October 26, 2012
This edition of Open Line includes information I want to share with you:
- Middle Tennessee Assistive Technology Clinic: On Tuesday, I toured the Assistive Technology (AT) Clinic in Nashville, part of the Middle Tennessee Resource Center. I had the opportunity to meet several persons supported, their direct support professionals, and family. I met Jeff (pictured), a bright and cheerful young man, and his parents whom he lives with. Jeff and his parents told me about how he helps out on their family farm. I learned about the difference the services and the customized equipment designed and built at the AT Clinic has made in his life including improved health, comfort, and the ability to take part in daily activities. In addition, I toured the shop and gained an understanding about how equipment is made and why the ability to customize equipment makes such a difference for persons supported. Special thanks to Deborah Poirier, AT Clinic Director and her staff for arranging the tour and making it such an enjoyable experience.
- DIDD Clinician Obtains Specialty Certification: While at the AT Clinic, together with Dr. Cheetham and Karen Wills, I had the honor of presenting AT Clinic Director Deborah Poirier with an award of excellence for obtaining her Seating and Mobility Specialist (SMS) certification through the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) this past summer. She is the only Occupational Therapist Assistant to have obtained this certification internationally. We are grateful for her tireless dedication, accomplishments, and leadership over the past 20 years.
- Arlington Mediation: In his September 4, 2012, “Order denying Defendants’ Amended Motion to vacate and Dismiss,” U.S. District Court Judge Jon McCalla ordered the parties to complete mediation with a Magistrate Judge within ninety (90) days of entry of the order to develop “objective and measurable exit criteria for the dismissal of this action.” The first mediation session, which was directed to occur within thirty (30) days of entry of the order, took place on September 24 before Magistrate Judge Diane K. Vescovo. The next mediation session is set to take place before Magistrate Judge Vescovo in Memphis on October 29 and 30.
- Rising to the Challenge: Recently, the Civil Rights Division of the U.S. Department of Justice has made enforcement of the Olmstead Decision one of its top priorities. At its core, the Olmstead Decision expects that people with disabilities will be supported in the most integrated setting appropriate to the person. In Oregon, the Olmstead Decision plays a central role in the lawsuit, Lane v. Kitzhaber, which is about sheltered workshops. In its June 29, 2012 Letter of Finding in Lane v. Kitzhaber, the U.S. Department of Justice wrote, “The civil rights of people who can and want to receive employment services in the community are violated when they are unnecessarily segregated in sheltered workshops” (p. 3).
In this letter, the U.S. Department of Justice makes a number of recommendations to the state (p. 19). Tennessee intends to use these recommendations as a roadmap to move forward. This means focusing on increasing the number of people in community employment and decreasing the number of people in sheltered workshops. Visit http://www.tn.gov/didd/EmploymentFirst/documents/Printable%20oregon_findings_letter.doc for a copy of the Letter of Finding.
To learn more about the U.S. Department of Justice’s Olmstead enforcement activities, visit http://www.ada.gov/olmstead/index.htm. Stay tuned to Open Line as Tennessee moves forward.
- Provider’s Role in Accreditation: The department is the entity who will receive accreditation and will therefore be responsible for developing and implementing a written plan to the Council on Quality and Leadership in order to become accredited. To determine what is needed in that plan, data will be collected regarding people who use services in the form of Personal Outcome Measures and for providers and ISCs in the form of Basic Assurances Assessments. Official data collection for the accreditation plan will begin in 2014. During 2013, providers and ISCs will be encouraged to host and participate in both Personal Outcome Measures workshops and Basic Assurances training. The purpose of this training will be to familiarize stakeholders with the standards and tools CQL will use to review the department's efforts in Person-Centered Excellence. Finally, the system will be impacted by changes needed to ensure that DIDD will become accredited, which will impact the way providers are expected to do business.
- Accreditation Process Status: DIDD is in Phase I of the accreditation process that involves building internal capacity. Twelve DIDD employees from across the state have almost completed the process of becoming inter rater reliable in performing Personal Outcome Measures interviews, with the final certifications being completed early November 2012. They are early in the process of becoming certified by CQL to train and perform the basic assurances assessments for providers and ISC agencies. This process will be completed in Spring 2013. To date, eight Personal Outcome Measures workshops have occurred at provider agencies across the state. Feedback from the workshops has been very positive with participants expressing excitement about learning new and better ways to support people to have quality lives. Eleven self-advocate mentors completed their two-day training. Beginning in 2013, these mentors will be working with various groups across the state to facilitate focus groups and gather data from people who use DIDD services.
