Welcome

Regulations and their

Impact on Policy

Presentor- Di Hayes

BS Education and MS Recreation Recreation Therapist – Residential

Treatment Program Director- Residential Treatment Program Director- Shelter Services Regional Director – Child Placing AgencyMS Mental Health Counseling Director of Community Base Services Clinical Director Chief Administrator

Goals

To provide an overview of the youth receiving services

To provide an overview of the Continuum of Care

To provide an overview of Residential Treatment facilities and impact of regulations

To provide an overview of the Human Rights regulations

To provide an opportunity for students to use their critical thinking skills related to policy

Hallmark Youthcare

Residential Services

62 Beds- General

and A & D 16 Beds Sexually

Acting Out Males

Community Base Services

In-Home Services Mental Health Skill

Building Services

CONTINUUM OF CARE

About the Youth Placed in Residential Treatment

98% of youth are awarded to the State of Virginia Social Worker- legal guardian

Ages 11 to 17 Experienced Multi Traumatic Events Identified as High Risk

Danger to Self Danger to Others

Services started at the lowest level on the continuum and after failing to reduce high risk behaviors they are referred to Residential Treatment

Hallmark Policies and Procedures

Over 400 policiesEach policy is reviewed

every three yearsPurpose of policies are to ensure the agency follows the same steps every time

Example of a Policy

Temporary Detention Order

 

PURPOSE of the TDO Policy

 In the event that the treatment team identifies a resident that may need a higher level of care, staff need to know how to obtain a Temporary Detention Order so the resident can be moved safely from a lesser level of care to a higher level of care.

Procedures- to outline steps to ensure the policy is followed

RESPONSIBILITY ACTION

Treatment Team Based on observation of the resident, believes the resident needs a higher level of care.

Director of Therapeutic Services

Oversees the process to ensure all required steps are fulfilled.

Licensed Nurse Completes a risk assessment and based on findings determines if a resident needs to be on nursing one-to-one.

Notifies attending physician and secures an order for 1:1. Notifies program therapist during regular business hours Monday – Friday.

Program Therapist Identifies that resident behavior is escalating. Notifies Goochland of the probability of the need for a Temporary Detention Order (TDO),

during regular business hours M – F. In the evening or on the weekend, the supervisor notifies Goochland. Notifies the legal guardian that a TDO process has been initiated. Leaving a message is NOT

sufficient. The therapist is REQUIRED to speak with someone. Notifies Goochland CSB and request TDO screening. Notify the Chief Administrative Officer and Intake Department is notified. Collaborates with the doctor to locate a bed. A list of acute care bends and phones number is

provided.

Goochland The Screener assigned by Goochland will meet with the program therapist and charge nurse on the unit to gather pertinent information.

The Screener meets with and evaluates the resident. If Screener determines resident meets TDO criteria, the therapist notifies the acute care

hospital that the bed is needed.

Therapist Notifies the legal guardian that the resident meets criteria for acute care and the facility that is accepting the resident. Leaving a message is NOT sufficient. Therapist is REQUIRED to speak to someone.

Nurse Obtains discharge orderNotifies the guarding at the time of discharge. Leaving a message is NOT sufficient. Nurse

is REQUIRED to speak to someone. Nurse notifies the Intake Department at 6432. A message can be left.

Goochland Deputy transports.

Nurse If transporting officer refuses to take the discharge paperwork (transfer form and MAR) nurse faxes the paper to the guardian to ensure no delay in treatment/continuity of care.

PROCEDURE

Successful Agencies

= A SUCCESSFUL RESIDENTIAL TREATMENT

FACILITY

Quality Services and Solid Finances

The Residential Treatment Budget

Income = CENSUS Room and Board

Medicaid Tri-care – all inclusive at Non-Mandated Youth Private Pay

Education Services CSA

Budgeting Residential Treatment

Expenses Personnel Services

Salaries Benefits

Other Operating Expenses Rent AT Supplies Food School Supplies Insurance Housekeeping Supplies Travel & Conferences Plant Operations

Budgeting Residential Treatment

Capital Operating Expense Vehicles Furniture Heating/Cooling System Flooring/Carpet

Balanced Budget

Agency must be able to ensure they can collect funds for every resident served

Requirements of Medicaid

To provide the following 3 Individual Therapy-20 minute

sessions 3 Process Groups - 20 minute

sessions 1 Family Therapy- 20 minute sessions 18 therapeutic invention groups –

20 minute sessions

Questions

You are on the Executive Team

Medicaid makes unannounced visits to conduct audits of resident records to ensure their requirements are met. Failure to meet any requirement will results in the take-back of funds for that week or month.

Agencies have had take-backs up to $1.4M.

You are on the Executive Team

Write a policy that will prevent Medicaid take-backs. The policy should ensure all residents receive 3 individual therapy sessions, 3 process groups, 18 therapeutic intervention groups and 1 family therapy session every week.

