HOST HOME PROVIDER MANUAL
This HHP Manual has been issued to ______
On ______
There are quizzes that you will need to take regarding this manual.
All quizzes are online except for the one on Incident Reports and one on the Manual itself.
To take the online quizzes, go to www.imaginecolorado.org
Go to the top right of the screen and find Services; trainings.
Next go to Web Classes, pay by Credit Card. Overture requires: Confidentiality, MANE, Rights, HIPAA, and Overview of DD System.
If you have any questions regarding the quizzes, please contact Overture HR at
303-926-8840.
All quizzes must be completed prior to becoming an HHP for Overture. In addition, you must be current with Medication Administration, CPR and 1st Aid.
TABLE OF CONTENTS
HHP MANUAL
1. About Overture……………………………………………………………………………..6
Including: A brief history of the DD System in Colorado Quiz - Online
The current DD System and Overture
Overture Vision, Mission, & Values
2. Your Role as a Host Home Provider……………………………………………….....11
3. Confidentiality and Confidentiality Quiz – Online…………………………………..12
4. HIPAA and HIPAA Quiz – Online...... 14
5. Rights and the Human Rights Committee Quiz – Online………………19
6. Mistreatment, Abuse, Neglect and Exploitation and M/A/N/E Quiz – Online…..21
7. Host Home Provider Orientation………………………………………………………23
Including: Individualized Plan (IP)
Health Services Orientation
Universal Precautions
Emergency Procedures
Medication Overview
Schedules, Routines, Home Visits
8. Individualized Plan (IP) and Individual Service and Support Plans (ISSP)...... 28
9. Other Overture Training…………………………………………………………………29
10. Documentation and Due Dates……………………………………………………….30
Including: Yearly: Contractual Documentation Requirements
Home Documentation Procedures
Monthly: Host Home Day
11. Incident Reports – Incident Report Quiz in this manual…………………………32
12. Host Home Provider Contract Responsibilities………………………………...…40
Including: Documentation Requirements
Class Training Requirements
Back-Up Service Providers
TABLE OF CONTENTS
POLICIES AND PROCEDURES
1. M/A/N/E Investigations
2. Incident Reports
3. Physical Restraints
Emergency Control Procedures
Safety Control Procedures
4. Transportation of Persons Served
5. Grievance Procedures
6. Dispute Resolution
7. Life Threatening Injury or Illness
8. Routine Health and Medical Care
9. Dietary/Nutrition
10. Medication Administration
11. Psychotropic Medications
12. Confidentiality
13. Suspension of Rights
14. On-Call Notification
15. Performance Improvement Projects
16. Personal Needs Receipt Protocol
17. Host Home Provider Hiring Process
18. Disqualification of Potential Employees and Contractors
19. HHP Contract and Training Requirements
Host Home Provider Manual
The purpose of this handbook is to establish Host Home Provider expectations and responsibilities in their agreement to provide care and services for the people Overture serves.
Host Home Provider responsibilities and procedures are mandated by the state of Colorado Developmental Disabilities Services Rules and Regulations. Additional requirements beyond those required by the state may be requested as a part of your ongoing training as an Overture Host Home Provider.
This manual is in no way comprehensive and requests may be made beyond those described herein. Any questions may be directed to the appropriate Program Manager or the Executive Director.
A Brief History of the DD System in Colorado
The treatment of people with disabilities has progressed considerably in the past decades. With increasing awareness of human rights and the accompanying unacceptable conditions of state institutions, developmentally disabled persons are approaching a more acceptable quality of life in our country.
Historically, the treatment of disabled persons varies by culture. Some were perhaps regarded as saints or mystics, while others were labeled as demon-possessed. Children were regarded as potential income for their parents through labor, and those who were unable to work might have met with an unthinkable fate. The definition of mistreatment in the DD System has changed over the years.
In the 1800s, Dr. Seguin understood that injured or malfunctioning brains caused “disabilities”, and that there was a possibility of rehabilitation. Some of his techniques are still used today. At the time, the popular consensus among doctors and scientists was that people with disabilities were the products of bad genes. They deduced that these people were immoral, indecent, and needed to be locked up and kept away from society. The role of the caregiver was basically the equivalent of the prison guard.
