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Enhanced BehavioralSupports Homes (EBSH)

Origins of EBSH Concept The Secretary of the California Health and Human Services Agency (CHHS),established the Task Force on the Future of Developmental Centers (DCTask Force) in 2013 and the Developmental Services Task Force (DS TaskForce) in 2014. The scope of the DS Task Force work is broader than that of the DC TaskForce, covering essentially all aspects of the community system. Stakeholder input and guidance was received on the need for a safety net ofservices to support individuals who have developmental disabilities. DDS identified new service options to broaden the continuum of serviceoptions available to support individuals with the most challenging serviceneeds. EBSH facilities only developed through Community Placement Plan (CPP)approval process.Enhanced Behavioral Supports Homes2

Philosophy of EBSHFocus is on: Person Centered Planning - balance betweenwhat is important to and what is important for aperson, supports the consumer in reaching theirpotential and enhancing quality of life. Positive Behavior Supports - strive to support anindividual’s personal development, enhance qualityof life, avoid use of restrictive and punitiveinterventions. Trauma Informed Care - any trauma an individualhas experienced over the lifespan should beincluded in the functional behavior assessment andaddressed when recommending support strategies.Enhanced Behavioral Supports Homes3

DefinitionsEnhanced Behavioral Supports Homes(EBSH)An adult residential facility or a grouphome certified by the Department ofDevelopmental Services (DDS) andlicensed by the Department of SocialServices (DSS) that provides 24-hournonmedical care to individuals withdevelopmental disabilities who requireenhanced behavioral supports, staffing,and supervision in a homelike setting.Enhanced Behavioral Supports Homes4

Definitions (cont.)Enhanced BehavioralServices and SupportsEnhanced Behavioral SupportsHomes provides additional staffing,supervision, and other services andsupports to address a consumer’schallenging behaviors which arebeyond what is typically available inother community livingarrangements.Enhanced Behavioral Supports Homes5

Definitions (cont.)Individual Behavior Supports Plan (IBSP) The plan that identifies and documents the behavior andintensive support and service needs of a consumer; details thestrategies to be employed and services to be provided to addressthose needs; and includes the entity responsible for providingthose services and timelines for when each identified individualbehavior support will commence. This plan will include provisions of Welfare & Institutions Code(WIC) 1180.4(a). If the provisions of the Individual Emergency Intervention Plan(IEIP) are addressed in the IBSP, a separate IEIP is not required.- Source: Title 22 89968.2Enhanced Behavioral Supports Homes6

Definitions (cont.)Individual Behavior Supports Team (IBST)Those individuals who contribute to the development, revision and monitoring ofthe individual behavior supports plan. The team at minimum is composed of:1) Consumer and where applicable the consumer representative2) Regional center service coordinator and other regional center representatives,as necessary3) Facility administrator4) Qualified Behavior Modification Professional (QBMP)5) Regional center clients’ rights advocate, unless the consumer objects on his orher own behalf to participation6) Any individual(s) deemed necessary by the consumer, or, where applicable, hisor her authorized consumer representative for developing a comprehensive andeffective IBSPEnhanced Behavioral Supports Homes7

GeneralProgram PlanRequirementsEnhanced Behavioral Supports Homes

HouseRequirements Operable Automatic FireSprinklers Private Bedrooms- (4 beds maximum for EBSH)Enhanced Behavioral Supports Homes

HouseRequirements(cont.)Delayed Egress:California Building Code1010.1.9.7(For any Residential Facility,approved through CPP)Enhanced Behavioral Supports Homes

House Requirements (cont.) Sprinklers System disables in anemergency Clearly marked with signs Has audible signals The egress path from any pointshall not pass through morethan one delayed egresslocking system Emergency lighting11

Emergency Plan & Procedures Emergency Intervention Plan- a written plan, addressing the prevention ofinjury and implementation of emergencyintervention techniques by the licensee, that isincluded in the facility's plan of operation.Source: Title 22, 85101(e)(2) Must have emergency evacuationprocedures including an estimated responsetime of emergency medical services Must have a schedule of fire and earthquakedrills for all shiftsEnhanced Behavioral Supports Homes12

Program Plan Requirements Describes how the facility is going to meetall the diverse needs of the population to beserved and unique needs of the consumers. Must include a description of how thefacility is going to expedite the admissionof consumers. Applicant and administrator shall completethe RC’s Residential ServicesOrientation. The Program Plan is signed and dated byapplicant.Enhanced Behavioral Supports Homes13

Program Plan Requirements (cont) The program plan should describe the facility’s Continuous Quality ImprovementSystem, including but not limited to how:-Consumers will be supported to make choicesConsumers will be supported to exercise rightsChanging needs of consumers will be addressed, including community integrationConsumers receive prompt and appropriate routine and specialized medical servicesIndividual risk is managed and mitigatedMedication is managed safelyStaff turnover is mitigated(include narrative of the Continuous Quality improvement System, assessment tools to beutilized)Enhanced Behavioral Supports Homes14

