adult autism waiver supports coordination training...•7 module training was developed in spring,...

> www.dpw.state.pa.us > www.dhs.pa.gov

Adult Autism Waiver Supports Coordination Training

Bureau of Autism Services

August 2016

> www.dpw.state.pa.us > www.dhs.pa.gov 2

BAS Mission


BAS Values


What are the goals of AAW?

• Increase person’s ability to care for themselves

• Decrease family/caregiver stress

• Increase quality of life for both the person and the family

• Provide specialized supports to adults with an ASD based on need

• Help adults with ASD reach their employment goals

• Support more involvement in community activities

• Decrease crisis episodes and psychiatric hospitalizations


LESSONS LEARNED What we know and where we need to focus our efforts


0

500

1000

1500

2000

1990 1995 2000 2005 2010

Number of Autism-Specific Research Articles on Children or Adolescents versus Adults, by year

Child/Adolescent

Adult

1. Best Practices Paucity of Research on Adults with ASD

> www.dpw.state.pa.us > www.dhs.pa.gov Children and Adolescents (under 21)

Bipolar 8%

ID 13%

Depression 10%

ADHD 46%

Behavioral/ Conduct

53%

Stress 15%

Anxiety 15% ID

49%

Schizophrenia 13%

Bipolar 23%

Depression 27%

ADHD 18%

Behavioral/ Conduct

25%

Stress 11%

Anxiety 29%

Schizophrenia . 1%

Co-occurring Diagnoses

Adults (over 21) Source: PAautism.org/needsassessment

2. Co-occurring Diagnoses


• Many adults with ASD have been

receiving no support;

receiving inappropriate support; and/or

struggling with powerful past experiences that impact them.

All this may add to the complexities in understanding how to best support them.

3. Historical Experiences


Adults for Whom a Caregiver Responded:

55% unemployed

Adults who Responded for Themselves:

47% unemployed

Of those who are employed:

Full Time Employment: ~6% of Adults

Part Time Employment: ~25% of Adults

Source: PA Autism Needs Assessment PAautism.org/needsassessment

What are we learning?

4. Employment


Individuals with autism, regardless of their complexities or their challenges, with the right kind of support, provided by

individuals who are trained to understand how to support them, can make progress toward a life of quality, dignity and

joy.

5. Providers Need Training & Tools


Although people with ASD often struggle with navigating the social world, many have expressed a desire to be connected to

their community and to build relationships

6. Relationships


RESOURCES TO SUPPORT YOUR ROLE AS AN SC


• SC Manual (updated January 2016)

• AAW: Tools for Supports Coordinators (updated 5/23/16)

• SC Cheat Sheet: AAW Participant File Documents (updated

5/23/16)

• AAW QSR Due Dates Chart (updated 03/31/16)

• SC Individual Monitoring Form Guidance (issued via

Communication: BAW16-28 )

• ISP Signature Page (including instructions) (updated June 2016)

• Initial and Annual ISP Documents (updated July 2016)

… Remember to view Virtual Targeted Trainings for additional support

SC Specific Resources


• Provider Information Table (updated 7/5/16 and issued via Communication BAS16-32)

Adult Autism Waiver Service Procedure Codes Error Status Codes (issued June, 2016)

• AAW Provider Qualifications chart (updated February, 2016)

• Exceptions Process (Issued via Communication: BAW16-31 )

• AAW Provider Manual (updated March, 2016)

• SSD/SSB Process Guidance (issued via Communication: BAW16-3)

• Best Instructional Practices Manual (updated June 2016)

• Admin and Communications to Providers (Uploaded after they are sent out via BAS list-servs)

All Provider Resources


RENEWED AAW: JULY 1, 2016


• In accordance with State Statute:

Commercial General Liability insurance

Workers’ Compensation insurance

Professional Liability Errors and Omissions insurance

• Providers of services in unlicensed settings may enroll service locations in contiguous states (NJ, DE, MD, WV, OH, and NY).

• Providers of Day Habilitation and Residential Habilitation (both Community Home and Family Living Home) must provide those services from service locations in PA.

