Maryland Developmental Disability Administration (DDA) Creating a flexible, person-centered, family-oriented system of supports so people can have full lives.

DDA Transformation Update The DDA Transformation Newsletter | November 9, 2018 8

Employment

Developmental Disabilities Administration (DDA) leadership participated in multiple Professional Learning Opportunities (PLOs) statewide this week to continue strengthening state partner collaboration for Employment First. The DDA staff provided an overview to the Maryland State Department of Education Division of Early Intervention and Special Education Services staff on Employment First values, as well as systems realignment. The opportunities also included "Speed Learning" sessions that allowed state partners to facilitate brief, small-group conversations related to their area of focus.  These cross-training and collaborative initiatives help to strengthen Maryland's joint vision that students with disabilities will have a smooth transition from school to work and community life, with a vision for their good life.

Upcoming Webinar - "Bringing it all together - Part II"

If you’re still trying to make sense of DDA’s Employment and Meaningful Day Services, join Staci Jones, DDA employment services coordinator, for a continuation of July’s webinar with a more in-depth discussion. This webinar will move beyond basic service definitions, to include multiple scenarios that will help bring the new service delivery system to life.   Date: Friday, Nov. 16 Time: 10 a.m. to noon Register for the webinar at Bringing it all together - Part II .

IMPORTANT for New Providers— Long-Term Services and Supports (LTSS)

Medical Assistance Numbers and Site-Based Enrollment   The Maryland Department of Health (MDH) is transitioning to a new automated Medicaid provider enrollment system, ePrep , which will go live for DDA providers on Monday, Nov. 12. With this transition, ePrep will be used to complete all pending and new provider Medical Assistance (MA) applications.     The DDA is aware that an email was sent out to all DDA providers by Automated Health Systems (AHS) inviting providers to participate in webinars on how to use the ePrep system.     The DDA recommends that our providers do not attend these sessions or complete any work in ePrep at this time.     The AHS sessions are targeted at non-DDA providers and will not provide the correct and necessary guidance for DDA providers to use the system and complete provider MA applications. The DDA, in conjunction with the Office of Health Services (OHS) and AHS, will conduct a separate ePrep webinar in early December exclusively for DDA providers. The date of the DDA's webinar will be announced soon.   Until you are able to attend the DDA-specific ePrep training, please do not try to setup an ePrep account or complete any MA applications in the system.

Behavioral Support Services (BSS) Update

BSS include an array of services to assist people who, without such supports, are experiencing, or are likely to experience, difficulty at home or in the community as a result of behavioral, social, or emotional issues. These services seek to help understand a person’s challenging behavior and its function. If needed, this information will assist in developing a behavior plan with the primary aim of enhancing the participant’s independence and inclusion in their community.   BSS include: Behavioral Assessment- identifies a person’s challenging behaviors by collecting and reviewing relevant data, discussing the information with the person’s support team, and if needed, developing a behavior plan that addresses the function of the behavior; Behavioral Consultation- services that oversee, monitor, and modify the behavior plan; and Brief Support Implementation Services (BSIS)- time-limited services to provide direct assistance and modeling to families, agency staff, and caregivers so they can independently implement the behavior plan To access these services, the needs of the person and family should be shared with their Coordinator of Community Services (CCS) during the initial person-centered planning process and at any time the need arises. The CCS will submit the request to support the assessed BSS need in the initial Person-Centered Plan (PCP) or revised plan via the Modified Service Funding Plan process. Behavioral Consultation and BSIS are only accessed when a behavioral plan is developed. A behavioral assessment is a “milestone payment,” meaning the provider is paid based on completion of a formal behavioral assessment. Only one assessment will be authorized within a 12-month period unless the DDA determines the assessment did not meet the required standards A behavior plan is also considered a “milestone payment.” The behavior plan will only be reimbursed if the assessment indicates a need for a behavior plan per state regulations and policies Behavioral consultation is an hourly service that can be provided for up to eight hours per day. However, there must be documentation to support the need for the full day of behavioral consultation. Consultation will be used to oversee, monitor, and modify the behavior plan. This can be done through a recommendation for subsequent professional evaluations; working with the person and caregivers to implement the plan; ongoing education on recommendations, strategies, and next steps; and ongoing evaluation and assessment of the plan. Through behavioral consultation, a behavior plan can be updated at any time under the scope of the behavioral consultation service. Therefore, there is no need to request authorization for another behavioral assessment BSIS can be billed in 15-minute increments. This is used when additional training is needed for implementation of the behavioral plan. BSIS is used when family, caregivers, or staff need hands-on, "in the moment" assistance to learn techniques to address challenging behaviors as they happen. This service can be billed up to eight hours per day. However, there must be documentation to support the need for the hours of BSIS. It is considered a brief support because the people providing the services are mentoring the caregiver, or Direct Support Professionals (DSPs). BSIS should not take the place of the informal supports BSS provider and staff qualifications are described in the approved DDA Waiver application. Qualified clinicians that may complete the behavioral assessment, behavior plan, and consultation services include a: Licensed Psychologist; Psychology Associate working under the license of the psychologist (and currently registered with and approved by the Maryland Board of Psychology); Licensed Professional Counselor; Licensed Certified Social Worker; and Licensed Behavioral Analyst. All clinicians must have training and experience in Applied Behavior Analysis and Behavioral Tiered Support Plans. The staff providing the BSIS services need to have completed a 40-hour registered behavior technician class. BSIS staff must have supervision from a qualified clinician in order to perform BSIS services.

