Residential ISP Staffing: It’s about the Person, Not the Numbers · 2019-08-14 · Residential...

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Residential ISP Staffing: It’s about the Person, Not the Numbers

Overview Webinar

July 25 & 31, 2019

Hello. My name is Shelley Zaslow, ODP Regional Manager from the SE Region. I am here today with Jennifer Fraker, Quality Oversight and Supports Coordination Director from ODP Central Office. Today we are going to describe a new approach to discussing and documenting Residential Staffing in individual plan development that will be implemented at annual plan meetings held on or after January 1, 2020.

This webinar is being recorded. The recording and the PowerPoint presentation with full trainer notes will be posted to the MyODP website after the last webinar.

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Residential ISP Staffing Webinar

Purpose

• Overview of the revisions to the Residential ISP Staffing approach.

• Describe background and pilots.

• Renew emphasis on Person-Centered Thinking and Planning.

• Connection with Health Risk Screening Tool and other health and safety information.

• Use of technology and environmental changes.

• Revisions to the annotated ISP.

• Team roles and responsibilities.

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The purpose of this webinar is to provide you with an overview of the new Residential ISP Staffing approach. We will briefly describe the background of this new staffing plan including the:• pilot that was instituted with Philadelphia and Dauphin counties;• renewed emphasis on Person Centered Thinking and Planning;• connection with the Health Risk Screening Tool and other health and safety information;• use of technology and environmental changes;• use of the revised annotated ISP; and • team roles and responsibilities.

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Reframe the Discussion

Number of staff guarantees an individual’s health and safety

What support the individual needs during specific activities, situations and time of the day.

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For decades we have talked about the number of staff but not specifically enough about what staff need to do to support individuals.

We know from Incident Management reports that the number of staff identified in the ISP don’t guarantee a person’s health and safety or the delivery of quality services. The intention of this revised Residential Staffing approach is to reframe the discussion from the number of staff needed to what support the individual needs during specific activities, situations and times of the day.

The revised annotated ISP prompts for more descriptions of what support is needed and expands the discussion to supports beyond staff to include the use of technology and environmental strategies. This is not really new but this approach formalizes the need for this discussion with a level of creativity and expanded ideas.

This revised ISP Staffing approach, and changes to ratio, only applies to residential services. However, all ODP services are rooted in the principles of Person‐Centered planning. Health and risk factors should be identified and addressed in every service location so that staff know how to respond specific to each individual.

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Accountability

• Focus on team discussion.

• Provide more specific information about what supports are needed.

• The individual is receiving the support that is needed, when and how it is needed; including protection of health and safety.

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The revised Residential ISP Staffing approach focuses on team discussion to provide more specific information about what supports are needed by the individual. Knowing what supports are needed, rather than relying on the number of staff who are present will increase accountability.

The number of staff present do not necessarily guarantee that a person is receiving what they need to receive or when they need to receive it; and that includes protection of health and safety. Here are stories of two people in PA to explain this idea.

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Joe

2:3 Staff

Choking precautions

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Joe lives in a residential group home with 2:3 staffing in the house. Joe needs help eating due to choking precautions. His food needs to be cut to the correct size, to eat slowly and take regular sips of water.

The two staff identified in the ISP were present one day but did not fully understand their role at that moment to help Joe while he was eating. While one staff person was finishing cooking with one of Joe’s housemates, the other staff member left Joe alone to help the third housemate. While the food had been cut to the correct size, Joe ate too quickly and had a minor choking episode.

What we learn from Joe’s story is that physical presence of staff, in and of itself, does not guarantee that individuals are getting the support that is needed. Staff need to understand context (what is happening) and that needs vary based on time of the day, activities and situation. This person and activity/situation specific information is what needs to be discussed by the team and documented in the ISP.

A staff schedule is more than just the number of people present but what the staff is doing during that time. The correct number of staff were present when Joe was choking because staff did not understand that at meal time a staff member needs to be sitting with Joe to assist him to eat safely until he is finished eating.

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Carla

• Ensure team discussion on what the person needs.

• Person-centered individualized planning.

• Staff understand what to do to provide support.

• Technology and environmental strategies.

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Here’s the second true (very brief) story.

Carla lives in a residential group home with 2:1 staffing. One of the reasons for the number of staff is that Carla runs away and has been lost in the community for more than a day. Staff know about her long history of running out of the house.

One day there is a staff person cooking with her back to Carla. The other staff person is in the bathroom and so Carla is left alone in the living room. You can probably guess what happens next. Carla realizes she is alone for just a few moments and runs out of the house. Luckily, this time she was found quickly and was not harmed.