• Most services may be delivered in states contiguous to PA, even if the service location is in PA. Services in licensed settings (Day Habilitation and Residential Habilitation) and Home Modifications must be provided in PA.

What you should know: General


• Updated terminology used throughout

• Revised several quality measures

• Increased the limitation on the number of participants served at any point in time from 518 to 568 and increased the number of unduplicated participants from 544 to 596

• Added reserved capacity for ten individuals discharged from a state hospital and for three individuals transferring from the Adult Community Autism Program

• Allowed use of an interim service plan when an individual is enrolled in the waiver using reserved capacity and has a protective services plan that specifies a need for long-term support.

• Revised the intake process for individuals between 18 and 21 years of age

• Revised provider qualifications

• Revised the section on risk assessment and mitigation

What you should know: General


• Assistive Technology

includes the independent evaluation as required for this service, if not available through the State Plan, other waiver services, or private insurance

• Behavioral Specialist and Community Inclusion

is expanded and combined to form a new service, Specialized Skill Development (SSD). The scope of the Behavioral Specialist service remains largely unchanged. The qualifications are expanded and clarified.

A third component, Systematic Skill Building is included in the SSD service., which uses ABA methods to help the participant acquire skills that promote the participant’s independence and integration into the community, which are not behavioral in focus. Like BSS, SSB includes plan development, direct ongoing support and indirect ongoing support.

Community Inclusion is renamed Community Support. The purpose, scope, and qualifications of service remain largely unchanged. However, staffing levels are expanded: 1:1, 1:2, and 1:3 staff to participant ratios

What you should know: Service Specific


• Environmental Modifications

separated out into two services: Home Modifications and Vehicle Modifications

• Family Training and Family Counseling

combined, and renamed Family Support. The limitation on utilization of Family Support is 40 hours per plan year.

• Occupational Therapy

eliminated

• Residential Habilitation

Respite services will be allowable for participants receiving Residential Habilitation in Family Living (Chapter 6500) settings.

• Respite

The limitation is clarified to 30 times the day unit rate for respite in a licensed facility, but may continue to be used in any combination of in- or out-of-home respite that does not exceed that amount.



• Job Assessment and Job Finding

renamed Career Planning which includes two components, Vocational Assessment and Job Finding.

• will only support competitive integrated employment at or above minimum wage.

Vocational Assessment will develop a Vocational Profile to identify a career direction and plan to achieve employment; the scope includes evaluating social capital, learning opportunities and benefits counseling.

The scope of Job Finding is expanded to include networking with prospective employers, supporting self-employment and job carving.

Both components of Career Planning are billable in 15-minute units subject to limitations. Staff qualifications are broadened.



• Supported Employment

expanded to include two components: Intensive Job Coaching and Extended Employment Supports.

Supported Employment supports competitive integrated employment at o, and may provide support directly to the participant and indirectly to others involved in the participant’s employment such as supervisors or co-workers

Intensive Job Coaching supports participants who require on-the-job support for more than 20% of their work week at the outset of the service, with the expectation that the need for support will diminish during the Intensive Job Coaching period.

Extended Employment Supports helps participants for an indefinite period as needed by the participant for 20% or less of their work week.

• Temporary Crisis Services

renamed Temporary Supplemental Services and allows for additional staff support to assist the participant in avoiding a crisis or developing coping skills after a crisis.



SPECIALIZED SKILL DEVELOPMENT AND EMPLOYMENT SERVICES


SPECIALIZED SKILL DEVELOPMENT (SSD) SERVICES


Behavioral Specialist and Community Support Services remain largely unchanged.

Let’s walk through what Systematic Skill Building looks like and what it means for SCs

How is BSS different from SSB?

-Assessments (formal or informal) drive outcomes -Plans are developed to clearly identify strategies that will be used to teach skills -Based on principles of ABA -Instructional Decisions based upon data -CS or other supports implements both plans -Both have direct and indirect services -Other services are required to follow both plans -They both do not submit MPNs to SCs (only QSRs)

BSS -FBA drives the BSP/CIP -Primarily targets maladaptive behaviors -BSP Template targets antecedent strategies, replacement behaviors, and consequence strategies

SSB -Informal Assessments drive SBP -Primarily targets adaptive behaviors -SBP identifies prompting strategies, materials/environmental adaptations, generalization, GAS, etc..)


