The State of the State Presented by the Office of Provider Development

The State of the State Presented by the Office of Provider Development July 23, 2020 Eric Williams, Provider Development Director

What we will cover Introduction Provider Development activities Key Performance Measures & Targets Regional data Opportunities Next steps Questions and suggestions 7/23/20 Virginia Department of Behavioral Health & Developmental Services 2

Mission The Office of Provider Development focuses on developing and sustaining a qualified community of providers in Virginia so that people who have developmental disabilities and their families have choice and access to options that meet their needs. 7/23/20 Virginia Department of Behavioral Health & Developmental Services 3

Provider Data Summary Report Semi-annual Report Reports, webinar slideshows, and other materials related to Provider Development are available for download online at http://www.dbhds.virginia.gov/developmentalservices/provider-development . 7/23/20 Virginia Department of Behavioral Health & Developmental Services 4

Services Considered Benefits Planning Community Coaching Community Engagement Community Guide Electronic Home-Based Services Employment and Community Transportation Independent Living Supports In-home Supports 7/23/20 Peer Mentoring Shared Living Supported Living Crisis Support Services Private Duty Nursing Skilled Nursing Sponsored Residential Virginia Department of Behavioral Health & Developmental Services 5

For this report June 2018 Baseline 7/23/20 May 2020 Virginia Department of Behavioral Health & Developmental Services 6

Baseline Measurement Tool Virginia Department of Behavioral Health & Developmental Services

Provider Development Activities Community Resource Consultants met with 9 providers seeking to diversify or expand services. Notable additions: 5 new Therapeutic (Behavior Support) providers with 2 more considering adding DD Waiver, and 1 new Electronic Home Based Services provider. Barriers: COVID-19, time involved in agency planning to make changes, waiting on licensing approval, out of state providers starting services in Virginia having to complete additional requirements, and the lack of regulations and a policy manual. 7/23/20 Virginia Department of Behavioral Health & Developmental Services 8

Provider Development Activities Provider Roundtables and Support Coordination Meetings: January 2020: In-person meetings held in all 5 regions with 333 provider representatives and 138 Support Coordination representatives. April 2020: 7/23/20 Due to COVID-19 a statewide webinar was held with more than 500 attendees consisting of both providers and SCs. Virginia Department of Behavioral Health & Developmental Services 9

My Life My Community Provider Database and Designation Process Launched November 15, 2019. As of May 2020, 60 providers have registered. Provider Designation: -4 providers hold badges in Autism, Behavioral Support, and Complex Health Supports -22 have passed surveys with next step of submitting evidence. http://mylifemycommunityvirginia.org/t axonomy/mlmc-menu-zone/verify-or-re gister-new-provider-profile Virginia Department of Behavioral Health & Developmental Services 10

CRC Assignments Recap Individual Capacity-Building 7/23/20 Provider Capacity-Building Virginia Department of Behavioral Health & Developmental Services System Capacity-Building 11

CRC Assignments Recap http://www.dbhds.virginia.gov/developmental-services/provider-d evelopment 7/23/20 Virginia Department of Behavioral Health & Developmental Services 12

Jump-Start Funding Program Awarded approximately 55,490 in Fiscal Year 2020 to create integrated residential and day options in underserved areas. Provider Roundtables Open House If interested in applying for funding to start or expand integrated services in an underserved area, visit: http://www.dbhds.virginia.gov/developmental-services/pro vider-development 7/23/20 Virginia Department of Behavioral Health & Developmental Services 13

DSP Supervisory Training Updated to meet indicators of the DOJ Settlement Agreement. Available on Commonwealth of Virginia Learning Center (COVLC) on July 1, 2020. 3 modules that take approximately 2 ½ hours collectively to complete. Mandatory for new DSP Supervisors and optional for DSP Supervisors who have already received a certificate from completing the previous version in COVLC. 7/23/20 14

Virtual Training Interactive virtual Part V Plan for Supports Training coming soon! Instructor Led Remote (ILR) Community Connections and Person Centered Thinking Training developed by The Learning Community for Person Centered Practices (TLCPCP), available beginning in July 2020. Training and orientation for other TLCPCP-credentialed instructors around the Commonwealth. 15