One reason why Carla was left alone for a few minutes is that staff did not fully understand what they were to be doing during the time they were providing support. In the new staffing approach, Carla’s needs would be fully identified and described to staff so staff will know what supports are to be provided, how and when.

In the past, the number of staff or the staffing ratio was sufficient to fulfill the requirements for supervision needs and support to live a good life. In this revised Residential Staffing approach, we want to ensure that the team meeting discussion includes a full description of what the person needs; it is not enough to say how many people will be in the home at different times of the day.

This is back to basics using person‐centered thinking and planning; where the needs of the individual are understood and addressed by the team through an individualized staffing plan. The plan includes an emphasis on technology and other environmental strategies to protect health and safety and promote a person’s rights to choice, control, dignity and respect. We’ll talk more about technology and environmental strategies later in this webinar.

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Background

• Change from rates based on historical costs to fee schedule.

• Agreement on need for greater flexibility in staffing.

• Request for approaches, strategies and recommendations to provide staffing flexibility.

• Refocused efforts on ensuring health and safety.

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For the next few minutes I will describe the background of the Residential ISP Staffing approach and the pilot.

In January 2018, ODP made a major change in the residential service payment system. This change involved moving from a system where rates were based on the provider’s historical costs (based on expenses incurred and the people served during the cost‐reporting period) to a fee schedule methodology that reflected each person’s current support needs.

In anticipation of this and other changes, the Alliance of Community Service Providers, a professional membership organization representing over 90 non‐profit and for‐profit organizations in Southeastern Pennsylvania, met with ODP leadership. There was agreement about the need for greater flexibility in deploying and redeploying staff when all identified health and safety needs were met.

ODP asked for specific approaches, strategies and recommendations on how to provide staffing flexibility through the elimination of the time‐based staffing ratios in ISPs and refocusing efforts on ensuring that health and risks specific to the person are thoughtfully and clearly addressed. This discussion led to the submission of a proposal to ODP and implementation of a pilot project.

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Background – The Pilot

Goal:

To make necessary updates to plans to

describe the level of support the person

needs based on risks/activities and the

role of staff during those activities.

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Four residential providers, two SCOs, an AE and ODP participated in the pilot.

A sample of individual’s with upcoming annual review ISPs associated with the providers and identified SCOs were selected. The goal was to make necessary updates to their plans to describe the level of support the person needed based on risks, activities and the role of staff during those activities. The residential staffing ratio grid was not used.

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The Pilot – Applied Principles

• Greater flexibility in meeting individual needs must be balanced with accountability.

• ISPs must contain sufficient detail to validate that all identified health and safety needs are being adequately addressed through staffing or other supports.

• Supplemental habilitation staffing, enhanced support resulting from a rate exception approval and the need for staff qualifications must be documented in the ISP.

• Alleged failure to provide support to meet identified health and safety needs continues to be reportable in accordance with the Incident Management Bulletin.

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Four principles were applied in implementing the revised Residential ISP Staffing approach with the pilot ISPs:1. Greater flexibility in meeting individual needs must be balanced with accountability.

• Managing risk is better tied to how the person must be supported in meeting their needs for a healthy and safe life, not the number of staff.

• It should be specific in determining each type of risk and the type of attention, supervision and support necessary to reduce risk while supporting the person’s everyday life and using staff resources wisely – a person‐centered approach.

2. ISPs must contain sufficient detail to validate that all identified health and safety needs are being adequately addressed through staffing or other supports; that the interventions and strategies to reduce risk are clearly articulated and that staff are properly trained and supervised.

3. Supplemental habilitation staffing, enhanced support resulting from a rate exception approval and the need for staff qualifications such as Licensed Practical Nurse (LPN) or NADD must be documented in the ISP.

4. An alleged failure to provide support to meet identified health and safety needs continues to be reportable in accordance with the Incident Management Bulletin.

After the pilot, SCOs and Providers completed the plans using the revised staffing approach and the plans were reviewed by the AE. Follow‐up discussions focused on how to generalize the lessons learned including a new look at assessments, existing risk tools and the annotated ISP. We will talk about assessments, risk tools and the annotated ISP later in the webinar.

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The Pilot – Early Success

Plans with richer, more descriptive information.

Conversation changed - team members prepared to discuss needed level of support.

Focus on support needs at home, in the community; by situation or activity.

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Use of the revised Residential ISP Staffing approach, including tools and resources developed in the first stage of the pilot, were used in the final stage of the pilot. A group of Providers, an SCO and AE from Dauphin County, who were not involved in the initial development work, were also included at this time to broaden the testing and feedback.

