Report: Support Service Teams, First 60 Days

Department of Human Services
Division of Developmental Disabilities
Information Bulletin
DD.10.004

Report: Support Service Teams, First 60 Days

12-01-10

The Support Services Teams (SSTs) slowly began receiving referrals in a provisional mode on August 16, 2010. See general information about the Support Services Teams. 

In the subsequent 60 days through October 14th, 2010, 58 referrals were made to the SSTs. Since the SSTs accept referrals on a "no decline" basis, the distribution of referrals reflects the referrals made to them. Those referrals were assigned to the following SSTs:

Name of Team Number of Referrals (as of 10-15-10)
Rockford 10
Chicago 6
New Lenox 8
Peoria 11
Springfield 13
Carbondale 10
TOTAL 58

First a few basic facts about those referrals, then more qualitative information about the experience will follow. Of the 58 persons referred to SST:

  • 17 were female and 41 were male.
  • 37 were in a Community Integrated Living Arrangement, 11 were in an ICFDD, 1 was in a child group home, 2 in Community Living Facility, 1 was in a nursing facility, and 6 were at home (not receiving residential support).
  • Of the 52 persons who were receiving services, there were 43 different providers.

With 14 different possible reasons for referral, most referrals have multiple reasons and only three persons have one reason. Physical aggression that the provider agency or family have been unable to address is by far the most common reason for referral. The top six most common referral reasons are:

  • Physical aggression (46 persons)
  • Property destruction (26 persons)
  • Verbal aggression (23 persons)
  • Self abuse (21)
  • Recurrent psychiatric hospitalizations (17 persons)
  • Other behavior problems (17 persons)

Please see a complete list of Definitions of Reasons for Referral. 

Several persons were hospitalized when referred to SST; others experienced a hospitalization during the SST involvement.

During the first 60 days, four persons referred to SST were admitted to a State-Operated Developmental Center for a short term intervention:

  • one in September from an ICFDD
  • three in October, two from a CILA and one from home

During the first 60 days, two referrals were closed: 

  • one person from a CILA in west central Illinois
  • one person was at home in northern Illinois

    In both situations, the SSTs provided services and were no longer needed to address the reasons for referral.

The following comments from a service provider and a PAS/ISA provide a bit of a window into the SST experience. They emphasize the importance of good communication, the value of a fresh perspective, and the ability to use SSTs' recommendations for the referred person in working with other individuals.

Mark Ammer, Director of Clinical Services at Clearbrook in Arlington Heights reports:

"Overall, I was impressed with the skill level of the team, the recommendations that were made and the commitment to make sure that they observed the client and staff persons in the environments where he lives and works at various times of the day and night. I am sure that we will be seeking out these services again when we are faced with a particularly challenging client."

Bobbi Grawe, Executive Director of West Central Service Coordination in Pittsfield offers the following reflection after working with SST on 4 referrals:

"We recently closed a case with them. The SST gave behavioral suggestions in working with the individual and the comments from the IDT members (home, DT and ISSA) were that many of the suggestions can be used not only with this person, but with others in the home. With this particular case, we all just felt like we were in a rut and looking for new ideas that were specific in supporting the individual. The SST gave us that.

I think it is natural for us to get defensive about how we are doing things and not wanting someone from the outside to come in and think they can suggest to us how to do it better. Learning what doesn't work is an important step in succeeding. Success comes when we try something that doesn't work and then are willing to accept we need to try something different.

We get stuck wanting to continue doing what wasn't working before partly because we are not challenged to do something different and partly because we aren't able think outside our current way of thinking, we get so caught up in the crises and daily struggle we don't have the energy to think objectively. The SST has challenged us to change and given us suggestions for different ways in dealing with the individual."

In addition to observing and assessing the person in their environments at a wide variety of times, supporting staff and family members to provide consistent helpful interventions, and identifying needed clinical resources on a case-by-case basis, SSTs have provided unique supports to the persons referred and to the larger system. Some of the kinds of general and more unique supports and activities that SSTs have provided:

  1. Behavioral services: functional analysis, training on behavioral programming, review of existing behavior plans. Many agencies report to SST that this is the primary and most desired feature of the program. Key is observing staff after implementation and providing feedback. Southern Illinois has a shortage of available behavior analysts (BAs). Northern BAs will not make the long drive and local BAs have a 6 week waiting list. Community Ties of America funded ABA of Illinois to have a BA on site for a couple days a week until they had enough funding from the waiver clients to operate. ABA of Illinois has added another BA to the area.
  2. Linkage: Finding options for placement in the community. SSTs help PAS/ISC by giving better descriptions of the kinds of environments and supports the person needs and being available to help in the transition and training of new staff. During start-up, the northern SSTs focused on creating a database on existing services that they continue to improve. The SSTs employ staff who formerly worked in developmental disability services that have familiarity with existing resources.
  3. Training: Training on de-escalation techniques and defensive techniques, education on mental illness, modeling for staff, and role-plays have already been provided for referrals, their staff and families and will continue to be done. The northern SSTs brought in and were trained on Quality Behavioral Solutions, Safety Care Training and their providers will benefit from these new skills. The Oregon Technical Assistance Corporation (OTAC) trained the southern SST staff on how to train behavior specialists so that SST can provide this training to their agencies.
  4. Access to specialists or specialty services: The southern SST's consulting psychiatrist has been used many times to review diagnosis, medications, and to consult and give feedback to treating medical doctors and psychiatrists. A northern SST has been helpful in getting a person into a psychiatric hospital after that person had been denied access. A northern SST was able to obtain an ambulance to take a person to the SODC after the family had been unable to get an ambulance.
  5. Coordination between Network Facilitators, PAS/ISC Agencies, providers, families, and day programs on these complicated and needy persons referred to SST. The SST flexible role and clinical expertise is helpful to bridge communication between treatment providers, PAS/ISC and state staff.
  6. Education: The SSTs are attending CART and advisory councils to let them know about the SST service, as well as offer clinical input into persons brought to CART. The SSTs are helping PAS learn about how to apply for additional services they may not have used previously. One SST helped a new agency that received their first client, a person referred to SST and transferring from another provider, to understand how to best apply the CILA policies to this needy client.
  7. Collaboration: SSTs focus on supporting existing providers, hearing their issues, limitations and frustrations, what they have tried to do, and then empowering the providers to implement their own solutions to complicated behavioral issues or to learn new skills or try new methods.

The SSTs and the state staff are in frequent communication with the evaluator for this program. The following areas will be evaluated:

  • cost effectiveness of SST
  • changes in usage of hospital services SODCs and medications by referred persons
  • changes in availability of clincial services
  • changes in agencies' (with referred persons) ability to provide services to persons with behavior and medical challenges
  • changes in the stability, quality of life and functioning of persons with developmental disabilities after SST intervention.

The SST processes and procedures continue to evolve as feedback is received and all partners better understand how to work together in this new way. Examples of changes made as a result of input:

  • PAS/ISC asked to be included in SSTs first meeting with service provider or family. This change was made immediately.
  • State staff asked for weekly written reports on each person referred and that was implemented.
  • As a result of many requests about how to be considered for assistance of SST, a flow chart was sent out to the broad DDD community system.
  • Some asked for a list of the potential information that SST will want to review upon receiving a referral.

These items were sent out and posted to the DDD web site. Individuals are receiving help and the Support Services Teams are progressing. Thanks to those of you who have volunteered comments, suggestions, and requests.