In 1910, an institution opened in Wheat Ridge. At the time, the facility was about 23 miles from Denver and the suburbs expanded to meet it. From then until about 1960, the treatment style was standardized and inadequate. Non-ambulatory residents were confined to basements; a rickets epidemic was blamed on the lack of exposure to the sun. At that time, the staff/resident ratio was 1:40. It is difficult to imagine anyone working or living under such abysmal conditions.
Living and working situations soon improved. People with severe behaviors were given more attention and additional buildings were constructed. Residents became more involved with daily chores, making dinners and working in public environments. Ridge ran the largest laundry facility in Denver and most of the residents worked there and contributed in some way. Unfortunately, many children were admitted and many would most likely spend their entire adult life there. Many of the people served by Overture were these children.
In the 1960s, Dr. Sunada joined Ridge to examine and test these people with developmental disabilities. To his dismay, he discovered that several people were not legally “retarded” and many were involved in the long process of community integration. The Kennedy administration gave financial grants to state institutions such as Ridge to allow for more thorough training in behavior modification. Classes were taught for six hours a day, more training than counselors receive today. The most important outcome of this implementation was knowledge and proof that basic skills could be taught to help people become independent. This evolved into the Individualized Plan, which is one of the foundations of service organizations such as Overture. At last, instead of managing difficult behaviors all day, the needs of the residents became a priority. In 1974, a bill of rights was passed for people with developmental disabilities, workers became advocates and the system gradually changed away from institutions and towards community integration.
The Current DD System in Colorado and Overture
Major funding comes from the Medicaid waiver (HCB-DD), which is administered by the state. The state Joint Budget Committee sets these budgets. State reorganization in 1994 redesigned the Division for Developmental Disabilities by assigning some services to other state agencies. Renamed the Developmental Disabilities Services, the office is still the channel for funds allocated for services which are directed to twenty Community Centered Boards covering the state. That office monitors direct care services through survey teams through a process of monitoring and quality assurance done at the local level.
Services provided through Medicaid include residential, day service, and support to persons living in the family home. Approved service agencies (some private, for profit, and non-profit) contract with the local county Community Centered Boards to provide any of the services. The CCB for Boulder County is Imagine! located at 1400 Dixon in Lafayette, CO. In Jefferson County, the CCB is DDRC and is located at 11177 W. 8th Ave. Suite 300 Lakewood, CO. Residential programs, such as Overture, have been approved as service agencies through the state office. This approval is renewed through surveys, which monitor all aspects of the program. The clients they serve have come from institutions and intermediate care facilities as they were downsized or from foster or family homes as openings were available.
Parents of adults with autism established Overture due to the need for expertise beyond that needed to serve most persons with retardation or developmental disabilities. The facility was intended for anyone throughout the state of Colorado diagnosed with Autism. However, when Overture received approval to provide residential services within the state system, Overture was initially required to serve clients from institutional settings. Some of the parents who founded Overture waited for long periods for Overture placement for their sons or daughters. Some waited up to six years for a facility until a group home in Boulder County opened.
Persons living in institutions were originally placed there due to the inability of the family to provide care in the home due to the behaviors of the individual and the need for assistance and supervision, or due to the choice of the family to have no responsibility for the individual. Life in the institution complicated the problems to a greater degree and predominantly provided custodial care. This resulted in behaviors, which were exhibited to get attention, express frustration and rage, or the inability of the individual to maintain control due to extreme brain damage. The first persons admitted to Overture represented many such challenging behaviors. The philosophy from which Overture grew was from a method called “gentle teaching” and which led to the non-aversive treatment of all residents. This was not the philosophy of most providers of the time who still used mechanical, medical and physical restraints and a “time out” room where individuals were isolated with no effort to define and/or assist with the problem causing the behavior. The philosophy of gentle teaching was tightly adhered to and persons who came to work for Overture and stayed as valued, conscientious providers were people who supported a positive, respectful relationship with the clients. This continues to be true at the present.