The approach to the revised Residential ISP Staffing approach represents the many tries and adjustments needed to determine an effective way to proceed. We included SCOs, Providers and AEs. The pilot considered plans for people requiring various levels of support and the impact on roles and responsibilities for staff and agencies.

We learned from the pilot that using the revised Residential ISP Staffing approach produced plans with richer, more descriptive information. Pilot members described the positive results of conversations with team members. Team members sat down prepared for the discussion based on their knowledge of the person. They were ready to discuss ‐ what is the level of support that this individual needs. Teams were able to focus on the support needs the person has while at home versus in the community; and based on the activity or situation.

In many cases, the information provided on the individual’s support needs were well known but the conversation changed from staffing numbers to how to meet the person’s support needs through staffing or other support.

Jen Fraker is going to take us through the next section of the webinar.

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Person-Centered Thinking and Planning

Know and Do to Support

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The revised Residential ISP Staffing approach supports and emphasizes the need for Person Centered Thinking and Planning.

The Individual Preferences section of the ISP contains valuable person‐centered information for the team to discuss when planning for staffing and other supports needed by the individual. When we know what is Important To an individual (quality of life things like – family and friends, routines, possessions, spirituality, pets and fun) we can develop supports that help the person to have their good life.

And when we know what is Important For a person we are able to protect and promote a person’s health and safety; and support being a valued member of the community. The Know and Do section of the ISP describes WHAT the staff need to know to assist the person to stay healthy and safe AND makes the clear connection to HOW to do it. This is at the core of the revised Residential ISP Staffing approach.

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Know the Person Well

Know and Do

Change in emphasis and conversation.

Why are the supports being provided; not the count of hours and people but

the reason why staff are there.

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The core concept is that when we know the person well (what is Important To and For the person) we can more effectively identify the needed supports and how we need to provide those supports. The focus needs to be on the conversation to help the person to live their good life while protecting and promoting health and safety.

The change in emphasis and conversation is around why the supports are being provided; not the number of hours and people, but the reason why staff are there.

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Understanding Communication

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When this is happening Circumstances around the individual, the setting, the environment, the time of day, etc. For example, loud noises or eating.

The individual does Observable actions in which the individual engages, or sounds/words or phrases the individual uses in those situations.

We think it means Shared understanding and meaning of the action for the individual.

We should Response or actions expected or to be avoided from the people providing support.

Everyone we support can communicate. Understanding a person’s communication (both with words and actions) will guide us in developing person‐centered supports. We will be able to design supports that promote what is Important To the person and match the person’s needs. When we work to discover how to best understand a person’s communication, we are able to recognize what supports are needed and how supports should be provided.

Discovering how the person communicates will help the team to think through the person’s communication. The Functional Information: Understanding Communication section of the ISP is where communication information is documented; both words and actions.

Some people think that the Communication Chart is only helpful for people who don’t use words to communicate. But people who have words sometimes don’t use them or their words are not matched to what the person is truly thinking or feeling. So the Communication Chart should be completed and updated regularly for everyone you support.

When we don’t understand how a person communicates, the person is at greater risk for harm and illness. At the very least, you should know how the person you support communicates pain and not feeling well.

If you have not already completed Person‐Centered Thinking training or would like a refresher on foundational components like the Communication Chart, Know and Do and Important To and Important For, there are mini‐modules on the MyODP website for you to learn more.

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SIS-A™

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The Supports Intensity Scale (SIS‐A™) is a valuable assessment tool for information on a person’s support needs. The SIS‐A™ does not identify staffing numbers but rather identifiesthe type and intensity of support needed by the individual.

Teams should discuss the SIS‐A™ results in developing a staffing support plan specific to the person’s support needs during daily life activities and for medical and behavioral needs.

The support needs identified in the Supports Need Scale are rated by:• Frequency (how often is the support needed)• Daily support time (when needed and how much time is required for support)• Type of support (none to full physical assistance)

The Exceptional Medical and Behavioral Support Needs section capture additional medical and behavioral information. In this section the possible ratings are:• 0 = no support needed• 1 = some support needed • 2 = extensive support needed

For example, for someone with frequent and extensive support needs, the team should use this SIS‐A™ information as indicators of risk and discuss how these needs will be addressed.

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Health Risk Screening Tool (HRST)

An HRST Health Care Level of 3 or higher must be addressed in the individual’s ISP.

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Staffing and other supports need to address the individual’s risk factors, health conditions, and general safety issues. I will briefly touch on a few of the tools and assessments that should be used and discussed by the team in determining the staff and other support needed by the individual.

