Considerations for Willowbrook Service Coordinators

1. Considerations for Willowbrook Service Coordinators MSC SupervisorsVideoconferenceMarch 26, 2008

2. Willowbrook Guiding Principles Protection from harm Sufficient and appropriate services Community based, integrated services

3. The Willowbrook parties advocate for… Smaller residences and community based services that accommodate changing needs Individual community inclusion strategies based on the class member’s interests, preferences, and capabilities Individual and small group experiences, with person centered frequency and variety Documentation of inclusion implementation

4. The Willowbrook service coordinator is expected to ensure... Compliance with OMRDD policies and regulations Compliance with the Willowbrook Permanent Injunction

5.  Advocacy and the Advocate The Service Coordinator advocates but is NOT The Advocate The Service Coordinator secures consent/sign off but does NOT give consent/sign off. That is the role of The Advocate.

6. Willowbrook Active Representation Is… A court ordered entitlement Active Representation is first and foremost for the class member

7. Per the Permanent Injunction, Willowbrook Active Representation… IS Correspondent participation with the program planning team in planning and evaluating the person’s plan of services; and/or visits the class member at least annually IS NOT Merely signing consent forms sent through the mail or receiving phone calls initiated by staff with no other involvement

8. For class members who are not self-advocates, the correspondent would be… A parent or legal guardian Alternate family member The Consumer Advisory Board (CAB)

9. CAB Communication Protocol All official communication with the CAB, both verbal and written, is directed to Central CAB Official communication includes notifications required by the Permanent Injunction, policies and procedures, and regulations Includes plan of services, i.e., ISPs, CFAs

10. CAB Communication Protocol If you need to speak to someone immediately, call Central CAB: During normal business hours, staff will contact the assigned local CAB or advise accordingly After hours and on weekends, the answering machine is checked regularly If a response is necessary before the next workday, specific information and a request to respond should be included in the message.

11. CAB Communication Protocol Don’t use email to schedule meetings: To schedule meetings on an urgent issue or emergency, and local CAB is not reachable by phone, leave a message with Central CAB Informal email between staff is unofficial communication and should be summarized for the local CAB as official communication, verbally, or by letter to Central CAB. Informal email exchange is not to be used in lieu of formal team communication for decision making and service review.

12. Service Coordination Activity Plan Required for all class members Attach to the class member’s ISP Describes certain short-term service coordination activities that are most important to the person. Represents a method to track activities to achieve valued outcomes or other goals on behalf of the person

13. Timeframes for Completion Within 60 days of enrollment into the MSC program Reviewed at least every six months but activities may be added at any time The review must be referenced in service coordination notes

14. Activity Plan Best Practices Complete immediately following ISP or other team review ~ serves as a way to track agreements from the meeting May also be modified, updated following a meeting with the individual and advocate or after an important life changing event

15. Activities may include: Arrangements for new life experiences Follow up with a provider about a current issue or problem Discovering new ways to promote community inclusion Learning more about the person Resolving a difficult situation Identifying ways to help the person contribute at work, home and in the community

16. The Activity Plan is not designed to reflect… Ongoing services that are part of the routine maintenance of a person’s ISP Required MSC activities Completing required monthly notes or required MSC forms Writing, reviewing or updating the ISP, and convening ISP or other required meetings

17. Service Coordination Observation Report (SCOR)You need a good eye to get a good SCOR! SCORs for Class ~ Who? Willowbrook class members who receive MSC and live in OMRDD certified residences, including family care homes, IRAs, CRs For class members living in VOICFs, SCORS are completed by the DDSO case manager/ service coordinator

18. SCORs for Class ~ When? Any time the MSC observes a significant issue in the home related to health, safety or the environment Minimally required one time in a six month period, i.e., two times a year Always have a SCOR form when you make a home visit

19. SCORs for Class ~ Collaborative Visits? Participate in a collaborative SCOR visit with local program associate once annually when CAB is involved on behalf of the class member At mutually convenient time or at team meeting convened at the residence when both service coordinator and CAB are in attendance

20. SCORs for Class ~ Follow up? Ensure that corrections are made by the residential agency within reasonable time frame. What is considered “reasonable” will vary. Report delays in correction to the supervisor. The supervisor should contact residential agency regarding unresolved issues, or provide other follow up to facilitate corrections if delays are noted. Beware of repeat SCOR citations, either the same issue or related.