- Transition NOW: The At-Risk Team continues to offer informed choice for class members residing in nursing homes and their families relative to alternate community placements. The Transition NOW packets, which include a DIDD brochure, a comparison of service models sheet, and Frequently Asked Questions, are ready. Also, the Disability Law and Advocacy Center (DLAC) has completed a video on community life, which should be ready for distribution by the end of October 2012. In addition to focusing on transition efforts, the team is completing quality care reviews. The Transition NOW taskforce is diligently working to address barriers and other recommendations to ensure that transition of class members from nursing facilities occurs in a timely and effective manner.
Currently, there are 103 class members residing in nursing facilities in West Tennessee. Although not all have shown interest in the transition process, I want to thank the provider agencies who have shown interest in supporting persons residing in nursing facilities.
- 2013 Budget Hearing Correction: In last week’s edition, it was noted the department’s 2013 budget hearing was November 10. The correct date is November 8 at 2:00 p.m. (CDT). We will distribute information on how to access the hearing online once the complete schedule is finalized.
- An Ounce of Prevention: This week’s topic is “Reporting Changes in Agency Information.” When an agency has a change in name, address, ownership, legal structure, and/or FEIN number, such changes must be reported to the department before they occur. A memo explaining the steps to take was issued in late 2010 and is still in effect. This memo is available for review on the department’s website within the Commissioner’s Correspondence page (10-01-10 Reporting Changes in Agency Info ) at http://www.tn.gov/didd/provider_agencies/CommisionerCorrespondence.shtml#2010.
For agencies providing a licensed service, such changes must also be reported to the respective licensing entity. For agencies currently licensed by the Department of Mental Health and Substance Abuse Services (DMHSAS), please note that changes in the ownership or operator of a currently licensed facility or service, the relocation of a currently licensed facility or service, or a major change in use or occupancy of a currently licensed facility or service requires new application processes and the prior approval of the DMHSAS Office of Licensure and Review. More information can be found on the DMHSAS website at http://tn.gov/mental/licensure/licensure3.html.
- DIDD Policies: The following policies have been renumbered, reformatted, and are now published on the DIDD website:
Housing Costs Subsidy (80.5.2)
Vehicle Protective Barrier Subsidy (80.5.3)
Click on http://www.tn.gov/didd/provider_agencies/policies.shtml.
- Consultation Group: Professionals of all kinds, including direct support professionals, are invited to attend a consultation group for those providing services to persons with characteristics of Borderline Personality Disorder. Participants should be prepared to present information regarding persons supported at these meetings. Names and any identifying information must be excluded from these presentations. It is anticipated that this group will also spawn the formation of local groups for this purpose. Groups are scheduled via teleconference for the 4th Wednesday of each month, from 1:00 p.m. to 3:00 p.m. (CDT). Please call the following numbers to participate: 615-532-5082 (Local) or 866-947-6428 (Toll-Free Long Distance). The first group meeting was very successful and the next one is scheduled for November 28. Participants are encouraged to purchase the following book:
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.
Please read through Chapter 2 in preparation for the next conference call. Any questions should be directed to Dr. Bruce Davis at Bruce.Davis@tn.gov.
- Mobile Crisis: An incident recently occurred in which a person supported was evaluated by mobile crisis and transported to a psychiatric hospital by law enforcement personnel. The staff, believing that the person would be admitted to the hospital, left the person with law enforcement personnel and returned to work. Ultimately, the person was not admitted to the hospital. The hospital, unaware of the person’s situation, called a taxi and had him transported back home. The staff was not present at the home when he arrived and a neighbor had to assist the person until they arrived.
Involuntary psychiatric hospitalizations are governed by TCA 33-6-4 which states that two professionals must complete a “Certificate of Need” prior to admission. In our system, the first certification is done by mobile crisis personnel acting as a Qualified Mental Health Professional. The second certification is done by a licensed physician at the mental health facility where the person is to be admitted. There can be no certainty that the person will be admitted to the hospital until this second certification is completed. Therefore, assigned staff should remain with the person until they are assured that the second certification has been completed.
Whenever dealing with the mental health crisis of persons supported, it is critically important to ensure that all pertinent information is available to mobile crisis and the mental health facility. Emergency numbers including, but not limited to should be provided: name and contact information of the conservator or family, name and contact information for the provider management, and name and contact numbers for staff who accompany the person. When a person has a high probability for mental health crisis, it is important to develop a crisis plan that identifies key people with contact information and the steps to follow in managing the crisis. The crisis plan will also provide an easy way to communicate with mobile crisis and the hospital.
Providers should ensure that direct support professionals accompany the person through the process until a final determination is made to either approve or deny admission to the mental health facility. Shift changes also need to be taken into account so that the person does not go without support for any amount of time.