A new standardized screening tool is being implemented for all individuals receiving residential services to identify health risks; the Health Risk Screening Tool (HRST). The HRST provides measurable data in five categories on a total of 22 rating items. The category, Eating, is shown on this slide. Health Care Levels from 1 – 6 are assigned to the individual based on the information gathered in the screening process. A score of three (Moderate Risk) or higher must be addressed in the plan but lower scores may also be discussed and considered by the team in determining the staff support needed by the individual.

High risk factors identified in the HRST must be identified and fully described in the plan.

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ISP Planning Tool – Identify Possible Risks

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Team meetings using the revised Residential ISP Staffing approach may occur before the HRST is fully implemented. To assist teams in identifying possible risk factors prior to the HRST, the ISP Planning Tool has been developed based on the SIS‐A™ and other risk assessments. On the screen you can see a section of the tool with medical diagnosis and health conditions in the left column. In the corresponding right column are the indicators of possible risk.

This basic tool is designed to help the team identify risks and then discuss how to address in the plan whether through staff or other supports. A copy of this tool was distributed in ODP Communication # 19‐091 on July 9, 2019.

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• Health And Safety:

• Focus Area

• Supervision Care Needs: Staffing Ratio

• Behavioral Support Plan

• Health Promotion

Revisions to Annotated ISP

Annotated ISP Changes

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As Shelley mentioned earlier, follow‐up discussions and lessons learned from the pilot formed the basis for proposed changes to the annotated ISP focus area questions. Pilot team members were looking for guidance about documentation; specifically standardized elements and where information should be documented.

Changes to the annotated ISP have been made in the following Health and Safety sections: • Focus Area• Supervision Care Needs: Staffing Ratio• Behavioral Support Plan • Health Promotion

Revisions include general guidance and specific directions that point to where risk information should be documented in the plan. The purpose of the revisions is to frame the team conversation around staff, technology and environmental strategies to meet an individual’s support needs. Tailored focus area questions are also included for specific risk areas. We are going to look at highlighted examples of changes within each ISP section. Not all changes will be identified and discussed in this webinar.

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Health and Safety: Focus Area

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In the Health and Safety: Focus Area you will see new direction to identify level of support or technology the person needs to manage any significant health and safety risks.

Identifying the level of support or technology the person needs to: • Maintain or enhance their current status; • Live a healthier lifestyle; • Be more independent and/or • Achieve the outcomes important to them and noted in this plan.

Notice the emphasis on level of support or technology needed.

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Definitions: Assistance

Verbal assistance - step by step instruction.

Partial physical assistance - the individual participates in some parts of the activity.

Total physical assistance - all essential steps need to be completed for the person.

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Also in this section on Health and Safety: Focus Area there is a new prompt for types of assistance. If there are any significant health and safety risk(s) in any of the focus areas, describe what type of assistance the person may need such as verbal assistance, partial physical assistance or total physical assistance. The types of assistance are matched to what is used in the SIS‐A™.

Verbal assistance is defined as step by step instruction; walking a person through required steps; providing visual prompts/showing; modeling, teaching, role play, social stories.

Partial physical assistance is defined as the individual participates in some parts of the activity; some essential steps are required to be completed for the person.

Total physical assistance is defined as all essential steps need to be completed for the person.

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Health and Safety: Water Safety

Record any significant health and safety risks that the person may have related to water safety and temperature control.

Identify the level of support needed and any technology or equipment required for the person to ensure water safety and appropriate temperature control.

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Prompts and direction are tailored to the specific risk areas within the Health and Safety: Focus Area. We are going to look at Water Safety as an example. Similar prompts and instruction are included in all of the risk areas.

• Record any significant health and safety risks that the person may have related to water safety and temperature control.

• Identify the level of support needed and any technology or equipment required for the person to ensure water safety and appropriate temperature control.

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Health and Safety: Water Safety

If there is any significant health and safety risk(s) in this area, describe what type of assistance the person may need (verbal assistance, partial physical assistance or total physical assistance).

Include the level of supervision support and assistance required for hot water usage and when around swimming pools, lakes or other bodies of water.

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Two additional prompts are noted in the Water Safety risk area. The first is the types of assistance needed – verbal, partial physical or full physical.

The second prompt is only a word change but it is significant and worth pointing out. In this instruction the word – supervision ‐ is deleted; replaced by the word ‐ support. This is important because change of language is always critical in supporting a change in practice. Supervision is related to the number of people who are present and watching. Support is related to what the responsible person is doing to assist the individual during an activity.

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Health and Safety: Supervision Care Needs

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In the section Health and Safety: Supervision Care Needs: Staffing Ratio – Home, the instruction now states ‐ Residential staffing ratios are no longer required. This includes activities in the individual’s home, or the home of a family member.