EACH EXECUTIVE TEAM SHARES THEIR RESPONSE

How to Survive during Turbulent Times

Competitive Strategies Provide High Quality

Services Exceptional Customer

Services Awareness of the

Environment Advocacy

Social Work Organization State Committees Virginia Network of

Private Providers

Virginia Coalition of Private Provider Associations (VCOPPA)

Mission Is to serve as the unified voice for providers to advocate for a quality system of services for children and families with special needs and challenges.

Historical OverviewPublic Policy concerning children and families was taking a new direction with little organized input from the agencies serving these children.

Virginia Coalition of Private Provider Associations (VCOPPA)

The group focuses on developing relationships with governing agencies in order to have a voice in policy development and funding trends.

Questions

Critical Thinking Activity

Bill HB 523Create a mandatory juvenile sex offender registry, taking court discretion away in these circumstances and place juveniles adjudicated of these offenses onto a public registry.

Such an action would certainly jeopardize current accepted treatment procedures in these cases and potentially curtail community based alternatives.

What would be the impact of Bill HB 523?

In your assigned groups, determine the impact on the following services (include policy changes):

Treatment Foster Care Group Homes Residential Treatment Schools Recreational Centers Sport Teams Clubs- Boy and Girl Scouts

EACH TEAM SHARES THEIR RESPONSE

A Financial Issue Arises

The Executive Team must come together to resolve a potential finance issue

facing the agency

The Letter from Prince William County

Due to financial shortfalls with State reimbursements, the County needs to reduce its out-of-home placements

Discharge 50% of current placements

The State of your Agency

The agency budget census is 70 and you have averaged a census of 62 10% of your residents are from Prince William CountyAll residents have Medicaid approval

What will you do?

EACH EXECUTIVE TEAM SHARES THEIR RESPONSE

Human Rights

Division of Human Rights

Their mission is to promote and preserve the human rights of individuals in the Commonwealth by raising the awareness of human rights, accepting complaints, and providing conflict resolution and mediation for the resolution of complaints.

Every Agency is assigned a State Human Rights Advocate

Human Rights and Residential Treatment

The agency must protect the rights of residents

receiving services!

Assurance of Rights

Residents are entitled to know what their rights are.

Information listing their rights and how they can contact their local human rights advocate must be posted. At Hallmark we post a list of their rights on the bulletin boards on each unit.

Assurance of Rights

A resident has the right to call/talk to someone if they feel they are being mistreated including the State Advocate.

At Hallmark the goal is to help residents resolve their complaint or concern internally so that they do not need to seek assistance from their outside advocate.

Abuse/Neglect “Abuse” means any act or failure to act by an

employee or other person responsible for the care of an individual in a facility or program operated or licensed in Virginia

Assault or battery Use of language that demeans, threatens,

intimidates, or humiliates the person Use of excessive force when placing a person in

physical restraint Use of more restrictive or intensive services or

denial of services to punish the person or that is not consistent with their individualized services plan

Neglect

“"Peer-on-peer aggression" means a physical act, verbal threat or demeaning expression by an individual against or to another individual that causes physical or emotional harm to that individual. Examples include hitting, kicking, scratching, and other threatening behavior. Such instances may constitute potential neglect.

Peer-on-Peer

Each peer-on-peer may constitute potential neglect of staff. Examples: Was staff negligent in allowing a peer to harm another peer? Was the staff following policies and procedures when the event occurred? Was staff within ratio? Was staff actively supervising?

Abuse/Neglect

When there is an allegation of abuse or neglect, the agency must immediately take steps to protect the resident until an investigation is complete.

Example of an Allegation of Abuse/Neglect

A resident alleges that a staff member made fun of them.

Telling them they are too “fat” to wear an outfit.

Abuse/Neglect

Hallmark will:1. Immediately notify the human rights advocate and the legal guardian of the allegation.2. Initiate an investigation. 3. Come to a conclusion4. Complete and send a report.

Abuse/Neglect

Hallmark may also choose to do one of the following:

Direct the employee involved to have no further contact with the resident.

Temporarily reassign or transfer the employee involved to a position that has no direct contact with resident.

Temporarily suspend the involved employee pending completion of an investigation.

Abuse/Neglect

A conclusion is made based on the investigation, whether abuse/neglect occurred.

If abuse/neglect has occurred, the agency will take action required to protect the residents.

Written investigation report due to human rights advocate within 10 working days from the date the investigation began. The report shall include the following: Whether abuse, neglect or exploitation

occurred; Type of abuse; and Whether the act resulted in physical or

psychological injury.

12 VAC 35-115-230Provider Requirements for Reporting to the Department

Questions

Human Rights

The Executive Team must come together to write a policy and procedures on the person

response for investigating allegations of abuse or neglect from a resident

For this policy the person responsible for investigations is titled the “Resident Advocate”

EACH EXECUTIVE TEAM SHARES THEIR RESPONSE

Questions or Comments