Department of Developmental Services

At a Glance

PETER H. O’MEARA, Commissioner

Kathryn du Pree, Deputy Commissioner

Established – 1975

Statutory authority – CGS Chap. 319b – 319c

Central office – 460 Capitol Avenue,

Hartford, CT 06106

Number of full-time employees – 3,762*

(total filled count as of June 30, 2008)

Number of consumers served – 20,387

Recurring operating expenses - $970,408,142

Organizational structure – Services and Supports to over 20,000 individuals and their families, including birth-to-three services, are provided through a network of public and private providers across Connecticut. The Office of the Commissioner oversees and directs the following divisions: Administrative Services; Family and Community Services; Legal and Government Affairs; Financial Services; Equal Opportunity Assurance; Investigations; Quality Management; Consent Decree Coordination; Legislative and Executive Affairs; and the Office of the Ombudsperson. The department operates three regional offices, various campus programs, and an Operations Center in Central Office, which coordinates all contracted services. In addition, the department is the lead agency for the Connecticut Birth-to-Three Program.

*This number was reduced to 3,466 due to 296 full-time employees who retired under the RIP as of July 1st.

Mission

The mission of the Department of Developmental Services is to join with others to create the conditions under which all people with mental retardation can experience presence and participation in Connecticut town life, opportunities to develop and exercise competence, opportunities to make choices in the pursuit of a personal future, good relationships with family members and friends, and respect and dignity.

Statutory Responsibility

The Department of Developmental Services (DDS) is responsible for the planning, development, and administration of complete, comprehensive, and integrated statewide services for persons with mental retardation and persons medically diagnosed as having Prader-Willi Syndrome. DDS provides services within available appropriations through a decentralized system that relies on private provider agencies under contract or enrolled with the department, in addition to the state operated services. These services include residential placement and in-home supports, day and employment programs, early intervention, family support, respite, case management, and other periodic services such as transportation, interpreter services, and clinical services. In addition, the Autism Division (created pursuant to PA 07-4 JSS) continues to operate the Autism Pilot Program developed by DDS for adults with autism who do not have mental retardation.

Public Service

The department continues to engage in a number of activities designed to improve services and the management of its public and private programs. DDS continues to be involved in initiatives designed to meet the increasing expectations of the Centers for Medicare and Medicaid Services (CMS) concerning health and welfare and quality improvement protocols for the operation of Home and Community Based Services (HCBS) waivers.

Emergency Management:

DDS and the Connecticut Department of Emergency Management and Homeland Security (DEMHS) continue to enhance their collaborative relationship established in 2002. DDS, in association with DEMHS, has participated in twenty-six emergency exercises designed to test response readiness at federal, state and local levels. Exercises cover an array of circumstances that require emergency response, such as radiological accidents, bioterrorism, weather related events, and pandemic disease outbreaks. DDS has developed a Pandemic Influenza Business Continuity Plan. The department developed additional Business Continuity Plans that address a disruption of services as a result of a local emergency event. Both plans are updated annually. DDS staff participated as attendees and as presenters at an array of emergency management workshops sponsored by federal, state and local agencies.

DDS staff, in collaboration with members of the Capitol Region Council of Governments’ Capitol Region Emergency Planning Committee, participated in the design and implementation of a training curriculum titled Addressing the Needs of People With Disabilities During Emergency Circumstances. As of July 2009, more than 1,000 municipal, regional, and state emergency planners and first responders across north central Connecticut have completed the training.

DDS staff are members of the following emergency management committees: DEMHS Area 1 and Area 2 Regional Emergency Planning Teams, The Inter-Agency Supportive Care Shelter Workgroup, and the Pandemic Interagency Strategic Planning Taskforce. DDS maintains an associate membership in the Connecticut Emergency Management Association. In addition, DDS in association with DEMHS, FEMA and the Nuclear Regulatory Commission (NRC) is in the process of establishing Southbury Training School as a host facility for special populations. The host facility will be a reception, triage and decontamination site in the event of a radiological accident at the Millstone Nuclear Power Station in Waterford. To establish the host facility, DDS has received grants from the Nuclear Safety Emergency Preparedness (NSEP) fund for physical plant renovations, equipment and training. The projected completion date for this initiative is during FY10.