For Health and Safety: Supervision Care Needs: Staffing Ratio, the only question that needs to be answered is specific to awake/overnight staff.

For individuals who have intense support needs that require a high level of support, receive Supplemental Habilitation, or an approved needs exception; the plan should be explicit around the need for enhanced staffing levels.

There will be no changes to HCSIS at the time the Residential ISP Staffing approach is implemented. The staffing ratio grid will still appear and can be left blank. We are exploring HCSIS changes to address mandatory fields connected to the staffing ratio or we will be reissuing the Annotated ISP with updated instructions.

What replaces the residential staffing ratio is the discussion and information provided in response to the revised annotated ISP prompt questions. Through the descriptive information provided in the ISP, staff will understand what support is needed and how to provide the support for the individual.

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Summary of behavioral support plan if a psychotropic medication is prescribed:

• document the psychiatric symptoms and plan to address the individual’s social, emotional and environmental support

• review the person’s current behavioral health status and identify any significant health and safety risks

• Include risks due to major mental health diagnoses and conditions.

Health and Safety: Behavior Support Plans

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The Health And Safety: Behavioral Support Plan (BSP) section of the Annotated ISP requires newly added Summary information. The directions state ‐ If a psychotropic medication is prescribed, document the psychiatric symptoms and plan to address the individual’s social, emotional and environmental support.

Then the team is to review the person’s current behavioral health status and identify any significant health and safety risks that the person may have including risks due to major mental health diagnoses and conditions.

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• Emergency Room or Crisis Response Visits

• Psychiatric Hospitalizations

• Elopement

• Self-injurious behavior

• Aggression/violence towards others

• Suicide Attempts/Ideations

• Unhealthy/Unsafe Sexual Activity

• PICA/swallowing inedible objects

• Drug or Alcohol Abuse

• Law Enforcement involvement/arrest/probation/parole

• Fire Setting

• Property Destruction or Theft

Example Risks Related to Behavior Support

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On the screen is a list of diagnoses/conditions/situations which would indicate risk related to behavioral support. This list of risks is not all inclusive and the team’s consideration of risk should not be limited to these identified items.

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For each risk area identify needed support or technology

Additional Summary Information - BSP

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Describe what type of assistance the person may need

Include any environmental changes that have occurred or are planned

There are three additional focus areas in the Behavior Support Plan Summary that will now start to be familiar to you. These focus areas are included in other sections of the Annotated ISP including Health Promotions which I will describe next.

Just to review quickly, the three focus areas are:• For each risk area identify needed support or technology to:

• Maintain or enhance their current status• Live a healthier lifestyle • Be more independent and/or• Achieve outcomes that are important to the person

• Include any environmental changes that have occurred or are planned• Describe what type of assistance the person may need

• Verbal assistance• Partial physical assistance• Total physical assistance

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Health and Safety: Health Promotions

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The Health Promotions section of the ISP contains medical status and health condition information.

Included in this section (and unchanged) is how the individual takes care of themselves or would like to. Additions to this section include the same focus areas as we saw for behavioral support plans: • A list of diagnoses/conditions/situations which would indicate risk;• The level of support needed including technology;• Environmental changes that have occurred or are planned and • Type of assistance

Diagnostic medical health information is in multiple sections of the plan. The Health Promotions section was selected as the place in the ISP to document medical, health and risk factors because it is a text field allowing for descriptive information. This field was being used to describe how staff were supporting a person’s health. This descriptive information places a renewed emphasis on how staff are addressing risk and how the person is able to or can be supported to maintain or improve their own health.

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Consider the Environment

What is the most effective and appropriate response to the person’s support needs?

Environmental changes are identified as other types of supports that need to be considered and can be provided to meet an individual needs. For an individual who is supported through a behavior plan or a health promotion strategy, thoughtful changes to the person’s environment may be a creative part of the support plan.

Privacy and time alone is something that most of us need to maintain our peace of mind. We can find that time when we are driving, showering, listening to music, or taking a walk. But for most of the people we support, they are living with other people and have staff in their home and with them most if not all of the time. This is true even during the most private times having to do with their bodies.

So what can the team come up with to help people we support find some quiet time? Maybe it is about turning the TV off in the background if a person is not watching something that they enjoy. Can people in the house have a meal on their own a few times each week? Is there a way to figure out times when a person can be alone in their room if shared with a roommate? Can furniture in the house be arranged so that a more private space is available in the common rooms? And how about personal music systems, IPODS, to create privacy and your own space?

And one more thing – consider how staff may impact the environment and the person. Adding staff, more people in the house, may indeed provide the additional needed support OR increase the challenges for the person being supported. The question to ask is ‐ what is the most effective and appropriate response to the person’s support needs?