SSD/SSB was designed to emphasize the use of evidence-based methods to help the participant acquire skills that

promote the participant’s independence and integration into the community, which are not behavioral in focus.

SC’s role is to educate the family and participants to explore this component in order to benefit from systematic instruction

delivered by highly-trained professionals, which include the development of skill-specific strategies to reach the identified

goals and objectives, and ongoing data analysis to make instructional decisions.

Where to start with SSD/SSB? What is my role as an SC?

What does the SBP look like?


• Skill Building Specialist (SBS): send goals and objectives to the SC after all SBPs are completed.

Hard copies of SBPs remain in participant files

• SC: enter goals and objectives into HCSIS

• BAS Clinical: review goals and objectives for formatting and quality

• BAS/SC: Once approved, SSB- Plan Development is authorized and Direct/Consult may be added via a CR

• SC: At the end of every quarter, enter progress toward each goal into HCSIS (see GAS section of this training for more specific details)

What do I need to do once the SBP is complete?


• 7 Module training was developed in Spring, 2016 and posted to our online training platform Module 1- Applied Behavioral Analysis

Module 2- Best Instructional Practices

Module 3- Introduction to Systematic Skill Building

Module 4- SBP: Demographics, Goals, and Objectives

Module 5- SBP: Instructional Strategies

Module 6- Goal Attainment Scaling

Module 7: Progress Reporting and Making Instructional Decisions

• Although anyone can access the training to learn more about SSB, BAS will NOT be scoring or providing feedback on SBPs submitted for review for SCs or any other provider who is not intending to enroll as SSD.

Where do I go for more information on this service?


• Goals and Objectives Cheat Sheet

• Goal Categories

• SBP Tip Sheet

• SBP Quick Reference: What Goes Where

• Instructional Decisions

• QSR Due Dates for BSS/SSB Providers

• SBP Guidance

• SBP Examples

SSB Service Guidance Documents


EMPLOYMENT SERVICES


Your role in employment is to emphasize the importance of employment with participants and their families; to discuss establishing employment goals in the ISP; and to assist with

referrals to the Office of Vocational Rehabilitation (OVR)

Where to start?


If the participant does not meet an exception to receiving OVR services as outlined in the joint ODP/OVR bulletin 00-16-02

issued and effective April 1, 2016, the participant is expected to first seek employment services through OVR.

Do you need to make an OVR referral?


• Career Planning

Vocational Assessment

Job Finding

• Supported Employment

Intensive Job Coaching

Extended Employment Supports

• Transitional Work Services

What service(s) will assist with actualizing the desired vocational outcome?


• Service Guidance Document: “When Should I Make a Referral to the Office of Vocational Rehabilitation”

• Completing a Vocational Profile (Communication BAW16-34)

• Clarifications regarding AAW Employment Services (Communication BAW16-39)

Resources


Goal Attainment Scaling (GAS)


What is GAS?

• Individualized approach for establishing and measuring the attainment of goals/objectives for people with varying levels of disability and support needs

• A set of unique goals/objectives and range of criteria are established

• A standardized approach to measuring and reporting outcomes


History of GAS

• Developed in 1968 to evaluate mental health programs

• Since then, GAS has been used in education, nursing, rehabilitation, medicine, corrections and social work fields

King, McDougall, Tucker, et., al (1999)

GAS in therapy setting for functional skills for children with disabilities in a school setting.


Merits & Benefits of GAS

• Criterion NOT Norm referenced

• Uses quantitative measures

• Encourages data-based instructional decisions

• Measures individual goals

• Allows for group analysis


• Fall 2014- BAS gathered data to review goals, objectives, and Quarterly Summary Reports Across 4 quarters from a sample of 86 objectives, over 65% of QSRs were

either identified as inconclusive (unable to determine progress) or not reflective of actual objectives within participant plans

• December 2014- January 2015- Identified 10 participants and trained SCs and providers on GAS model

• Ongoing Technical Assistance from Clinical was provided

• Round Table Discussions held to gather feedback on the model for statewide implementation

• Data was collected and monitored for one year to track progress

GAS Pilot with AAW Providers


Effective July 1, 2016, GAS Implementation began Statewide with

Systematic Skill Building ONLY

All other providers will implement within the next 6 months- stay tuned for more information


GAS Chart

GAS Guidance for Providers


• SC is responsible for:

Entering goal phrases, goal statements, and objectives received from the SSD/SSB provider into HCSIS

Collecting QSR data from providers (providers must submit to SCs by the 10th following the end of the quarter

• See: Service Guidance Document QSR chart

Entering QSR data into HCSIS following the NEW FORMAT!

