GLENWOOD, INC



GLENWOOD, INC.

Children’s Residential Services

Subject: Programs Description Number: 3.00

Effective Date: 11/12/2015 Reviewed: 11/12/15 Revised: 11/12/15 Page 1 of 7.

Authority Reference: CARF 1.M.1-7; Glenwood Inc. Policies and Procedures Manual

HISTORY

Children’s Residential Services was established in 1980 to provide residential facilities for students who attend Allan Cott School and whose needs required around the clock care in learning self-help daily living skills and behavioral management skills.

The program began with one home, McDonough House, which was established in 1980 with 6 residents. In 1983, the second home, Reynolds House was added. By 1985, the two homes moved out of the community to their present locations at Glenwood. The Drummond center was added, initially as a crisis unit, in 2002 and was later transitioned into a long term facility (2010). Harper House was added in 2013.

TREATMENT PHILOSOPHY

Glenwood, Inc.’s treatment philosophy requires a positive approach to behavior management and the progressive use of the least restrictive alternative, guides the various therapeutic programs offered through the Division of Autism Services Children’s Residential Program. Glenwood’s positive approach to behavior management emphasizes and enforces Client Rights and Employee Code of Conduct/Ethics.

Glenwood Inc. and the Division of Autism Services prohibit the following procedures:

1) Any procedure that violates client and/or family rights for respect, dignity or safety.

2) Procedures that may result in denying a nutritionally adequate diet

3) Verbally abusive and/or derogatory comments and language

4) Corporal punishment

5) Psychoactive medications for the sole purpose of behavioral control, convenience of staff or as a substitute for a behavior management plan.

PROGRAMS DESCRIPTIONS

Children’s Residential Services meet the residential and behavioral needs of individuals with severe autism, who have difficulty functioning in a public school setting, community setting, and in the homes of their families. We provide 24 hour treatment, focused on the Individuals unique needs and captured in a Person Centered Treatment Plan. Intensive training is provided to our individuals served in behavior management, communication skills, social skills, activities of daily living and community involvement, to assist them in becoming as independent as possible and to foster appropriate interactions in a community setting. We collaborate with JCIDDA, the ID/DD 310 Board case managers, and the Department of Human Resources social workers, if applicable, to develop and review our Individuals served Person Centered Plans of Care (POC) and to develop transition plans for individuals exiting the program to ensure appropriate placement to their home setting or to adult day and/or subsequent residential programming.

Between 28 and 33 individuals are placed in the Children’s Residential services long term residential care program. The children reside at Reynolds House, McDonough House, Harper House or Drummond Center. The expected length of stay in until this is no longer their least restrictive environment or until age 21. These individuals attend Allen Cott School during the day (Monday – Friday). Male and female children and adolescents, between the ages of 6-19 are eligible for placement consideration.

POPULATION SERVED

The Children’s Residential Services group homes, Reynolds, Harper, McDonough and Drummond, serve a total capacity of 33 male or female individuals ages 5- 21 with a primary diagnosis of autism (ASD). All houses are located on Glenwood’s campus; three hundred and sixty three acre wooded setting in southeast Jefferson County. Referrals are accepted throughout the state of Alabama from professionals and parents.

The individuals in the homes are placed according to their age, size, functional level and behavioral issues. A Person Centered Plan of Care (POC)) emphasizes instruction in the independent performance of daily living activities and supervised community experiences. A Behavior Intervention Plan (BIP) addresses target behaviors for remediation by emphasizing positive programming and adaptive skills.

REGARDING SPECIAL TREATMENT CONSIDERATIONS FOR FAMILIES AND/OR INDIVIDUALS SERVED

The Children’s Residential Programs can make accommodations for family members who are deaf, hard of hearing, or have limited English proficiency by arranging for the necessary interpretive services. In addition, access to a TTY and closed captioning can be arranged. Facility accessibility for families with mobility impairment is available throughout Glenwood’s campus. The admission of Individuals requiring these accommodations would be subject to Daniel House I’s admission/ exclusionary criteria and initial clinical assessment. This assessment would address the feasibility of providing best practice care to the Individual served given the impact of his impairment upon necessary milieu participation. Upon admission, Individuals served and/or family members who have demonstrated the need for these services will be served through a treatment plan that addresses these needs with agency resources or through collaborative referral.

