f or Support Coordination 1 The New Jersey Department of Human Services Division of Developmental Disabilities Objectives 2 SC Expectations Define Emergency External Resources CrisisBehavior Resources ID: 672193
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Slide1
Crisis Behavior Resources for Support Coordination
1
The New Jersey Department of Human Services
Division of Developmental DisabilitiesSlide2
Objectives2
SC Expectations
Define
Emergency
External
Resources
Crisis/Behavior Resources
Division Resources
ICM Referral ProcessSlide3
SC Expectations 3
Responsible for managing crisis24/7 services / On-callBe supportive to individual & familyAssess
situation
Understand the meaning of a true emergency/crisisSlide4
Definitions4
What is considered an Emergency?Slide5
Emergency…5
… means that the eligible person ish
omeless or in imminent peril.Slide6
Homeless…6
…means that the individual has no place to live or the individual’s living arrangement will end on a certain date within 30 days or he/she has no other living arrangements after that date.Slide7
Imminent peril…7
…means a situation which could reasonably be expected to cause serious risk to the health, safety or welfare of the individual receiving services or another person in the current living arrangement.
*Imminent peril does not exist if the Division can put supports into the living arrangement which eliminates the serious risk to the individualSlide8
External Resources8
The New Jersey Department of Human Services
Division of Developmental DisabilitiesSlide9
Division of Disability Services (DDS)9
Office of Information and Assistance ServicesOffice of Home and Community ServicesSpecial Projects and Initiatives
Statutory Advisory Boards and Councils
Contact Information
Telephone: 888-285-3036
www.state.nj.us/humanservices/ddsSlide10
Personal Preference Program (PPP)10
PPP offers an alternative way for individuals to receive their Medicaid Personal Care (PCA) services.Using a monthly allowance, PPP individuals work with a consultant to develop a Cash Management Plan that is used to identify the services needed and the workers/agencies they want to hire to provide the services
.
PPP vs. PCASlide11
Personal Preference Program (PPP)11
PPP allows the individual to:Choose the services they want
Hire people that they know/trust
Schedule services to meet their needs
Exercise greater control over their livesSlide12
Additional PPP Uses12
Additional possible uses of PPP monthly allowance:
Purchasing services from an agency
Making home modifications that increases the individual’s ability to live more independently (i.e., ramp or chair-lift)
Purchasing equipment, appliances, technology, or other items that increase independence (i.e., microwave oven or washing machine)Slide13
How to Apply for PPP13
Inform families to contact their Medicaid HMO Care Manager to inquire about PPP Services Division of Disability Services (DDS)Toll Free, 1-888-285-3038, Option 2
Direct, 609-292-7800Slide14
Adult Protective Services (APS)14
APS programs have been established in each county in NJ to receive and investigate reports of suspected abuse, neglect, and exploitation of vulnerable adults living in a community setting.The purpose of APS is to stabilize a crisis situation using the least intrusive methods while respecting an individual’s rights to self-determination.Slide15
Making a Referral to APS15
The referral should be made by the person with first-hand information and made directly to the county in which the individual resides.The referral information should include:
Individual’s name, address, phone number
DOB, Social Security number
Diagnoses – medical and/or mental health needs
Family members/support systems (services/agencies involved)
A specific allegation of abuse, neglect, or exploitationSlide16
Limits to APS Services16
An APS worker is not authorized to:
Remove an individual from his or her own home without a court order
Force an individual to accept services
Move an individual to an alternative living situation without his or her agreement or a legal representative’s agreement.Slide17
Unusual Incident Reporting (UIR)17
DDD Circular # 14 establishes policies and procedures related to incident reporting.SCs are required to report suspected or know abuse, neglect, and/or exploitation
immediately.