21. Beyond the SCOR, look out for… Offices in common space such as dining rooms, living/recreation rooms, hallways ~ find furniture that blends with the décor Postings: Staff communication can go in binders, not posted on walls or cabinets. Don’t post menus, feeding protocols, schedules ~ remember privacy. NO freezers in the dining room Misfit Window Treatments – Take time to shorten window treatments or raise the curtain rod

22. Caseload Compliance ~ Ratio and Experience Caseload no greater than 1:20 ratio equivalent Qualified mental retardation professional (QMRP) QMRP standards defined within regulation 14 NYCRR 690.99 AC. Must be functionally independent when the same agency provides both residential or day services. Service coordination administered “arms length” from operational programs within the agency.

23. If the class member changes MSC vendor… The sending agency should ensure that the receiving agency knows about class status and requirements for caseload ratio, experience and functional independence The sending agency should confirm that compliant choices are offered The sending agency should notify the DDSO Willowbrook liaison of the change

24. Willowbrook Community Inclusion The Willowbrook parties are looking for… Individual inclusion strategies based on the class member’s interests, preferences and capabilities Individual and group inclusion with person centered frequency and variety Documentation to reflect implementation

25. Monitoring of inclusion ~ Service coordinator? Advocate for a rhythm of life based on the things the class member enjoys Advocate for regular experiences, community relationships, family connections Review documentation Suggest new community experiences when appropriate

26. Community Inclusion Is… Activities from both the home and day services that ensure the person Uses facilities that are typically used by community members; AND Interacts with people who are not paid staff and who do not have a disability Recreation experiences, while appropriate and useful at times are not considered to be inclusion.

27. Community Inclusion Is Not… Taking people around to community places in large groups Bringing community members into segregated programs in large groups

28. Inclusion documentation should reflect… Breakaways, i.e., if the class member arrives to an activity together with other people, and then splits up into smaller groups or go out as individuals upon arrival at the destination. Weather conditions, clinical concerns, weather restrictions, health issues, preferences, etc. that impacted on the class member’s participation in a planned community experience.

29. Willowbrook Community Inclusion ~ Refusals? Look at patterns of refusals Convene a team meeting to discuss and document community options being refused, reasons for refusals and new options to explore Ensure counseling and alternatives consistent with preferences and interests

30. Due Process (30 day) Notice Permanent Injunction requires 30 day written notification via due process forms Use correct letter format for planned placement proposals, i.e., IRA or non-IRA See Compendium Sample Letter Formats Match letter to placement proposal, NOT current residence NO hybrid letters Remember necessary cc’s and attachments Residential agency should NOT issue 30 day notice Follow the process for waiver of 30 day review period

31. Emergency Notification Reference “Green Book” CP9 for definition: Time limited services elsewhere [requires bed hold] Emergency transitional or emergency permanent moves Use correct letter format for emergency moves See Compendium sample letter formats List necessary cc’s Residential agency should NOT issue due process notification for emergency moves

32. Emergency and 30 day notices are… Official communication ~ presented on letterhead with proper spelling and grammar Send to correspondent Some common “flubs” Urinary tract NOT urinary track Intubate NOT incubate Holdover from letter “file texted” for another person [this happens with ISPs as well]

33. An ISP or plan of services should… Be developed at least annually based on current assessment information Reflect who serves as the advocate for the class member, specify the relationship and give contact information Be specific on frequency of contact not “visits often” but “visits once weekly” not “died last year” but “died 1/1/2007” Include safeguards bed safety, environmental adaptations, hospital coverage, special diet, aides

34. For Willowbrook Incident Reporting The requirements related to access of incident reports for the Willowbrook parties is unchanged based on recent revisions to Part 624: NYCLU receives OMR 147 for allegations of abuse CAB receives all OMR 147s of serious reportable incidents and allegations of abuse For events/situations subject to Access to Records Law reporting, when CAB is correspondent or co-rep, Central CAB receives the OMR 147 and 148 automatically and the offer for a meeting New cheat sheet related to incident reporting will be issued in April 2008

35. Informed Consent for Willowbrook Class Members Fully Represented by the Consumer Advisory Board (CAB) Effective 11/23/2005. OMRDD's regulation on informed consent for medical treatment 14 NYCRR 633.11 was amended to include CAB on the list of surrogate decision makers. CAB was authorized to make informed consent decisions “in loco parentis” for a class member who is not able to make the informed medical decision and has no other identified surrogate.

