DBHDS Virginia Department of Behavioral Health and Developmental Services Presentation
Review of DBHDS and system changes in the Commonwealth's commitment to community, including training for community providers with continued emphasis on person-centered thinking and positive behavioral supports.
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Presentation Transcript
DBHDS Virginia Department of Behavioral Health and Developmental Services DBHDS Presentation to TACIDD DOJ Settlement Agreement June 15, 2012
Provider Information Session Agenda DBHDS Virginia Department of Behavioral Health and Developmental Services 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 Page 2
DBHDS Virginia Department of Behavioral Health and Developmental Services Review of DBHDS and System Changes
Commonwealths Commitment to Community DBHDS Virginia Department of Behavioral Health and Developmental Services 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 4
Commonwealths Commitment to Community DBHDS Virginia Department of Behavioral Health and Developmental Services 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 5
Commonwealths Commitment to Community DBHDS Virginia Department of Behavioral Health and Developmental Services 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 6
DBHDS Virginia Department of Behavioral Health and Developmental 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 Page 7
DBHDS Virginia Department of Behavioral Health and Developmental Services Overview of Provider Expectations, Measuring Quality, Case Management Expectations, and Discharges from Training Centers
Quality and Risk Management System DBHDS Virginia Department of Behavioral Health and Developmental Services 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 9
DBHDS Virginia Department of Behavioral Health and Developmental Services Data Collections Areas 1. 2. 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 3. 4. 5. 6. 7. 8. 10 Page 10
DBHDS Virginia Department of Behavioral Health and Developmental Services Enhanced Oversight Categories 1. 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 2. 3. 4. 5. 6. 11 Page 11
DBHDS Virginia Department of Behavioral Health and Developmental Services Sources of Information 1. 2. 3. 4. 5. 6. 7. 8. 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 12 Page 12
DBHDS Virginia Department of Behavioral Health and Developmental Services Case Management 1. 2. 3. 4. Role of case management Enhanced visits to targeted population Transmission of key indicators to DBHDS Core competency training 13 Page 13
DBHDS Virginia Department of Behavioral Health and Developmental Services Review of New Training Center Discharge Process, Role of Community Integration Managers, and Post Move Monitoring
Additional Training and Information DBHDS Virginia Department of Behavioral Health and Developmental Services 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 15
Community Integration Managers (CIMs) DBHDS Virginia Department of Behavioral Health and Developmental Services 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 16
DBHDS Virginia Department of Behavioral Health and Developmental 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 17
DBHDS Virginia Department of Behavioral Health and Developmental Services SVTC/CVTC Initiative Training Center Target By July 1, 2012 Moves to date Number moved to Private Providers # of Providers chosen 20 40 18 39 17 38 11 22 CVTC SVTC Page 18
DBHDS Virginia Department of Behavioral Health and Developmental Services Census Reduction Goals Fiscal Year 2012 2013 Individuals D/C** 60 199 Waivers in SA 60 160 SVTC 40 103 NVTC 06 56 SWVTC CVTC 20 25 15 2014 2015 2016 2017 2018 2019 2020 105 52 39 20 20 40 40 38 25 57 56 50 50 35 35 202 116 96 90 88 50 55 160 90 85 90 90 35 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 19
Identifying Individuals for Discharge DBHDS Virginia Department of Behavioral Health and Developmental Services 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 20
DBHDS Virginia Department of Behavioral Health and Developmental 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 21
DBHDS Virginia Department of Behavioral Health and Developmental Services 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 Page 22
DBHDS Virginia Department of Behavioral Health and Developmental 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 23
DBHDS Virginia Department of Behavioral Health and Developmental Services Active Move Process Continued Initial pre-move meeting Choosing possible support options Pre-Move Monitoring Visits Tours Visits Training Page 24
DBHDS Virginia Department of Behavioral Health and Developmental Services Post-Move Monitoring ~3 day ~7 day ~10 day ~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 x x x TC x x x x x x x x x x x x x x OL x x x x x x x x x x x x x CSB x CRC PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN PRN OHR *** Additional visits may occur based on needs of individual or provider Page 25
DBHDS Virginia Department of Behavioral Health and Developmental 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) Nursing Clinical Administrative 1,856 258 189 882 Page 26
Southside Virginia Training Center Petersburg, VA DBHDS Virginia Department of Behavioral Health and Developmental Services Total Number of Staff: 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 937 550 91 46 250 Page 27
Northern Virginia Training Center Fairfax, VA DBHDS Virginia Department of Behavioral Health and Developmental Services Total Number of Staff: Direct Support Staff 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 503 288 21 45 149 Page 28
DBHDS Virginia Department of Behavioral Health and Developmental 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 29
DBHDS Virginia Department of Behavioral Health and Developmental 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 30
DBHDS Virginia Department of Behavioral Health and Developmental Services Employee Concerns Compensation Fringe Benefits (Health) Retirement Job Security Work Environment Page 31
