The proposal to create Enhanced Behavior Support Homes (EBSH) in Washington state is an attempt to provide appropriate therapeutic options to meet the needs of DDA-eligible individuals with level 2 or 3 autism and/or Intellectual Developmental Disability (IDD) who experience significant challenging behaviors putting them at risk of institutionalization. Behaviors may include self-injury, injury to others, property damage, lack of personal safety, frequent police involvement and/or trips to the Emergency Department or hospitalization that are not medical in nature.
What currently exists
The highest level of residential support for DDA-enrolled clients is Supported Living. Unfortunately, we have heard from many families with a loved one who experiences significant challenging behaviors whose applications are being denied by multiple Supported Living Agencies. In other cases, individuals are not being accepted back to their Supported Living placement after an episode of explosive behavior.
While some Supported Living agencies can manage the care of individuals with less challenging behaviors, EBSH is being proposed for the population with the most significant challenging behaviors who currently is not being served. To be clear, currently there are no therapeutic long-term placement options in Washington state for this high-needs populace.
It’s not enough and the results are devastating
When residents of Supported Living lose their placement or when applicants are rejected, the person may end up stuck in Emergency Departments or hospital beds for long periods of time. Physical restraints and sedation are commonly used. Individuals are often sent home, unsafe to themselves and others to overwhelmed aging parents, and the traumatizing cycle repeats. Sadly, the worst-case scenario is happening across our state: parents are not equipped to keep their loved-one or family safe, and the individuals are placed outside the state away from family, community, routine, and all they know. Here is one family’s story.
What is being suggested now: More pay and more training.
To address the high staff turnover rate at Supported Living agencies, there is currently funding allocated to increase hourly wage and provide more staff training. We fully support this advocacy and agree that it is absolutely vital for Supported Living staff to earn a living wage.
Having said that, wage increases alone will not meet the needs of this very specific segment of the ID/D population, who are profoundly impacted by their disability and have significant challenging behaviors.
What EBSH offers, not available in other housing options:
The two things EBSH offers, not available in current the Supported Living model of support is
Direct care provided by Behavior professionals and
Timely medication management, as needed, by on-staff medical providers:
1. Positive Behavior Support plans and implementation by in-house staff professionals:
Behavior Specialists (PhD or MA level therapists with expertise in Positive Behavior Supports) conduct Functional Assessments, design written Positive Behavior Support Plans, and collect and review data.
They oversee the behavior supports on an on-going basis to ensure the continuing efficacy of the behavior plan, and make adjustments as necessary.
The Positive Behavior Support Plans, in the EBSH model, are implemented in the home environment by Behavior Technicians, experienced providers who implement the treatment plan according to design, modify the environment to meet the individual’s needs, and report back to and consult with the supervising Behavior Specialist.
To be clear, Behavior Specialists are not able to supervise non-behavior professional staff.
2. Medication monitoring and adjustments by on-site medical professionals. Currently, there are very few providers in the community who work with the population who experience significant challenging behavior, and as a result, there are very long wait lists to see someone for medication adjustment. Currently, a huge barrier is how to be able to safely change or titrate medication while the individual remains in the community.
In the EBSH model, the medical providers, who are able to prescribe medications, are on staff as part of the team, and can make safe, timely adjustments, as needed.
In conclusion, more Supported Living homes and/or additional slots are not enough to address the needs of our DDA-enrolled high-needs individuals who experience significant challenging behaviors who require both therapeutic behavioral interventions, and specialized psychiatric services (including medication management) in the home setting. Both of these needed elements are addressed in the Enhanced Behavior Support Home model.
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