36. CAB will NOT give informed consent… …when the class member or a family member is available and willing to give consent or has objected to the proposed treatment.

37. CAB is not authorized to give informed consent… for class members who are able to give informed consent on their own behalf; for class members who have a legal guardian, health care agent or other actively involved family member that acts as surrogate decision maker; or when CAB provides co-representation.

38. TIPS to expedite requests for CAB informed consent Remember ~ the CAB review process does not include a formal hearing. Failure to submit all required documentation delays the review, and may result in the return of the information packet to the originating requestor for resubmission. Use the CAB Informed Consent Submission Checklist to guide the compilation of required information.

39. TIPS to expedite requests for CAB informed consent Do not use SDMC forms ~ they will be returned to the originating requestor. Piecemeal submission will delay the review process.

40. TIPS to expedite requests for CAB informed consent If sedation or anesthesia is required, include an explanation and risk/benefit information Always include recent annual medical assessment and laboratory reports Provide a listing of current medication ~ remember name and dosage Any known medication or food allergies Don’t forget weight information for the past year

41. TIPS to expedite requests Local CAB should be contacted immediately when professional medical treatment is recommended, and communicate throughout the process. Advance notice should be given to the local CAB of related appointments so that, if possible, they can make arrangements to attend.

42. TIPS to expedite requests If an expedited decision is needed, defined as within 8 business days of submission, advise the local CAB, and reflect this on the CAB Informed Consent Submission Checklist and cover letter. Remember to provide the medical recommendation and justification for the expedited review.

43. TIPS to expedite requests Include a statement in the ISP, CFA, or a recent assessment by a qualified examiner that confirms: The class member lacks capacity to give informed consent for medical treatment and the basis for the statement. There is no known health care agent, legal guardian, or available family member authorized under Public Health Law or OMRDD regulation to grant informed consent. The class member is fully represented by the Consumer Advisory Board.

44. TIPS to expedite requests Ensure the primary health services contact (RN or MD) is available to respond to CAB questions Take steps promptly to facilitate CAB’s communication directly with the health care provider proposing treatment, to explain/clarify the request. The secondary contact may be the service coordinator/case manager, residential director or other agency designee. The local CAB rep is NEVER the secondary contact.

45. TIPS to expedite requests Seek a second opinion for medical/dental treatment when questions can be anticipated. Include all applicable documentation from these medical/dental consultations to facilitate the CAB review.

46. What’s New with Personal Allowance? Personal Allowance regulations were revised effective 1/1/2008 Personal Allowance Manual and power point with revisions available on the OMRDD Internet on the secure Provider webpage. Suggested formats for Personal Expenditure Plan (PEP) and Money Management Assessment also available on the webpage. To access the webpage: Enter http://www.omr.state.ny.us/hp_provider.jsp - Click on OMRDD Benefit-Related Memoranda link; - Enter provider in the password box and press Enter.

47. Timeframes for PA Changes Effective 1/1/2008 Enforced 4/1/2008, after 3-month implementation period Year long phase-in during CY 2008 for two requirements (personal expenditure planning and money management assessments)

49. Participating in PEP process Although an individual's MSC should be part of the team to design the PEP, he or she cannot be assigned the responsibilities of writing, monitoring or auditing the PEP since it is not a Medicaid service.

50. Money Management Assessment Will be developed as part of PEP Written assessment of how much cash person can independently and safely handle at any time and the frequency funds are provided to the person Need to have rationale for the conclusion on the amount of money and the frequency that the person can handle. It is not enough to just state the amount and frequency.

51. Personal Expenditure Plan (PEP) Written plan required Project personal spending over a 12 month period Develop via team process Implement within 12 months of regulation effective date OR next annual review, whichever is sooner Non-agency payee doesn’t have to do PEP

52. Contact your DDSO liaison or Denise Pensky for assistance