Contact your Regional Office to report any unusual incidents using the phone numbers found on Support Coordinators Guide to Unusual Incident Reporting.Slide18
Crisis/Behavior Resources
18
The New Jersey Department of Human Services
Division of Developmental DisabilitiesSlide19
Crisis Assessment Response and enhanced services (Cares)
19
Community-Based Behavior/Crisis ResourcesSlide20
CARES20
CARES provides services to individuals with a dual diagnosis (Mental Illness and Intellectual/Developmental Disability)Adult services – 21 years and older
Their goal is to reduce/eliminate the presentation of individuals at mental health screening centers, psychiatric hospitals, and other in-patient servicesSlide21
Mobile Crisis Response21
Contact Number – 1.888.393.3007
i
.
iii.
ii.Slide22
Additional CARES Services22
Case follow along for up to 120 daysIncludes face to face visits with individual and provider/caregiver
Training for crisis screening, agency, and own home caregivers related to how to best address the presenting challengeSlide23
Developmental Disabilities HealthAlliance (DDHA)
23
Community-Based Behavior/Crisis ResourcesSlide24
DDHA Eligibility Criteria24
Individuals who:have
been discharged from Developmental Centers to community
settings
have been brought back to NJ
from other settings
who are at-risk of losing their community living arrangement; and/or
reside in their own home and
are
in jeopardy of needing an alternate
living
arrangementSlide25
DDHA Program Services25
Assessments
On-site Intervention
Behavior Skills Training
Social Skills Training
Interagency Support & Consultation
Staff Training
Systems Integration
Health Care Services
Mental Health ServicesSlide26
DDHA Referral Process26
Send a completed Clinical Services Referral Form to:
Kenneth Eley
609-689-1781
Kenneth.Eley@dhs.state.nj.us
*Include the individual's DDD ID # and the phrase
“DDHA Referral
” in the subject line of the email (i.e. – 123456
DDHA Referral
)Slide27
DDHA Discharge Criteria27
The individual is no longer at risk of institutionalization.
The individual is no longer at risk of loss of placement in a residence, day program or own home.
Appropriate medical, mental health and/or behavioral follow-up is in place.
The identified behaviors and issues have been stabilized and are manageable in the placements. Slide28
Social/educational/residential/Vocational
(SERV)
28
Community-Based Behavior/Crisis ResourcesSlide29
SERV Behavior Specialist29
SERV Behavior Specialists
provide
intensive in home behavior support services to
DDD individuals
residing within the following five counties
:
Mercer
Middlesex
Monmouth
Ocean
HunterdonSlide30
Types of Referrals: Mobile Crisis (MCRS)30
4-week intervention/ Severe Behaviors Intake/AssessmentBaseline Data/Observation
Skills Training/Treatment Planning
Behavior Plan/Implementation
Outcome Measures/Follow up observationSlide31
Types of Referrals: Home-Based(HBS)31
Home-Based Referral is an eight week behavioral interventionBehaviors that warrant a HBS referral are less severe than a MCRS referral
A resource used for skill building and addressing minor behaviorsSlide32
SERV Referral Process32
Crisis Hotline – 609-240-3738SERV Access Department - Karin
Jobe
, Access
Coordinator -
1-800-987-7378
For
Home-based
referrals, send a completed Clinical Services Referral to:
Debra Burke
609-292-0271
Debra.Burke@dhs.state.nj.us
*
Include the individual's DDD ID # and the phrase
“
SERV
Referral” in the subject line of the email (i.e. – 123456
SERV
Referral
)Slide33
Case study #1
33
The New Jersey Department of Human Services
Division of Developmental DisabilitiesSlide34
Case Study #134
Ryan was recently assigned to your agency. He has a NJCAT score of 2-level of care, 4-behavioral, 3-medical. There is no service plan in place but a home visit is scheduled. You receive a call from Ryan’s caregiver informing you that Ryan has been admitted into the hospital for evaluation. 911 was called due to Ryan and his caregiver getting into an altercation that resulted in Ryan getting burned with hot coffee. Ryan calls you the following afternoon to inform you that he has been discharged and will be staying with a friend for the next few days until things calm down at home. What do you do?Slide35
Case Study #1 Suggestions35
Complete and submit an UIRContact
APS
Complete
a face to face/home visit
Develop an appropriate
service plan
Look
into services: DP, PPP, HHA, SE,
CARES, DDHA, SERV
etc.
Follow
up with the hospital’s social worker
Follow
up with caregiver
Find
out what the result was from the 911 call. Restraining order? Charges pressed?
Obtain
contact information for friend
Update
case notes and monthly monitoring
tools
Read NJCAT for informationSlide36
Division Resources36
The New Jersey Department of Human Services
Division of Developmental DisabilitiesSlide37
Accessing Family Support Services37
The New Jersey Department of Human Services
Division of Developmental DisabilitiesSlide38
Family Support Service Descriptions38
DDD evaluates requests for Family Support based on an individual’s need, the services and supports already available, and the availability of DDD resources. Most services are limited and some may not be available in specific geographic locations.