What does GAS mean for my role as an SC?


Remember…

• To end date all previous goals and objectives before adding GAS goals and objectives

Goals and objectives can continue from previous plan year, but should be end dated and written in GAS format

• Keep goals and objectives individualized and prioritized

• To categorize each goal (ADL, Social/Communication, Behavior, or Employment) when entering into HCSIS

E.g. Money Management (ADL) or Coping Skills (Behavior)


Reporting Progress in HCSIS


.

Note: The data collected for the last month of the quarter will be reflected on the GAS chart as

well as Quarterly Summary Report.

The GAS chart only needs to be submitted to SC at the end of the quarter for BSS and SSB.

Example- Shawn MPN- Page 1 (May)

Example- Shawn MPN- Page 2 (May)

Example- Shawn MPN- Page 1 (June)

Example- Shawn MPN- Page 1 (July)

Shawn’s GAS Chart Through 2nd Quarter

Example- Shawn QSR


Entering QSRs into HCSIS


The following slides are only relevant for goals and objectives developed by SSD/SSB providers, who are implementing GAS

as part of the SBP.

Additional guidance for implementing GAS for all other services will be forthcoming.

Meal Prep

Transportation

Meal Prep

02/01/2013

02/01/2013 01/31/2014

01/31/2014

PAY ATTENTION: This is a CHANGE from normal Quarterly Summary Entry. The “Quarterly Summary Report Name” is the GOAL PHRASE from the GAS Charts/SBP!

Hint: Every goal phrase should be entered separately by selecting “Add.” For example, If the team completed 5 charts, then 5 goal phrases should be added to this section.

02/01/2013

01/31/2014

Meal Prep

Transportation

Meal Prep

01/23/2013

01/23/2013 01/22/2014

01/22/2014

01/23/2013

01/22/2014

PAY ATTENTION: This is a CHANGE from normal Quarterly Summary Entry. The “Quarterly Review Period Begin Date” and “Quarterly Review Period End Date” needs to reflect the ENTIRE PLAN YEAR!

~ The begin date is the first date of the new plan year, (and is also the first date on GAS chart in quarter 1).

~ The end date is the day before the next plan year starts (and last date on GAS chart, quarter 4)

01/31/2014

01/31/2014 02/01/2013

02/01/2013

02/01/2013

Meal Prep 01/22/2014 01/23/2013

PAY ATTENTION: This is a CHANGE from normal Quarterly Summary Entry. For every goal phrase, the SERVICE and PROVIDER needs to be entered 4 times, one time for each quarter, with the correct dates for each quarter.

Quarter 1

Quarter 2

Quarter 3

Quarter 4

Hint: The review period begin and end dates should match the GAS chart!

02/01/2013 04/30/2013

05/01/2013

08/01/2013 10/31/2013

11/01/2013 01/01/2013

07/31/2013

2nd Quarter Progress, copied directly from QSR received from provider


• Have you visited the ASERT website (www.paautism.org)?

Did you create profiles for the participants you support?

Did you sign up to receive the ASERT monthly newsletter?

Do you follow ASERT on facebook or twitter?

• Are you signed up on BAS list-servs (all providers and SC specific)?

Are you receiving Admin Notices and Communications via the list-serv?

• Do you communicate with the Regional and Clinical Reps to ask questions and share participant concerns?

• Do you visit the online training platform and save all pertinent documents and watch trainings?

If you have questions on any of the above, please contact the Provider Support Mailbox ([email protected])

How to ensure you have all the information to do your job as an SC

http://www.paautism.org/

mailto:[email protected]