ADMISSIONS CRITERIA AND INDIVIDUALS SERVED

The following illustrates the admission criteria to on campus

• Individuals must be between 5 and 19 years of age

• Clearly defined primary diagnosis of:

o Autism Spectrum Disorder (ASD)

o Schizophrenia/other psychoses with intellectual disability

o Intellectual Disability with associated behavioral disorders

o Serious emotional Disturbances with intellectual disabilities

• Ability to participate in the staff to individual served ratio of 1:3, no more than 1:1

• Parent or guardian must abide by the Parental Participation Contract

• Support by the Local Education Agency (LEA) as the least restrictive alternative setting.

• Presence of at least three of the following criteria:

Poor self-control Child abuse victim

Cruelty to animals Depression

Inappropriate aggressive behaviors Anxiety

Angry/Hostile temper tantrums Homicidal/suicidal ideations

Hyperactivity Drug experimentation

Withdrawn Sexual Abuse

Running Away Irrational fears

Destructiveness Attention seeking behaviors

Poor school performance Encopretic/eneuretic

Truancy Low frustration tolerance

Manipulative Behaviors Defiance of authority

Sexual maladjustment Inadequate social skills

Assaultive behaviors Dysfunctional family relations

LENGTH OF STAY

The expected length of stay for children admitted to the Children’s Residential Services program is until 21 years of age, unless successful completion of treatment goals and objectives warrant a lesser restrictive environment, which is addressed through the Person Centered Plan of Care reviews.

CONTINUED STAY CRITERIA

Individuals in the Children’s Residential Services Program are reviewed on an on-going basis for continued appropriateness for the program. On-going assessment of residential habilitation goals and objective may include:

Weekly reviews Monthly reviews

Quarterly Plan of Care reviews Monthly psychiatric evaluations

Behavior Intervention Program plan reviews

Annual Plan of Care reviews

As long as the child is showing progress as demonstrated by these reviews and the placement remains the least restrictive most appropriate setting, stay in the program continues.

DISCHARGE CRITERIA

• The development of a medical condition that requires constant licensed medical supervision or highly specialized medical care that must be provided by a licensed medical practitioner

• Aging out of the program at 21 years of age

• The inability to function in the program with a 1:1 staffing

• The presence of dangerous behaviors that cannot be managed with the Behavior Intervention Plan

• The recommendation by the treatment team that placement is no longer appropriate

• Specified discharge criteria are met.

EXCLUSIONARY CRITERIA

Individuals may be excluded from the program if they possess any of the following criteria:

• Medical conditions that will require constant licensed medical supervision or highly specialized medical care.

• If they are diagnostically or clinically inappropriate.

• The individual needs/benefits from an academic program rather that a functional program, i.e. can read, spell, and benefits from general education curriculum

• If severe profound intellectual disability versus autism is the major diagnostic issue.

• If the individual is in need of additional and/or more intensive collaborative services that we can provide –OT, PT, speech and Language, etc…

• If the individual is not ambulatory or cannot be appropriately accommodated.

• If there is a lack of custody clarification

• If socialization and imitative skills are present and public and /or a lesser restrictive environment has not been tried

• If parent/guardian wants an inclusive opportunities with non-disabled peer unless there is an opening in one of the community placements

• If the individual cannot be served in a 1:3 staff to individual ratio or require more than a 1:1.

SERVICE LOCATION

The Children’s Residential Services are located on the campus of Glenwood, Inc. in southeast Jefferson County in Birmingham, Alabama. Children’s Residential Services is a year round residential treatment facility that is continuously in operation.

SERVICES PROVIDED

Individuals referred to the Children’s Residential Services program are screened to evaluate their appropriateness for services. Upon admission, a Person Centered Plan of Care (POC) is developed to address identified needs. Individuals served by Children’s Residential Services receive individualized treatment by a team of professionals that include: Psychiatrist, Social Workers, Licensed Professional Counselors, Board Certified Behavior Analysts, Teachers, Teacher’s Aides, Nursing Staff and Residential Instructors. Every child and their family are encouraged and supported in development, implementation and follow through of their POC. The POC is always considered a work in progress and can be modified according to the Child’s needs. Individuals served receive daily training on their POC objectives. The children receive training on a variety of skill areas, including self-care, communication, independent living skills, social skills, leisure skills, self –direction and community social skills, to establish a foundation for independence and successful integration into the community. A functional behavioral assessment is completed for each child and a behavior intervention plan is developed and implemented as appropriate to address maladaptive behaviors.

