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 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 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

19. 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.

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. 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.

22. 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

23. 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 .  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.

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

25. 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

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
Clinical
Administrative

27. Southside Virginia Training Center – Petersburg, VA
Total Number of Staff: 937
Direct Support Staff
High school graduate or GED
Predominately female
Nursing
LPN’s & RN’s
Clinical
Psychologist, SW, OT, PT, & Speech Therapist
Administrative
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
LPN’s & RN’s
Clinical
Psychologist, SW, OT, PT, & Speech Therapist
Administrative
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