External Program Review Committee (EPRC) agenda

Date: 2-4 p.m. Dec. 7, 2023

DSD liaisons: Stacie Enders and Ari Dionisopoulos

Type: Whole committee

Location: Room 2222, Elmer L. Andersen Building, 540 Cedar St., St. Paul, MN 55101

Meeting link: https://minnesota.webex.com/minnesota/j.php?MTID=m18725c4007b15e4c653d9dc3ddd2064a

Access code: 2486 040 8341

Accommodations: If you need an accommodation for this meeting, you must notify a DSD liaison three days before the meeting. Email PositiveSupports@state.mn.us or call (651) 431-4300.

Common acronyms used by the committee

We ask committee members to avoid the use of acronyms. Here are common acronyms:

· BIRF: DHS form 5148: Behavioral Intervention Report Form

· CABC: Context, antecedent, behavior, consequence

· DEED: Minnesota Department of Employment and Economic Development

· DHS: Minnesota Department of Human Services

· DLI: Minnesota Department of Labor and Industry

· DSD: Disability Services Division

· DSP: Direct support professional

· EUMR: Emergency use of manual restraint

· FBA: Functional behavior assessment

· HCBS: Home and community-based services

· IRP: Interim Review Panel (Predecessor to the EPRC)

· MDH: Minnesota Department of Health

· PCA: Personal care assistant

· PSR: Positive Supports Rule: Minnesota Rule 9544

· PSTP: DHS form 6810: Positive Support Transition Plan

General reminders for committee members

Before speaking, please state your name. Committee members are expected to:

· Be on time.

· Read the minutes, agenda and supporting documents before each meeting.

· Participate in ideas and conversations, as well as pause to allow others to share input.

· Commit to spending the whole meeting time present and not engage in other activities during the meeting.

Technology

The first few minutes of every meeting will be dedicated to addressing any connectivity issues, to ensure everyone can hear other meeting participants.

Agenda items

Public comments

The committee encourages public participants to share their thoughts and ask questions about committee activities at the beginning of each meeting. The committee will continue on to the next agenda item when either 1) 30 minutes have passed or 2) when there are no additional comments or questions, whichever comes first.

Vote

The committee will discuss and vote on the minutes from November.

Updates to share

Direct care workforce shortage

DHS is considering the following workforce shortage concepts to present to the governor for the 2024 session - please note this list is not comprehensive:

· Increasing rates for some services, such as Early Intensive Developmental and Behavioral Intervention services, Community-Based Mental Health Treatment services, Behavioral Health Home services, and Positive Support services.

· Increasing the weekly hours that qualified parents of minors and spouses may be reimbursed for home care nursing from 40 hours per week to 60 hours.

· Establishing biennial automatic inflationary updates for the PCA/CFSS program.

· Allowing people receiving HCBS to have their direct support professional assist them during a short-term hospital stay, so they can receive the care they need and not lose their staff to other employers while they are not at home.

· Expanding the Elderly Waiver program by offering an enhanced budget for people who have complex needs and require intensive support to live in the community.

· Paying for background study fees for direct care professionals employed by personal care provider organizations and home care providers.

· Implementing some of the recommendations from the Human Services Background Study Eligibility Task Force, such as updating disqualification rules.

· Making Minnesota a Technology First State, which would require teams to examine if technology can meet some or all of a person’s support needs. This is important because there will not be enough workers to fill all the open jobs, in all sectors, in both Minnesota and nationally given our country’s aging population and other economic factors. Technology will be able to fill some of that gap.

DHS recently published a new resource for lead agencies to help people with using technology supports: Guidance on support technology and service planning.

Subcommittee updates

Requests for approval subcommittee

This subcommittee is supporting an individual where the questions of important to and important for are complex.

Emergency use of manual restraint subcommittee

This subcommittee noted that one provider became more responsive to emails after the rollout of the new secure email system, which is intended to be more user friendly.

Discussion

Review of annual recommendations

The committee recommends DHS and committee representatives work towards the following goals (in no particular order) in 2023 to reduce the use of restraint:

2023 Goal 1: Provide resources and guidance for improving communication skills

The committee recommends expanding their 2022 goal related to communication. The new goal is to share existing or create new resources or materials for teams on how to support people with developing additional communication skills. The target audiences for this goal are service providers, lead agencies, direct care professionals and families because all members of the team have a role in supporting effective communication. Additional communication skills can be helpful in giving people greater control over their services and improving health outcomes. Many people who fall within the EPRC’s purview, due to use of restraint by license holders, need support with developing additional communication skills.

2023 Goal 2: Simplify and organize online DHS materials and training resources related to positive supports or intervention services

There are many materials related to positive supports online, but the materials are scattered and numerous, and it can be unclear to service providers where to find information. There are also some gaps in the information. The committee recommends:

· Reviewing all DHS-owned positive support materials and related topics.

· Organizing the materials by topic and grouping related materials in fewer locations to reduce search times.

· Identifying the most helpful materials and removing less helpful materials to reduce clutter.

· Identifying gaps in resources, and developing new materials as needed to fill those gaps.

The goal of this project is to provide clear and easily accessible guidance to providers so they have the tools and knowledge they need to support people using services with living their best lives.

2023 Goal 3: Explore ways to improve access to positive support services

Waitlists for positive support services continue to be long, often taking several months to start services. This can be a safety concern for people and their teams when the person is engaging in serious aggressive or self-injurious behaviors. The committee recommends DHS continue working towards increasing positive support service capacity.

2023 Goal 4: Support efforts to improve the direct care workforce shortage

While many people have quality positive support plans, it can take months or even years to find positive support specialists or other direct caregivers to implement the plans or to provide general care. Additionally, turnover in these positions is common. As noted for 2023 Goal 3, this can be a safety concern for people and their teams. The committee recommends DHS continuing to support efforts to address the direct care workforce shortage, particularly efforts to improve wages and benefits for professionals who provide day-to-day care that reflects the complexity and skill needed to do the job well.

Closing

Committee members are welcome to ask questions or bring up other topics for discussion.