Individuals served at Children’s Residential Services participate in a variety of activities including therapeutic games, sporting activities, arts and crafts, music therapy, and walks. Children also go on community outings 1-2 times per week to develop their socialization skills, and participate in field trips to parks, the zoo, museums, historic landmarks, movies, etc… The field trips encourage the children’s connection with the community and provide important learning opportunities.

Monthly the individuals are seen by the child psychiatrist and the treatment team to discuss progress and for medication monitoring. Psychological evaluations are available when needed. Health service personnel set up the individual’s appointments and monitor their height, weight, and blood pressure. Children’s Residential Services staff and Allan Cott Staff provide transportation for medical appointments, dental appointments, and other community services as needed. Health Services Personnel, Children’s Residential staff, and Allan Cott staff administer medications and monitor medical conditions. The child and his/her parents/guardians are educated regarding their age-related emotional and cognitive developmental, illness, medications, and educational needs.

As each child approaches the age of 21, the program staff assist with the discharge planning by providing information to and encouraging involvement from referral sources, parents, and case managers. Program staff facilitate meetings with referral sources, parents/guardians, the individual, and potential adult service providers and participate in discharge meetings.

EDUCATIONAL/VOCATIONAL SERVICES

Allan Cott school is located on campus and provides educational, vocational, Speech/Language, and occupational therapy services to the residents of Children’s Residential Services. The individuals served attend school between 8:30am and 2:30pm on weekdays, year round.

PROGRAM STAFF

Children’s Residential Services provides 24 hour of supervision and treatment a day, 7 days a week, 365 days a year. The programs are staffed at a minimum ratio of 1:3 during all waking hours and a minimum of 1:8 during hours of slumber.

STAFF QUALIFICATONS

Children’s Residential Services programs shall be staffed cooperatively by a Program Coordinator, Director of Clinical Services, and Residential Instructors (Senior, Lead, Res Instructor I and Res, Instructor II) and are all overseen by a Division Director.

• Division Director: The Division Director shall have an MA/MS in psychology, social work, or counseling from a College/University accredited by one of the six regional accrediting associations of the US. A minimum of 5 years clinical experience with at least 2 years with administrative, supervisory duties. Licensure in mental health discipline is preferred. Will have current certification in CPR, First Aid, and MCS. Current Al. Driver’s license and must be insurable through Glenwood contracting agencies.

• Program Coordinator: The Program Coordinator shall have a MA/MS in Social Work, Counseling, ABA or related field, 3 years experience in residential care of children/adolescents with MI/ID with 1 -2 years management experience. Professional licensure or certification preferred. Will have current certification in CPR, First Aid, and MCS. Current Al. Driver’s license and must be insurable through Glenwood contracting agencies.

• Clinical Director – The Clinical Director shall have a MA/MS degree in Counseling or Social Work with 3 years in a clinical or Mental Health Setting and be licensed (ALC, LGSW, LPC, or LCSW).

• Senior Residential Instructor (Weekend) – The Weekend Senior RI will have a MA/MS in social work or counseling, or related field. Plus, 2 years exp. working with C&A MI and/or SED Residential care. 1-2 years management experience. Will have current certification in CPR, First Aid, and MCS and current Alabama Driver’s license.

• Senior Residential Instructor (Weekday)– The Weekday Senior RI will have a high school diploma - preferred BA/BS in psychology, social work, or other human services field and at least 2-year experience working with C&A MI/ID Residential care within Glenwood, Inc. and/or 3 year of exp. In C&A MI/ID Residential care externally. Will have current certification in CPR, First Aid, and MCS. Has a valid Alabama’s Driver License.

• Lead Residential Instructor – The Lead RI will have a high school diploma or bachelor’s degree in psychology, social work, or other human services field and at least 1-year experience working with C&A MI/ID Residential care within Glenwood, Inc. and/or 2 year of exp. In C&A MI/ID Residential care externally. Will have current certification in CPR, First Aid, and MCS. Has a valid Alabama’s Driver License.

• Residential Instructor I – The Residential Instructor I shall have a high school diploma, prefer 1 year of exp. In C&A MI/ID Residential care. Will have current certification in CPR, First Aid, and MCS. Has a valid Alabama’s Driver License.