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Staffing ratio grid is being replaced with descriptive information. • Staff, technology and environmental strategies

Describes what and how the staff should be supporting a person to:• Address risks

• Protect and promote health and safety and

• Support someone to live a good life.

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Annotated ISP

The amount and quality of the responses to the focus area questions is critical to the Residential ISP Staffing approach. Through this overview of the changes to the Annotated ISP, we have shown you how the staffing ratio grid is being replaced with descriptive information including what and how the staff should be supporting a person to address risks; protect and promote health and safety and support someone to live a good life.

Shelley will be leading us through the remainder of the webinar.

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Technology Innovations

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As you heard in the review of the revisions to the annotated ISP, there are focus area questions throughout the Health and Safety section focused on technology.

The reason for this emphasis is that our use of technology has lagged behind innovation. There are many low tech options that can be used to enhance safety and independence. Behind the focus area is this question that all teams should be discussing ‐ what else in addition to staff can be implemented to provide the needed support, perhaps reduce reliance on staff and increase the individual’s independence?

Some examples of every day technology that we all are using includes ‐ electronic medication distribution systems with reminders; phone alerts; and GPS on smart phones. Earlier we identified understanding communication as a core foundation to identifying supports. Communication technology is changing constantly and should be considered for everyone you support.

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Technology Resources

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https://techowlpa.org/

http://www.paautism.org/

Technology Innovation Conferences

We are fortunate to have state of the art technology resources in the Commonwealth specific to support people with an intellectual disability and autism. If you are not already aware of these resources, you should take some time to learn about:• PIAT (Pennsylvania’s Initiative on Assistive Technology) at Temple University has been

renamed TechOWL ‐ https://techowlpa.org/• ASERT (Autism Services Education, Resources and Training Collaborative) ‐

http://www.paautism.org/

In addition, ODP will be sponsoring two regional Technology Innovation Conferences in October 2019. The conferences will include speaker presentations as well as vendors displaying new technology innovations and solutions. More information on the conferences is coming soon.

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Suggestions for Modifications

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NTG Education & Training Curriculum on Dementia and ID. Copyright 2014. All rights reserved.

Reduce visual clutter.

Organize visual clutter into specific appropriate places.

Clearly identified walking paths.

Reduce glare.

As Jen described in the Annotated ISP section of this webinar, there are environmental strategies that can also provide needed support. For people who are experiencing dementia, environmental considerations are critical to providing quality support.

The information provided here is from the National Task Group on Intellectual Disabilities and Dementia Practices.

There are many things to do in the environment to support someone with dementia including reducing visual clutter and glare, clearly identifying walking paths, reducing unnecessary stimulation and removing obstacles. I am going to focus on one environmental consideration – maximizing location and function.

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Environmental cues:Ex. Pictures on door

Familiar textures for matching.Ex. On the seat for meals.

Lighting.

Contrasting colors.

Reduce unnecessary stimuli.

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NTG Education & Training Curriculum on Dementia and ID. Copyright 2014. All rights reserved.

Maximizing Location and Function

Organizing the environment by purpose, adapting environments with clear cues, help people know what the environment is for and what they are supposed to do there. The example here is the toilet. In the picture on the left, all of the colors are the same shade. Someone experiencing visual problems might have difficulty finding exactly where to sit, miss the safety bar, or not be able to find the toilet paper.

On the right is an example of how bringing together location and function – with clear visual cues – can assist people in finding their way and using their environment they way they need to. The sign is clear and matches what people will see when they enter the room. Notice how the bright red seat and grab bars are in strong contrast to the toilet. The floor and walls are also in contrasting colors.

These modifications are simple, inexpensive and benefit everyone. The benefit to the individual is increased independence and promoting health, safety and privacy. For staff there is the potential benefit of using your time differently to support other identified needs of the person.

If you would like to learn more about Dementia and specifically environmental considerations, view the webcast series, An Overview of Dementia Capable Care for People with ID, on the MyODP website.

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Person-Centered Planning – Waiver, ISP Manual and draft 6100 Regulations

Preparation and Participation

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Participation - the individual and the people who know him or her best

Preparation – share detailed information

At the beginning of this webinar, I talked about the importance of Person‐Centered planning in the implementation of the revised ISP Staffing approach. In order to identify and address an individual’s health and safety support needs, it will be critical that the people who know the individual best are prepared and share information at the team meeting so that the discussion is focused and efficient.

