1. Pam Treadway, M.Ed. Clinical Consultant Bureau of Autism Services
Thursday Afternoon Adult Autism Waiver Provider Training Critical Revisions: Reflecting the change in supports and services in the ISP
Pam Treadway, M.Ed.
Clinical Consultant
Bureau of Autism Services

2. Agenda Revision Types BAS Expectations/Recommended Process
Putting it into Practice

3. PLAN REVISIONS

4. General Update Vs. Critical Revision
Using the “Perform Revision” screen the user can perform two types of revision to the current plan:
General Update
Critical Revision

5. General Update
Allows the user to modify any part of the plan except Service Details (increasing frequency of services, adding new services or deleting services)
After a General Update is performed, the Plan automatically goes back to “Approved” status (no review by BAS is required)
Goals can be modified
The Behavioral Support Plan and the Crisis Intervention Plan can be modified

6. Critical Revision
A Critical Revision allows the user to update any part of the plan
If a service is added or removed, the units of a service are increased, or dates of a service are changed the plan goes into “Pending Review” status
SC Supervisor and BAS must review and approve the changes made to services on the Plan

7. Screen Access During Plan Revisions
Component
General Update
Critical Revision
Individual Preferences
Update
Medical Information
Health and Safety
Functional Information
Goals
Services
Read Only
Behavioral Support Plan
Crisis Intervention Plan

8. BAS EXPECTATIONS

9. Straight from the source
Waiver Appendix D - Service Plan Development:
“The ISP must be updated as appropriate when the participant’s needs change. The SC will be particularly aware of changes necessary to assure the health and welfare for the participant regarding services that have a distinct limitations in amount of services. This change may be identified by the participant, the SC, another service provider, or another individual (not necessarily individuals on the planning team). For all ISP updates that change the amount and frequency of services, the SC will reconvene the individual and his or her support team to discuss needed changes and revise the ISP. A planning team meeting is not necessary when the only change is the provider of a service.”

10. Translating Waiver Expectations
ISP is updated when participant needs change
ISP should reflect current needs
Team meeting reconvened for changes in need (amount and frequency of service)
Critical revision = change in needs (typically)

11. Plan Revision Expectations/Process
Document all occurrences of plan revisions in the Service Notes
Type of revisions performed (General Update or Critical Revision)
Description and reason for revision
Ex: General Update performed on 12/14/2011. Objectives received from ABC Agency on 12/12/2011 and entered in the ISP for goals linked to Community Inclusion (Independent Living skills, Social Skills).

12. Plan Revision Expectations/Process
Critical revision service note example:
Critical revision submitted on 11/11/ A team meeting was held on 11/10/2011 to address concerns related to Jonah’s food sensitivities and ongoing weight loss which is excessive. The team agreed that Nutritional Counseling would be beneficial to address concerns. Nutritional Counseling service added to plan for 240 units, 4 units per visit, 1 time per 7 days. In addition, SC reviewed the Clinical ISP Review Checklist and made all the requested revisions throughout the plan.

13. Plan Revision Expectations/Process
Critical Revision triggers review by Regional Office and Clinical rep
Regional Office reviews for accuracy of service details (units, frequency, service limits not exceded), justification of service change in Plan
Clinical reviews Plan to check for revisions requested on the ISP Review Checklist, justification of service change noted in Plan

14. PUTTING IT INTO PRACTICE

15. Critical Revision: ISP Considerations
What is the reason for the critical revision?
(e.g., new service added, increase in service frequency, service deleted)
What is the specific change in participant need?
(e.g., recent psychiatric hospitalization with significant increase in destructive behaviors, skill development/improvement so that the service is no longer needed)
What section(s) of the ISP can best capture this need?
(e.g., Medical Information: Psychosocial; Functional Information: Adaptive/Self-Help; Individual Preference: Know & Do)
Will this need result in a change in goal(s) and/or objective(s)?
(e.g., Goal mastered – end date; new goal to be added to address new need)

16. Examples Service Note ISP Crosswalk
A team meeting was held on 11/10/2011 to address concerns related to Jonah’s food sensitivities and ongoing weight loss which is excessive. The team agreed that Nutritional Counseling would be beneficial to address concerns. Nutritional Counseling service added to plan for 240 units, 4 units per visit, 1 time per 7 days. In addition, SC reviewed the Clinical ISP Review Checklist and made all the requested revisions throughout the plan.
Service Details change to add Nutritional Counseling
Goal Section – goal added to address need for nutritional service
Individual Preferences – Know & Do
Medical Information – Current Health Status for weight loss concerns
Health & Safety – Meals/Eating for food sensitivities

17. Examples Service Note ISP Crosswalk
SC received a telephone call from Kathy’s mother. Kathy is being discharged from the psychiatric unit at ABC Hospital. Team meeting was held on 9/25/2011 to discuss concerns that behaviors (self-injurious behaviors) are not under control yet. BSS, CI and mother agree that an increase in hours is warranted for both services. SC submitted Critical Revision to increase CI hours and BSS (direct & consultative). Plan updated to reflect change in needs.
Service Details change to increase Community Inclusion and Behavioral Specialist Service (direct & consultative)
Goal Section – possible new goal, possible new objective to address increase in behavior (collaborate with BSS)
Individual Preferences – Know & Do
Medical Information – Medications (if changed), Current Health Status to reflect psychiatric hospitalization, Psychosocial to address change in behavior, any new psychiatric diagnoses
Functional Information– Social/Emotional to address behavioral changes; Understanding Communication

18. Examples Service Note ISP Crosswalk
Critical Revision submitted to delete the Supported Employment service from the plan and to decrease the hours of Community Inclusion. The SC met with Rick and his mother on 10/7/11 to discuss this change of need. Rick obtained a job on his own and does not want a job coach to support him on the job. He feels confident that he understands the job functions and his co-workers are willing to assist him if needed. Because of his new job, he and his mother do not feel he needs as many CI hours. They both would like the service to continue at decreased frequency to help Rick address his social skills and independent living skills needs.
Service Details change to decrease CI hours and deletion of Supported Employment
Goal Section – Delete goal associated with Supported Employment, possible revision of goals/objectives associated with CI
Individual Preferences – Know & Do
Functional Information– Employment/Volunteer screen to reflect new job; possible update to other screens in this section depending on needs associated with the CI services

19. Final Note
REMEMBER!!
Service Providers do not have access to Service Notes
ISP is main source of current information regarding the participant
Provide details
Update, Update, Update!