Since August 2007, DDS staff has sent more than 70 emergency safety alerts and advisories to public and private service providers. Topics ranged from hot water temperature safety awareness to food and product recall information. Safety alerts and advisories are also published on the DDS website.

Self Advocate Coordinators:

DDS’s Self Advocate Coordinators (SACs) have become an integral part of the agency. These positions assure that consumers have an active role in the development and evolution of the department’s service system. They continue to assist DDS staff within each of our three regions to better understand and apply best practices in self-advocacy and self-determination for all individuals who receive services from the department. DDS Self Advocate Coordinators continue to help lead change efforts in Connecticut by 1) expanding and enhancing self advocacy in Connecticut (In 2008-2009, the Self Advocates helped create six new regional self advocacy groups. They also assisted other existing groups to create and implement monthly FAB agendas (Fun, Advocacy, Brain Power activities); 2) representing consumer viewpoints on agency committees and workgroups (The main focus of the SACs this past year has been on employment. They have been involved in a variety of employment activities and committees with both DDS and Connect-Ability); 3) encouraging consumers to have more influence in policy development (The SACs were involved in helping the department to review and upgrade it’s fire safety policy and training curriculum); 4) enhancing the training provided by the department from a consumer’s perspective (The SACs helped organize the Connecticut People First Self Advocacy Conference and participated in the STS Healthy Choices Conference. The People First Conference had its highest attendance ever with more than 250 attendees); and 5) creating materials written for, and by, people with developmental disabilities (The SACs are in the process of creating a DDS consumer website which will be a significant expansion of the existing self-advocacy website.)

Improvements/Achievements 2008-09

Individuals Served:

During this past year the department successfully completed the fifth and final year of the “Waiting List Initiative” by providing new residential supports to 218 people who had been on the Waiting List, and enhanced family supports to 101 families, with the FY09 allocation. In FY09, a total of 1415 individuals were provided new or additional services with residential, day and employment supports.

In FY09, DDS provided supported employment or adult day services to 253 new high school graduates and 78 individuals receiving day age-out funding. The department also provided community residential supports for 52 young adults aging out of the Department of Children and Families (DCF) or local education authorities (LEAs). This is the fourth year that DDS has operated the Voluntary Services Program (VSP) for children who have mental retardation and behavioral health needs. During the past year, 39 children transferred to this program from DCF and another 45 were newly enrolled, bringing the total number of children served in the DDS VSP to 427.

Aging Services:

There are more than 2,500 individuals served by DDS who are over the age of 55. The Aging Focus Team advises the department on the priorities and the future needs of aging individuals, including the development of new service alternatives and the integration of aging persons with developmental service needs into generic elderly programs. The Aging Services Coordinator continues to develop policies and procedures that support the needs and desires of aging consumers, collects and disseminates relevant data, and shares educational information with individuals, families, DDS employees and support providers. The department piloted a caregiver education program that was well attended and received. Caregiver education programs will continue to be provided.

Individual and Family Support Teams:

Late in 2007, the Department of Developmental Services (DDS) began offering a new support service to families of children and adults who are not enrolled in a DDS HCBS Waiver. A core group of Family Support Workers is available in each region to provide in-home and community supports including respite, short-term in-home assistance, support to participate in community activities, individualized family support, assistance to develop life skills, implementation of behavior programs, and assistance to attend medical and dental appointments.

Family Support Workers provide time-limited supports to assist families who care for their family members at home. Supports are provided by DDS paraprofessional staff with extensive experience and training. Their services are available Monday through Saturday from morning to early evening, and on Sundays if needed. Family Support Workers are experienced with individuals who have mental retardation and associated physical, behavioral and mental health issues. During FY 09, 1189 individuals were served statewide, including 448 children.

Case Management:

DDS, in its ongoing commitment to improving Case Management, continued to convene the Case Management Review Team during FY 09. The Team further reviewed case management processes and identified areas to streamline, simplify, eliminate duplication and layers of review, enhance technology support and enhance clerical support. A number of work process improvements have been implemented based on survey results. The department has plans for information technology enhancements during FY 10 that will result in additional efficiencies in case management.

