Self-Determination Advisory Board

Self-Determination Advisory Board

September 7, 2016

Meeting Notes

Chairperson: Nancy Alterio, Executive Director, Disabled Persons Protection Commission

Elin Howe, Commissioner, Department of Developmental Services

Members attending: Margaret Abrams,John Anton, Valerie Bradley, David Brill,

Mandy Chalmers, Julie Lavin-Flaherty,Lindsay Foley,Robin Foley, Anne Fracht,

Gail Gillespie,Jeff Keilson, Andrea Lunden, John Nadworny, Leo Sarkissian, Julie Westwater

Members on speaker-phone: Leslie Kinney,Marissa Szabo, Joseph Wood

Members not attending: Molly Adams, Sue Adams,James Brett, Buddy Bostick, Sam Wood

Guests: Janet George,Gail Grossman, Patrick Heffernan, Victor Hernandez, Pamela Hickey,Fran Hogan, Betsy Eaton-Irwin, Brad Keddal, Caroline Leary, Eric McAfee,

Beverly McGovern, Terry O’Hare,Helen Quinn,Larry Tummino, Edward Wilson,

Mary Barry

Welcome and Opening Comments

Nancy Alterio welcomed the SD Advisory Board members and guests to the meeting.

CommissionerHowe thanked the Regional Managers for their work and announced that there are now 877 individuals enrolled in self-directed services, an increase over the last few months. DDS has a goal to add another 100 participants this fiscal year to self-direct their services.

She announced the Self-Direction conference organized by Buddy Bostick for

September 13. Commissioner Howe stated that events like this encourage individuals and families to consider self-directing their services.

Other announcements from Commissioner Howe:

• The Budget for FY ’17 presents significant fiscal challenges for DDS.
• DDS is continuing with all employment initiatives; all workshops have been closed and there are 2067 individuals employed.
• Shared Living has expanded to 1120 shared living individuals.
• Amendments to regulation and rates (Chapters 5, 9,13) are in progress.

In addition, Commissioner Howe thanked Mandy Chalmers, Northeast Regional Director, for her 44 years of dedicated service to DDS; we wish her the best in her future.

MASS Report

Anne Fracht reported that MASS has a new State Coordinator: Caroline vanBruinswaardt.

Anne also reminded the Board about the upcoming MASS Annual Conference on October 15. The theme of this year’s conference is: “Self- Advocates: Make the Future.” This conference has been well attended in the past with 485 persons participating last year.

Evaluation of Self-Direction in DDS Contract Award

Commissioner Howe announced the contract award for the evaluation of self-directed services in Massachusetts. Two excellent proposals were received. The 3-year contract has been awarded to Human Services Research Institute with a start date of September 1, 2016.

Mary thanked the members of the Selection Committee for their work.

Valerie Bradley said how excited HSRI is to be a part of evaluating the State’s work on self-determination. She believes it will be a great opportunity to work on such an important service model.

Fiscal Intermediary Contract

Commissioner Howe announced that the contract for a fiscal intermediary had gone out for competitive bid and the two proposals received to deliver this service were very strong. DDS is now finalizing its reviews with a selection to be made soon.

Work Plan Update

• Eligibility Letter- Janet George distributed revised “Proposed Language for Insertion in Eligibility Letters” for the Board’s review.

The Board was in agreement about this additional language to be added in the eligibility letters.

• Item 1.(e)(6): “Individual budget based on need” was approved by the Advisory Board on March 2, 2016. Guidance is in development.
• Item 1. (d): Informational materials and training documentation are to be shared at this meeting and will be posted on the website.

The Participant Directed User Manual was distributed to board members and to all Area and Regional staff involved with the PDP.

• The Annual Report on DDS Self-Determination Services was included in the packet at this meeting. It has been approved by EHS and forwarded to the legislature. The board is encouraged to review and make comments; the report can be amended if needed. Key items in the report are: 1.) the accomplishments of the Advisory Board; 2.) contributions from Self-Advocates and the work done to respond to their issues;3.) role of the Regional managers.
• The “Repository” website has expanded to include information about 85% of all agencies. The INDEX is working to make the website more accessible to everyone by including enhanced “search requirements,” more information from each agency and a short video to assist with using the website.

The complete work plan will be available for the December Advisory Board meeting.

Agency With Choice

Larry Tummino presented on the work of the joint workgroup requested by Commissioner Howe to review the program’s strengths and challenges and to provide recommendations to increase self-determination options for individuals and families. He reviewed the Interim Guidance document developed by the group which clarifies many of the expectations for this model. There will be two other documents issued in the fall: a Guide for FAQ for individuals and families and a detailed “AWC Operations Manual” for Area Office and Provider Agency use.

The Board had the following questions/comments:

• Navigation hours are guidelines for new participants and can be known but are not portable. They are to ensure consistency and to help avoid “overspending” the navigation allotments.
• Is there flexibility in the guideline of the $3000.00 cap for Flexible Funding/Financial Assistance?

-The current protocol involves the Area Directors consulting with the Regional Directors for exceptions to the $3K cap.

