Please take the time to read the attached Sonoma Developmental Center Service Plan. The PHA Board has voted to support the plan and post it on the website for your review. Please know that the changes that are coming, the implementation of the task force recommendations, are not our first choice. Like you we would rather that SDC services remain as a safe haven for all of our residents. We do know however that changes are already being implemented for some as regional centers step up efforts to force SDC residents into alternative placements. This plan is our attempt to provide some safeguards for our beloved residents as they face the changes ahead. Remember -- the task force recommendations are the blueprint for change!
You will note that there is a family questionnaire included in the upcoming issue of the Gazette. Please take a moment to complete it and return it. It is your chance to give voice to your choices and concerns.
As always I welcome your thoughts and input. Lets continue to work together to make a better and safer future for all of our SDC residents! Thank you for your continued support.
[Click the link below to continue to the Services Plan.]
Plan Submitted by PHA
In keeping with the final report of the Task Force on the future of the developmental centers, “Plan for the Future of Developmental Centers in California” January 13, 2014 Plan, the Parent’s Hospital Association (PHA) advocate for a specific approach to the Plan recommendations directed at Northern California. Specifically, we urge continued use of portions of the current state owned property at Sonoma Developmental Center (SDC) in the provision of services. Beyond just reassigning living units, we will outline a concept that would repurpose and resize the facility to meet the specifics outlined in the Plan to meet the needs of current residents as well as future populations whose needs remain an issue in the system today.
Provision of Services for Medically Fragile Residents
The Plan calls for medical residents to move from developmental centers into community homes. Approximately 445 individuals with complex medical needs were identified and about 200 of the most medically fragile reside at SDC. The Plan recommendations state that various models exist to support individuals with complex medical needs. The two types cited that appear to best fit SDC residents are the SB962 orSB853 homes and the ICF/DD-Continuous Nursing. In addition the Task Force supported the concept of coordinated health care services. Included in their health care recommendations were psychiatry, medication management, durable equipment maintenance, and dental care. We note that most SDC residents are Medi-Cal with a few Medi-Cal/Medicare.
PHA recommends a permanent clinic that acts as a hub of medical services be created on the SDC site. This hub would provide medical, dental, and possibly psychiatric services for those moving out of SDC. Those former SDC medical residents served by regional centers, who have services in place, may be served by existing service. If there are service gaps, however, they can return to the SDC based clinic to receive services not provided elsewhere.
Creating the clinic on the SDC site serves a number of advantages. First, it would allow for trained state medical SDC staff to work side by side with community providers who may be less familiar with the complex medical issues of SDC movers. Ideally these trained state staff could transition as state staff to the Medi-Cal community clinic now located on the SDC site. Second, it would allow for planning and coordination between the Sonoma County, the area regional center, and DDS to create a complete service picture for these complex movers. Third, it would also allow for the utilization of existing land and building resources to provide needed services. Finally, it would provide assurance and security to the families, staff, and friends of the SDC movers that stable medical services will remain available to their loved ones once they are placed elsewhere.
The SDC hub clinic may also provide medical services for other populations who could benefit much like other community clinics. The clinic would be particularly suited to provide services to developmentally disabled residents who have never resided at a developmental center, but have similar or unmet medical needs.
Related Issues
There should be some consideration given to repurposing a site for additional services, including for example-a step- down residence for individuals that no longer require acute care but are not yet recovered enough to return to their previous home. An additional example would be someone recovering from hip replacement, hospice or other surgery. Also there might be a need for a specialized clinic recovery site (light anesthesia, knee surgery).
There should be placement of ICF/ DD Nursing facilities on site for those extremely medically fragile who might not otherwise survive transition from SDC on the grounds of the facility. These would include individuals who will require rapid assistance and constant medical oversight. Some of these extremely fragile residents are among the youngest population at SDC.
In addition, legislation to extend the Lieber bill to all developmental staff in good standing increases the possibility of capturing the most highly specialized staff in the DDS system to work with challenging populations as well as to train new staff to work with these populations.
Funding for the Clinic and Related Services
Existing Medi-Cal reimbursement rates are not sufficient to pay for the ongoing medical care needed by the fragile and complex SDC movers. In the past the legislature has made specific provisions for those clients living in a developmental center that have been designated for closure. Those provisions included the creation of enhanced reimbursement rates for those providing medical services to former developmental center residents. This provision now needs to be extended to all of those who move from a developmental center. In addition Sonoma County may also be able to identify funding sources to support a community clinic at SDC.
Provision of Services for Behaviorally Challenging Individuals
PHA recommends that acute crises facilities, similar to the one at Fairview Developmental Center, be created both in northern and southern California. It makes sense that SDC be the site of the crises facility in the north, as the land, and buildings, already exists for such a facility. This would mean that a specific residence be designated to provide this key service. There are a number of additional reasons that a crises residence needs to be located on the SDC site. First, is the fact that some of the best trained staff in the state now working with behaviorally challenging individuals are at SDC. Creating a crises facility on the SDC site would allow the state to maintain the licensed and trained staff who already work with this population. Second, if the state “no reject facility” also remains at SDC, those individuals in crises that require a longer time to stabilize can easily transfer to this state facility until they are stable and ready to move on. Finally, northern California residents in crises will not be subjected to going into general acute psych facilities where they are at serious risk of being medicated by strangers who are unfamiliar with their history and medication issues as well as risks specific to this vulnerable population.