• Residential Instructor II – The Residential Instructor II shall have a high school diploma or bachelor’s degree in psychology, social work, or other human services field and at least 1-year experience working with C&A MI/ID Residential care within Glenwood, Inc. Will have current certification in CPR, First Aid, and MCS. Has a valid Alabama’s Driver License

PERFORMANCE MEASURES / MANAGEMENT SYSTEM

Data Collection/Targets:

1. Reduce Medication Errors

2. Reduce Turnover in Personnel

3. Reduce Overtime Expenditures

4. Conduct Safety Drills per policy (Fire & Severe Weather)

5. Clinical UM deficiencies are corrected & reported within time frames as per policy

6. Satisfaction Surveys – stakeholders

7. Satisfaction Survey – Individuals Served

A. Reliability:

1. New and existing personnel are trained on recording each individuals medication administered in the MAR (Training is conducted initially and then reviewed every 6 months.

4. Coordinators and Senior Residential Instructors receive initial training on the completion of safety drills (Fire drills monthly and Severe Weather drills quarterly). These are submitted to the program Administrative Assistant for recording and dissemination to Auxiliary Services and our Safety Subcommittee. These drills are reviewed on a monthly/quarterly basis.

2. Human Resources (HR) monitor turnover rates per program and as an agency through their database. Monitoring this database occurs monthly.

3. Our accounting department monitors overtime hours utilized by programs every two weeks (per payroll) and disseminates this information to program Directors and executive staff.

5. UMUR reviews are conducted monthly by the clinical staff of the program. Deficiencies are totaled and the summary sheet is sent to the PI Manger for data gathering. Corrections to deficiencies are noted for the previous month on each summary sheet.

6. & 7. Standardized Satisfaction surveys (Parent and Individuals served) are administered annually by program therapists and collected and returned to the compliance officer for compiling and dissemination to the programs.

B. Validity:

1. Stakeholders (Board, Parent/guardians, etc…) are interested in Individuals served receiving medication as prescribed by physicians. The program collects data regarding administration of medication through an electronic Medication administration record (MAR) system.

2. Stakeholders are interested in the progress of treatment denoted by the reduction in the need for physical assistance to manage aggressive or self-harming behaviors. The programs utilize physical holds to prevent individuals from hurting themselves or others. Data is collected on a Restraint/Seclusion form, every time an individual requires physical holds to prevent harm to self or others.

3. Stakeholders are interested in the safety of Individuals served in the event of a fire or severe weather. Staff conducts fire and severe weather drills within the programs and document these drills on safety drill logs. This is done at a minimum of once monthly for fire drills and once quarterly for severe weather drills.

4. Stakeholders are interested in the stability of programming and the overall health of the agency. One method utilized to discern if staff are content and happy working within the programs as well as indicating stability within the programs is to monitor the rate of turnover in each program. Human Resources monitor this on a monthly basis and store data in their personnel database.

5. Excessive overtime can wear staff down and weaken therapeutic milieus. It can also absorb monies that could be utilized in many other productive ways. Thus, managing overtime expenditures is of great interest to stakeholders. Overtime is monitored every two weeks (according to payroll) by our accounting program. Numbers are disseminated to programs on a biweekly basis.

6. Individuals being able to return to more homelike environments, public school settings and communities are the ultimate goals of the program and indicates success of treatment. The program Therapist denotes movement to a less restrictive setting in discharge summaries. Directors gather and manage this information on tracking sheets.

7. UMUR reviews are a checklist to help monitor the accurate provision of services and progress being made in the clinical record of an Individual served. This allows stakeholders an accurate look at the services provided and progress being made by an individual at any given time. UMUR reviews are conducted monthly – no clinician is allowed to review and individual on their caseload.

8. Productivity standards show stakeholders that the individuals being served are getting the person centered treatment that is indicated by assessment, needs lists, Individual input, etc… and is in accordance to the standards and program description. Productivity is monitored by the billing office and is determined by the number of hours a clinician works in a month and the hours of service they denoted on the progress notes submitted.

9. Accessibility to services is a focus of stakeholders. The ability to fill beds and provide services to Individuals and families in need is a key factor. Reducing the time it takes to bring an individual into service is monitored by the intake coordinator who documents when referral packets are complete as well as when intakes occur for the program.