The preparation and participation of the individual and the people who know him or her best, in the development of the ISP, is not new. This has always been the expectation and reinforces a person‐centered planning approach. Over the past few years, ODP has aligned the expectations for a person‐centered planning process and the team’s roles and requirements through the waivers, the ISP Manual (specifically the ODP Role Expectations And Required Timeline For ISP Activities ) and through the draft 6100 Regulations.

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Spend More Time

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• Need rich and full person-centered information

• Describe support needs

• Discuss environmental strategies and technology supports

Team member roles and responsibilities are not changed but are strengthened. Their importance is heightened. Expanded language is included with an expectation that the individual and the people who know him or her best will be supported to attend the team meeting. Specific to the implementation of the revised ISP Staffing approach, the pilot work group highlighted the need for rich and full person‐centered information as the basis of this discussion on health, safety and risk.

In order to provide the detailed information that is needed, there will need to be more time spent describing support needs and discussing environmental strategies and technology supports. Teams especially need to include more technology and environmental supports similar to how we are using in the general public.

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Finding Solutions

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Finding solutions that will work to address the individual’s support needs will be best identified by the people who know the individual well. Providers must make the commitment to send staff to the ISP team meeting who really know the individual.

If the provider staff who knows the individual well cannot attend the ISP team meeting, their information and knowledge of the individual needs to be shared in advance with the Provider representative and the team.

Preparation is key and will help with time management. In order to make best use of the ISP meeting, Provider agencies need to respond to requests for assessments and provide information ahead of time as identified in the ISP Timeline document.

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• Administrative Entity

– Thorough plan review

– Manual approval

• ODP

– Regional point people

– QA & I Monitoring Tool – gauge implementation

• All team members

– Share what is learned at training

– Understand changes to ISP Staffing approach

– Prepare for and participate in team meetings

Team Members

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The AE review of the ISP is heightened in the revised ISP Staffing approach. Plan content will change requiring that the entire ISP be read thoroughly in order to approve the plan through the manual approval process. Many plans may have been subject to auto‐authorization in the past. Counties are encouraged to consider and plan for implications for their ISP reviewers related to this expanded review.

ODP will be identifying a point person from each region who will attend the face to face training to address implication concerns. The ODP regional point person will be available to provide guidance as the revised ISP Staffing approach rolls out. The QA&I Monitoring tool will be updated to reflect the revised ISP Staffing changes. Feedback and information obtained through SC Monitoring and QA&I, will be used by ODP to gauge implementation of the revised ISP Staffing approach.

I will talk in a moment about the face to face training that will accompany the implementation. Training participants will need to share what they learn with their co‐workers to be sure we reach all SCs, DSPs and AE staff. The SC is responsible for plan facilitation and development, but all team members need to understand the change to the ISP Staffing approach and their role to prepare for and participate at the team meeting.

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• 18 face to face sessions in October and November 2019– Small groups; 30 to 35 people per session

– Interactive with application based on examples

• Target audience:– Providers and SCO staff who regularly attend or supervise team

meeting

– Provider and SCO trainers

– AE staff who review and approve plans

• Attendance and commitments– One person per agency

– Commit to provide support to their home agency as a local resource

Training Design

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Beginning in October 2019, face‐to‐face training will be conducted in 18 locations across the Commonwealth. Training will be geared to key residential provider and SCO staff who regularly attend team meetings, supervise staff who attend team meetings or train staff that attend team meetings; and AE staff who review and approve plans. It is expected to be conducted in small “mixed” audience groups (Provider, SCO,AEs reps and ODP) to better assure exposure to a variety of perspectives and roles.

One person per entity is expected to attend to provide a maximum of 30‐35 people per session. Participants and their agencies will need to commit to the understanding that, upon completion, they will be a resource at their home agency. The training will be interactive. Examples will be used to apply the concepts in small groups and to reinforce understanding.

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All training participants must complete the following prerequisites located on MyODP**:

• ODP ISP Staffing Webinar

• HRST Webinar

• Addressing Day-to-Day Risk with the Team

• Person Centered Thinking Mini Modules

** links to coursework will be provided where you register for the face-to-face sessions.

Training Prerequisites

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Prior to attending a face‐to‐face session, all training participants must complete the following prerequisites located on the MyODP website:• ODP ISP Staffing Webinar – today’s session• Health Risk Screening Tool Webinar• Addressing Day‐to‐Day Risk with the Team Webcasts• Person Centered Thinking Mini Modules

Content for the face‐to‐face training will be based on the concepts, principles and knowledge provided in the prerequisite coursework.

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• Local agency volunteers selected by ODP.

• Endorsed by Agency CEO/Director.

• Commit to conduct at least two external trainings in 2020.

• Recommend same person attends one of the 18 face to face training sessions.