Respite Program:

DDS’s Respite Centers continue to be a tremendous success. DDS Respite Centers provide 24-hour care for extended weekends in comfortable home-like environments. The department has 11 respite centers that served a total of 1,203 individuals statewide in FY 09, including 384 children.

Federal Reimbursement:

During FY 2009, the department generated $392,359,788 in federal Medicaid reimbursement. In fiscal year 2009, 8,714 people participated in the Home and Community Based Services Waiver Program. This is a net growth of 698 individuals over fiscal year 2008 enrollment. The HCBS waiver program allows for federal reimbursement for residential habilitation, day programs and support services provided in the community.

Birth to Three Program:

The Birth to Three Program received a total of 9,228 new referrals in FY09, a 1.3% increase over FY08.  Over the course of the year, 9,671 eligible children from all 169 towns received early intervention services.  In FY09, because autism specific programs and additional general programs were added to address capacity issues, Birth to Three now has statewide coverage of all types of programs (general programs, autism-specific programs, and programs for children who are deaf or hard-of-hearing). The restoration of 2003 eligibility criteria that began July 1, 2007 has resulted in a 12% expansion of the number of children served over the past two years (700 more children per month as of June, 2009).   The Birth to Three Program, for the third consecutive year, received the highest determination of “meets compliance” from the U. S. Department of Education, indicating that the program fully complies with the Individuals with Disabilities Education Act, Part C.   Outcome data shows that 91% of families agree that Birth to Three services have helped their family to help their children develop and learn and in looking at three functional outcomes for children, 54% to 58% of the children who received at least six months of service attained age level functioning by exit.  Of all children exiting Birth to Three, 65% do not require special education services in Kindergarten.

Quality Service Review:

DDS has redesigned its quality management system to align with requirements and expectations of the federal Centers for Medicare and Medicaid Services (CMS) and existing state statutory and regulatory requirements. The department’s new quality system is based on quality of life outcomes, emphasizes continuous quality improvement, and involves individuals and families in the design, review and oversight of the quality system.

The Quality Management Services (QMS) Division was reorganized in FY08 to include the centralization of regional quality monitoring functions. The reorganization integrates ongoing review and results for all services into a statewide system of oversight.

The Quality Service Review (QSR) is the department's quality review system that measures personal outcomes and provider support expectations across all service delivery settings. The QSR evaluates the quality of supports delivered by qualified providers and assesses the individual’s satisfaction with services and supports. The QSR incorporates elements from pre-existing departmental quality assurance activities as well as new components to address CMS’s quality system expectations. It consolidates quality management activities for the variety of services offered to individuals into one review system. All providers will have services reviewed using the same personal outcome measures, performance indicators and methods, and will be certified to deliver distinct services as part of the expanded quality oversight process. Provider service performance can then be compared, and the results from this comparison can be used by individuals and their families to choose from the array of service providers throughout the state.

The QSR also engages providers in self-assessment activities to evaluate the effectiveness of their own service and quality management systems. These combined activities result in comprehensive data collection and analysis that includes quality improvement planning and implementation at provider agency, regional, and state system levels. This integrated quality management approach will allow for better communication, coordination, analysis and reliability.

The QSR uses several approaches to review and improve quality. Information is collected by consumer interview, support person interview, document or record review and observation. DDS case managers serve an important role in assisting individuals and their families to plan and review the quality of their supports and services. DDS quality reviewers and resource managers look at service patterns and trends and evaluate provider performance at the regional level through quality review visits with individuals in their home or day setting. DDS quality reviewers, using a random sample of individuals by the type of service they are receiving, also conduct periodic state-level provider certification reviews. These services include Individual Supports (including services formerly known as Supported Living), Day Services, Supported Employment, Community Living Arrangements and Respite.