Key Performance Measures 7/23/20 Virginia Department of Behavioral Health & Developmental Services 16

Key Performance Measures Data continues to indicate an annual 2% increase in the overall DD waiver population receiving services in the most integrated settings. 7/23/20 Virginia Department of Behavioral Health & Developmental Services 17

Key Performance Measures Data continues to indicate that at least 90% of individuals new to the waivers, including for individuals with a “supports need level” of 6 or 7, since FY16 are receiving services in the most integrated setting. 7/23/20 Virginia Department of Behavioral Health & Developmental Services 18

Key Performance Measures The Data Summary indicates an increase in services available by locality over time. 7.12.19 Virginia Department of Behavioral Health & Developmental Services 12

Key Performance Measures The Commonwealth ensures that at least 86% of individuals who are assigned a waiver slot are enrolled in a service within 5 months, per regulations. 7.12.19 Virginia Department of Behavioral Health & Developmental Services 12

Key Performance Measures 86% of people with a DD waiver, who are identified through indicator #13 of III.D.6, desiring a more integrated residential service option (defined as independent living supports, in-home support services, supported living, and sponsored residential) have access to an option that meets their preferences within nine months. 7.12.19 Virginia Department of Behavioral Health & Developmental Services 12

Key Performance Measures 86% of provider agency staff meet provider orientation training requirements 7.12.19 Virginia Department of Behavioral Health & Developmental Services 12

Key Performance Measures 86% of provider agency direct support professionals (DSPs) meet competency training requirements 7.12.19 Virginia Department of Behavioral Health & Developmental Services 12

Demographic Data Waitlist -by region and priority -by time on waitlist and age Residential setting size and type Day Services by type Data specific to types of services received by region Availability of specific services Waiver Service Authorizations by region. 7.12.19 Virginia Department of Behavioral Health & Developmental Services 12

Net Losses (unique) Since June 2018 Private Duty Nursing -2 providers; 45 people Crisis Services -1 providers; 87 people Note: These account for the only net losses by unique providers 7/23/20 Virginia Department of Behavioral Health & Developmental Services 25

Notable Updates All services tracked through this report have experienced an increase in the number of people supported since June of 2018 (with exception of Peer Mentoring and ECT). A significant expansion in the data provided through this report to support a better understanding of Virginia's DD system of supports and services and achieve compliance with the Settlement Agreement A reduction in Virginia's training centers to one location with a census of 78 in the past six months the first authorizations (15) were authorized for Community Guide Services Use of Electronic Home-based Services more than doubled from 24 to 49 authorizations in the past 6 months. DSP supervisory training has been expanded and loaded into the Virginia Learning Center for supervisor access. 7/23/20 Virginia Department of Behavioral Health & Developmental Services 26

Regional Data For each more integrated or critical service: 7/23/20 Change in non-unique providers by regional sub-area. Total of people authorized. Change in number of authorizations. Net gains/losses of providers. Total number of providers by regional sub-area. Virginia Department of Behavioral Health & Developmental Services 27

Regional Subareas 7/23/20 28

Community Engagement 7/23/20 Virginia Department of Behavioral Health & Developmental Services 29

Community Engagement 7.12.19 Virginia Department of Behavioral Health & Developmental Services 22

Community Coaching 7/23/20 Virginia Department of Behavioral Health & Developmental Services 31

Community Coaching 7.12.19 Virginia Department of Behavioral Health & Developmental Services 23

Independent Living Supports 7/23/20 Virginia Department of Behavioral Health & Developmental Services 33

Independent Living Supports 7.12.19 Virginia Department of Behavioral Health & Developmental Services 23

In-Home Support Services 7/23/20 Virginia Department of Behavioral Health & Developmental Services 35

In-Home Support Services 7.12.19 Virginia Department of Behavioral Health & Developmental Services 24

Shared Living 7/23/20 Virginia Department of Behavioral Health & Developmental Services 37