• Attend Train the Trainer session

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ODP Certified Trainers

ODP is looking for Provider, SCO and AE staff who are interested in becoming an ODP Certified Trainer on the Residential ISP Staffing content. Selected volunteers must be endorsed by their CEO/Director and commit to conducting at least two external (outside of their agency) trainings in 2020. During the face‐to‐face training, there will be an opportunity for people to express their interest in becoming an ODP Certified Trainer.

If an agency is interested in identifying a person to become an ODP Certified Trainer, it is recommended that the agency consider sending this same person to one of the 18 sessions. Nomination forms will be available at the face‐to‐face training sessions for those who are interested in becoming an ODP Certified Trainer. Once all 18 face‐to‐face sessions are completed and ODP identifies individuals to become an ODP Certified Trainer, ODP will host a required train‐the trainer session for these prospective trainers.

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Impact – Licensing/Incident Management

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Consistent with the draft Regulatory Compliance Guide and the current and draft

Incident Management Bulletin.

Measuring the provision of needed services; focus on identifying and addressing risk factors through

staff and other supports.

The impact of the revised ISP Staffing approach on current requirements and business practices was discussed and reviewed with ODP Licensing and Incident Management staff. Leadership agreed that this is a change but consistent with philosophy and intent of service provision. The revised ISP Staffing approach changes years of practice but it is consistent with the draft Regulatory Compliance Guide and the current and draft Incident Management Bulletin. Measuring the provision of needed services with focus on identifying and addressing risk factors through staff and other supports.

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Current Question - Does the overall staffing reflect what is called for in the approved ISP?Guidance to SCs points to the approved staffing ratio

section.

Impact – SC Individual Monitoring Tool

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New Question - Were individual’s supervision needs met as outlined in the ISP? Describe observations.

In order to prepare for the implementation of this revised ISP Staffing approach, the SC Individual Monitoring tool replaces this staffing ratio question – Does the overall staffing reflect what is called for in the approved ISP? Guidance to SCs in answering this question points to the approved staffing ratio section.

The new question (beginning October 2019) will be ‐ Were individual’s supervision needs met as outlined in the ISP? Describe observations. The guidance related to Licensing, Incident Management and Individual Monitoring will be different from what we have been doing in the past. Previously we verified staffing ratios; and it is easier to count numbers.

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Requires observation, discussion with staff and the individual, and document review to

make a determination if the person’s support needs are being met.

ISP Review

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The emphasis is not on the number of staff but on what staff are doing and

that it is consistent with the identified support needs.

A review of this type of staffing approach requires observation, discussion with staff and the individual, and document review to make a determination if the person’s support needs are being met. This is not a change in practice.

The emphasis in the revised Residential ISP Staffing approach is not on the number of staff but on what staff are doing and that it is consistent with the identified support needs. For example, if a person needs a staff member to provide verbal assistance when she is eating, that staff member must provide this identified support as documented in the plan.

Changes of this significance will take time to implement. ODP will be working with you providing support and guidance to Providers, AEs and SCOs as implementation gets underway.

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• Begin use of the new annotated ISP at annual team meetings occurring on or after January 1, 2020.– Prerequisite in order to remove or change the

staffing ratio listed in the “Health and Safety: Supervision Care Needs: Staffing Ratio – Home” of the ISP.

• All first plans must be manually reviewed by the AE.– SC must override the auto-authorization function

and request manual review of the ISP by the AE.

Implementation

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Use of the new annotated ISP will occur at annual team meetings occurring on or after January 1, 2020 and is a prerequisite in order to remove or change the staffing ratio listed in the “Health and Safety: Supervision Care Needs: Staffing Ratio – Home” of the ISP.

On it’s own, the change or removal of staffing ratios will not rise to the level of AE review and approval. As this Residential ISP Staffing approach is new, and to promote best practice, all first plans must be manually reviewed by the AE. Upon completion of any ISP that removes or changes the staffing ratio, the Support Coordinator must override the auto‐authorization function and request manual review of the ISP by the AE.

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• Reduction or change in staffing documented in the ISP is requested before 1/1/2020.

– Team must identify all areas of risk and discuss how all health and safety needs will be met.

– Requirements outlined in ODP Communication 026-18 apply.

• Questions - contact the appropriate ODP Regional Office.

Implementation

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If a reduction or change in staffing as documented in the ISP is being requested by the residential provider before that date, the team must identify all areas of risk and discuss how all health and safety needs will be met. In these instances, the requirements outlined in ODP Communication 026‐18 shall apply.

If you have questions, please contact the appropriate ODP Regional Office.

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Residential ISP Staffing: It’s about the Person, Not the Numbers · 2019-08-14 · Residential...

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