6/25/2018 RW1 RW2 Understanding Crisis Needs for Tennessees IDD - PDF document

6/25/2018 RW1 RW2 Understanding Crisis Needs for Tennessee’s IDD Community Panelists • Bruce Davis, Ph.D., LBA, BCBA-D, SrLPE, LPC, Director of Behavioral and Psychological Services, Department of Intellectual and Developmental Disabilities (DIDD), Nashville, TN • Kris Roberts, M.S., BCBA, SrLPE, Former Intensive Consultation Team Director • Zachary Stevens, MS, LBA, BCBA, Clinical Director, Practical Behavior Analysis, Nashville, TN • Luke Crabtree, Executive Director, Project Transition, Philadelphia, PA • Michelle Palmer, Program Supervisor, Project Transition, Knoxville, TN 2 Learning Objectives At the conclusion of this training, participants will be able to: 1. Describe challenges experienced by persons with IDD when they need mental health services. 2. Describe systemic components in place for the crisis prevention and intervention. 3. Identify gaps in the current service system and strategies for making the system more effective. 3 1

Slide 1 RW1 Robin Wilmoth, 12/20/2017 RW2 start with the basic rights of the person then the HCBS settings rule, restrictions then the roles and responsibilities of the FHHRP Robin Wilmoth, 12/20/2017

6/25/2018 RW3 Introduction A Difficult Life • – Often disrespected – Low expectations – Unreasonable expectations – Lack of control over their lives Exposure to Stress and Trauma • – High rate of unrecognized abuse/trauma (ACEs - Adverse Childhood Experiences) and their impact on adults – 70% people with IDD have ACE-like experiences – 35-50% also have a co-occurring mental health disorder The Results • – Risk to self and community – Police intervention – ER visits and psychiatric hospitalizations – Coercion/Restriction 4 Kris Roberts MS, LBA, BCBA, SrLPE 5 BEHAVIORAL CRISES AND COMMUNITY INTERVENTION Zachary Stevens, MS, LBA, BCBA Clinical Director Practical Behavior Analysis, LLC www.practicalbehavior.com 2

Slide 4 RW3 closer to the top of slides Robin Wilmoth, 12/20/2017

6/25/2018 CLIENT-RELATED CHALLENGES: CRISIS BEHAVIORS • Physical Aggression • Self-Injurious Behavior • Property Destruction • Elopement • Threats of Harm, Homicide, or Suicide SYSTEMIC COMPONENT: BEHAVIOR ANALYSIS SERVICES • Assess the functions of problem behaviors • Develop Behavior Support Plan to treat behaviors • Identify crisis-level responses • Implement and monitor implementation of treatment PREVENTION OF PROBLEM BEHAVIOR • Antecedent Modification • Environmental Enhancement • Priming • Manipulating Motivation 3

6/25/2018 A BEHAVIORAL CRISIS Crisis-Level Response Occurs Behavior Support Plan - Crisis Responding Agency crisis response plan Law Enforcement/Mobile Crisis Hospitalization/Respite GAPS/PROBLEMS: THE CRISIS RESPONSE ITSELF Law Enforcement contact • Could this reinforce the crisis-level behaviors? • Are there any other possible consequences? • Reinforcers available at hospitals/respite • Attention from other individuals and staff • Access to tangibles (food, drinks, medications, etc.) • Temporary escape from environment • WHEN ARE WORDS JUST WORDS? • Threats of Harm, Homicide, or Suicide • What if the individual has never acted upon such threats? • Risk of reinforcing inappropriate behavior • Increased likelihood of future crisis responses 4

6/25/2018 MAKING THE SYSTEM MORE EFFECTIVE • Identify whether individual is truly at risk contingent upon verbal threats • Withholding crisis responding for verbal threats • Assessing risks associated with crisis responses for the individual • Developing alternative crisis responses based on whether reinforcement is likely Systems of Support (SOS) Behavioral health services for individuals with I/DD and co-occurring mental health and/or behavior disorders delivered through TennCare MCOs June 27, 2018 14 Project Transition Proprietary & Confidential Systems of Support Mission “Building integrated systems of support through innovative partnerships and collaboration to empower Tennesseans with I/DD to live the lives they want in their communities” 15 Project Transition Proprietary & Confidential 5

