Support Service Teams (SSTs)...The Support Service Teams \⠀匀匀吀猀尩 provide an interdisciplinary technical assistance and training response to persons with a de\൶elopmental
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Support Service Teams Bureau of Clinical Services Division of Developmental Disabilities Illinois Department of Human Services Molly Chapman, Project Manager 11/12/2014 1
Bureau of Clinical Services Division of Developmental Disabilities Illinois Department of Human Services
Molly Chapman, Project Manager
11/12/2014 1
What is SST?
• Request for Proposal • Illinois Crisis Prevention Network
• First referrals accepted in August 2010
• 1,480 referrals opened in 4 years
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The Support Service Teams (SSTs) provide an interdisciplinary technical assistance and training response to persons with a developmental disability in a medical or behavioral situation that challenges their ability to live and
thrive in the community.
Presenter
Presentation Notes
The Support Service Teams (SSTs) provide an interdisciplinary technical assistance and training response to persons with a developmental disability in a medical or behavioral situation that challenges their ability to live and thrive in the community. SST was created through a Request for Proposal released to the community in July 2008. The contract originally awarded to two entities, but now is operated by a single contractor. The Illinois Crisis Prevention Network First referrals (adults) accepted in August 2010. In 4 years, SST has opened slightly over 1,480 referrals. Over 1,000 referrals have been closed and they are currently working with 403 individuals.
Where are they
located? • Rockford
• Chicago
• New Lenox
• Peoria
• Springfield
• Carbondale
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Presentation Notes
SST services are split into 6 teams, each covering a specific geographic area of the state. With the exception of Cook county, each team’s boundaries run along County lines. Cook county is split into a Northern and Southern area and has two teams sharing the coverage responsibility. On the map, you see Cook county in blue with a line running just south of center. The northern portion is covered by the Chicago team while the southern portion is covered by the New Lenox team, which is also represented in the pink geographic area. Tim Baker is the Director for the teams located in Rockford, Chicago (Hillside), and Springfield. His office location is in Hillside, with Clinical supervisors working out of the Rockford and Springfield offices. Kim Shontz is the Director for the teams located in New Lenox, Peoria and Carbondale. Her office is located in New Lenox with Clinical Supervisors located in New Lenox and Carbondale. Need varies on a weekly basis. Highest area of need is typically in the Rockford, Chicago, and New Lenox coverage areas.
What counties are covered by each team?
• Rockford- Boone, Bureau, Carroll, Dekalb, Henry, Jo Daviess, Kane, Lake, Lee, Mchenry, Mercer, Ogle, Rock Island, Stephenson, Whiteside, & Winnebago
• Chicago- Cook (Loop, north of Kennedy, west of Rt. 43, Oak Park, Maywood, Hillside north)
• New Lenox- Champaign, Cook (south the Loop, south of the Kennedy, east of Rt. 43, Cicero, Forest park, Broadview and south), Dupage, Ford, Grundy, Iroquois, Kankakee, Kendall, Vermillion, & Will.
This slide gives a detailed listing of which counties are covered by each team. It also give a more detailed breakdown of the boundary line in Cook County.
Who makes up an SST?
• Each team is comprised of staff from a variety of professional disciplines.
• Team size varies as well as the composition of the professionals working in each team.
• Not every professional discipline is needed for each referral.
• Teams are diverse, comprised of staff with various backgrounds and skills.
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Presenter
Presentation Notes
The teams are comprised of staff from a variety of professional disciplines: Social Workers; Qualified Intellectual Disabilities Professionals (QIDPs), Registered Nurses, licensed clinicians/psychologists, behavior specialists, and Board Certified Behavior Analysts (BCBAs). In addition, SSTs may have access to other needed specialty providers, such as physicians. They also contract with a pharmacist who extensive experience in working with individuals with DD and is able to conduct detailed medication reviews. Team size varies as well as the composition of the professionals working in each team. The smallest team location has three staff, while the largest team has approximately 20 staff. Most teams are a mix of QIDP, BA/BCBAs, RN, Psychologists, Therapists. Not every discipline is needed for each referral. Sometimes an individual will only be working with 1 SST staff person while another individual may have 3 SST staff that are working the referral in some capacity. Teams are diverse, comprised of staff with various backgrounds and skills. Although SST operates 6 different teams throughout the state, staff will cross boundaries if they possess a specific skill that is needed for a referral, an example would be the ability to speak a specific language.
