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Welcome to this webcast on Regulation Revisions Related to the Individual Support Plan. My name is Genean Westbrook-Hart. I am the Risk Management Unit Supervisor for the Office of Developmental Programs and the statewide operational lead for risk management, incident management, the certified investigator program and licensing. This presentation will summarize the regulation amendments related to the Individual Support Plan or ISP that are targeted to go into effect by early September. These amendments reiterate and support the role of the team in the development, revision and implementation of the ISP and the ISP Process. The participation of every member of the plan team is important in this process, from the individual receiving services, to the Direct Service Worker, to the Supports Coordinator. The goal of the regulation amendments is to encourage the collaborative sharing of knowledge and expertise by all team members. 2
This presentation will provide all interested stakeholders with an overview of why these amendments were needed and their scope. We will also identify new requirements that were added or significantly revised and the projected impact of these changes on the licensing processes. At the end of the presentation, we will also provide information regarding additional resources that will be available to support these amendments. Many of the revisions contained in the amendments are not new concepts and in fact are practices that have been encouraged by ODP for some time. Individuals receiving services and their families, ODP licensing staff and providers have expressed concerns with these practices not being reflected in the current regulations. As a result, I am happy to provide you with this presentation on the amended regulations, which embed the practices related to the Individual Support Plan (ISP) in the regulations. 3
This presentation is divided into two parts. Part 1 will address the importance of these regulation changes, the impact of these changes and provide an overview of the basic changes made to all four chapters. Part 2 will take a closer look at the roles and responsibilities of the Plan Lead and Program Specialist, expectations regarding ISP participation, implementation and review as well as implementation of the amended regulations. We will also look at the fundamental impacts of the amendments on the various stakeholders. So let s get started.. 4
The regulation chapters that have been amended include: the 2380, Adult Training Facilities; 2390, Vocational Facilities; 6400, Community Homes for Individuals with Mental Retardation and 6500, Family Living Homes. These regulations establish the minimum requirements that all providers must comply with in order to be licensed. The amended regulations are specific to the ISP. Other sections of the chapters have been maintained and continue to be applicable. 5
Some of the reasons why the regulations have changed are: Current regulations have not been revised or updated in 15-20 years. Many changes to the ODP service system have occurred since then. For example, Everyday Lives as a driving philosophy has created a culture change not only for ODP, but for the lives of the individuals we serve. As a result, the revised regulations align with current Everyday Lives initiatives such as community inclusion and choice. Since the ISP and ISP process are integral to providing services and supports, ODP focused the amendments toward those sections of the regulations that address the ISP process and plan development. The second reason the revisions were made are the result of changes in the ISP processes and practices. In the past, the provider created a plan and the Supports Coordinator created a separate plan. With the implementation of the amendments, the practice of a single ISP that has been encouraged and supported by ODP is now incorporated into each of the chapters. ODP continues to promote the development of person-centered plans and the requirement for all services needed by the individual to be included in the ISP. Lastly, terminology has changed or been redefined since the regulations were written. The regulations were revised to address the changes in language usage, as applicable. 6
The primary intent of the regulation amendments is to improve consistency throughout the four chapters. The amendments contain similar numbering throughout the regulations as much as possible. For example, section 2380.181 is titled Assessment. The Assessment sections in the other chapters occur at 2390.151, 6400.181 and 6500.151. An effort was also made to have consistent language in all the chapters. For example 2380.182(d)(4) states An invitation shall be sent to plan team members at least 30 calendar days prior to the ISP meeting. The same requirement is found at 2390.152(d)(4), 6400.182(d)(4) and 6500.152(d)(4). As already stated, the regulations needed to be revised to incorporate current practices. As well, the roles and responsibilities in relation to those practices needed to be identified. Later, we will talk more specifically about the roles and responsibilities of the provider, Supports Coordinator (SC) and other team members throughout the ISP process and development. 7
Information regarding the new regulation amendments is very important for the following reasons. 8
Regulations must be able to meet and support the needs of the individual, various entities and other interested parties. Regulations are important to individuals and families because they emphasize the Everyday Lives concepts of collaboration, choice, community inclusion, individuality, quality and control. Both residential and day program service providers need regulations to identify the state requirements regarding the operation of their facilities. Also the regulations allow the provider to self-assess their compliance to the standards the department has created. Understanding these regulations is important to the Supports Coordinator as they coordinate the development of the ISP and monitor the implementation of the services identified in the plan. The Supports Coordinator and the provider must ensure the ISP complies with regulations as well as meets the needs of the individual for whom the ISP is written. The state needs regulations to establish the minimum standards to protect the health and safety of the individuals we serve. 9