6/25/2018 Strengths and Challenges Strengths • The Department of Intellectual and Developmental Disabilities (DIDD) has consistent thought leadership in working with persons who have intellectual or developmental disABILITIES (I/DD) who are experiencing Behavioral Health challenges - Evidence-Based Practices - Person-Centered Practices - Encouragement Network • Other states are watching TN’s leadership with the I/DD population • Entire Medicaid population in Managed Care since 1994 • 3 national MCO’s operate statewide • LTSS leadership and others leverage a settlement agreement in litigation to increase person-centered practices • State Transformation Leadership Group (STLG) pushing Person Centered Practices through all levels of the System • improving delivery system to persons with I/DD 16 Project Transition Proprietary & Confidential Strengths and Challenges Challenges • Cost - About 3% of TennCare members account for 50% of the cost - Many of those persons benefit from the Systems of Support • Physical health, behavioral health, and LTSS are not always tightly coordinated and aligned • Multiple Systems (Medicare, Medicaid, MLTSS, DIDD, RMHC’s, State Centers, DOC, etc.) touch our Members’ lives • Each System is “optimized” to be efficient on its own • Very difficult to navigate across systems • High turnover rates among direct service providers - High employment rate in major metro cities in TN leads to DSP’s leaving the industry for higher pay jobs • Many Champions and DSP’s would benefit from increased training and awareness of Person Centered Practices and effective approaches to working with Persons who have I/DD and experience behavioral challenges 17 Project Transition Proprietary & Confidential Systemic Component: Systems of Support • Developing and supporting the individual’s support system through training to recognize trigger, de-escalate crisis and stabilize • Assist the person in achieving greater independence and improved quality of life, free of challenging behavior, and a higher degree of stability and community tenure • Decreasing the frequency of crisis events • Increasing one’s ability to remain safe in the community, and out of the hospital • Build the capacity of the system to better support individuals with I/DD who experience challenging behavior—creating more effective Systems of Support 18 Project Transition Proprietary & Confidential 6

6/25/2018 Resources - Systems of Support • Person-centered assessment and crisis prevention planning • Comprehensive face-to-face person-centered assessment • Discussions with caregivers (paid or unpaid), family members/conservators, etc. • Comprehensive review of physical and mental health diagnoses and emotional concerns that could trigger need for behavior intervention • Identification of medications which could impact behaviors • Development of individualized Crisis Prevention and Intervention Plan (CPIP) Easily understood, individualized, person-centered, and predictive of actions the person’s system of support can take when • needed Updated on an ongoing basis, and as needed following any crisis requiring intervention and/or stabilization services • 19 Project Transition Proprietary & Confidential Resources - Systems of Support • Training of the Champion and Circle of Support (for paid and unpaid caregivers) in the CPIP to equip them to: • Provide positive behavior supports to effectively manage day-to-day situations and environments • Crisis Situation: Identify  Address  Intervene  De-escalate • Development of community linkages and cross-system supports based on the individualized needs of each member and in accordance with the member’s CPIP • 24/7 crisis intervention and stabilization response • Assist and support the person or agency who is primarily responsible for supporting an individual with I/DD who is experiencing a behavioral crisis that presents a threat to the individual’s health and safety or community living arrangement, or the health and safety of others • Work in collaboration with mobile crisis, the provider or family caregiver to stabilize, divert from unnecessary/inappropriate inpatient, and support sustained integrated community living • Over time, the SOS team gains ability to anticipate and prevent behavioral escalations, reducing the need for crisis intervention by the SOS provider 20 Project Transition Proprietary & Confidential Existing Resources - Systems of Support Supported Housing/Community Living Supports Family Support Program Day programming Project Transition Case management 21 7