At Quality Trust (QT), staff who provide monitoring and advocacy interact directly with people receiving support and their families, the Dept. on Disability Services (DDS), and provider staff. While not across the board, we are seeing staffing problems, an overly siloed bureaucracy at DDS, and how that negatively affects some people with significant behavioral health and psychiatric needs. This post intends to discuss trends identified through advocacy referrals and ongoing monitoring.
We are currently helping three people with their requests for changes to their residential services. Two families contacted us to assist with transition issues, while the third person has been “transitioning” from St. Elizabeth’s Hospital for seven months. He is well known to us.
The person transitioning out of St. Elizabeth’s has been clinically ready to do so for months. His discharge has been delayed partly because he is seen as difficult to support due to psychiatric issues and because of DDS’ transition process. The referral process for transitioning to a new community-based IDD provider began in January. That initial process continued for five months. Although multiple referrals were generated, they were inappropriate for his needs. Reliance on an overly siloed internal approach and poor communication within DDS/DDA and between DDS and potential providers resulted in five months of frustration. He has yet to move at the time of this post.
The second person, a young man who has been in respite for approximately six months, is waiting for permanent residential placement. This person’s complicated diagnoses caused his previous provider to become overwhelmed, so his family began the residential transition process. His family felt left out of the process, so they reached out for QT’s assistance and expertise. Again, only after a lengthy and chaotic process (eight and a half months at this point) he and his family chose a provider. He has yet to move at the time of this post.
A third person is a young man who has a housemate whose aggressive outbursts left him unwilling to continue the placement. Here again, the family’s outreach to us was rooted in their frustration with the lack of urgency demonstrated by DDS’ in finding his roommate a new place to live. As in the other cases, the transition process dragged on. His usage of an emotional support dog and the providers’ reluctance to make that accommodation are cited as the reasons why this has taken so long.
These three people represent a trend we are seeing. For varied reasons, they are not the “typical” person previously supported by DDS. Many of the young people who come to us demand more autonomy in their lives and are disappointed with what they receive from the current system. People experiencing significant behavioral health issues are not receiving the interventions they need. In some cases, this creates stress and fear within the provider community. Staffing shortages stemming from the pandemic are made worse by staff who leave due to what they see as chaotic working conditions. The younger generation of people coming into services is making it clear that change is needed. The issues noted here: bureaucratic silos within DDS, failure to understand and react to behavioral health needs, and someone needing his pet to accompany him to a new home should not be occurring in the Nation’s Capital in 2022. We must do better!
DDS is taking steps to address some of these issues. The new waiver expands services and provides more regulatory teeth regarding quality assurance activities. The Individual Family Supports Waiver should enable DDS to provide more targeted services to many people to rationalize spending across that system. This should delay the introduction of a waiting list for as long as possible. DDS also provides enhanced training for their own and provider staff on how best to support people with significant behavioral health issues.
If you would like to read our report, which looks at several of these issues in greater detail, please click here. Looking Back: A Collaborative Longitudinal Analysis of Data Impacting People in the Disability Service System over 10 Years