The regulations support the principles of Everyday Lives in the following ways: Community Integration- several sections emphasize the integration of individuals into the community. There is an expectation that individuals receiving services not only attend community functions but are supported to be contributing members of the community. Collaboration- The concept of having only one ISP emphasizes the importance of all team members participating and contributing in the ISP Meeting, including the content of the ISP, so that the ISP is written to include all knowledge and expectations in relation to the individual and their needs for service. Quality- is emphasized through the requirement of determining progress towards outcomes. Services are to be provided so the individual and plan team can see progress towards the individual s expectations and outcomes. Accountability- All plan team members are an active participant in the ISP process and providers will be held accountable for ensuring compliance with the regulations, including review of the completed ISP and identification and reporting of content discrepancies. Safety- The regulations require an assessment of the individual s skills or functional abilities related to health and safety focus areas including water safety, handling or storage of poisons, and level of supervision needed in different environments. 10
These amended regulations identify the ISP as the single source document to identify, support and provide for the assessed needs of the individual. In order to support ODP s vision of a single plan, the Individual Program Plans, or IPP, and Individual Written Program Plans, or IWPP, previously used by service providers, will no longer be accepted as part of a licensing review. Licensing staff will be looking at the ISP to identify the services needed to support the achievement of the individual s identified outcomes, documentation that supports the provision of those supports or services, and compliance to the regulations. The ISP regulations place a large emphasis on team collaboration and the shared responsibilities of the plan team. Everyone on the plan team is responsible for the development of content. This means everyone is to contribute their knowledge of the individual to assist in the creation of an all inclusive ISP. The plan team is responsible to make sure the ISP process is completed as required in the regulations. All plan team members must be invited to the meetings and all plan team members suggestions are to be discussed at the meeting. The plan team is also responsible for the implementation of the ISP, providing supports and services as identified in the plan, monitoring those supports and services to ensure their effectiveness in meeting the desired outcome, and communicating identified concerns or needs for revision to the Plan Lead/ Supports Coordinator. Also, the team is responsible to ensure that all needed revisions are made to the ISP. This means if a provider staff member or a family member of the individual feels that a revision is needed, they are responsible for contacting the plan lead or supports coordinator to have those revisions considered by the team. 11
The impact of these amendments also required some other changes. 12
ODP assessed what type of impact the regulation amendments would cause. Some related items that were identified as requiring revisions are listed above. For example, the Licensing Inspection Instrument for the 2390 will no longer be a statement of policy. The 2390 LII will no longer be part of the regulations. The LII for each chapter will be posted on ODP s website. There is an advantage to this. What this means is that the LIIs will be able to be modified as needed. Therefore, if ODP finds that there is a significant amount of clarification needed for a regulation, the LII can be updated at any time. It was also necessary to obsolete several bulletins relating to the Licensing Indicator System, Licensing Inspection Instruments and Licensing Weighting Systems. These bulletins are obsolete as of the publication of the regulation amendments in the Pennsylvania Bulletin. Continuation of the Licensing Indicator System is currently under review by ODP. The revised documents will be posted to the ODP website for easy access. 13
In order to continue with current practices, ODP has decided to continue to use the weights that are already available for the regulations where the wording was modified, but the intent remain unchanged. For those new regulations, weights will be added. The new weights being considered will fall in line with similar existing regulations. As noted on the previous slide, the revised Weighting System will be published on the ODP Website. 14
So let s take a look at some of the basic changes to the regulations. 15
During your review, you probably found many changes to the language related to ISP requirements in the regulations. One very significant change was the use of language for one plan. The use of the terms Individual Program Plan (IPP) and Individual Written Program Plan (IWPP) have been removed. These terms have been replaced with the Individual Support Plan or ISP. One of the largest changes that occurred was the renumbering of regulations. The ISP sections are numbered 181 through 190 in the 2380 and 6400 chapters. The ISP sections are numbered 151 through 160 in the 2390 and 6500 chapters. While the numbering of these sections do differ, the content of the sections closely mirror each other. For example 2380.181(a) says that each individual shall have an initial assessment within one year prior to or 60 calendar days after admission to the facility and an updated assessment annually thereafter. 6400.181(a), 2390.151(a) and 6500.151(a) all use similar language to address the same issue. New terms have also been defined and consistency in terminology has been attempted as much as possible. For example the term Plan Lead is used in each section of regulation to denote the individual in each licensed setting that is responsible for the coordination of the ISP process when Supports Coordination services are not provided. (We ll talk more about this later.) The only exception to this is the term individual. Individual is used to describe a person who is receiving mental retardation services in each chapter except the 2390. In 2390 the term client is still used. The term individual is used in the other chapters but could not be changed in the 2390 s because it is a part of the general definitions and used throughout the chapter. We were only allowed to change those terms that are exclusively used in the amended regulations. Also, information and/or documentation referenced in the ISP can apply to multiple regulations. For example, an assessment used for compliance with a regulation in the 6400 licensed setting could be used for compliance with a regulation in the 2390 licensed setting, if it has all the elements needed. There is no need for each provider to have different assessments completed as long as the assessments utilized meets the needs of all providers involved. 16
