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External Program Review Committee (EPRC) agenda

Date: 2-4 p.m. July 11, 2024

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 June 2024.

Updates to share

Regional positive support capacity building meetings

· The Regional Quality Councils are coordinating monthly meetings on the topic of “positive supports,” which they define as:

Positive Behavioral Supports

Person Centered Thinking and Practices

Culture of Safety

Trauma-Informed Supports

Motivational Interviewing

Cognitive Behavioral Therapy

Systems of Care

Wellness Recovery Action Plan

Wrap around planning

· For context, Minn. Rule 9544 defines “positive support strategies” more narrowly as “a strengths-based strategy based on an individualized assessment that emphasizes teaching a person productive and self-determined skills or alternative strategies and behaviors without the use of restrictive interventions.”

· The committee may want to explore how they can coordinate with the RQCs given their overlapping responsibilities. More information can be found at: Regional Capacity Building – Positive Supports.

· Some of the topics discussed at the May 2024 RQC meetings include:

One of their goals is to create a tool to evaluate how a person feels their positive supports are working.

Participants would like trainings on all the ways the RQCs define “positive supports.”

There is a need for trainings that are targeted towards parents and foster families.

Finding enough staff or service providers is a barrier to implementing positive support strategies.

It can be challenging to coordinate with schools, and school staff are not always informed on what resources or programs exist outside of the schools.

Direct care workforce shortage

· The Age-Friendly Minnesota Council is developing a Multisector Blueprint on Aging, which is a 10-year plan that looks beyond the traditional aging sector to ensure all Minnesotans are able to age well. The final blueprint will have a set of commitments and initiatives state agencies and key partners have under way or agree to launch in support of the plan. One of the strategies in the blueprint is having a well-trained and well-compensated workforce.

· Have you ever wondered why some professions that have worker shortages can accept foreign workers but others can’t? You can review federal regulations on that topic in the U.S. Citizenship and Immigration Service's Chapter 7 – Schedule A Designation Petitions webpage, and the Bipartisan Policy Center’s Suggestions for Modernizing Schedule A.

· The Minnesota Department of Employment and Economic Development recently shared that Minnesota’s labor market remains tight, with nearly two job openings for each unemployed person in the state. Compared to 2022, the number of vacancies decreased and the number of unemployed individuals increased slightly. With 87,000 unemployed workers statewide in 2023, there were 0.6 unemployed people for each vacancy, up slightly over the last two years and just below levels before the pandemic recession.

Subcommittee updates

Requests for approval subcommittee

· This subcommittee continues to support providers with phasing out the use of mechanical restraint and improving quality of life.

Emergency use of manual restraint subcommittee

· This subcommittee is developing several positive support transition plan examples for DHS to share with the public.

Discussion

Annual goals

The committee will review its 2024 goals, which are listed in no particular order:

· Provide resources and guidance for improving communication skills.

The committee will work 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.

· 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 and 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 with living their best lives.

· 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.

· 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. 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.

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