Developing a Credentialing System for PBS Facilitators in Virginia

1. Developing a Credentialing System for PBS Facilitators in Virginia  Carol Schall, Ph.D. Virginia Autism Resource Center cschall@varc.org

2. What we will Discuss: Our context Why �endorsement� was an issue in Virginia Training and mentoring process Implementation of endorsement process Our struggles as we tried to develop this system Issues and challenges

3. Our Context, 1990 to 2003 1990 MR waiver Therapeutic consultation included �Behavioral Consultation� Process to become behavioral consultant flawed 1995 DD waiver Therapeutic consultation included �Behavioral Consultation�

4. Our Context, 1990 to 2003 1996 We had approximately 130 �behavioral consultants� statewide Our Attorney General stopped our DMHMRSAS from being the endorsement agency Committee formed to develop new process for identifying behavioral consultants � blocked by psychologists � at least 3 tries between 1996 and 2003 2003 Service continues to be offered Behavioral consultants dwindle to 28 statewide People go without services

5. Why consider �endorsement�� Capacity to provide behavior consultation became extremely limited PBS was not recognized as a technique/practice/modality Many providers could not be reimbursed for the service Providers who could bill were often not familiar with individuals with developmental disabilities

6. SWOT Analysis for Virginia Strengths People across systems supported and understood PBS Many stakeholders participated DOE, DMHMRSAS, DRS, DMAS, Public Community Services, Private Agencies, Parents, Persons Shared vision of services for all Qualified People Weaknesses No on-going system Adults Higher Ed Schools Low Reimbursement rate Qualified People could not bill People who could bill were not qualified No standard to define PBS

7. SWOT Analysis for Virginia Opportunities Our MR and DD waivers were up for renewal in 2004 and 2005 respectively Downsizing our state facilities Re-investment in communities a priority CRIPPA complaint and case Threats The Virginia Psychological Association Practicing Psychology without a license? Threatened to block any attempts to provide community based services DMAS �We will never fund this!� Proposed a service called �behavioral assistants� Did not understand PBS

8. And So We Began! Beware of what you wish for!

9. Sequence and Funding VPBD recognized the need for PBS as a support Issued an RFP Partnership and VARC responded and were funded through 2 grant cycles: Study, design, and propose training and endorsement process Pilot the process by beginning the training and endorsement process Evaluate the process Develop a sustainability plan

10. Impact Individuals with disabilities, who also present challenging behaviors, have positive behavior support plans that enable them to live productive lives in their home communities

11. Goals Philosophy, policy, and practice of PBS is recognized and embraced Qualified and endorsed PBS facilitators who can provide consultation to teams that support individuals with challenging behaviors are available PBS facilitators are recognized as providers of therapeutic consultation in Medicaid waivers in Virginia

12. How we accomplished goals Enrolled Steering committee Studied Other States Developed generic credentialing policy, process, and curriculum Worked in subcommittees for each

13. Studied and Developed policies that would work in any agency Included Definitions Roles Services included Eligibility criteria for consumers and facilitators Descriptions of the plans and team Identified case initiation, review, and termination o the service

14. Studied all types of professional credentialing and developed our own credentialing process that Embraced PBS throughout Balanced rigor versus candidate friendliness Included 5 essential components Formal training Mentoring/supervision Demonstration of competence (Test versus other method) On-going education Inclusion of current practitioners

15. Developed formal training curriculum that Included Knowledge, Skills and Abilities of PBS Facilitator Addressed the whole Person-centered planning and PBS curriculum Added sections on team facilitation and systems assessment/change Embedded the team process outside of the training process Honors Adult Learning Principles

16. Training Process and Curriculum

17. Training and mentoring process: knowledge, skills, and abilities  Understand the Principles of Behavior Identify and Prioritize Behaviors for Intervention Complete Functional Behavior Assessment Develop Positive Behavior Support Plan Implement PBS Plan Facilitate Person-Centered Plan Facilitate Team

18. Training and mentoring process: requirements Four Parts to Training and Mentoring Attend Sessions Read Assignment Material Implement PBS and PCP processes with a team or teams Meet regularly with assigned mentor

19. Training and mentoring process: content 8 full day training sessions Session Content Person-Centered Planning Team Facilitation Functional Behavior Assessment Positive Behavior Support Plan Development Systems Change

20. Training and mentoring process: reading and references Bambara, L. M., Dunlap, G., & Schwartz, I. S. (2004). Positive Behavior Support: Critical Articles on Improving Practice for Individuals with Severe Disabilities. Austin, TX: Pro-Ed, Baltimore: TASH. Mount, B. 2000. Person Centered Planning: Finding Directions for Change Using Personal Futures Planning. New York: Capacity Works. O�Neill, R. E., Horner, R. H., Albin, R. W., Sprague, J.R., Storey, K., & Newton, J. S. (1997). Functional Assessment and Program Development for Problem Behavior: A Practical Handbook. (2nd ed.) Pacific Grove, CA: Brooks/Cole Publishing Co. Reid, D.H., & Parsons, M.B. (2004). Positive Behavior Support Training Curriculum, Supervisory Trainees� Resource Guide. Washington, DC: AAMR.