RESPITE
:
Services
provided to individuals unable to care for themselves that are furnished on a short term basis because of the absence or need for relief of those persons who normally provide care for the person.Slide39
Family Support Service Descriptions39
After Work Program: provides activities and assistance with daily living skills at a site based facility typically Monday through Friday between the hours of 2:30 and 6:00 pm.
Trained
Caregiver
: a respite worker trained by the Division who provides in home respite services based on the individual’s needs.
Home
Health Aide
(Respite)
: a respite worker trained by a Division contracted entity to provide in home respite services based on the individual’s needs.Slide40
Family Support Service Descriptions40
Community Care Residence Provider (CCRP): a person licensed to operate a Community Care Residence under N.J.A.C. 10:44B.
This service provides out of home overnight respite in a Division licensed setting. Depending on the structure of the home and the qualifications of the CCR
Provider,
individuals who are
non-ambulatory,
require nursing
care,
or have other needs can be served in this setting.
Out
of Home Respite in an agency setting
(overnight or day time)
: services typically take place at a site based facility or in the community.Slide41
Family Support Service Descriptions41
In Home Respite through a Contracted Agency: services are provided in the individuals’ home through a DDD contracted provider.
Out
of Home Respite at a Hotel
:
overnight respite services provided in a hotel and based on the individual’s need.Slide42
Family Support Service Descriptions42
Non Respite Services:Assistive
Technology
:
an item, piece of equipment, or product system that is used to increase, maintain, or improve the functional capabilities of an individual
.
Communication devices, mobility aids, computer software
Environmental
Modification
:
physical adaptations to the private residence of the individual or the individual’s family which are necessary to ensure the health, welfare and safety of the individual or to enable the individual to function with greater independence in the home
.
Ramps, grab-bars, bathroom modifications, widened doorwaysSlide43
Family Support Service Descriptions43
Vehicle Modification: adaptations or alterations to an automobile or van that is the individual’s primary means of transportation in order to accommodate the special needs of the
person.
Wheelchair or scooter lift, assist handles,
exterior access device controlsSlide44
Conversation to Assess the Need for Family Support Services
44
All available generic services must be sought prior to requesting services through Family Support
What
generic resources are available to support the individual and have those services been fully explored?
Does
the individual receive Personal Care Attendant (PCA) Services through Medicaid? These services assist an individual with Activities of Daily Living (ADL).
If
so, are the services provided by an agency or the Personal Preference Program (PPP)? PPP allows the individual and family more choice of who provides the necessary care.Slide45
Conversation to Assess the Need for Family Support Services
45
Does
the individual have any behavioral or medical needs?
Respite
Services: What time periods would be most helpful?
Weekend
(include time of day)
Weekdays (include time of day)
In-Home
or Out of Home (day time or overnight)
If
out of home overnight respite is requested (30 day advanced notice
).
Specific
dates and limitations on how far the family is willing to travel to drop
off the individual
at the respite
location.Slide46
Processing Requests46
Once the referral is sent to the provider, it is reviewed to ensure that the provider is able to meet the individual’s needs. If so, the family is contacted by the provider to complete the intake process. DDD is notified by the provider when the service starts or of lack of response from the family.
The
Family Support Contact will notify the Support Coordinator of any issues with the referral or when the service is scheduled to start.Slide47
How to Make a Request47
After generic resources have been explored, requests for Family Support Services are made by the family to the Support Coordinator
SC sends an email outlining the request to the Regional Family Support Contact. The request should include a justification of why the service is needed, PCPT, & NJISP. 30 day advance is needed for all Respite Requests.
The Regional Contact reviews the request. Based on the review, additional provider specific documentation may be needed for the SC to obtain.