Beyond Compliance: Creating a Culture of Quality

DDA leadership recently attended the National Association of State Directors of Developmental Disabilities Services (NASDDDS) 2018 Directors Forum and Annual Conference. Important information on topics critical to DDA and our stakeholders was shared. A major focus was on enhancing health and welfare of people receiving Home and Community Based Services (HCBS).   Sessions highlighted effective strategies states have developed to promote greater self-determination and community integration. Another critical topic discussed was, “The Improvements and Challenges: How States Address Incident Management.” This covered proper reporting of critical incidents, investigations, follow up of incidents, as well as data analysis to identify risk and how to mitigate risk.

The Mandt System ®

The Mandt System®   is DDA’s new framework for behavioral supports which focuses on building healthy relationships and providing a more person-centered, values-based process that encourages positive interactions. Mandt promotes individual and organizational well-being and safety with both non-physical and physical interactions. Focus areas of the training include de-escalation during the crisis phase, Positive Behavior Supports, and trauma-informed care to help direct support professionals in understanding human behavior.  Over the past six months, the DDA has diligently worked to get 350 trainers trained in the Mandt system’s basic training. There are four more sessions left until training is complete. If providers do not have a trained staff member, they should register as soon as possible. Providers interested in having an additional trainer should contact their regional professional development coordinator for availability. The Mandt Advanced Training Program is available for agencies that serve people with highly-aggressive and challenging behaviors. If eligible, the DDA will reimburse the cost of the advanced training. To be eligible for this training, the agency must receive approval from the DDA Director of Clinical Services, Dr. Meg DePasquale. If interested, email Dr. DePasquale at meg.depasquale@maryland.gov with justification to include:  the number of people served the percentage of people who have intensive behaviors the percentage of people served who are on behavior plans of the people on behavior plans, the percentage of people that have restrictive techniques in their plan proactive strategies currently being used additional information the agency believes is pertinent Once this is received and approved, the provider may sign up for an advanced training class done that will be completed through the Mandt website.    If you have additional questions regarding the Advanced Training Program, email the DDA’s representatives at the Mandt System®; Tim Geels at tim@mandtsystem.com or Nikki Wince at nikki@mandtsystem.com . Please do not call the customer service department at the Mandt System®. Recommendations for Agencies: Providers must ensure clinical staff that will be updating behavior plans into Mandt language are trained first, in order to allow time for plans to be re-written and approved by the standing committees prior to implementation. Senior leadership should be trained in the first six chapters of Mandt, so they are aware of the relationship-based, trauma-informed approach. A review of agency policies and procedures should be done to align with the Mandt language or philosophy. DSPs will also need to be trained before any updated behavior plan can be implemented.  All behavior plans will need to be updated with Mandt language and terminology. The DDA Deputy Secretary has approved four hours of behavioral consultation to be used to transition behavior plans into Mandt language by using the current Modified Service Funding Plan process and Cost Detail Sheet. The invoice can be accessed at Community Pathways Waiver BSS Invoice Template . 

CCS Contract has been awarded

The DDA is excited to announce the award of the Targeted Case Management Training request for proposal (RFP) contract to the Columbus Organization. The Columbus Organization has national expertise in case coordination service delivery, quality improvement enhancement and the Division of Clinical Staffing Services. The Columbus Organization is also working towards becoming Charting the Life Course Framework™ Ambassadors, which the State of Maryland has already initiated.   The goal of this contract is to create, establish, and implement state-wide competency-based training standards for the CCSs. The contractor will develop the training curriculum content, provide direct training to identified agency lead trainers, and develop and maintain a training database. This database will provide direct tracking of training completion for all CCS agencies.  Over the next few months, the DDA and the CCS Coalition will collaborate with the Columbus Organization to develop 12 training modules that will eventually be included in a packaged, approved certification for CCS agencies. The DDA remains committed to supporting CCS agencies in improving quality service delivery to the people and families receiving DDA services and supports.

Did you know?

The DDA case management providers from across the State of Maryland have established a collaborative organization, the Coordination of Community Services Coalition (CCC). Originally formed in 2006 as the Resource Coordination Coalition of Maryland, the CCC’s mission offers a platform for open communication and collaboration to promote best practices for person-centered, conflict-free case management services. The CCC representatives consist of the leaders from Maryland’s CCS. The CCC meets once per month, minimally. The CCC supports DDA’s vision, which continues to transform the person-centered system by maximizing people’s choices and control in helping to make progress towards living their defined good life . To that end, the CCC continues in its collaboration with the DDA to identify needs and supports to strengthen quality service provision through partnership in the development of new initiatives that support people and their families. As the DDA continues to transform its service delivery system, CCSs are charged with the initial roll-out of many changes as the key facilitators in the development of person-centered planning and monitoring of service delivery. As implementation of improvement strategies remains a priority, the CCC seeks input from stakeholders and advocates for infrastructure supporting best practices in case management services. If you have concerns or topics that would help you understand the roles and responsibilities of our CCS agencies, please reach out to your CCS organization’s leadership, who will inform the CCC for follow-up.

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