A major change is to reinforce the provider s shared accountability for the content of the ISP. With this change, the requirement is for the provider to review the content of the ISP, identify discrepancies, communicate those discrepancies to the SC or Plan Lead and keep record of the communication in the individual s record. Also, the Supports Coordinator or Plan Lead has a responsibility to respond and support the needs of the providers by responding to the requests for revision, including the scheduling of an ISP Update Meeting, if needed. By encouraging team members to communicate with the Supports Coordinator or Plan Lead, we are encouraging collaboration and accountability to ensure the ISP is of high quality and that it meets the needs of everyone involved. 17
The people who must be invited and must be in attendance during an ISP meeting include those listed above. The individual must be present if they choose to attend. The program specialist from each program providing services must attend. This would include both the residential and day program specialist. There is also a requirement that at least one direct service worker from each licensed program be included. This creates an expectation that the person(s) that work closest with the individual on a frequent basis are considered a part of the team and a contributing member of the team. The regulation also allows that other people identified by the plan team be present and accounted for during the ISP planning meeting. 18
The requirements related to the assessment have also been standardized both in timeline and in content. There is a standard time range that identifies when an initial assessment is required to be completed. The range is from one year before to 60 days after the individual begins to receive services from the provider. Specific content requirements for assessments are outlined in the regulations. There are also requirements that items required for the ISP meeting, such as updated assessments or assessments from other sources, are provided to the Supports Coordinator or plan team members at least 30 calendar days before the ISP meeting. A copy of the completed or revised ISP must be provided to the Plan Team within 30 days following the ISP meeting. The expectation is that the information from the assessment is to be summarized in the ISP and the assessment itself could be attached to the ISP and kept within the record. A review of the completed assessment will be included in a licensing review. 19
In addition to the assessment, the Social/Emotional/Environmental Support Plans and Restrictive Procedure Plans are documents that are to be completed when applicable. A Social/Emotional/Environmental Support Plan is required when a medication has been prescribed to treat a diagnosed psychiatric illness. A Restrictive Procedure Plan is required when restrictive procedures are being utilized. Like the assessment, even though these items are separate documents they are to be summarized and/or identified in the ISP. Also the use of the term maladaptive behavior has been discontinued in the regulation and has been replaced with diagnosed psychiatric illness. This language has been changed to reflect a change of focus in ODP. The focus now is on the use of medication to treat the diagnosed illness not for the behavior of the person. An individual s knowledge of water safety in regards to pools and bodies of water must be assessed under all 4 chapters. (Previously this was only a requirement for the 6500s.) This change was made to ensure that each licensed provider has this information readily available to them in cases where individuals could have contact with pools or any large bodies of water, on or off grounds of the facility. Knowledge of an individual s ability to handle heat sources above 120 degrees must also be assessed. This item will be assessed for all sources even if the heat sources are covered. The requirement is that the ability of the individual should be assessed to cover situations where the individual may be in environments where heat sources exceeding 120 degrees are not covered (for example, restaurants). As mentioned, these regulations identify a plan lead. The plan lead is the Program or Family Living Specialist employed by the licensed provider who is responsible for ISP related activities, when the individual does not have Supports Coordinator. This person is identified by the provider agency and is responsible for the coordination of ISP related activities. 20
This concludes Part 1 of this presentation. Please be sure to view Part 2 of the presentation where we will take a closer look at the roles and responsibilities of the Plan Lead, Program Specialist and Family Living Specialist, requirements regarding ISP participation, implementation and review. We will also look at the fundamental impacts of the amendments on the various stakeholders. ODP has provided a means to ask questions and submit responses. Any ODP Stakeholder can call the Customer Service line at 1-888-565-9435 or submit questions/concerns electronically through ra-odpregscomment@state.pa.us. The submitter should indicate ISP regulations in the subject line. The submitter should include the appropriate chapter reference, if possible (for example, 6400.44 staffing). ODP will provide periodic summaries of these clarification requests and responses. In addition, you can go to the website identified above for more information such as the updated licensing inspection instruments and access to this training. 21
Thank you for joining us. 22