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External Program Review Committee (EPRC) agenda

Date: 2-4 p.m. Oct. 3, 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 September 2024.

Updates to share

Regional positive support capacity building meetings

Committee members are invited to give any updates they may have on this topic. More information can be found at: Regional Capacity Building – Positive Supports (qualitycouncilmn.org).

Direct care workforce shortage

· During the 2023 session, the Legislature passed a new requirement that service providers must pay a minimum portion of Disability Waiver Rate System (DWRS) revenues as compensation to direct care professionals. This new requirement takes effect Jan. 1, 2025. DHS will begin tracking required compensation thresholds via DWRS cost reporting during the 2026 reporting period. For more information about the new compensation policy, refer to the DWRS compensation thresholds policy webpage.

· Rhode Island has experienced substantial improvements in recruitment and retention in recent years after increasing wages and training supervisors and managers.

Statewide staff are now receiving a starting wage of $20 per hour and an average wage of $22.14 per hour plus full benefits.

One of the state’s employers recently shared they have more than 700 staff and are paying a starting wage of $23.33 per hour plus full benefits (though not all staff accept the benefits for varying reasons). This is an increase from a starting wage of only $14.51 in 2020.

The state’s DSP turnover rate in 2023 was only 16%, and their DSP vacancy rate was only 17%.

They also implemented a statewide hybrid cohort model training for supervisors and managers.

· National Core Indicators (NCI) recently shared that their data indicated support from upper level management disproportionately affected employee satisfaction. Direct supervisor support is still very important, but not as important as support from upper management.

· Many states have been focusing on training supervisors and managers to be more person-centered toward their staff, and they have found the strategy to be effective.

· A presenter from the Reinventing Quality conference shared in September that their nationwide survey data indicated 48% of caregivers experience food insecurity and 42% experience housing instability.

· Many states and independent organizations are working on developing credentials/certifications for support professionals. However, there does not seem to be a coordinated effort to align across all the groups working on this strategy. Without coordination, the United States may end up with a lot of different credential types for nearly identical jobs.

· The Nursing Home Workforce Standards Board is working to ensure nursing home staff know their rights. They are drafting a curriculum for training workers about their rights.

· There continues to be significant competition for workers among employers from different industries. In August, Minnesota employers added 14,400 jobs, which was the largest monthly job gain in two years. Over the month, employment grew by 0.5% in Minnesota, far faster than the national rate of 0.1%. Minnesota’s unemployment rate increased slightly to 3.3% and the labor force was flat over the month. The state’s unemployment rate is lower than the national average of 4.2%. The labor force participation rate is among the best in the country. For more details, visit: DEED News: Minnesota Posts Largest Monthly Job Gain in Two Years.

Subcommittee updates

Requests for approval subcommittee

This subcommittee continues to assist service providers in their work to support people who engage in self-injurious and aggressive behaviors.

Emergency use of manual restraint subcommittee

This subcommittee continues to build, rebuild and maintain relationships with providers, both to their benefit as well as to support them in the long- and short- term. These relationships help with transitions with new providers and new staff to best support a person.

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 high-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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