SUCCESSFUL LEGISLATIVE STRATEGIES TEXAS

1. SUCCESSFUL LEGISLATIVE STRATEGIES TEXAS Aaryce Hayes Advocacy, Inc.

2. SB 325: • Relates to child care facilities, ICFs, psychiatric hospitals, nursing homes, assisted living facilities, chemical dependency facilities and programs and Medicaid waiver programs. • Defines emergency as: a situation in which attempted preventative de-escalatory or redirection techniques have not effectively reduced the potential for injury and it is immediately necessary to intervene to prevent: • Imminent probable death or substantial bodily harm to the person because the person overtly or continually threatens or attempts to commit suicide or threatens to attempts to commit serious bodily harm; or imminent physical harm to another…

3. SB 325: • Defines seclusion as the involuntary separation of a resident from other residents and the placement of the resident alone in an area from which the resident is prevented from leaving. • Prohibits restraints that obstruct airways, impairs breathing by putting pressure on the torso, interferes with the person’s ability to communicate. • Restricts prone or supine holds to last resort when other interventions have proven ineffective, transitional and time limited and requires an observer not involved in the restraint monitor the person (small facilities excepted).

4. SB 325: • Defines acceptable holds, as those that hold the limb close to the body to limit or prevent movement. • Governs the use of seclusion. • Develops practices to decrease the frequency of restraint and seclusion. • Prohibits retaliation. • Requires notification of the resident and LAR of restraint and seclusion rules.

5. SB 325: • Regulations must reflect this language by June 1, 2006. • Requires a workgroup (including juvenile justice and the education agencies) to develop best practice recommendations on common definitions, common reporting requirements (including injuries, deaths and use of medication), and minimum standards. A report will be given to the Legislature by July 1, 2006.

6. NEVER GIVE UP/NEVER SURRENDER

7. Just Because It Is Right Doesn’t Mean It Will Pass

8. Strange Bed-Fellows • CCHR • TANHR • P&A

9. Use Legislators With Clout to Carry Your Bill • The Chairperson of the Committee where the bill will be heard is a good choice. You may prefer one party over another, but in a certain season you need to make new friends. Use members who sit on Finance or Appropriations committees.

10. Media Attention • Use testimony from families, witnesses, survivors or experts. Having testimony with TV cameras makes the move forward with lots of support. Get groups to give written testimony in support but do not take up a lot of time with verbal testimony. It makes the legislators grouchy!

11. Share the Pain • We provided committee members with de-identified information about deaths that occurred across Texas by legislative district, facility type and the type of intervention.

12. Keep Your Friends Close and Enemies Closer • Even if a legislator put on a good face at the hearing, it doesn’t mean you will have his support. Keep in close touch with legislators who represent provider or trade organizations, physicians, hospitals and facility providers. You need to address any issues they bring up. Remember this is a public process and opponents will likely testify. It is best to identify and address their issues in advance of the hearing.

13. No Fiscal Note - $$$ • A fiscal note delays a hearing until budge issues are resolved.

14. Learn to Compromise • Don’t sweat the small stuff. SB 325 exempts TEA, TJPC, and TYC from many mandated portions of the bill because of the fiscal notes they would have tacked on. When difficult issues arose, we compromised and often deferred to the HHSC workgroup where best practice recommendations would be developed. Just make sure your organization has a seat at the workgroup table. If you fail in the workgroup, you can always go back to amend the legislation but not if you don’t get something passed!

15. Bypass the Discussion on Eliminating Restraint/Seclusion • Avoid any value statement about emergency interventions. Its’ not good or bad. It is more politically effective to describe it as an intervention that may be necessary in some circumstances but research indicates is overused. Make it a clinical issue and focus on establishing orders, medical assessment and collecting data. These ultimately decrease the frequency of use. Focus on making it more difficult to order and use and increase accountability.

16. Narrowly Define Emergency • Most stakeholders likely did not realize that the definition of emergency would be used to determine when an emergency intervention can be used. The narrow language prevents interventions being used unless someone basically meets the involuntary mental health commitment criteria in Texas. It mandates that less restrictive alternatives be proven unsuccessful first. It does not allow for restraint for property damage.

17. What’s In A Name?

18. Chemical Restraint vs. Emergency Medication • Stakeholders get so caught up in the discussion about medication is good or bad, that it delays hearings and the legislation does not pass. The opposition just won. We did not debate about what it is called or how used (Physicians generally win that debate). Instead we made the issue clinical in nature and focused on accountability. The legislation mandates that use of medication in situations that meet the definition of emergency will be reported and analyzed. Make the issue clinical. If you can get it, no PRNs!!!

19. Make Good Use of Down Time • Texas has a legislative session once every two years, thank God. During the interim, we worked with individual agencies and programs to revise their regulations and establish better standards. You still need the legislation because of the variances between the definitions and the rule language but often they included language that was in the legislation that did not pass. • May they saw the writing on the wall, or eventually accepted that it was the right thing to do, or simply decided that it was good risk management. Whatever the reason this helps you get buy in from the agencies. If one agency includes language in their rule, it makes it more questionable for the others to disagree.

20. Interim Committee Study • There was an interim committee study after the 3rd attempt to pass the legislation (03) but when the new administration came in no one cared what had been recommended.

21. A State-Wide Conference(Held in December Just Before the 05 Legislative Session) • The conference information and participants crossed agencies, facility types, and populations. Juvenile Justice, Education, and Health and Human Service agencies all participated enthusiastically. Legislators spoke on the issue. In the conference, agencies acknowledged that their issues were very similar regardless of population. MORE BUY IN.

22. The Workgroup • The Health and Human Services Commission is the umbrella agency for all the health and human service agencies in Texas (this does not include education or juvenile justice). They have ultimate approval over the regulations for these agencies. They have little expertise in issues around emergency interventions. When needed they take their lead from the Legislator who passed SB 325. The legislator defers to the primary expert used for legislation, the P&A.

23. !!!!!!!!!!!!Get The Support of the Governor!!!!!!!!!!!

24. Most Important • HAVE A REALLY GOOD FRIEND (preferably an attorney) WHO WILL DROP EVERYTHING TO GIVE YOU THE NECESSARY INFORMATION AND SUPPORT WHEN YOU NEED IT!!!