2nd Report Independent Reviewer Report - ADA.gov · PDF fileOctober!7,!2012!O!April!6 ... serving!individuals!with!complex!medical!needs.!Each!review!included!studying!service!

Case 3:12-cv-00059-JAG Document 130 Filed 06/11/13 Page 1 of 147 PageID# 4821
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REPORT!OF!THE!INDEPENDENT!REVIEWER!
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ON!COMPLIANCE!
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WITH!THE!
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SETTLEMENT!AGREEMENT!
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UNITED!STATES!V.!COMMONWEALTH!OF!VIRGINIA!
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United!States!District!Court!for!
Eastern!District!of!Virginia!
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Civil!Action!No.!3:12!CV!059!
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October!7,!2012!O!April!6,!2013!!
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TABLE&OF&CONTENTS!
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I.! Summary! 3!!
II.! Introduction! 5!!!!
III.! Activities!of!the!Commonwealth!of!Virginia! !!7!!
IV.! Activities!of!the!Independent!Reviewer! !!8!!
V.! Findings:! !!! A.!!!! i s!in!the!Most!Integrated!Setting!!
11
11
B.!!!!
Ser
Ser
vi
vi
ng!
ng!i
ndi
ndi
vi
vi
du
du
al
als!with!complex!medical!needs! 14
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C.!!!!Discharge!Planning!and!Transition!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!19! !
D.!!!!Resolving!Barriers! 22
E.!!!!Safety!in!the!community! 24
F.!!!!Waivers! 25
! G.!!!!Youth!Residing!in!Nursing!Homes!and!the!Largest!ICFs! 26
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H.!!!!Individual!and!Family!Supports! 27
I.!!!!!!Case!Management! 28
J.!!!!!!Crisis!Services!and!Prevention! 32
K.!!!!!Integrated!Day!Activities!and!Supported!Employment! 40
L.!!!!!Access!and!Availability!of!Services! 47
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M.!!!!Community!Living!Options! 50
N.!!!!Famil OtoOFamily!and!Peer!Programs! 53
O.!!!!Qualit
y
y!and!Risk!Management! 54
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VI.! Additional!Information!and!Considerations! 57!
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VII.! Conclusion! 61!
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VIII.! Recommendations! 61!
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IX.!! Appendices!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!64!
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I.&&SUMMARY& &
This!report!is!submitted!to!the!Court!at!the!end!of!the!second!review!period!covering!
October!7,!2012!through!April!6,!2013.!Some!facts!were!included!through!May!8,!2013.!
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There!have!been!two!major!approaches by!the!Independent!Reviewer!to!monitoring!
implementation!of!the!provisions!of!the
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!Settlement!Agreement!during!the!second!review!
period.!First,!the!planning!and!implementation!of!the!new!programs!and!systems!required!
by!the!Agreement!have!been!monitored!and,!second,!the!outcomes!for!a!selected!sample!of!
individuals!who!received!new!services!have!been!studied.!
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There!were!many!provisions!of!the!Agreement!scheduled!to!be!accomplished!during!the!
second!review!period.!The!Reviewer!monitored!the!development!of!the!plans,!and!the!
initial!implementation!of!these!provisions.!An!expert!consultant!was!retained!to!evaluate!
and!report!on!the!status!of!compliance!with!two!initiatives:!the!development!of!crisis!
services!and!the!planning!related!to!Integrated!Day!Activities!and!Supported!Employment.!
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The!Reviewer!gathered!information!related!to!the!planning!and!implementation!of!
provisions!with!a!broad!array!of!methods!and!sources.!These!included! athering!
information!from!officials!and!internal!reports,!holding!regular!meetin
g
gs!with!those!leading!
the!efforts,!and!convening!focus!groups!with!stakeholders!to!hear!their!perspectives!
directly.!The!expert!consultant!evaluated!the!planning!and!implementation!efforts!using!a!
nationally!recognized!tool!to!review!the Commonwealths!ability!to!plan,!develop,!monitor,!
and!evaluate!evidencedObased!practices
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!regarding!systems!development!and!program!
implementation.!This!review!included!studying!related!documents!and!data,!interviewing!
the!officials!leading!the!efforts,!and!interviewing!a!sample!of!those!involved.!
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The!Reviewer!and!expert!consultants!utilized!a!monitoring!questionnaire!to!gather!
information!to!review!the!status!of!services!to!individuals!who!are!receiving!new!ID!waiver!
services.!The!individuals!selected!for!review!were!those!with!the!most!complex!medical!
needs.!TwoOperson!teams!reviewed!the!services!of!a!statistically!significant!random!sample!
