The New Jersey Department of Human Services Division of Developmental Disabilities

1. The New Jersey Department of Human ServicesDivision of Developmental Disabilities Crisis Behavior Resources for Support Coordination

2. Objectives • SC Expectations • Define Emergency • External Resources • Crisis/Behavior Resources • Division Resources • ICM Referral Process

3. SC Expectations Responsible for managing crisis 24/7 services / On-call Be supportive to individual & family Assess situation Understand the meaning of a true emergency/crisis

4. Definitions What is considered an Emergency?

5. Emergency… … means that the eligible person is homeless or in imminent peril.

6. Homeless… …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.

7. Imminent peril… …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 individual

8. The New Jersey Department of Human ServicesDivision of Developmental Disabilities External Resources

9. Division of Disability Services (DDS) Office of Information and Assistance Services Office of Home and Community Services Special Projects and Initiatives Statutory Advisory Boards and Councils Contact Information Telephone: 888-285-3036 www.state.nj.us/humanservices/dds

10. Personal Preference Program (PPP) 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. PCA

11. Personal Preference Program (PPP) 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 lives

12. Additional PPP Uses 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)

13. How to Apply for PPP • 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, 609-292-7800

14. Adult Protective Services (APS) 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.

15. Making a Referral to APS • 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 exploitation

16. Limits to APS Services 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.

17. Unusual Incident Reporting (UIR) 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.

18. The New Jersey Department of Human ServicesDivision of Developmental Disabilities Crisis/Behavior Resources

19. Community-Based Behavior/Crisis Resources Crisis Assessment Response and enhanced services (Cares)

20. CARES 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 services

21. Mobile Crisis Response Contact Number – 1.888.393.3007 i. ii. iii.

22. Additional CARES Services • Case follow along for up to 120 days • Includes 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 challenge

23. Community-Based Behavior/Crisis Resources Developmental Disabilities Health Alliance (DDHA)

24. DDHA Eligibility Criteria 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 arrangement

25. DDHA Program Services • Assessments • On-site Intervention • Behavior Skills Training • Social Skills Training • Interagency Support & Consultation • Staff Training • Systems Integration • Health Care Services • Mental Health Services

26. DDHA Referral Process • 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)

27. DDHA Discharge Criteria • 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.

28. Community-Based Behavior/Crisis Resources Social/educational/ residential/Vocational (SERV)

29. SERV Behavior Specialist SERV Behavior Specialists provide intensive in home behavior support services to DDD individuals residing within the following five counties: • Mercer • Middlesex • Monmouth • Ocean • Hunterdon

30. Types of Referrals: Mobile Crisis (MCRS) 4-week intervention/ Severe Behaviors Intake/Assessment Baseline Data/Observation Skills Training/Treatment Planning Behavior Plan/Implementation Outcome Measures/Follow up observation

31. Types of Referrals: Home-Based(HBS) Home-Based Referral is an eight week behavioral intervention Behaviors that warrant a HBS referral are less severe than a MCRS referral A resource used for skill building and addressing minor behaviors

32. SERV Referral Process Crisis Hotline – 609-240-3738 SERV 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 “SERVReferral” in the subject line of the email (i.e. – 123456 SERVReferral)

33. The New Jersey Department of Human ServicesDivision of Developmental Disabilities Case study #1

34. Case Study #1 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?

35. Case Study #1 Suggestions Complete and submit an UIR Contact 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 information

36. The New Jersey Department of Human ServicesDivision of Developmental Disabilities Division Resources

37. The New Jersey Department of Human ServicesDivision of Developmental Disabilities Accessing Family Support Services

38. Family Support Service Descriptions 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.

39. Family Support Service Descriptions 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.

40. Family Support Service Descriptions 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.

41. Family Support Service Descriptions 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.

42. Family Support Service Descriptions 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 doorways

43. Family Support Service Descriptions • 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 controls

44. Conversation to Assess the Need for Family Support Services 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.

45. Conversation to Assess the Need for Family Support Services • 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.

46. Processing Requests 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.

47. How to Make a Request 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. After generic resources have been explored, requests for Family Support Services are made by the family to the Support Coordinator 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. The Regional Contact reviews the request. Based on the review, additional provider specific documentation may be needed for the SC to obtain.

48. The New Jersey Department of Human ServicesDivision of Developmental Disabilities Community Services

49. Regional Psychologist Roles • 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 staff

50. How to Access a Regional Psychologist • 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)