Who do they work with? Individuals with developmental disabilities who are experiencing an unresponsive behavioral or medical concern which jeopardizes their community placement. • All adults with a developmental disability qualify
regardless of: o Medicaid or Waiver status o Community agency involvement o Residential setting o Hospitalization or incarceration
• Children and adolescents with a developmental disability qualify if they receive funding as listed below: o Children’s Home and Community Based Services waiver o Children’s Residential Services waiver o Other DHS funded services considered o Very few exceptions made for no service provider
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Presentation Notes
Simply put, SST works with individuals with developmental disabilities who are experiencing an unresponsive behavioral or medical concern which jeopardizes their community placement. The SSTs will serve all adults (18 or older) with a developmental disability (regardless of Medicaid or Waiver status) living in a community setting such as CILA; ICFDD; own apartment; Family home with or without supports such as HBSS, family CILA or DT only funding. Even individuals living with family or on their own that currently receive no services are eligible. Individuals that are currently hospitalized or incarcerated (meaning the local county jail) can initiate SST services. In May of 2011 SST began accepting referrals for children, but not all children. SST referrals for children and adolescents are limited to those who receive services funded by the Division of Developmental Disabilities (DDD) such as the Children’s Home and Community based services waiver or the Children’s residential waiver. Other children and adolescents may be referred as an exception for approval, on a case-by-case basis. Those would primarily be children receiving another DHS funded service. No Services- Disqualifies Children from receiving SST. Hesitate to provide a referral in these situations. Either referred to SASS (DCFS/HFS Screening, Assessment and Support Services program) or consideration for DD services if meeting crisis criteria.
What are the Numbers? FY14 Service Statistics
331 total referrals opened from July 2013 – June 2014
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• Gender o Male 60% o Female 40%
• Age o 0 – 17 13% o 18 – 24 35% o 25 – 44 36% o 45 – 64 15% o 65 – over 1%
• Residential Setting o CILA 36% o ICF/DD 16 4% o Family Home 30% o Other 32%
• Diagnosis o Mild ID 30% o Moderate ID 22% o Severe ID 11% o Profound ID 4% o Other 32% o Axis I Diagnosis reported 100%
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Presentation Notes
Statistics are fairly consistent with previous years although there is an increase in children and those living in a family setting. As well as an increase in Axis 1 DX up to 100%
Behavior is very subjective. What one person thinks is a problem, another person may be completely fine with it. It’s also surprisingly difficult for people to describe what is actually happing. You’ll hear things like: He had a behavior….. He got beat up….. Bill got up and attacked John…..for no reason… None of that really tells you what is happening with the person. SST has predefined the reasons why someone would want to make an SST referral into the following areas: Self abuse. Injures own body. Also self inflicted violence, self injurious behavior, self-harm. Examples: banging head, hitting head with fists, cutting self, pulling hair, pinching self, biting nails, not letting wounds heal, throws self from chair with resulting injury, threatens suicide. Physical aggression. Causes physical pain to other people or to animals. Examples: hitting, kicking, biting, pinching, scratching, pushing, pulling hair, or striking with an object. Verbal aggression. Demeaning, hurtful, or threatening comments, bullying, pestering, teasing, arguing, yelling, or screaming, etc. Elopement. The act of leaving (without permission) the place you are supposed to be, running away. Inappropriate Sexual behavior. Unwanted sexual advances or touching, making comments of a sexual nature that offend those who hear, masturbation in inappropriate settings, exposing genitalia to others, voyeurism. Property Destruction. Deliberately breaks, defaces, or destroys things. Examples: hitting, tearing, cutting, throwing, burning, marking, or scratching things. Eating non-food objects. Or PICA diagnosis Examples include eating cigarette butts, paper or safety pins. Overutilization of emergency services. Excessive, repeated use of the 911, fire or police services by person calling, or staff feeling the need to use these. Recurrent Psychiatric hospitalizations. Multiple psychiatric hospitalizations over a few months. Negative Community contacts. Creating a disturbance in the community, such as going into other people’s houses, urinating in public, or creating an atmosphere that results in neighbors not wanting them in their neighborhood. Other behavioral concerns not listed above. Laughing or crying without reason, interferes with activities of others, unusual or repetitive behaviors, socially offensive behaviors, uncooperative behavior, stealing, or breaking laws. Medical non-compliance. Lack of cooperation with carrying out recommended steps in a medical treatment plan. Unexplained physical deterioration. Weight loss, sleep disturbance, loss of use of limb or gait disturbance, falls from chair, change in control of bowel or bladder without known cause Other medical concerns not listed above.
How do you rate behavior?