-The exceptions must relate to the person-centered plan; it is essential that all involved design a reasonable plan and budget; then whatever relates to or enhances the plan may make sense.

-There needs to be established criteria for going beyond the $3K cap. The Operations Manual may be a place to start.

• Training for support persons needs to be built-in to the budget and not take away from direct service hours. An amount of up to $750 per AWC participant will be made available to agencies to cover attendance at trainings for direct support staff. The funding is separate from the service allocation.
• Will the AWC assist families with staff recruitment?

-Yes, this is shared partnership between agency and family with expectations that need to be clarified from the beginning; the AWC cannot recruit for every hour of support but will assist to the extent possible. Some families need more assistance than others.

-The provider agency needs to initiate this conversation/agreement with the family so that the family is clear.

-Workforce issues pose a significant challenge for all service delivery agencies nationwide. We are competing with staffing needs for elders, for those with mental health issues, etc.

-There are challenges in addressing the blocks of time that the individuals may need supports, for example, the “20 minute ride” in the middle of the day. We need a team-approach in partnership with the agency to successfully problem-solve.

-Families are uncomfortable, fearful without a solid back-up plan.

-With rules for overtime, if a large agency does have staff willing to fill in, the “time and a half” overtime pay may need to come from the service allocation.

-Some agencies want to have one person work with multiple families; could this work with individualized services and schedules?

IGO Training

Julie Lavin Flaherty discussed the review of the Inspector General’s focus on fraud abuse prevention. The Real Lives law mandates that financial abuse be reported to the DPPC and that training is required for this mandate.Training will be provided in November for DDS and DPPCinvestigators to help determine if reported cases meet the definition. A survey has been prepared to help staff determine the needs of this audience. Last May, the Inspector General presented on fraud abuse to Senior Managers. A video conference is also available to help both understand and deal with the issues. These trainings will raise awareness of the “red flags” in many settings.

A suggestion was made that the training would be a helpful part of orientation to individuals/families that are self-directing.

In addition, there is overlap with elder abuse through marketing and potential identity fraud perpetrated on vulnerable seniors.

Julie will plan a 45 minute presentation with time for questions for a future Board meeting.

DDS Self Direction Training, Outreach and Support Activity FY16

Brad Keddal presented a summary of the activities and numbers of participants for

FY16. There were a total of 145 events and 3418 participants. The summary is included in the information packets.

Each Regional Manager presented a brief summary of his/her Regional work:

• Betsy Eaton-Irwin, Metro Region

Betsy talked about her presentations to DDS staff. Like all the regional managers, she regularly meets with Support brokers/Service Coordinators and Area Office staff involved in self-direction. At these meetings, there have been a variety of training topics such as budget development, review trainings, and best practice. She has developed and encourages staff mentoring.

Betsy presents regularly in the Service Coordination Institute which provides training for new Service Coordination staff. Betsy co-presents with a parent involved with self-direction. The group’s goal is to include self-direction participants in all trainings. New staff members respond well to these trainings and are excited about these options for individuals.

• Pamela Hickey, Central West Region

Pamela talked about outreach to individuals and families. She participated and presented at Family Support Center events throughout the Central and Western Massachusetts Region. At these events she describes what Self Determination is in practice and shares its history and current status. The Transition Service Coordinators call her for guidance for individuals who are transitioning from their school systems and may be interested in self-directing their adult services; she has participated in school-sponsored “Transitional Fairs.” She also works with groups of Self-advocates and families. She has seen an increase in interest and enrollments in AWC and PDP.

• Beverly McGovern, Northeast Region

Beverly recently began working in the role of Regional Manager. She described participating in eight family forums with over 400 people attending during the months of her work. There has been a direct correlation with the forums and an increased interest in AWC and PDP.

She also participated in North East “Ask the Agencies” at which six Family Support agencies attended to be available to respond to questions posed by families and individuals.

• Edward Wilson, Southeast Region

Edward described his recent involvement with Massasoit Community College and classes that provide career-enhancing opportunities for direct support staff. In the classes he describes self-direction and the choice and control it offers to individuals. He helps the students understand different options to the traditional group living situations. His goal is that the direct support workers share the information with those in decision making positions in the agencies. Edward talked about his work with the provider agencies to develop different choices for individuals and families including self-directed services, Agency With Choice and Shared Living.

Brad summarized the training, outreach and support activities presented by the Regional Managers. The group is gathering feedback from the participants and stakeholders to continue to learn and to build a strong infrastructure for self–determination services. He and the Regional managers continue to ask themselves, “How do we reach more families, individuals and support staff?” An additional project they are working on is to develop a speakers’ bureau to give individuals the tools to become speakers and to tell their stories. He and the Regional managers will also collaborate with HSRI on the evaluation of self-directed serves.

Janet George suggested that it would be helpful to integrate more self-direction training in existing professional development opportunities for all DDS staff.

Next Meeting date: December 7, 2016 10AM-12noon

Meeting adjourned at 12 noon

Submitted by Mary E. Barry

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