Staffing - Scheduling Staff must be awake at night (including policy &monitoring system to be utilized). Must include at least one Lead DirectSupport Professional (LDSP) and one DirectSupport Professional (DSP) on duty are atthe facility at all times. Additional staffing isdetermined by needs of Individuals. Must ensure DSPs who have not completedon-site orientation and training will be underdirect supervision and observation of trainedLead DSP. Must have an administrator on duty a minimumof 20 hours per week per facility to ensure theeffective operation of the facility.Enhanced Behavioral Supports Homes15

Staffing - Qualifications To be an Administrator you should be aRegistered Behavioral Technician (RBT),Licensed Psychiatric Technician (LPT) orQualified Behavior Modification Professional(QBMP), with 2 years experience providingdirect care to individuals with developmentaldisabilities.Enhanced Behavioral Supports Homes16

Staffing – Qualifications (cont.) To be a Lead DSP you must become aRBT within 60 days of initialemployment or be either a QBMP, or aLPT, with 1 year experience providingdirect care to individuals withdevelopmental disabilities who havechallenging behaviors.Enhanced Behavioral Supports Homes17

Staffing – Qualifications (cont.) To be a DSP you must become aRBT within 12 months of initialemployment or be either a QBMP,or a LPT, with 6 months priorexperience providing direct care toindividuals with developmentaldisabilities who have challengingbehaviorsEnhanced Behavioral Supports Homes18

Staffing Requirements A minimum of six hours per month ofbehavioral consultation must be providedfor each consumer by a QualifiedBehavior Modification Professional Additionally, a minimum of six consultanthours per month per consumer, whichmust be appropriate to meet individualconsumer service needs.Enhanced Behavioral Supports Homes19

Staff Training DSPs must complete a minimum of 32hours of on-site orientation within 40hours of employment. In addition, DSPs receive 16 hours ofemergency intervention training.(DSPs may not implement emergencyintervention until after successfulcompletion of training.) Emergency intervention training mustbe updated annually.Enhanced Behavioral Supports Homes20

Staff Training (cont.) Must complete both years of CompetencyBased Training (Direct Support ProfessionalTraining (DSPT)) prior to or within first yearof hire. DCS: Have hands-on First Aid and CPRtraining by certified instructor prior toproviding direct care. CPR certificationmust be renewed annually. EBSH Group Homes must meet all Title 22Group Home training requirements.Enhanced Behavioral Supports Homes21

Continuing Education DSPs needs to complete a minimum of 20 hours of continuingeducation annually.- The Department requires that EBSHs provide an additional 5 hours ofcompetency-based continuing education in the areas of person-centeredpractices, positive behavior supports, trauma-informed care, and culturalcompetency. Successful completion of the competency based training (DSPT)satisfies continuing education requirement for that year only. For EBSH licensed as group homes, 10 of the continuing educationhours required by Title 22, California Code of Regulations, Section84065(j) may be counted towards the required hours.Enhanced Behavioral Supports Homes22

Admission Process Prior to Admission- RC shall assess consumer’s need for enhanced behavioral services andsupports and provide a copy to the administrator.- RC shall release written information about the consumer to the administrator- Medical assessment of the consumer Within 7 days of Admission- Administrator ensures completion of IBSP for EBSH. Within 30 days of Admission- Administrator ensures completion of functional behavior assessment.- Administrator ensures update of IBSP.Enhanced Behavioral Supports Homes23

Admission Process After the Regional Center hasdetermined the consumer meetseligibility, the provider needs toexplain how the facility:1) Obtains relevant documents:including a copy of a medicalassessment of the consumer that, at aminimum, meets the requirements ofTitle 22 Section 80069 (c) and (d)2) Plans to expedite the referral andadmission process.Enhanced Behavioral Supports Homes24

Individual Behavior Supports Plan (IBSP)Development Administrator is responsible for coordinating the development andsubsequent updating. IBSP must be developed. Administrator ensures: Within 30 days for EBSH, the team will givetheir input for inclusion into the plan and will review the plan monthlyand update as necessary. Plan must be function based, evidence based, target functionallyequivalent replacement behaviors. Administrator shall submit the IBSP and updates to vendoring orplacing RC and to the RC Client Rights Advocate.Enhanced Behavioral Supports Homes25

Consumer Rights Consumer’s Rights Protection Reporting requirements Inclusion of Disability Rights California Representative Explanation of how facility will ensure the protection of consumerrights, including those specified in Sections 50500-50550 (include howrights are explained to consumers and facility practices to protectconsumer rights, including reporting provisions of rights violations andsuspected abuse).Enhanced Behavioral Supports Homes26

Facility FilesFacilities shall maintain a facility file available on site, which mayinclude electronic formats, that includes at least the following: Facility program plan Regional center facility Substantial inadequaciesliaison monitoring Weekly staff schedules Corrective action plans Regional center Qualified Sanctions Personnel recordsBehavior Modification Emergency InterventionProfessional monitoring Facility appeals.Plan Behavior and emergency Certificate of programintervention dataapproval as issued by the collection and reportingDepartment Findings of immediatedangerEnhanced Behavioral Supports Homes27