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External Program Review Committee (EPRC) minutes

Date: Feb. 3, 2022

DSD liaisons: Stacie Enders and Linda Wolford

Type: Whole committee

Location: Remote only because of the COVID-19 pandemic

Attendees: Lindsay Nash, Dan Baker, Jodi Greenstein, Kim Frost, Laura Daire, Liz Harri, Mary Piggott, Tatiana Kerestesh, Danielle Bishop, Stacy Danov, Melanie Eidsmoe and Susie Haben

Not present: None

Agenda items

Public comments

There were no public participants at this meeting.

Updates to share

Direct care workforce shortage

· See the agenda for additional details.

· Benefits for direct care workers

· Many direct care workers meet the income limits for health care benefits offered through state programs, but they may not be enrolled or eligible for a variety of reasons. DHS will work with providers to share practices for helping their employee gain access to benefits and will work with navigators to share insurance information with direct care workers.

· It would be helpful to provide several webinar trainings about benefits to both providers and workers – DHS will work on this.

· If providers need personal protective equipment, here is a form to request those supplies: COVID-19 Supply Chain

Subcommittee updates

· See the agenda for additional details.

Vote

Vote to approve the minutes from the whole committee meeting in January 2022:

· Lindsay Nash: abstain

· Dan Baker: yes

· Danielle Bishop: abstain

· Jodi Greenstein: yes

· Kim Frost: yes

· Laura Daire: yes

· Liz Harri: yes

· Mary Piggott: abstain

· Melanie Eidsmoe: yes

· Stacy Danov: abstain

· Tatiana Kerestesh: yes

· Susie Haben: not present for vote

Discussion

· The committee started reviewing its role and how things have changed with Covid-19 and workforce shortage. The committee had a brainstorming discussion about what has and has not worked. They will continue their discussion at the committee’s March meeting.

· Life Trajectory discussion (My LifeCourse Portfolio materials at lifecoursetools.com)

· Members each shared a positive:

· A person assigned to the EPRC for many years now experiences much less restraint.

· It is nice to have a connection with direct support providers.

· For the teams that use advice from the EPRC, we are seeing positive effects on quality-of-life.

· We are seeing a much better focus on quality-of-life. We are seeing less quality-of-life being defined solely by lack of self-injury.

· We have good communication with our requests group. They are willing to take our recommendations and to have discussions.

· It is good that we focus on quality-of-life and evidence-based recommendations. We take a holistic approach and consider many factors.

· Teams are willing to try different things to help improve quality-of-life.

· We are seeing better quality-of-life measures and outcomes.

· We have enjoyed collaboration and teamwork with members. We enjoy seeing positive outcomes from medication reviews.

· We enjoy taking time to build relationships with providers. Trust is a big factor in hearing feedback. Having that awareness and connection, we’ve noticed an increase in quality-of-life or other positive outcomes.

· We appreciate support from the rest of the EPRC.

· For a person with previously high number of BIRFs, there has been significant decline in use of restraint. The provider has been more open to using external support. It seems that person’s life has gotten better and it doesn’t seem as chaotic for staff when they come to work.

· Overall, BIRF numbers are down and continue to go down.

· It’s good that so many people on this committee have stayed healthy.

· We appreciate learning from everyone.

· Stacie hears good things from providers about the assistance they receive from EPRC members.

· Members each shared one concern or issue:

· Can we expand our scope on what we look at?

· Some providers do not respond, but then we see repeated EUMR on our list. How do we build those relationships?

· With us going out on-site less, it leaves us less able to help and less capable of verifying information.

· Our inability to meet with people in person is unfortunate. In-person helps with understanding.

· Sometimes it can be hard to know each person’s role and how to help.

· It can be hard to read paperwork but then not meet the people it’s about.

· We’ve seen a lot of providers hanging on by a thread with high staff turnover.

· Sometimes when we provide recommendations, we are unsure how they are translated and implemented. Are recommendations implemented with fidelity and rigor?

· Do providers see this as compliance only, instead of good positive support practices?

· With some of the requests for medication reviews, the information being provided is often difficult to assess and to put together a review, due to lack of information or wording. We are unsure if the information gets to prescribers.

· It is unfortunate we are unable to meet with people directly.

· We miss seeing people in person.

· With people being overwhelmed, they are sometimes missing the basics. They don’t have time to check their work.

· There is a lack of positive support providers and an inability to access helpful services. There is a long wait time (often several months) to access clinicians who can do functional behavior assessments.

· We miss being able to see people in person.

· Sometimes it can seem like we attend a lot of meetings and don’t have time to share more.

· Everyone seems to want to help others and to offer quality services, but the workforce shortage continues to be a barrier to implementing everyone’s best intentions.

· Past EPRC experiences and events that supported the vision for a good life for people:

· When we highlight best practices in positive supports

· When direct support professionals are trained to provide effective positive supports

· When teams effectively balance risk and safety

· Past EPRC experiences that pushed toward things we don’t want for people:

· Staffing shortage – lack of training and high turnover

· Concerns about use of buckle guards sometimes lead teams to not drive people or to not serve people with challenging behaviors

· A tendency to choose safety over allowing risk and providers not feeling like they have alternatives or can use their creativity or judment

· Coming down hard on providers to the point they don’t feel they can take on people with risky behaviors

· Current/future EPRC experiences that continue to support the EPRC vision for a good life for people:

· Highlighting best practices in positive supports

· Supporting dual-diagnosis

· Getting feedback from everyone on the team on alternative ways or thoughts on how to best support the person

· Better systems for direct support professionals to chart data online so it can go to teams more quickly

· Better technology for people using services and knowledge for teams on what is out there and how to pay for it

· Realistic ways to measure quality-of-life, beyond just looking at self-injury, so we ensure the people we support are living it

· Training

· For EPRC members

· For providers

· For others

· Topics

· Rights restrictions – things to try before restricting someone’s rights

· Helping people without a guardian in supported decision-making and informed choice

· EPRC experiences to avoid because they push people toward things we don’t want:

· Fear of the EPRC and seeing us as compliance instead of support

· What the EPRC wants in terms of a “good life” to look like:

· Choice in services – from whom and where

· People who have high support needs have competent support

· Appropriate medication management that’s supported with accurate data and evidence-based practices

· More collaboration between professions and eliminating silos (medical professionals, law enforcement, etc.)

· Educating therapists, psychiatrists, etc. about data and how to coordinate with other service providers

· Community activities that match the person’s preferences but also support enriching activities

· People have the ability to communicate their needs in a way that staff understand, such as pain or any other type of discomfort – and they have staff who can identify the function of the behavior

· Things the EPRC doesn’t want in people’s lives:

· Inability to implement ideas because of workforce shortages

· Inability to implement because of lack of cooperation among other supports beyond providers

· Other comments:

· In an ideal world, we wouldn’t need the EPRC because there would be enough competent professionals to help teams.

· A lot of people we support are showing stable or decreasing trends in BIRFs. However, we are seeing increasing trends in service terminations.

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