State of Indiana


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State of Indiana

  1. 1. State of Indiana Crisis Management System for Persons with Developmental Disabilities Summary Draft – December 16, 2005 Definition of Crisis: • A behavioral or psychiatric emergency resulting in the need for immediate, intensive services. Persons Served by the Crisis Management System: • The Crisis Management System will serve individuals ages 18 years and older who have already been deemed eligible as persons with developmental disabilities via the system established by the state, or who upon evaluation of the crisis management vendor, are determined to likely be eligible based on the state’s definition of developmental disability. This population includes persons with dual diagnoses (i.e., developmental disability and mental illness or addiction). • It is recognized that periodically persons with developmental disabilities who are younger than 18 years of age may be served by this system. Historically, in these situations a referral has been made to the Bureau of Developmental Disabilities Services (BDDS) as the person’s crisis needs were not able to be met by the Division of Family Resources and/or the Department of Education. Goal of the Crisis Management System: • The goal of the Crisis Management System is to establish and implement a multi-tiered Crisis Management System that is proactive to prevent crisis situations from occurring, and provides responsive supports and services in the least restrictive manner, thus enabling individuals with more challenging issues to remain in the community in a more efficient and cost-effective manner to the extent that funding is available. Organizational Model: • The Crisis Management System for persons with developmental disabilities will be implemented by state contracted vendors, one in each of the three geographical regions of the state of Indiana. • A single vendor will be selected for each region. It is possible for a vendor to be selected for more than one region. • It will be that vendor’s responsibility to establish arrangements with subcontractors, if necessary, to provide all required crisis management services needed to serve persons with developmental disabilities in that region. • These regions will be referred to as “North” (including the three most northern Bureau of Developmental Disabilities Services (BDDS) districts in the state), “Central” (including the three most central BDDS districts), and “South” (including the two southernmost BDDS districts). 1
  2. 2. • The approved vendor will be selected via a Request for Services (RFS) process. The term of the awarded contract will be three years, after which the RFS process will be repeated. Continuation of the contract may be re- evaluated if the performance measure outcomes are not achieved. • The approved vendor will be responsible for providing services to the clients of that region and will be required to meet the core service requirements determined by the Division of Disability and Rehabilitative Services (DDRS). • Key expectations for the crisis assistance vendor will include, but are not limited to, the following: o Employ or subcontract all personnel to provide the crisis assistance services. o Manage the day-to-day operations of the Crisis Management System for that region. o Work collaboratively with the State Director of Crisis Assistance for Persons with Developmental Disabilities. This individual will be employed by the DDRS. o Serve all persons with developmental disabilities in that region who require crisis assistance services, related to both prevention of crisis and appropriate intervention in the event of crisis. The focus will be to maximize the opportunity for the client to remain in his or her least restrictive living environment. o Coordinate crisis management services with the client’s Individualized Support Team. o Provide crisis management services that support the client being engaged in functional, meaningful, and purposeful activities. o Provide the core services as required by the state, as well as additional services deemed necessary by the vendor to successfully execute a Crisis Management System in that region. o Collect data required by the state. o Achieve the quality/performance indicators established by the Division of Disability and Rehabilitative Services and provide data within the required timeframes to demonstrate compliance. o Continually promote the availability of crisis management services within the region to market how to access the Crisis Management System. o Assess all possible funding options for a person in crisis, not only state line item dollars allocated for crisis management services. • As mentioned above, the Director of the Crisis Management System for Persons with Developmental Disabilities will be employed by DDRS. This position will provide direction, quality monitoring, and oversight to the regional vendors in the provision of a Crisis Management System to ensure that the desired outcomes are achieved for the system. • The regional crisis assistance vendors will also work collaboratively with the Director of Field Services and the field offices in their region. 2