Frequency Severity
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0- Not applicable 1- Less than once a month 2- One to three times a month 3- One to six times a week 4- One to ten times a day 5- One or more times per hour
0- Not serious, not a problem 1- Slightly serious, a mild problem 2- Moderately serious, a moderate problem 3- Very serious, a serious problem 4- extremely serious, a critical problem
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Presentation Notes
Rating behavior frequency and severity can be just as challenging as defining the behavior. If you ask someone how often does he do it…..All the time….Constantly…. It may feel that way, but what about…Sleep? Eat? Transportation? Behavior severity is probably the most difficult toHe beat the crap out of him….. Did he really? Bleeding? Broken skin? Medical attention? Bruising? How did they hit them…open hand, closed fist, one finger???
How to make a referral? • An SST referral can be initiated by family, guardian,
provider agency, school, PAS/ISC/ISSA, or DDD. • PAS/ISC/ISSA discusses the need for a referral with DDD. • PAS/ISC/ISSA submits 2-page referral form and brief
narrative to DDD. • If an individual lives in an ICF/DD without a PAS/ISC/ISSA,
facility staff should directly contact DDD. • The triage meeting is held Monday morning. Emergency
referrals may be considered throughout the week. • Chosen referrals will be submitted to SST by DDD. • SST will respond to the referral within 24 hours by phone
and 72 hours on-site.
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Presentation Notes
An SST referral can be initiated by family, guardian, provider agency, school, PAS/ISC/ISSA, or DDD. Making a referral to SST should not be the first thing that is tried when a person is having some challenges. Families and agencies are the first line of assistance. While, the majority of our referrals receive sometype of DD services, in FY14 8.5% of referrals had no funding at the time the referral was initiated. PAS/ISC/ISSA discusses the need for a referral with DDD. It may be decided that the individual will first go to CART or is in need of additional staff support. If it is decided the person needs SST, PAS/ISC/ISSA will complete and submit a referral and brief narrative to DDD. The referral form is a simple two page document that primarily cover demographic information as well as behavior rating. Narrative should briefly describe current behavior and/or medical situation. If an individual lives in an ICF/DD without a PAS/ISC/ISSA, facility staff should directly contact DDD. Either the Bureau of Regional Services or the Bureau of Transitional Services if the person recently transitioned from an SODC. Each Monday morning a conference call/triage meeting is held by Central office DDD staff from Chicago area, Springfield area, & Southern Illinois. The available capacity for each Team is provided by the SST Directors prior to the start of the meeting. Each potential SST referral is presented by the referring DDD staff. DDD staff need to ensure that they are presenting the individual’s current situation (not what it was 6 or even 1 month ago); The severity of the information presented is judged on a triage basis by the DDD staff present in the meeting. Those situations determined most severe will be referred to fill the available capacity of the team located in the individual’s respective geographic area within the state. There is no waiting list, A person presented for the first time next Monday might get a referral over a person who has been presented every week for the past 2 months. Emergency referrals may be considered throughout the week. Chosen referrals will be submitted to SST by DDD by the close of business on the day in which it was accepted. If you have requested a referral, it is very important that you respond to any request for information by Division staff as soon as possible. SST will respond to the referral within 24 hours by phone and 72 hours on-site.
What do they do?
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• SST staff will contact the family/agency staff within 24 hours of receiving the referral to begin the intake process.
• An on-site visit with the family/agency/individual will occur within 72 hours of receiving the referral.
• Request documentation from family and agency. • Begin to develop relationships through discussion,
observation and interaction. • Make initial recommendations and/or seek outside
consultation. • Develop, modify, and or work within the current service
plan. • Provide referral, linkage and information.
Presenter
Presentation Notes
SST staff will contact the family/agency staff within 24 hours of receiving the referral to begin the intake process. They will begin to gather background information on the individual as well as details surrounding the reasons for referral. An on-site visit with the family/agency/individual will occur within 72 hours of receiving the referral. SST contractually required to be on-site within 72 hours, although that does not always work for the family or agency. Request documentation from family and agency. At this initial visit, they will request specific documentation and continue discussion. They typically want to meet the individual although in some situations that may not occur in this visit. Begin to develop relationships through discussion, observation and interaction. SST will go into any and all settings that are a part of the individuals life. This is typically their residence, school and/or vocational setting. They will want to talk with and observe the individual in all of these settings as well as the people who are a part of the individual's life. Make initial recommendations, but SST is not a quick fix to an individual’s trouble. Sometimes they can make quick recommendations that will bring about immediate change, but most of the time it is a process that will take many months. They may also seek outside consultation from the pharmacist for a medication review, other therapists/behavior analysts, or other professionals not currently involved in the individual’s care. Using all of this information, they will develop, modify, and or work within the current service plan. If SST is not able to provide the services or training the individual/agency/family needs, they will provide referral, linkage and information.