of!individuals;!one!member!of!each!team!was!a!registered!nurse!with!extensive!experience!
serving!individuals!with!complex!medical!needs.!Each!review!include !studying!service!
planning!and!case!management!records,!visiting!and!observing!the!in
d
dividuals!usually!in!
their!homes,!and!interviewing!those!providing!services.!
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The!results!of!this!monitoring!are!described!in!the!Findings!section!of!this!report.!Also,!
included!in!the!Findings!Section!are!progress!reports!on!targeted!recommendations!made!
by!the!Reviewer!in!the!First!Report!to!the!Court.!Any!new!recommendations!are!included!
either!in!the!appropriate!Findings!Section!or!in!the!Recommendations!Section!at!the!end!of!
the!report.!
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Overall,!it!is!the!opinion!of!the!Reviewer!that!the!Commonwealth!has!made!a!good!faith,!
concerted,!and!coordinated!effort!to!comply!with!the!requirements!of!the!Agreement.!!
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Reports!of!the!Commonwealths!efforts!and!accomplishments!are!described!in!the!Findings!
Section!of!this!report.!!It!is!important!to!note!that!more!than!900!individuals!are!now!
receiving!new!ID!and!DD!Waivers!under!the!Agreement.!Hundreds!more!are!receiving!
crisis!services!and!individual!supports.!
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There!have!been!many!challenges,!and!some!delays.!It!is!important!that!the!challenges!and!
delays!be!addressed!as!soon!as!possible.!
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Recommendations!and!associated!concerns!in!the!Findings!Sections!are!related!to!the!
Commonwealths!ability!to!achieve!compliance!with!the!respective!provisions!of!the!
Agreement.!The!Reviewers!recommendations!at!the!end!of!the!report!are!for!the!
Commonwealths!consideration.!They!are!steps,!if!implemented,!that!the!Reviewer!believes!
will!help!achieve!the!goals!of!the!Agreement.!!!!!!!
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The!next!Report!to!the!Court!will!be!submitted!on!December!6,!2013.!It!will!report!on!the!
third!review!period,!covering!April!7,!2013!through!October!6,!2013.!!
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! Respectfully!Submitted;!
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Donald!J.!Fletcher!
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Independent!Reviewer!
June!6,!2013!
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II.&& INTRODUCTION&!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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This!is!the!second!report!of!the!Independent!Reviewer!(Reviewer)!to!Judge!John!A.!Gibney,!
District!Judge!in!the!United!States!District!Court!for!the!Eastern!District!Court!of!Virginia!
(the!Court)!in!the!Settlement!Agreement!(the!Agreement)!between!the!United!States!(DOJ)! and!the!Commonwealth!of!Virginia!(the!Commonwealth),!Civil!Action!No.!3:12cv059.!It!
covers!the!period!from!October!7,!2012,!to!April!6,!2013,!with!some!information!gathered!
through!May!13,!2013.!The!Reviewers!first!Report!to!the!Court!reported!on!the!period!
March!6,!2012,!through!October!6,!2012.!That!report!is!posted!in!the!Settlement!section!
of!the!Department!of!Behavioral!Health!and!Developmental!Services!(DBHDS)!website,!as! will!this!and!future!semi!annual!reports.!!
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It!is!the!reviewers!opinion!that!the!Commonwealth!made!a!good!faith,!coordinated,!and!
concerted!effort!to!meet!the!requirements!of!the!agreement!during!this!second!review!
period.!!Overall,!that!effort!has!resulted!in!important!and!considerable!progress!in!many!
areas.!However,!there!are!some!areas!where!progress!has!not!kept!pace!with!the!schedule!
of!implementation!in!the!agreement!and!where!improvement!is!needed.!The!reviewer! recognizes!that!implementation!of!the!agreement!involves!many!complex!initiatives!that! are!being!implemented!simultaneously.!!This!report!includes!highlights!of! accomplishments,!areas!of!concern,!and!recommendations.!It!also!provides!progress!
reports!on!targeted!recommendations!included!in!the!Reviewers!first!Report!to!the!Court.!!!
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The!second!reporting!period!includes!more!scheduled!plans!and!actions!than!in!any!other!
period.!The!Agreement!was!designed!to!initiate!and!accomplish!significant!change!!to!
enhance!services!and!to!strengthen!safeguards!!during!the!first!two!years.!Much!progress!
has!been!made!since!the!agreement!began.!!More!individuals!with!intellectual!and!
developmental!disabilities!(ID/DD)!are!receiving!a!wider!array!of!services,!and!the!quality! of!those!services!is!supported!by!new!and!enhanced!safeguards.!!More!than!900!individuals!
have!received!new!communityObased!waiver!services.!More!than!400!individuals!and!
familie

Documents

2nd Report Independent Reviewer Report - ADA.gov · PDF fileOctober!7,!2012!O!April!6 ... serving!individuals!with!complex!medical!needs.!Each!review!included!studying!service!