1. Role of case management
2. Enhanced visits to targeted population
3. Transmission of key indicators to DBHDS
4. Core competency training
13
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Review of New Training Center Discharge Process, Role of
Community Integration Managers, and Post Move Monitoring
Page 15
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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)
Page 16
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 17
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 18
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 19
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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.
Page 20
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 21
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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.
Page 22
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 23
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 24
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Active Move Process Continued
• Initial pre-move meeting• Choosing possible support options• Pre-Move Monitoring Visits• Tours• Visits• Training
Page 25
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 26
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 27
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 28
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 29
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 30
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
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
Page 31
DBHDSVirginia Department of
Behavioral Health andDevelopmental Services
Employee Concerns
• Compensation• Fringe Benefits (Health)• Retirement• Job Security• Work Environment