III.C.7.b.i.B.2.b. The number of individuals who remain employed in integrated work settings at least 12 months after the start of supported employment. Compliance The Commonwealth has set the target of 85% of the number of individuals in supported employment to remain employed for at least 12 months is a meaningful increase. III.C.7.c. Regional Quality Councils (RQC), described in V.D.5. … shall review data regarding the extent to which the targets identified in Section III.C.7.b.i.B.2 above are being met. These data shall be provided quarterly … Regional Quality Councils shall consult with those providers with the SELN regarding the need to take additional measures to further enhance these services. Deferred The employment target data were reviewed by the SELN Advisory The RQCs are now established and shall begin reviewing data during the State Fiscal Year 4th quarter. III.C.7.d The Regional Quality Councils shall annually review the targets set pursuant to Section III.C.7.b.i.B.2 above and shall work with providers and the SELN in determining whether the targets should be adjusted upward. Deferred The RQCs were not developed to be able to review the new targets prior to implementation on April 1, 2014. III.C.8.a. The Commonwealth shall provide transportation to individuals receiving HCBS waiver services in the target population in accordance with the Commonwealth’s HCBS Waivers. Compliance Of the Individuals studied, 24 (96%) of 25 were receiving transportation services. III.C.8.b. The Commonwealth shall publish guidelines for families seeking intellectual and developmental disability services on how and where to apply for and obtain services. The guidelines will be updated annually and will be provided to appropriate agencies for use in directing individuals in the target population to the correct point of entry to access services. Non-Compliance The Commonwealth completed draft guidelines in June 2013. There is no evidence that the guidelines were published or provided to appropriate agencies. A committee has been formed to update the guidelines. III.D.1. The Commonwealth shall serve individuals in the target population in the most integrated setting consistent with their informed choice and needs. Non- Compliance Individuals are primarily offered congregate settings. The plan developed will not meaningfully increase living options that offer most integrated settings. None (0%) of the 30 individuals who moved from Training Centers and were studied in the two recent review periods were referred for rental assistance.
III.D.5 Individuals in the target population shall not be served in a sponsored home or any congregate setting, unless such placement is consistent with the individual’s choice after receiving options for community placements, services, and supports consistent with the terms of Section IV.B.9 below. Non- Compliance Studies during the past year found that 27 (90%) of 30 individuals who moved from Training Centers to placements that were consistent with the individual’s, or if applicable the authorized representatives, choice after receiving options. The Independent Reviewer has determined that options received were not consistent with the terms of Section IV.B.9.b. III.D.6 No individual in the target population shall be placed in a nursing facility or congregate setting with five or more individuals unless such placement is consistent with the individual’s needs and informed choice and has been reviewed by the Region’s Community Resource Consultant and, under circumstances described in Section III.E below, by the Regional Support Team. Compliance The individuals reviewed who moved to congregate settings that were consistent with the individuals’ needs and informed choice. For many individuals who chose larger congregate settings, barriers were identified to less integrated setting. III.D.7 The Commonwealth shall include a term in the annual performance contract with the CSBs to require case managers to continue to offer education about less restrictive community options on at least an annual basis to any individuals living outside their own home or family’s home (and, if relevant, to their authorized representative or guardian). Compliance This term has been included in the Commonwealth’s “FY 2013 and FY 2014 Community Services Performance Contract.” III.E.1 The Commonwealth shall utilize Community Resource Consultant (“CRC”) positions located in each Region to provide oversight and guidance to CBSs and community providers, and serve as a liaison between the CSB case managers and DBHDS Central Office…The CRCs shall be a member of the Regional Support Team in the appropriate Region. Compliance Community Resource Consultant positions are located in and are members of the Regional Support Team in each Region and are utilized for functions.
III.E.2 The CRC may consult at any time with the Regional Support Team. Upon referral to it, the Regional Support Team shall work with the Personal Support Team (“PST”) and CRC to review the case, resolve identified barriers, and ensure that the placement is the most integrated setting appropriate to the individual’s needs, consistent with the individual’s informed choice. The Regional Support Team shall have the authority to recommend additional steps by the PST and/or CRC. Non- Compliance The CRC’s referred 37 individuals in the second quarter of FY 2014. The RST’s did not resolve identified barriers to living in most integrated settings or to receiving integrated day opportunities. Reasons for choosing less integrated residential options include: the lack of needed services, the lack of availability in the area, the lack of safety equipment (i.e. fence), and the severity of individuals’ needs for medical and behavioral supports. Integrated day opportunities are not available. III.E.3.a-d The CRC refer cases to the Regional Support Teams (RST) for review, assistance in resolving barriers, or recommendations whenever (specific criteria are met) Compliance DBHDS established the RSTs, which met monthly since March 2013. The CRCs are referring cases to the RSTs regularly. CRCs referred 37 individuals in the second quarter of FY 2014. RSTs frequently recommend more integrated options. See III.E.2. above regarding the RST’s ability to resolve barriers. IV Discharge Planning and Transition IV. By July 2012, the Commonwealth will have implemented Discharge and Transition Planning processes at all Training Centers consistent with the of this section Compliance Discharge planning and transition processes were implemented by July 2012. Improvements have occurred in response to concerns identified and to the Independent Reviewer’s recommendations. IV.A To ensure that individuals are served in the most integrated setting appropriate to their needs, the Commonwealth shall develop and implement discharge planning and transition processes at all Training Centers consistent with the terms of this Section and person-centered principles. Non-Compliance Most integrated settings that meet the needs of individuals with complex medical and behavioral concerns are often not available. A sponsored home that meets an individual’s needs is often not offered in most regions. Referrals for rental assistance have not occurred.
IV.B.11.b. Person-centered training will during initial orientation and through annual refresher courses. Competency will be determined through documented observation of PST meeting and through the use of person-centered thinking coaches and mentors. Each Training Center will have designated coaches who receive additional training. The coaches will provide guidance to PSTs to ensure implementation of the person-centered tools and skills. Coaches throughout the state will have regular and structured sessions and person-centered thinking mentors. These sessions will be designed to foster additional skill development and ensure implementation of person centered thinking practices throughout all levels of the Training Centers Compliance All receives person centered training during orientation and receives annual refresher training. All Training Centers have person-centered coaches. DBHDS reports that regularly scheduled conferences provide opportunities to meet with mentors. IV.B.15 In the event that a PST makes a recommendation to maintain placement at a Training Center or to place an individual in a nursing home or congregate setting with five or more individuals, the decision shall be documented, and the PST shall identify the barriers to placement in a more integrated setting and describe in the discharge plan the steps the team will take to address the barriers … Deferred Data about barriers are reportedly submitted and aggregated quarterly, and have been used by DBHDS to develop plans to overcome barriers (e.g. Bridge Funding, enhanced rates) The Regional Quality Councils will begin to review these data this quarter. IV.C.1 Once a specific provider is selected by an individual, the Commonwealth shall invite and encourage the provider to actively participate in the transition of the individual from the Training Center to the community placement. Compliance For 29 (97%) of 30 individuals studied during the past year, the residential provider was trained in support plan protocols that were transferred to the community and participated in the pre-move ISP meeting. IV.C.2 Once trial visits are completed, the individual has selected a provider, and the provider agrees to serve the individual, discharge will occur within 6 weeks, absent conditions beyond the Commonwealth’s control. If discharge does not occur within 6 weeks, the reasons it did not occur will be documented and a new time frame for discharge will be developed by the PST. Compliance Reviews found that 28 (93%) of 30 individuals within 6 weeks, or reasons were documented and new time frames developed.