  3. 3. Services Included: • Training: o The approved vendor will provide training and education to providers, families, and other community agencies serving persons with developmental disabilities regarding strategies to appropriately prevent and address crisis situations with persons who are developmentally disabled. o The approved vendor will be required to offer a comprehensive training program to all providers within the region. This comprehensive training program must, at a minimum, cover the curriculum developed by DDRS for crisis management. This training will focus on developing the providers’ personnel to more effectively address behavioral needs of clients with the goal of preventing the escalation of issues potentially resulting in a crisis situation. o The vendor will be expected to provide twelve training days in the region per year. o A “train the trainer” model is recommended to maximize the transference of training information to personnel. o Pre- and post-tests must be offered to participants to assess competency following the training sessions. o Focused training topics must include management of persons with dual diagnoses and medication management. o The vendor must be willing to offer distance learning and on-site training options within their respective region. o Vendors are also encouraged to partner and collaborate with other agencies providing related training. o The approved vendor will also serve as a resource of reference material for providers and family members in that region, including resource materials developed by the state. • In-Home Technical Assistance: o In-home technical assistance must be provided within 24 hours (preferably sooner) of the request, seven days per week, 365 days per year. o In-home technical assistance is required more quickly as deemed appropriate from assessment of the crisis situation. o A 24-hour telephone line must be provided by the regional vendor for behavioral consultation, problem solving, supportive counseling, and information and referral. If the call is not answered immediately, a message must be responded to within 30 minutes of the call. o In-home support visits will be provided by a behavioral clinician, psychologist, psychiatrist, or other professional approved to demonstrate the competence, as well as licensure/certification, to serve in that role as defined in 460 IAC 6 and 7. o Individuals providing behavioral consultation should have the necessary expertise to grow and enhance the skills and abilities of 3
  4. 4. providers, assess and develop effective behavioral plans, and facilitate implementation of such plans. o Mobile outreach services must also be offered to a variety of settings serving persons with developmental disabilities in that region including, but not limited to, family homes, agency homes, the community, and emergency rooms. o Areas of service must include behavioral and psychiatric evaluation and treatment. o The approved vendor must employ, or contract with, a qualified psychiatrist who is experienced in medication management for persons with developmental disabilities. • Out-of-Home Crisis Residential Services: o The approved vendor must directly provide, or subcontract with another provider in the region, out-of-home placement options. An out- of-home placement option can be considered when a client is in a crisis situation that threatens the safety and well-being of the individual, housemates, persons in the client’s home, or other individuals. This option should be offered only after other less restrictive intervention has occurred. This placement is temporary. At the time of out-of-home placement, a plan must be developed to address the client’s immediate needs and incorporate strategies for return to the person’s home environment or appropriate alternative living environment. o This out-of-home placement option may include beds with a provider of developmental disability services, a psychiatric unit in an acute care hospital, or other alternative that is appropriately able to meet the client’s needs. Even though this service may be subcontracted, it is still the responsibility of the regional vendor to closely manage and coordinate care for the client during that placement. o Out-of-home placement options must be available in locked and unlocked facilities. o The approved crisis management vendor must guarantee bed availability in the event of an out-of-home placement need. Therefore, arrangements with more than one provider may be necessary. o During the out-of-home placement, care must be coordinated with the Individualized Support Team (IST). o As part of the out-of-home option, the vendor must provide transition services into and out of this placement to facilitate timely transition to a less restrictive home setting as soon as possible. o Ongoing treatment and transition planning must also be coordinated with the person’s provider prior to the out-of-home placement. o Higher preference for vendor selection will be given to vendors that offer out-of-home placement options in closer proximity to the person’s residence and/or family, and that can also offer smaller settings. 4
