DBHDS Presentation to TACIDD DOJ Settlement Agreement June 15, 2012

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

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

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

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

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

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

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.

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

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

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

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

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

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) 

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

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

SVTC/CVTC Initiative CVTC 20 18 17 11 SVTC 40 39 38 22 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

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 52 202 2015 39 57 116 90 2016 96 85 2017 50 2018 38 88 2019 35 2020 55 **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.

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

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.

Initial Pre Move Meeting 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

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 OHR, OLS, CRC – share concerns directly with provider OHR, OLS, CRC – share any concerns regarding providers with members on this email.  Lee and I are passing on this information to CRCs and CIMs CIMs should share this information in a timely manner with the CSB and the SW teams, particularly as it relates to individuals who are identified to go to providers where concerns have developed CRCs should also share this information with SCs at the CSBs, in a timely manner and as appropriate OHR, OLS, CRC – update status of providers as concerns have been resolved so this information can be passed along using above process.

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

Post-Move Monitoring ~3 day ~7 day ~10 ~17 day ~1 mo ~2 mo ~3 mo ~4 mo ~5 mo ~6 mo ~7 mo ~8 mo ~9 mo ~10 mo ~11 mo ~12 mo TC x OL CSB CRC OHR PRN *** Additional visits may occur based on needs of individual or provider

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

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

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

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

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

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