1. Health and Safety Assurance in Arkansas’ ACS Waiver RISK ASSESSMENT

2. Big Picture From CMS

3. DHS Vision Arkansas citizens are healthy, safe and enjoy a high quality of life.

4. DDS Beliefs ● All eligible persons should have an opportunity to receive services ● Everyone has the right to personal space ● People will be as independent as opportunity and ability allows ● People will develop living skills that are important to them ● People are safe ● People are satisfied with their services ● People are supported by their communities

5. DMS Quality Assurance Review/Health and Welfare Participants' families/legal guardians' and caregivers complaints are identified, tracked and addressed Abuse/neglect/exploitation incidents are identified, tracked and actions taken to assure participant's safety Situations in which the participant's health and welfare have not been safeguarded are acted upon timely and appropriately

6. DMS Quality Assurance Review/Health and Welfare Have participants been informed of their right to a fair hearing and the process to request hearings? Is there proper documentation of accommodation for limited English proficiency?

7. This is all well and good, but… This is “after the fact” investigation What must be done ahead of time? Does someone we serve do things that can harm themselves or others? How often? Triggers? Health issues?

8. Failing to Plan = Planning to Fail The bottom line is that risk factors must be elicited, communicated, accounted for, planned for and addressed Then, as plan years come and go and risk factors change, programming/services must be adapted toward the individual’s specific needs

9. Providers have the power and, therefore, the responsibility There is trust and belief on the part of DDS Waiver that providers do a good job of keeping people safe and assure their health and welfare We all know that assuming risks is part of serving individuals in the Waiver Assessing, planning for and designing services that are “active treatment” toward identified outcomes are central toward assuring heath and safety

10. You do this already by… Submitting a MAPS narrative that details not only risk factors but also the programming and services to address them along with disclosing otherwise how health/safety assurances will be met Identifying barriers to goals/outcomes Reviewing reports of service objectives that may identify issues staff have encountered Regularly visiting/contacting the individual and the MAPS team

11. You should be doing this… Developing and implementing a sound and practiced internal reporting system that all stakeholders know about so that “non-IRIS” reportable incidents are identified, tracked and actions taken to assure the individual’s health and safety …if you haven’t already

12. Section 4 of MAPS 4) Participant Input and Safeguards: A) Participant input related to service desires including schedules and staffing: B) Participant satisfaction with current services: C) Medication management plan in place for all medications? Yes No If no, when will plan be in place? D) Positive Behavior Plan in place for any psychotropic given for behavior? Yes No If no, when will plan be in place? Progress of plans effectiveness: E) If Positive Behavior Plan is not in place for psychotropic, did prescribing physician certify that psychotropic is not for behavior (see attached)? Yes No If no, when will certification be in place? F) Specify back up/support plan for service delivery in the event of natural emergencies such as loss of primary and/or paid care givers, loss of house, etc.: G) Assurance of health and safety of person, person’s caregivers, workers and others (Identify any known risks, such as, aggression, elopement, aging primary caregivers, drug/alcohol abuse, criminal history, etc. and how they are or will be addressed if they recur.): H) Safeguards to assure participant rights:

13. Word to the Wise It is up to providers to determine their own policy/process/procedure/tools to ensure that this portion of the MAPS is complete and accurate More importantly, it is up to providers to assure that the policy/process/procedure leads to services that lead to greater independence while assuring health and safety of the individual In MAPS, include/cite health/safety assurances formalized from another setting (like DDTCS or school) if applicable

14. Some Outside Perspective Partner’s For Inclusive Communities is touching on Health/Safety and/or Risk Assessment through a Safety and Sexual Violence Prevention Task force The Provider Task Force has indicated that an additional, mandatory tool as part of the MAPS is unnecessary – the Narrative portion is adequate

15. Furthermore… The Task Force and a number of individuals and providers have expressed concern that whatever process and/or tool that is used to ultimately assure health and safety must not be intrusive or in any way step on or violate the rights of individuals we serve CMS does not require a formal assessment tool ….for now…but the issue will not go away. In fact, it will likely become a greater area of focus

16. Finally… Remember your own information is a valuable source to identify “risk” factors ● Incident Reports (IRIS) ● Incident Reports (Internal non-IRIS) ● Medical Issues ● Behavior Issues ● Aging and health fragile, primary (non-paid) caregiver(s) Remember the DDS Waiver Section is here to help you…we are in this together

17. Connections… http://www.arkansas.gov/dhs/ddds/New Website/index.htmlhttp://www.arkansas.gov/dhs/ddds/New Website/index.html Terrell Wade, DDS Waiver Program Administrator P.O. Box 1437, Slot N 502 Little Rock, AR 72203-1437 501-682-8674 terrell.wade@arkansas.gov