I/DD Changes Informational meetings 6/16/16 and 6/17/16
Julia introduced that she will talk about the draft plan for moving forward of re-organization of services and teams serving people with intellectual and developmental disabilities. We want to get feedback, and will also meet with providers to get feedback. The teams have been working on this for months.
Why are we making these changes? We want to improve the services we provide. We have not changed our services in a very long time; the people receiving services have complex needs and we know we can better meet those needs. Not everyone needs the same services; we need to get more specialized.
We started by taking a look at the people we serve and the categories of needs of those individuals. We looked at demographics such as age, gender, medical conditions, parental status, trauma history, and others. The number one reason for this re-organization is to improve practice. When we closed the 3 day programs and tried to develop more inclusive programs in the community, we learned that we needed a more individualized approach. We did follow up surveys regarding the day program closings and a lot of the feedback was positive, but we found there are still a lot of unmet needs. This is an ongoing process and we are still working on this. We realize that things don’t always work the way we intend them to.
There is a lot of change going on in the behavioral healthcare field including regulatory changes as well as changes to improve practice based on what evidence tell us. There are federal and state regulatory changes in addition to wanting to improve practice. One of these is “conflict free case management.” This means the case manager (supports coordinator), whose job it is to provide advocacy and assessment, is not to provide authorization for service. However, we have had this happening in our specialized residential settings.
Currently we have a team which works with individuals who live in specialized residential homes, two “general” teams and one intensive case management team serving people with significant mental health challenges. Right now we have one supports coordinator for everyone in a specialized residential home, which is good for many reasons but also creates the aforementioned conflict. Additionally, we want workers to be able to follow a person regardless of their setting (ie, if they move.)
In the new draft design, there would be 5 (rather than 4) teams. This would include 2 general teams, 1 team for people with medical complexities, 1 team for transition age youth (age 18-30s), and one team for people with significant mental health challenges. Each of these teams will have a team leader, supports coordinators (5-10), supports coordinator assistants, nurse, master level clinician, and shared staff such as peer support, OT/PT/Speech therapists and employment specialists. We have a very robust and specialized team here which is unique for a CMH.
Two individuals receiving services at HealthWest spoke about how they are going through peer support specialist training currently to become part of the new re-structuring. We currently have Peer Support Specialists in our adult MI and Youth programs; this is a Medicaid billable service that helps provide support in a different and very meaningful way. We also have Parent Support Partners who have lived experience and can support other parents with behavioral health challenges. It is our hope that our provider agencies will also start hiring Peer Supports in developmental disability services.
Leadership laid out some ideas and then talked to staff on the existing teams to see where interests and abilities were to help match these with the upcoming opportunities.
The downside of this draft plan is that some people will have a change of worker/supports coordinator. The specialized homes will be split into two teams and so there will be some changes. For example, right now there is one supports coordinator in a home, whereas with the changes, there will be multiple supports coordinators in the homes. We don’t want to unnecessarily disrupt relationships.
There are some other special needs populations that will not have a full “team” but more services are needed. These include: substance use disorders (we currently have groups but this isn’t always the best fit), trauma histories (we have Dialectical Behavior Therapy, DBT, but may need more of this), individuals involved in corrections system, people who have increased need for employment opportunities.
That is how we came up with this model. We do not have a timeline yet. We always want to use the person centered planning process with any changes that are made, and we always want to focus on individualized treatment. Julia gave a shout-out to staff on the DD teams and said they are doing an exceptional job, being creative to meet people’s needs. Things need to be medically necessary so that we are being fair and truly meeting people’s needs.
In order to be more individualized we will need to do more frequent person centered planning, and engage the individuals who know the person served best. The state standard is to do person centered planning once a year; HealthWest’s new standard is every 90 days. We really want to be more dynamic. Maggie O’Toole wants everyone to know she is a resource at the ARC and can help provide advocacy during person centered planning so feel free to reach out to her. If you are not getting your needs met, you can reach out to team leaders if you have any issues. A list of this contact information will be put on the website and also available in hard copy so you can contact who you need to contact.
This will broaden the possibilities for placement because it won’t be one worker with one home.
The home and community based waiver will make changes as well, and we will have more informational meetings down the road around this. Right now we have some supports coordinators assistants, and they do not have the credentials needed under the super waiver. We do not want to lose these staff so we are trying to prepare and plan for this, by changing some of the duties of these individuals (ie, CLS or brief interventions.) We envision they will become specialists in things like housing, entitlements, money management, and other areas where they can offer support to the teams.
Historically, master level clinicians were managing behavior support plans. We have reduced these and are working on treating things like trauma histories rather than behavior modification.
We will also have a consultation team with behavior supports and OT/PT/Speech (these people will not have caseloads but will provide support for staff, providers, etc.)
We already have on-call crisis; we will soon be implementing mobile crisis. This will include a bachelor level, master level, peer support available to respond in the community to crisis. This will help prevent hospitalization and keep people in the community. This will be for all adults (no distinction between people with substance use disorder, mental illness, and developmental disability.) Some people need behavior support plans but it is not always the right solution for everyone.
Question: What happens if you lose Medicaid?
Answer: We don’t always know, this continues to be a question. We are hoping to get more benefits expertise at the agency. Another issue is spend down; there is some money for this that will help us to help people meet their spend downs in the coming year. Part of the team’s job is to help problem solve paying for services that are needed.
Question about if people will have nurses and get health assessments: Yes there are nurses available on every team, people might not have a nurse assigned to them but there will always be nursing available if needed.
There is a need for new Medicaid dollars, and to prioritize direct care staff. What we need is new money, to hold on to staff.
Time line – no dates and details. We don’t want to move too quickly as that is when mistakes happen.
Questions about this model or concerns:
Tom Zmolek- nurses won’t have caseload ie homes- how will cases be divided between them? Julia gave example of when an med error occurs within the home, they won’t have to contact our nurses but rather take these services on to designate solutions. “We can look at their needs and Tom could say we need to negotiate the contract to meet these needs.” Again we want to provide advocacy and support for the individual and not for the home.
My son is in thetransitional ages group, where will he go after that? Remember the numbers are not written in stone, but we will look at his individuals needs and we want to look at what the needs are of that person and where their needs will be best met?
The crisis team- how do they call and what is determined a crisis? They call our current 24 hr on call and they triage this and define if the mobile team is appropriate to assist. They may be told if it is necessitated to go to the hospital based on the need. We will utilize our current staff for this.
My son is 19 and doesn’t want to stay in school and he wants to work..how do we help with this transition now? He is a perfect example of the transitional group and the expertise that we need for this team and how we can best help them through this process.
Will there be any changes to pcp and how services are authorized? Yes, SC cannot be in charge of authorizing services. The supports coordinators now know what the services are… now we want to how to have formal processes to help facilitate the preplan in a more formal way and work through what the needs are and how we can meet them. We have been more informal now. The other part of this is that the LRE may have a role in this authorization piece.
What do we do if we don’t get the services we want? Julia informed her to ask for more conversations, talk to the supervisor, and even me! But remember that it has to be based on need.
****Julia requested Customer service to get information out to people involved some contact information for example put these on the website.
Do you see something down the road for those programs that got cut? To replace this? We do have community partners that serve this need.
Discussion of difficulties with GT financial and payments was brought up and . Judy from contracts was introduced andLaura Ritchie stated they do have an upcoming appointment set up with them to discuss the challenges they are having.
Comment of mom- my son has been involved with CMH for 26 years and I have always had wonderful workers! I just wanted you to know this!