21. Training and mentoring process: practice of learned skills Team assignment: During training each participant must facilitate a team and complete 1 person-centered process 1 FBA 1 PBS Plan Mentoring during and after training Each participant is assigned a mentor and must complete 2 hours of mentoring a month

22. Training and mentoring process: expectations Participants must attend all sessions, or propose an alternative assignment Participants must complete mentoring Not all participants �make it� all the way through the process

23. Training and mentoring process: format for training sessions Training Sessions include: Quizzes on reading Discussion about team assignments Presentation of content Activities to enhance and illuminate content Discussion regarding team facilitation to implement process

24. Training and mentoring process: mentoring component Mentoring Answer questions about the content Review team assignments Advise �mentee� Evaluate �mentee�

25. Training and mentoring process: preparation of portfolio Remain with the �mentee� through the preparation of the portfolio Review the plans and provide advice on the completeness of the plans Prepare the mentee for the interview

26. Training and mentoring process: trainer qualifications Must regularly practice and facilitate PBS and PCP Must be knowledgeable about and skilled in the curriculum content Must be able to present information in an engaging way Must be able to facilitate activities with the training group Also frequently has mentor responsibilities

27. Implementation of Endorsement Process Making the Ball While Rolling it Down the Hill

28. Endorsement process: applicant requirements for �standard� Completion of PBS training (using curriculum as developed in 2004-2005) � 8 sessions (day-long) Mentoring -- 24 hours Completion of a portfolio, which includes: R�sum� or Vitae Copy of diploma or transcript Documentation of KSAs (using form provided) Two plans: 1 person-centered plan and 1 PBS plan with implementation data Mentoring log (meetings & activities) Written recommendations from: Consumer or family member who used applicant�s services Team member from a team that the applicant facilitated Mentor Supervisor or Advisor Training or course instructor Interview with Endorsement Board

29. Endorsement process: applicant requirements for �advanced� Attainment of PBS skills Completion of a portfolio, which includes: R�sum� or Vitae Copy of diploma or transcript Documentation of KSAs (using form provided) One PBS plan with implementation data Example of PBS product: writing, presentation, or research Written recommendations from: Consumer or family member who used applicant�s services Team member from a team that the applicant facilitated Interview with Endorsement Board

30. Endorsement process: board purposes Review and score the portfolio contents, checking Qualifications Training KSA documentation Plans Letters of recommendation Interview applicants using structured questions Make endorsement recommendations Assure that endorsed PBS Facilitators acquire ongoing professional development Ensure consistency across applicants and fidelity to the process

31. Endorsement process: board purposes (continued) Provide recommendations on an ongoing basis about how to improve the endorsement process Make recommendations about: Follow-up with PBS Facilitators to ensure ongoing quality Resolution of complaints/ grievances regarding PBS Facilitators State or regional level assistance with challenges (individual and system)

32. Endorsement process: board membership Members chosen based on extensive experience in PBS Members invested in the future of PBS and developing this process Diverse scope of membership 5-6 individuals for Pilot Board

33. Endorsement process: board membership (continued) LCSW: worked on original grant, 25 years experience as clinician, over 9 years experience with PBS Parent of adolescent with ASD: consults with Partnership on various projects, over 15 years experience with PBS Employment Services Supervisor: BA in Behavior Analysis, 25+ years working with persons with DD, 14+ years with PBS (training staff and implementation), certified to provide behavior consultation

34. Endorsement process: board membership (continued) Program Director at University: 15 years experience in PBS, one of the original members of PBS training team MSW: Involved in original PBS training through the Partnership, currently at DMHMRSAS/OMR, 15+ years with PBS, 15+ years with Developmental Disabilities Trainer: 10 years experience with PBS, part of original grant that preceded current project

35. Endorsement process: tasks Candidates are invited to submit by certain date Partnership staff receive portfolios, screen for completeness, then distribute to Endorsement Board members for review. Endorsement Board members review portfolios independently using checklists. Endorsement Board members submit scores prior to interview date. Endorsement Board members convene to interview candidates and to discuss scoring and eligibility for endorsement.

36. Where are we now? We changed from a university based curriculum to a community based curriculum We have trained about 100 people, but only about 20 facilitators have gone through the endorsement process We have learned a lot about the endorsement process! Two of our facilitators are working independently Sustainability is still an issue DMAS and DRS have bought in, but what about DOE?

37. Sticking Points for us! License versus certificate versus endorsement Did we need to develop a process that went before our �Board of Health Professions?� How many plans were enough to demonstrate competence? What were the pre-requisite qualifications for facilitators? Would DMAS ever recognize this? Will the agencies communicate and interact?

38. Issues and challenges Is the process balanced between demonstrating rigor/skill and enticing potential facilitators? Does endorsement = good practice? Does non-endorsement = poor practice? What do we lose with formality? What do we gain with such a process? Is this process desired over more informal ways of identifying facilitators?

39. www.vcu.edu/partnership/pbs

40. Group Action Planning What will you need to move forward? Policy? Process? Curriculum? What are the opportunities on which you need to capitalize? What are the threats for which you need to plan and what strategies do you need to use? What do you need to learn about? Where do you want to be 2 years from now? 1 year from now? 6 months from now? 3 months from now? Next month? Who else do you need? What is your first step?