10. The opinions of Stakeholders and Individuals served are taken seriously. The Compliance Officer disseminates standardized satisfaction surveys, annually to the program therapist to administer and return for compilation and dissemination of thoughts, feelings, and suggestions regarding satisfaction in our program and agency. The Director also utilizes interns and therapists to provide a standard Individual served survey to Individuals on a quarterly basis.

C. Completeness:

The organization takes steps to ensure that the data used for decision making are as complete as possible. The Compliance Officer conducts on-going assessment of documentation and cross references program information with data collection. The same is done regarding Accounting, Human Resources and Intake for turnover rates, overtime expenditures, and admissions into each program. Health Services monitors the Electronic Health Record and respond to alerts and indicators regarding medication administration. Utilization Management and Reviews are conducted monthly to ensure that all clinical documentation is complete, correct and legible and completed in a timely manner (including Discharge summaries). All subcommittees collect data and review for completion and report quarterly their findings.

D. Accuracy:

Spot checks and reviews of the clinical records, Fire and severe weather logs, MARS, Restraint Seclusion Logs, and Human Resources Databases are made periodically, (no less than monthly). The checks and reviews are to ensure that data abstracted from the records and databases are correct and complete. This data is to be used for on-going review as part of the Management and Performance Measures.

The Children’s Residential Programs maintains the agency’s mission, philosophy and values in all plans to reflect the commitment of cultural competency and diversity.

GLENWOOD’S MISSION STATEMENT

Glenwood leads the state of Alabama in providing behavioral health care and educational services for individuals with Autism Spectrum Disorder and severe emotional disturbances. Our services are provided in a least restrictive setting, through a continuum of care, with the highest respect for individuals and families served. In addition to direct care services, Glenwood provides consultation and training for mental health and educational professionals and promotes research in these specialized areas.

GLENWOOD’S VISION STATEMENT

Glenwood seeks to become a nationally recognized provider of premier educational and therapeutic services for individuals with mental health needs. Through state-of-the-art training for staff, collaboration with nationally renowned clinicians, and linkages with academic health centers for clinical care and research, Glenwood assures the highest quality services to consumers and families in the state and region

GLENWOOD’S PHILOSOPHY 

While symptoms may be subject to classification, people are not. At Glenwood, each person is evaluated and treated as an individual. Not only are services and treatment settings prescribed according to individual needs, but also professional staff creatively tailors programs to enhance each person’s opportunities for success. Glenwood believes each person has the potential to improve and strive to maximize that potential in the least restrictive setting possible. Equally important, Glenwood serves the families of each individual. Glenwood encourages parental involvement to strengthen the efforts of the support team. The staff at Glenwood respects the dignity of the individual and recognizes the individual as part of the family unit.

The treatment, education, and welfare of each individual are important and should be based on best-practice concepts. Glenwood is committed to research and is a member of a scientific research community affiliated with the University of Alabama at Birmingham that includes physicians, scientists, clinicians, Glenwood staff, and Glenwood Board members. A research committee was developed in 1987 and is dedicated to cutting edge research to improve treatment modalities for individuals with autism and mental illness.

GLENWOOD’S VALUES

▪ Uphold the dignity of the people we serve, their families, and each other

▪ Responsive and caring customer service

▪ Effective and open communication 

▪ Professionalism

▪ Accountability 

▪ Teamwork

▪ Creative thinking

▪ Positive work attitude

▪ Positive management of conflict

Children’s Residential Programs

CHILDREN’S RESIDENTIAL PROGRAM’S VISION STATEMENT

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Quality care and encouraging potential is the cornerstone of our program and the work we do in CRS. We continually evaluate and assess ways to improve how we provide services and opportunities to the children that we serve. In the upcoming year our focus and concentration will be on two particular areas of care, those are transitional services and enhanced communication.

Over the next 2 years, many of the children we serve will begin a new stage of their lives. They will be leaving our program and either transferring into an adult program or returning home. In order to best prepare them for what lies ahead we will begin to focus service provision on areas of independent living skills. Services will focus on areas identified as important to the child for instance, community involvement, job seeking skills, money management, public transportation and household care.

CRS program seeks to become one of the most visual learning programs on campus. We will do this by providing increased communication avenues such as American Sign Language, electronic mechanisms, picture exchange system, and picture schedules all readily available for the children and staff. We will organize classes for staff to learn ASL and we will encourage the children to sign as much as possible. Our ultimate goal is for all of the kids we serve to live as independently as possible.

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