The QSR is designed around seven general focus areas. The focus areas were selected based on the department’s mission, principles of self-determination, and discussions with individuals, family members, and support persons about what is important in their lives and what quality means to them. A broad statement of principle defines each of the seven focus areas. The focus areas are: Planning and Personal Achievement; Relationships and Community Inclusion; Choice and Control; Rights, Respect, and Dignity; Safety; Health and Wellness and Satisfaction.

Several methods are used to collect data in order to determine if the QSR personal outcomes, support expectations and quality indicators are achieved. These methods of data collection are used at both the regional and state levels at various times throughout the year. Reviewers use quality indicator data collection tools to conduct the review process. The quality indicators identify required items for verification and provide guidance for quality reviewers. The data collection methods are: interviews with the individual receiving services and his or her preferred support person; observation of the individual where his or her supports are provided; documentation review of the individual’s individual plan and other records; safety checklist review of the individual’s environment and emergency planning.

The department was awarded a Systems Change Quality Improvement Grant from CMS to design and build a data system to support the new Quality Service Review process. The data system permits analysis of quality indicators, tracking of performance measures over time, provides a mechanism to track corrective actions and contains the foundation for the larger Quality System Review and Improvement initiative. Additionally, the grant supported efforts to design methods to assess quality in family and personal homes while respecting privacy. The department’s regulatory compliance process for Community Living Arrangements (group homes) will soon be integrated into the QSR process, which will then be the department’s sole quality review methodology.

Information Reported as Required by State Statute

Affirmative Action/Equal Opportunity Assurance

Commitment to affirmative action is incorporated into all aspects of DDS’s employment process including recruitment, selection, hiring, training, promotions, benefits, compensation, layoffs, and terminations. It is the objective of the department to achieve the full and fair participation of women, African-Americans, Hispanics, persons with disabilities, and other protected groups in our workforce.

The department’s commitment to affirmative action is reflected in its practices for selecting outside contractors. In line with this, the department will not knowingly do business with any contractor, sub-contractor, bidder or supplier of materials who discriminates against members of a protected class. Additionally, DDS has established goals for the use of small businesses and minority and women-owned businesses and actively solicits their participation.

Culture is a major determinant in how various groups of people approach and use DDS supports and services. To this end, the department has developed strategies to nurture the development of a culturally diverse workforce, expand outreach efforts, and provide services and communications that are sensitive to the language and culture of individuals and families from diverse backgrounds. Additionally, DDS public and private providers are required to conduct organizational cultural competence self-assessments and improvement plans.

Developmental Disabilities

The Council on Developmental Disabilities is an independent entity, operating under the federal Developmental Disabilities Act (PL 106-402), composed of Governor-appointed members, and is attached administratively to the Department of Developmental Services. The mission of the Council is to promote full inclusion of all people with disabilities in community life. In 2008-2009, the Council’s budget was $781,567 for initiatives on public information and education, inclusive education, positive behavioral supports, adult and youth self-advocacy and self-determination, inclusion in faith communities, service broker and peer mentorship demonstration, aging-in-place, social role valorization training and robotics.

Regulations/ Studies:

Autism Pilot:

The Autism Pilot closed out the year with 56 participants from the Greater New Haven and Greater Hartford areas. The UCONN Outcome Study was completed and is posted on the DDS website. Training of private agency staff continued. The editing of the second training film was completed and will be used in the next year. The department continues the process of evaluating the feasibility of a waiver for autism services. The direction of the Autism Division will become clearer once costs are identified, eligibility is determined and dedicated funds are appropriated for these services.

Regulations:

Amended regulations concerning the Administration of Medications: Residential Facilities, Respite Centers, Day Programs, Community Training Homes, and Individual and Family Supports were submitted for approval to the Legislative Regulations Review Committee. These regulations are being amended to reflect changes in the settings where the department’s services are provided and to reflect current best practice. A public hearing was held on these regulations and comments and testimony were received and responded to by the department. The Administration of Medications regulations were amended to reflect the public’s comments. The Regulations Review Committee is expected to take up these regulations at the committee’s September 2009 meeting. The department is in the process of drafting regulations concerning Home and Community Supports and Services as well as amending the regulations concerning Community Living Arrangements and Community Training Homes Licensing.