Using non-aversive, positive interactions has resulted in success with persons with very challenging behaviors. Overture has become the local “expert” in non-aversive “gentle teaching. Our providers’ interaction has a direct effect in changing individuals who formerly exhibited dangerous, aggressive and insulting behaviors. Gentle, happy individuals who enjoy quality relationships and the opportunity to function within the community demonstrate our results.
VISION
Overture is the recognized leader in providing services to people with intellectual and developmental disabilities, with its uniquely focused and individualized models.
MISSION
The mission of Overture is to support and respect the needs and desires of those with intellectual and developmental disabilities.
The values guiding the mission are grounded in the belief that emotional and physical health is central to living a life of experience, opportunity, participation, choice and growth.
We will distinguish ourselves from other organizations by:
· Being the premier provider of services to those with intellectual and developmental disabilities in the state of Colorado.
· Obtaining and retaining the highest quality care providers.
· Employing and retaining only the most qualified individuals possessing a desire for ongoing personal and professional growth.
· Adhering to high standards of developing and utilizing best practices in the field.
· Making strong leadership the foundation of our success.
· Consistently maintaining a financial position with ethical and prudent management to ensure long-term sustainability.
VALUES
· We practice open, honest and direct communication, emphasize active listening by hearing others before we speak and are congruent in our words and actions.
· We treat others with the utmost respect through positive interaction with the people we serve, care providers, and coworkers.
· We take responsibility and serve with integrity as we remember the people we serve always come first.
· We promote teamwork and a positive work environment, where everyone feels valued and has fun as we support the mission of our organization.
· We encourage and promote innovation and positive change.
OVERTURE PHILOSOPHY
The philosophy of Overture is based on three very important principles:
1) Non-Aversion
2) Integration
3) Proper Relationship
NON-AVERSION means no punishment. Punishment and abuse can take many forms. It is important that providers are aware of this fact, and are able to distinguish between what are aversive interactions and what are not. For instance, if someone has a behavioral problem before a planned activity, and the provider decides to cancel the plans, the outcome of this action can easily become punitive. If the provider sincerely communicates with the person in services, explaining that they are uncomfortable with the planned activity because of what has just happened, this is less aversive than “scolding” the person or telling them they have just “blown it” because of the behavior. Non-aversion requires appropriate disposition and tone of voice from the provider.
At Overture, people respect the complexities of individuals and their developmental disabilities. Evidence suggests that most maladaptive behavior is primarily a communicative interaction. Other individuals might not be able to control outbursts. Non-aversive approaches do not mean that there are no consequences for maladaptive behavior (which has been a naive critique of the philosophy in the past) but it does occasionally require some careful teamwork to arrive at an appropriate, safe consequence. When Overture began in 1982, we were perhaps unique in this approach. Today, most governing agencies and various Human Rights Committees discourage “aversive” consequences.
One fairly straightforward and simple criterion for assuring appropriate non-aversive interactions is called the “normalization scale.” In other words, are the actions or deeds we use with individuals with developmental disabilities transferable to situations involving “unlabeled” people? For instance, some people feel that offering a treat as a reward for a task is acceptable. Imagine though, if you offered your roommate or partner a candy bar after they did the dishes. It would seem like an inappropriate, patronizing thing to do in most situations.
It is important to constantly ask yourself, is this dignified way to treat people? If there is any doubt, then it probably is not. Please talk to your Program Manager about any questions regarding these issues, or bring it up at IP and IDT meetings; it is extremely important to us, as well as the individuals in our care.
INTEGRATION is another aspect of our philosophy, and is basically very simple. It means that we would like the people we serve to have the same access to the community that everyone enjoys. Now that the ADA (American Disabilities Act) is in place, the people we serve cannot be excluded from the community, but being entirely welcome is still quite a challenge. Our goals at Overture are to provide the people we serve with the necessary skills to enable them to have successful community outings. This is an ongoing process, and some of the people we serve may never excel in all the social graces. It is our responsibility to teach them what is appropriate for social situations. Furthermore, if we can reduce the amount of undesirable behaviors that may exclude or stigmatize them, this is a step towards our goal. We want our providers to have the foresight to plan outings that will be successful, and want them to have the knowledge about potential problems. This way, the people we serve may enjoy themselves, and look forward to more outings in the community.