Issue Sheet – Build a quality system of care for the developmentally disabled

1. State supported living centers face an acute crisis because they have inadequate numbers of trained, qualified staff. The duties of all staff are growing much more complex and stressful as residents in state schools become more medically fragile, have more severe levels of developmental disabilities, and have increasingly serious and complex behavioral and psychological complications. More and better trained staff are urgently needed at every level, from daily direct care staff to para-professional and professional specialists. Some previous long-term decisions on staffing patterns have proved to be unwise, and must be reversed.

A. Low pay means that State Supported Living Centers (SSLC’s) are unable to attract and keep sufficient employees to provide consistent staffing ratios. This results in constant pulling of staff to work with residents with whom they are unfamiliar and forced overtime. We propose an across the board pay raise for all staff. In addition, direct contact workers in the MRA, RTT and the LVN series should all receive a two pay grade increase in pay.

B. More direct care positions must be approved and funded. SSLC’s are operating with staff-to-resident ratios less than those required when the system was under the direct court supervision that resulted from the Lelsz class action lawsuit. The Department of Justice has recently issued the results of an investigation that cites under staffing and under resourcing of critical professional positions as the source of unacceptable levels of care.

C. The number of staff in the professional specialties must increase. This requires increasing pay levels to make the positions attractive to qualified people, and increasing the number of positions allocated. Without sufficient psychological, psychiatric, medical, therapist and nursing services frontline supervisors and direct care staff are left without adequate programmatic guidance for care and treatment.

D. Training programs for staff must be dramatically improved. The work with SSLC residents today and in the future requires increasingly specialized skills for all staff. This includes: increasing staffing levels in staff development programs; increasing and improving training to deal with dual diagnosis and behavioral issues; and a real professional development program that provides employees with the opportunity to seek higher level training and certifications that lead to a career path.

2. The state’s overall system for referral of individuals to different levels and kinds of care must be thoroughly evaluated and reformed. In a legal and social environment that increasingly reinforces the principle that individuals should receive services in the most integrated setting possible and have a choice of placement the MRA’s are functioning only as a conduit to the community group homes This means that the of mission of MRA’s should be changed from one of just pushing as many people as possible out of the SSLC’s to one of fully informing parents, guardians, and individuals of the full array of services available including SSLC’s.

A. The Legislature should mandate a statewide inventory of available services. This is particularly crucial for services that provide individuals with severe developmental, behavioral, psychological, and medical challenges to receive appropriate care. Included with this inventory should be an analysis of services offered in SSLC’s and in group homes, levels of accountability for various services and providers and the ways in which various services and providers integrate and coordinate services and follow clients who may move from one provider to another.

B. The mission of the SSLC’s must be recast as a critical part of a broad system that provides a spectrum of services in a spectrum of settings rather than a stand alone alternative or competitor with other types of services.

C. DADS and the Legislature must reconsider the withdrawal from responsibility for direct provision of services that has marked the past decade. The transfer of responsibilities has made services more fractured, more confusing, more expensive, less accessible, and less integrated than before. A unified, integrated state operated system of SSLC facilities, varied community-based residential arrangements, and out-patient services in which the parts reinforce the whole is critically needed.

3. Re-align the mission of the SSLC and build an integrated statewide system. In the mid-1990’s TxMHMR was moving toward a system in which a statewide network of small group, semi-independent, and other community-based residential arrangements and other supports was built around and outward from the SSLC’s. Group homes and other residential arrangements were supported by the SSLC’s with medical care, casework, crisis intervention, therapy, workshops and other services. The programs (most notably at Richmond and Amarillo before it was dismantled) allowed individuals with serious challenges to live in progressively less restrictive settings.

A. Re-orient SSLC’s services to provide, in addition to the required levels of care for those who require institutional care, a spectrum of professional, supportive, crisis-intervention, respite, and other out-patient services for individuals who do not live on the campus and their families and care-givers.

B. Fund an expanded, state (DADS) operated system that includes group homes, various levels of semi-independent and independent living, and on-campus resources at the state schools so that individuals have access to an integrated system that provides appropriate services in appropriate settings for all who need them, and in which individuals have access to the various kinds of services, including residential arrangements, as their needs change.

4. Most of the failures noted in the DOJ investigation are the result of the long-term and severe refusal of the Texas Legislature to allocate adequate funding resources for care and services for the developmentally disabled. This is not a matter for budgeting tweaks: Texas ranks 48th to 50th in the country in funding for these services. While this issue will hear the response that “you can’t solve problems by throwing money at them,” in Texas we’ve never tried it.