Related Issues
Currently there is a moratorium in place that prohibits anyone from being admitted to SDC. This needs to be lifted, as it is at Fairview Developmental Center, for those in acute crises. It does not make sense, and never did, to separate regional center clients in crises from their support systems and families in times of crises.
Another issue is the fact that it remains too difficult and problematic for clients in crises to be admitted to a state crises facility. Regional centers continue to admit their clients to general acute psych facilities because they are unable to access services at Fairview. This must change. Access to the crises residence needs to be the same, or easier, as it is to access the more dangerous general acute psych facilities. Too many dual diagnosis clients left with no other option during times of crises.
Funding for the Crises Residence
The Task Force cites a cost of $8.8 million in operating costs for this type of facility. Development of such facilities within the existing developmental centers of Fairview and SDC should provide savings because the facilities can be located in existing buildings and utilize licensed staff already residing and working in the area.
Operation of Northern California Zero Reject State Facility
The Plan recommends transitional state facilities that cannot eject residents who are experiencing difficulty. The mention of a number (for example a 15-bed facility or smaller) does not reflect the language of the Task Force members, but rather the language in the Plan cites the importance of individual needs based planning. The size of the state facility, created as a haven of last resort, clearly needs to be dictated by need, as determined by both the IPP and the inability for individuals to be successful in alternative community facilities. One such a facility should be located in each the north and south, at the minimum, to assure that families and support systems can continue to be involved, advocate, and offer needed support and assurance. The northern California facility should continue to be located at SDC.
Access to the state facility should occur via two access points. First, those admitted to the crises residence unable to return to their previous community placement safely without further stabilization. Second, individuals who have a demonstrated inability to achieve success in existing community models and who currently reside in developmental centers due to failure in alternative settings, need to remain at the state facility. The state facility should include both a locked residence for those who need it as well as an unlocked residence for those learning to safely access their surrounding environment.
There are numerous reasons to maintain one of the zero-reject facilities at SDC. They are as follows:
- The state facility can maintain the well proven, licensed, and trained state staff. The true key to success at these facilities is access to motivated, trained, and stable staff.
- The open space at SDC can serve as a needed outlet for residents who need to deescalate when they are experiencing difficulty.
- The day program can be flexible and adjust according to the needs of the behavioral issues of the residents. An example would be a resident who was having difficulty could remain on the residence, on the grounds of SDC, or have a less demanding day program.
- The existing state facility, which could be more similar to Canyon Springs, would be able to provide a locked setting as well as medical and behavioral restraints in the event that residents require such intervention, with an appropriate level of oversight.
- Intermediate Care Facilities (ICFs) have the most extensive oversight. Oversight is pivotal in settings that may have restricted egress or use behavioral restraints. It is only through state/federal oversight of the use of behavioral restraints that the potential abuse of such can be adequately monitored.
Funding
The Plan cites operating costs of $4.4 Million. This number might vary depending on the number of residents as well as streamlining and outsourcing certain nonessential services. Canyon Springs can also be used as a point of comparison in terms of cost.
Transitional SB 962 Model Homes
The Plan recommendation mentions the creation of new “962” model homes with specialty services to provide a higher level of behavioral supports. Another way to describe such homes could be to label them half way, crises, or transitional homes. This is not a new idea. Residents leaving developmental centers and others with behavioral issues already have homes with increased staff, at times having staff levels of one on one, or more. Despite this, admissions to general acute psychiatric facilities and even jail continue at alarming rate. These homes have not met the needs of the most challenging behavior clients. A new vision is needed.
In order to improve their efficacy, the development of ICF “962” behavior homes could occur on SDC land. The homes could rely on the expertise available in the nearby state facility. Sonoma County mental health could partner to provide additional expert staff to guide the specialty behavioral approaches for working with these individuals. Nearby open space could be used for both healthy activities and de-escalation. The nearby clinic could provide needed medical and psychiatric support. The state day program could be shared and provide continued flexibility for those leaving the state facility. Access points could include direct placement from community facilities in cases where the resident is not being successful, those graduating from the state facility, and individuals coming directly from the crises facility.
The bringing together of critical expertise and resources to guide the programming in these homes will assure that residents have the maximum freedom and community access for residents, as well as eliminating the need for homes to have delayed egress, locked small perimeters, and behavioral restraints without the needed oversight. The recent death of the young man in the Mountain View Residential Ranch is the result of untrained staff dealing with challenging behaviors.
Related Issues
The development of these enhanced residences may be a chance for a public private partnership. The provider could be a nonprofit that has had proven success with other models. This model can include partnerships with local government, regional centers, and the state for additional supports. This could foster a solution for those experiencing temporary difficulty and those who are unable to benefit from alternative settings. The beautiful setting and nearby open space, local community support, and the ability to collaborate and share resources create the perfect storm for locating this key resource at SDC.
Funding
The Plan cites $500,000 for the development of each specialized home. CPP funding is cited as the funding source. While such funding is important to the development of these critical homes there may well be additional funding sources through private and other government sources to both create and contribute to this vision.
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