Monday, December 11, 2017

How we are helping providers better serve people with complex developmental disabilities and medical needs

Author: Mark Thomas, Assistant Secretary, Louisiana Department of Health
Office for Citizens with Developmental Disabilities

In Louisiana, there are over 38,000 people identified as eligible for services in our disability data system.  They are your friends, relatives, parents and children.  At the Louisiana Department of Health, we strive to assist those with disabilities who need our support and services. 

These benefits are achieved through our Office for Citizens with Developmental Disabilities, or OCDD, which serves as the single-point-of-entry into the developmental disabilities services system and oversees public/private residential services and other services for people with developmental disabilities. Local human services districts/authorities serve as the points of entry* for individuals to receive those services.

Our office recently completed a pilot initiative known as the Complex Needs Training and Technical Assistance Partnership, aimed at increasing provider capacity to support individuals with complex needs in home and community-based living situations.

We collaborated with the Louisiana Developmental Disabilities (DD) Council on this initiative with the primary goal of ensuring that provider agency staff members receive training in person-centered thinking, positive behavior supports, medical/nursing needs, and nutritional/physical supports followed by intensive technical assistance related to supporting individuals with complex medical or behavioral health needs.

According to the Council’s Executive Director Sandee Winchell, “The DD Council approached OCDD about partnering to train home and community-based providers and direct support professionals to address the lack of qualified staff, which often leads to the unnecessary and costly institutionalization of individuals with complex needs.”

The Office for Citizens with Developmental Disabilities currently has more than 600 home and community based service providers who employ more than 60,000 direct support staff statewide. These are people who assist individuals with a developmental disabilities to lead a self-directed life and become an active, contributing member of their community. These professionals assist in many ways, such as helping with activities of daily living, presenting opportunities to learn and develop new skills, empowering individuals to exercise their independence, and encouraging attitudes and behaviors that enhance community inclusion.

“Every person with a developmental disability deserves the same opportunities as everyone else to live in their own homes and fully participate in their communities. For those with the most complex behavioral and/or medical needs, it is often difficult to find staff with the training and skills needed to provide quality support services,” added Winchell.

The Technical Assistance Partnership Pilot Program
Two home and community based service providers were selected for the pilot program. Always TLC, which does business as All About U, was the first application received and the first provider selected. The second provider had to withdraw from the project after being impacted by the August 2016 flood.

As part of the initiative, the providers committed to a year-long partnership with the DD Council and our office. The first phase began in June 2016 and ended in early September 2017.

“Being a part of this partnership initiative and pilot study with OCDD and the DD Council has been one of the best business decisions we’ve made as an agency,” said All About U Administrator Kamal Dorsey. “With the help of the OCDD clinical team, they have enhanced all staff across the board by providing necessary tools and trainings to better serve our population.”

The initiative was overseen by the DD Council’s Self-Determination and Community Inclusion Committee, along with technical support provided by OCDD senior staff members, including Dr. Brandi Kelly, Dr. Amy Greer, Dr. Sylvia Melancon and Christy Johnson.

"The DD Council partnership has allowed our office to work alongside providers committed to serving individuals with complex needs in a manner that enhances individual lives and improves health outcomes,” said Dr. Brandi Kelly. “It has provided a vehicle for improving person-centered practices, evaluating provider needs and system challenges, and developing a road map and guidelines for larger system enhancements."  

The partnership training was broken down into a set of three core phase: the first being initial training, followed by intensive technical assistance, and ending with final implementation and outcome monitoring. The core training modules addressed person-centered thinking, introduction to positive behavior supports and recognizing signs and symptoms of illness. Advanced modules for enhanced training option were also provided for building foundational skills for DSPs. 

For the second phase of the partnership, 21 applicants applied with two providers being selected again, Care Solutions based in Monroe, which began in September 2016 and ShareCare based in Lafayette, which began in January 2017. Through the partnership, 108 direct service providers have participated in the training from the three pilot providers.

Some highlights and outcomes from the pilot initiative include:
·         Emergency room visits decreased significantly from an average of 1.83 (range of 0-4 each month) with only one ER visit since the beginning of the partnership 
·         Critical incidents decreased significantly from an average of 6.8 a month (range of 2-13 each month) to an average of 1.17 a month (most months at 0-1 with only 1 month higher than 1) and most incidents centering on illnesses that could not be anticipated and no behavioral incidents in the year since the partnership began
·         Enhanced family relationships and other community connections for all identified recipients
·         Increased independence or supports aimed at increasing independence for all but one individual identified
·         Actions toward competitive employment for 40 percent of identified recipients
·         No staff injuries, complaints or turnover for staff involved in the project

* A single point of entry is a process to determine the applicant’s eligibility for supports and services into the developmental disabilities service system. The individual and/or their family member would receive information about all the possible programs and services for which they might qualify, as well as appropriate referrals to service(s).

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