If the requested service is deemed necessary and is available, the Region will complete the referral. The Regional Contact will advise the SC about the status of the referral.Slide48
Community Services48
The New Jersey Department of Human Services
Division of Developmental DisabilitiesSlide49
Regional Psychologist Roles49
What they do:
Consultation
Attend IDT meetings
Input to case management
Participate in human
rights & behavior management committees
Diagnostic evaluations
Intelligence & adaptive testing
Provide
expert testimony in
court, when needed
Recommendations for supports needed based on psychological
needs
What
they
do not do:
Therapy
Group therapy
Personality testing
Write behavior plans
Train or monitor agency staffSlide50
How to Access a Regional Psychologist50
Send a completed Clinical Services Referral Form to:
Adilson
DaSilva
609-689-1732
Adilson.DaSilva@dhs.state.nj.us
*Include the individual's DDD ID # and the phrase “Clinical Services Referral” in the subject line of the email (i.e. – 123456 Clinical Services Referral)Slide51
Regional Nurse Roles51
Long Term Care
will assess for level of care (decline) and complete required Medicaid
paperwork
Clinical Services Referral Form
will
visit
upon request for
issues not limited to level of care needs, wound issues, current
hospitalizations, weight loss, diet,
nutrition, etc.
Miscellaneous
available as resource for medical questions or concernsSlide52
How to Access a Regional Nurse52
Send a completed Clinical Services Referral Form to:
Adilson
DaSilva
609-689-1732
Adilson.DaSilva@dhs.state.nj.us
*Include the individual's DDD ID # and the phrase “Clinical Services Referral” in the subject line of the email (i.e. – 123456 Clinical Services Referral)Slide53
Request for Intensive Case Management53
Y
An intensive CM will visit the individual
within 48
business hours
Regional/County Intensive Unit Director
Reviewed by Michele Elston and/or Mentor
Support Coordinator (SC)
Has the assigned SC exhausted all service
options?
Consult with
ICM Unit
YES
NOSlide54
Request for ICM Referral Form54
Demographic Information
Reason for Referral (Out-of
-
Home Supports, In-Home Supports, Case Consultation)
Support Coordination Information
Current Services
Important Information
What prompted referral, Last Home Visit, Barriers, APS, UIR, Services Offered)
History of Hospitalizations
*NJISP, PCPT, NJCAT, and Written Justification (if applicable) must be included with ReferralSlide55
Role of Support Coordination55
Before
ICM Referral is submitted
After ICM Referral is submitted
Communicate with fam
ily to confirm what is being requested
Connect with the assigned ICM worker;
p
articipate
in scheduled home visit
Explore
all service options – think about what can be put in place to safely maintain the individual in the home: Medicaid Funded Services, Family Support, Respite, Behavior Supports, Medical Rule Out, etc.
Continue with monthly monitoring
; revise service plan as needed
Obtain written justification,
if applicable
Assist with needed follow up (i.e. Family Support requests, change in services,
etc.)
Consult with Mentor/Division Staff
Ensure
a smooth transition to CCW services and Division Case Management for monitoringSlide56
Case notes 56
DOCUMENT!
Concise, specific, and non-judgmental
Dated (month, day, and year)
Professionally written with an emphasis on situational facts, accountability, problem solving, plan of action, and results
Up to date
DOCUMENT!
DOCUMENT!Slide57
Case study #2
57
The New Jersey Department of Human Services
Division of Developmental DisabilitiesSlide58
Case Study #258
Christina was assigned to your agency several months ago. She has a NJCAT score of 2-level of care, 4-behavioral, 1-medical. Mom is requesting residential placement due to Christina’s aggressive behaviors and the home being in foreclosure. No services are in place besides day program. Christina’s natural supports have recently changed due to her older brother getting married and moving out. Christina is also in need of a communication device but mom reports that she does not have any money to purchase one. What do you do?Slide59
Case Study #2 Suggestions59
Research & utilize
behavioral resources – DDHA,
CARES,
SERV
Research &
utilize Medicaid services – PPP, HHA, PASP
Follow
up on day
program /
day services
Follow
up with family support
Save
up SSI funds to purchase a tablet (suggest purchasing a used or refurbished one)
Reach
out to County Services to see if they have any resources that can be utilized
Encourage
the family to have
medications
checked by her PCP or
psych for a medical rule out
Discuss
with family reasons why Christina would not be moving with the family if their home becomes
foreclosed
Update
case notes and monthly monitoring toolsSlide60
Thank you!60
Michele Elston
973-252-3464 / 609-689-6717
Michele.Ruggiero@dhs.state.nj.us