What don’t they do? • Not crisis response teams
• Don’t provide direct care or support
• Don’t seek vocational or residential placement
• Not an investigatory authority
• Don’t replace PASS/ISC/ISSA or DDD
• Don’t evaluate compliance with rules, regulations, etc
(with the exception of being mandated reporters)
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Presentation Notes
The SSTs are not crisis response teams equipped to assist an individual in need of immediate help for an acute crisis of physical aggression or an individual in need of emergency medical and/or psychiatric services. It is not within the scope of their services to provide respite or direct support/care to individuals, They are not responsible for securing residential or vocational placement. Although, they have been very successful in securing short-term inpatient psychiatric treatment for individuals in various hospitals throughout Illinois. The SSTs are not an investigatory authority…OIG, DPH, While they do communicate openly with DD staff when needed, they should never be perceived as or used as a means to “spy” on an agency. They will not replace established processes utilized by provider agencies, PAS/ISC/ISSA agencies, and/or DDD. They don’t evaluate compliance with rules, regulations, contracts (attachment A), memorandums, or anything else that tells an agency what they should and should not do. Any work product they create, such as behavioral/medical assessments, behavior plans, treatment plans, medication reviews do not need to hold up to any standard for compliance set forth by the department. They are bound by their own professional licenses and standards of practice given their specific discipline. It is the agencies responsibility to implement the recommendations and use the information and plans in a way that ensures compliance with everything including their own agency policy and procedure. SST will work closely to modify information and plans at the agencies request. They don’t knowingly ask an agency to do anything that violates compliance. They will patiently work with the individual’s support team and make modifications based upon their recommendations and that of the BMC and/or HRC.
How long do services last?
• Referral Length o Undetermined length of time o Individualized process
• Delays in closure
o Move to new residential provider o Unresponsive staff or family o SODC admission
• Follow-up o One month o Individuals can have multiple referrals
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Presentation Notes
Referral Length is an undetermined length of time- there is No set minimum or maximum amount of time. Every individual and referral is different as it is an individualized process- Some are very brief, a few weeks to a month or two. Other last for a few years. Sometimes needed therapy or very complicated behavioral and medical/medication situations may extend a referral. Or behaviors occur so infrequently, can take a while to observe and understand. Closure is encouraged when a person is stable and has no significant life changes in the near future (moving or change of primary care giver). One thing to remember is that SST will not always resolve everything that is going on with the person. Delays in Closure Move to new residential provider- Can cause SST to readdress issues that have already been addressed with previous provider. It can mean new observations, new staff training, new plans or adjustment to plans. Lack of cooperation or unresponsive family members or agency staff may unnecessary delay or prolong a referral. Referrals don’t automatically close just because someone is admitted to an SODC. They are encouraged to continue to be involved in the meetings that occur and continue to visit and work with the individual. SODC admission is intended to be short-term only. SST will transition back into the community as they are needed to ensure consistency and success for the individual. SST will follow-up one month after closure. Individuals can have multiple referrals. Just because their referral has closed doesn’t mean that they can’t utilize the service again. While SST will already be familiar with the person, they must go back through the referral process from the beginning like everyone else.
Why close a referral? • Staff added • Agency/family request • Person deceased • Person incarcerated • Limited consultation • Ready to close, not
responsive • Agency/family non-
responsive to training • Agency/family non-
compliant • Reasons for SODC admission
resolved, placement not imminent
• Reasons for SODC not resolved & not expected to resolve in near future 11/12/2014 14
• Medical/dental needs met • Clinically appropriate
medication adjustment • Staff training needs met • Behavior plan successfully
implemented • Frequency of behavior
reduced • Severity of behavior
reduced • Needed resource identified
and linked • Person acquired new skill • Person goal(s) achieved • Person moved
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Presentation Notes
The following are what SSTs can use to describe the reasons (frequently there are multiple reasons) they are closing their active involvement with a referral. Medical/Dental needs met. Clinically appropriate medication adjustment. Staff training needs met. Behavior plan successfully implemented. Frequency of behavior reduced. Severity of behavior reduced. Needed resource identified and linked. Person acquired new alternate skill. Person goal(s) achieved. Service plan goal(s) achieved. Person moved. Staff added. Agency/Family request. Person deceased. Person incarcerated. Limited consultation/recommendations made. Ready to close, agency or family/guardian not responsive for several weeks. Agency/Family non-responsive to training for several weeks. Agency/Family/guardian non-compliant for several weeks. Reasons for SODC admission resolved, placement not imminent. Reasons for SODC admission not resolved and not expected to be resolved in near future.
Questions? Molly Chapman, SST Project Manager
Bureau of Clinical Services Division of Developmental Disabilities Illinois Department of Human Services
