External Program Review Committee (EPRC) agenda

Date: 2-4 p.m. on March 7, 2024

DSD liaisons: Stacie Enders and Ari Dionisopoulos

Type: Whole committee

Location: Room 2222, Elmer L. Andersen Building, 540 Cedar Street, Saint 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.

Best practices in matching

Scott Schifsky is creating an informational video about effective matching processes and Life Sharing, and he will be joining this meeting to ask the committee if they know anyone who might be able to share their processes for making effective, long-term matches between people who need support and caregivers.

Vote

The committee will discuss and vote on the minutes from February 2024.

Updates to share

Direct care workforce shortage

· Some unique bills to watch related to the direct care workforce shortage include:

Allows direct support professionals to access MNCare: SF 4042 as introduced - 93rd Legislature (2023 - 2024) (mn.gov)

Ability to share staff: HF 716 as introduced - 93rd Legislature (2023 - 2024) (mn.gov)

Allows parents of minors and spouses to be paid as personal care assistants: SF 3634 Status in the Senate for the 93rd Legislature (2023 - 2024) (mn.gov)

· 103 PCA training stipends have been distributed and 32 people are registered for upcoming trainings. The contracted vendor continues to advertise this opportunity, and DHS continues to notify employers about this opportunity.

· Employee-owned cooperatives: The contracted vendor conducted site visits with the cooperatives this past quarter and has been supporting each with individualized training sessions. DHS has also started conducting site visits with the cooperatives to help them comply with licensing requirements.

· SEIU training stipends are available through May 31, 2025. So far:

Total Voluntary Training Stipends paid: 836 ($418,000)

Total Voluntary Training Stipends left: 3,164 ($1,582,000)

Total Retention Stipends paid: 11,323 ($11,323,000)

Total Retention Stipends left: 38,677 ($38,677,000)

Total EVV Stipends paid: 6,023 ($1,204,600)

Total EVV Stipends left: 21,977 ($4,395,400)

· National Core Indicators-IDD State of the Workforce in 2022 Survey Report

Subcommittee updates

Requests for approval subcommittee

This subcommittee will be closing this meeting early to review a new request for approval of mechanical restraint.

Emergency use of manual restraint subcommittee

This subcommittee would like to highlight the importance of thanking providers and recognizing their hard work and contributions.

Discussion

One of Melanie’s colleagues provided feedback on the new communication tool. Two sections were updated to:

· Describe the person’s culture when it comes to communicating:

What do you know about the person’s cultural preferences? This may include, but is not limited to:

The person’s religious beliefs (e.g. the person may feel it is inappropriate for a male staff member to touch a female client).

What the person thinks is funny or enjoyable (e.g. sarcasm is funny to some people but to others it may be perceived as offensive).

What the person expects or thinks is appropriate (e.g. a person might expect certain titles to be used for elder members of their community).

What might cause stress for the person (e.g. the person may find it upsetting to be repeatedly wished a Merry Christmas as a form of greeting if they do not celebrate that holiday).

If the person cannot tell you these things, it might help to bring in their closest friends and family members to learn more about their cultural preferences and observe how they interact. However, sometimes people do not have others in their life who can share this information, such as situations of abuse or when the people closest to them have passed away. In those circumstances, it might help to get information from or observe the person interacting with their favorite staff member, social worker, teacher, doctor or other person in their life. You might also be able to learn more about the person’s cultural preferences by noting their favorite shows or music.

· Staff would like to know what community activities Aaron is interested in, but he does not use words to communicate, won’t point to pictures, and has not engaged in other communication strategies the team has tried. Staff have expressed that they find it challenging to know what he’s thinking. Sometime Aaron will go with staff but other times he engages in self-injurious behavior as they get ready to head out or while traveling. A behavior analyst learned that with Aaron’s family he indicates “yes” by touching a person’s arm/shoulder and “no” by not engaging with/ignoring the person. The team would like to encourage Aaron to use his current method of communication with other people and apply it in a way that helps staff know what he would like to do with his day.

Objective:

Over six months every day after lunch, when offered three activities outside the home, Aaron will:

· Decline each activity by walking away or ignoring staff.

· Accept an activity by patting staff on the shoulder or arm.

Activities will be offered one at a time. Staff should both verbally describe the activity and use visual examples – several dozen visuals are located on the desk by Aaron’s TV in the living room. Staff may also mix in new activities and use visuals from their phones, such as an upcoming sporting event or show at the local zoo. Staff should not repeat an activity if ignored. If Aaron walks away before all three activities are offered, staff should not intervene because that is his way of saying he is not interested in going out that day.

Annual recommendations

The committee will start brainstorming what their 2024 goals should be. The 2023 goals were:

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.