  5. 5. o Transportation services between the person’s residence and the out- of-home placement will not be required of the vendor, but will be a desired optional crisis management service. o Medication management must be coordinated between the out-of- home placement, the provider to where the person is returning, and the crisis management vendor to ensure continuity in the best interest of the client, particularly if multiple prescribing physicians are involved with the case. o In the event that transition from the out-of-home placement to the previous living environment is not appropriate, placement in a more restrictive, institutional setting must be approved by the Director of Crisis Management. The crisis management vendor has the authority to approve an out-of-home placement for up to five days. This placement will be reviewed and approved by DDRS within two business days. • Follow-Along Services: o The vendor must have a system in place to provide follow-along support services to a client and his/her support team following an out- of-home placement. o Follow-along cannot be terminated until there is agreement by the Individualized Support Team that the person is residing in the least restrictive environment. o Follow-along should also engage family members, as appropriate. o Follow-along will not be funded beyond 90 days. Performance Indicators for the Crisis Management Vendors: • Respond to all “Crisis Hot Line” calls within 30 minutes, 24 hours per day, 7 days per week, 365 days per year • Provide on-site visits in response to appropriate requests for in-home behavioral consultation within 24 hours of the requests 100% of the time; quicker response is required as deemed by the nature of the crisis • Utilize state approved curriculums of best practice training materials and implement a comprehensive plan for behavior management training of providers and families in the region (including all FSSA providers) • Develop and implement a plan for on-site training for agencies in the region that experience a higher number of crisis management referrals • Develop a complaint resolution process that demonstrates resolution of complaints within 90 days • Provide out-of-home crisis residential placement 100% of the time, when indicated • Through effective follow-along services, achieve a return-to-community rate (following out-of-home placement) that is sustained for at least one year (Year 1 – 60% of total persons served in out-of-home placement; Year 2 – 70%; Year 3 – 80%); thresholds may be re-evaluated based on data collection 5
  6. 6. • Achieve a satisfaction rating of at least 90% from a survey completed by the providers and consumers/families in the region • Develop and implement an outreach plan to promote the Crisis Management System within the region to promote awareness of the crisis management services available • Collect and analyze the cost of crisis services per person served • Demonstrate compliance with all FSSA auditing procedures, BQIS guidelines, and other applicable regulations • Collect requested data and submit to the Director of Crisis Management at DDRS in accordance with required timelines • Work in coordination with all providers, case managers, BDDS district staff and Director of Crisis Management • Utilize, manage, and maximize resources to support individuals in crisis • Vendor staff will participate in state approved training to be a provider of crisis services and demonstrate competency • Vendor will have staff available with credentials that will enable the vendor to perform expert, high-quality supports and services that are considered best practice and state-of-the-art above and beyond what the typical provider can provide that will enrich the skills and abilities of providers such that they can serve individuals with challenging issues Data to be Collected by the Regional Vendors: • Summary of the number of calls and average time allocated for “Crisis Hot Line” calls • Summary of in-home behavioral consultations and average time per consultation • Average response time between receipt of an in-home behavioral request and the on-site consultation • Number of cases, inpatient days per person, and location for out-of-home placements • Summary of total units of service and type of services provided to each individual served • Summary and analysis of referrals, including location of individual, agency serving individual, reason for referral, recommendations to systemically resolve, and benefit • Summary and analysis of outcomes for individuals, including ability to stay in own home and placements to more restrictive settings that were prevented • Number of persons referred for crisis services and served in an alternative setting (not involving the crisis management vendor) • Dollars spent for crisis management services per person served • Average number of days in an out-of-home placement (including the setting) • Collect data for reportable incidents to police/authorities to determine a reduction in reportable incidents • Collect data for persons with developmental disabilities who have been inappropriately placed in jail, a psychiatric unit, or state operated facility 6
  7. 7. • Number of training sessions, including length of sessions and topics covered • Number and names of persons who participated in training sessions, including place of employment or family • Number of persons with developmental disabilities who are in crisis that the regional vendor is made aware have been (or are being) served by another provider or agency (not facilitated by the Crisis Management team) • Consumer satisfaction survey information • Summary of complaints and associated resolution • Track reduction in physical and chemical restraints (per client over time) as a result of crisis management intervention • Cost benefit information All data is to be collected on a monthly basis, unless other direction has been provided by the Director of Crisis Management at DDRS. The Crisis Management Steering Committee emphasized the need to build a database, including performance measures data and other data/statistics collected. Monitoring and analysis of the data on an ongoing basis will be critical to evaluate the desired outcomes and make modifications to the Crisis Management System, as indicated. The state reserves the right to add or delete data collection elements. The vendors may also suggest data collection modifications. 7