Shared Living 7.12.19 Virginia Department of Behavioral Health & Developmental Services 25

Supported Living 7/23/20 Virginia Department of Behavioral Health & Developmental Services 39

Supported Living 7.12.19 Virginia Department of Behavioral Health & Developmental Services 27

Sponsored Residential 7/23/20 Virginia Department of Behavioral Health & Developmental Services 40

Sponsored Residential 7.12.19 Virginia Department of Behavioral Health & Developmental Services 28

Crisis Support Services 7/23/20 Virginia Department of Behavioral Health & Developmental Services 43

Crisis Support Services 7.12.19 Virginia Department of Behavioral Health & Developmental Services 31

Benefits Planning 7/23/20 Virginia Department of Behavioral Health & Developmental Services 45

Benefits Planning 7.12.19 Virginia Department of Behavioral Health & Developmental Services 29

Community Guide non-unique 7/23/20 Virginia Department of Behavioral Health & Developmental Services 46

Community Guide 7.12.19 Virginia Department of Behavioral Health & Developmental Services 30

Electronic Home-Based Services 7/23/20 Virginia Department of Behavioral Health & Developmental Services 49

Electronic Home-Based Services 7.12.19 Virginia Department of Behavioral Health & Developmental Services 32

Skilled Nursing 7/23/20 Virginia Department of Behavioral Health & Developmental Services 51

Skilled Nursing 7.12.19 Virginia Department of Behavioral Health & Developmental Services 33

Private Duty Nursing 7/23/20 53

Private Duty Nursing 36

Regional Support Teams 2nd and 3rd Quarters of 2020: 266 referrals No individual moved into a less integrated setting when a more integrated setting was desired. Most frequent barrier: Individual/SDM Choice includes: 7/23/20 Individual/ SDM/LG chooses less integrated option; Individual/Substitute Decision Maker (SDM)/Legal Guardian (LG) not interested in discussing/exploring options/refuses supports; Individual/SDM/LG does not choose provider after visit/still exploring community options Virginia Department of Behavioral Health & Developmental Services 55

Regional Support Teams RST Barrier Themes Individual/SDM Choice Lack of provider at referral Provider/setting match Lack behavioral expertise Lack medical expertise Lack mental health expertise 7/23/20 Virginia Department of Behavioral Health & Developmental Services 56

Regional Support Teams 7/23/20 Virginia Department of Behavioral Health & Developmental Services 57

Regional Support Teams 7/23/20 Virginia Department of Behavioral Health & Developmental Services 58

Regional Support Teams 7/23/20 Virginia Department of Behavioral Health & Developmental Services 59

Regional Support Teams 7/23/20 Virginia Department of Behavioral Health & Developmental Services 60

Regional Support Teams 7/23/20 Virginia Department of Behavioral Health & Developmental Services 61

Regional Support Teams 7/23/20 Virginia Department of Behavioral Health & Developmental Services 62

Opportunities 1 2 3 4 7/23/20 Virginia Department of Behavioral Health & Developmental Services 5 63

Next Steps quality improvement initiative to increase the number of individuals in independent housing in partnership with CSBs, establish a standard process to assess for changes in a person's status and to confirm that the ISP is implemented appropriately increase the availability of remote instruction for person-centered practices trainings work directly with providers to address barriers to service provision with a concentrated focus on Community Guide, Employment and Community Transportation, Peer Mentoring, Crisis Supports Services, and Skilled Nursing, continued participation in the community of practice initiative around Charting the Lifecourse , develop plans for the next Provider Innovation Collaborative to be held in the Spring of 2021 (depending on the state of emergency), increasing the number of providers per region identified as having expertise to support people with complex needs, and centralizing access to training resources for providers and Support Coordinators. 7/23/20 Virginia Department of Behavioral Health & Developmental Services 64

Questions & Suggestions For more information, visit Provider Development online at http://www.dbhds.virginia.gov/developmental-services/provider-development 7/23/20 Virginia Department of Behavioral Health & Developmental Services 65