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Copy of Copy of Child and Adult

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Guthrie Mainstream

on 14 July 2014

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Transcript of Copy of Copy of Child and Adult

Child and Adult
Developmental Home Training
Policies and Procedures
Introduction to the Department of Developmental Disabilities
Managing Inappropriate
Individual Family
Service Plan
Individual Service Plan
Abuse and Neglect
Article 10 & 11
Legal Issues
Relationships & Communications
How Children Enter the System
Children enter the Foster Care system through the newly established Division of Child Safety-DCS. (Formerly CPS)
If it is determined that a child needs to enter the system DCS becomes responsible for the child (i.e. providing services and a home), unless the child is already in the system through DDD. (Division of Developmental Disabilities)
If the natural parents are deemed unfit by the state, alternative and permanent placement will be sought.
Child Welfare
The underlying foundation of this system is ALL children have an absolute right to a safe, permanent, and stable home which provides basic levels of nurture and care, and is free from abuse, neglect, and exploitation.

If the parents are unable to provide this, the state will place children with developmental disabilities into Child Developmental Homes (CDH).
Process for CDH and ADH Placement
CDH and ADH families MUST have their license before providing care.
After receiving their license, the family and license worker will review potential placements, and work with the Support Coordinator to secure a successful match.
If the Support Coordinator feels there is a suitable placement, a placement visit is scheduled. During the "meet and greet" you meet the member, the Support Coordinator and other important people in the individual's life.
Placements Continued
If all parties are satisfied that a successful match of member to host family has been made, a transition meeting will be held to gather information about the member's school, day/work program, medical information, and family visitations.
Once an agreement is made, moving arrangements will be made, and an inventory of the member's belongings will be completed.
A 30-day meeting will be scheduled to insure that everyone continues to agree that a suitable placement has been established. At this meeting, objectives and habilitation goals will be set.
The Adult/Child Developmental Homes
To remain consistent, the goals of the developmental home are to provide:
A warm, stable,
, and loving home environment for the member.
Training and guidance to maximize the member's potential regarding their emotional, social, and physical needs
Nutritional maintenance of members by ensuring that three (3) nutritious meals per day and appropriate snacks are planned, prepared and served that meet the member's needs and in conjunction with the member's preferences in accordance with USDA dietary guidelines.
Transportation in a safe and appropriate vehicle.
The Support Coordinator and GMS representatives will visit the home to support the provider and member throughout the process.
If any concerns arise,
consult your GMS licensing worker
. They will be able to provide support and assistance as your needs require.
The Adult/Child Developmental Homes
Developmental homes include, but are not limited to
Allowing the individual with developmental disabilities to live in the community with the least restrictive environment.
Provide a broad array of support services to promote, social, emotional, physical, and mental well being of the member.
Provide a safe, healthy living environment, which meets the physical and emotional needs of the member, is culturally appropriate and available on a 24-hour basis.
Provide opportunities for the member to interact socially with the host family, their own family, friends and the community, including providing information regarding and facilitation access to community resources.
Assist the member in achieving and maintaining a quality of life that promotes the member's vision for the future.
All direct care providers are required to sign an ADH/CDH Agreement with the State before providing services. Please
read this agreement thoroughly before signing

as it outlines the State's expectations.

Placements Continued
At the time of placement, the Support Coordinator will provide information regarding the member to the provider, including but not limited to:
Therapy and other appointments
Special care needs
Communication methods
Food and activity preferences
Prior emergency situations
Visitation plans with the family
Medical history and conditions including medication instructions
Current case plan
Developmental delays or disabilities
Educational needs including school placement
During Placement Meeting
Host Family Provider(s) should:
Ask questions or address concerns regarding the member.
Carefully consider having this individual integrated into your family prior to making a decision of accepting the placement.
Support the goals of the member and their team.
Decline the placement if there are any concerns regarding the member being able to successfully join your family unit.
If you accept the placement and find that is was not a good match, GMS will attempt to find another home for the member but,

you continue to be responsible for the member, until an alternative placement can be found.

This process can take up to one year.

NOTE: We strive to make good initial matches so that the member will not have to be transitioned multiple times.
Provider Responsibilities
Advocate for the member
Participate actively with the member's team
Ask questions as needed
Assist in maintaining the member's records
the Division and GMS of any injuries or illnesses
Ensure the member receives routine medical and dental care
Cooperate with DDD (Division of Developmental Disabilities)
Support the member's relationship with their family
Attend meetings
Respect the member's and the family's right to privacy and confidentiality (Providers are to be HIPAA compliant at all times)
Providing transportation
, if Dial-A-Ride or taxi is used the provider is responsible for payment of transportation services
Record Keeping
Medical history
Dental history
Educational/DTA/work program participation
Habilitation services
Progress reports
Emergency contacts
Behavior Treatment Plan (BTP), if applicable
This book will include:
Monetary Record Keeping
Expenditures from consumer's SSI/SSA funds
Expenditures from consumer's trust fund/personal checking and savings accounts
Families are
required to keep receipts for items under $10 purchased from the consumer's personal spending allowance, but
purchases must be documented in the financial log.
Additionally, providers
keep track of all of their own records.
Current car registration
Current car insurance
Current certification
Home and fire inspections
Immunization records
Fingerprint cards
Home evacuation plan
This includes:
Mandatory Forms
By the 5th of each month
, you will turn in:
Medical reports
Monthly progress report
Habilitation data sheet
Medication log (if applicable)
BTP (Behavior Treatment Plan) data sheet (if applicable)
Any accounting for the consumer's monies
Psych reports or med review (if consumer is on behavior modifying medication)
*Each of these will be explained in the second portion of the training
Explanation of Some Forms
BTP (Behavior Treatment Plan) data sheet-
Target behaviors are behaviors we are hoping to decrease. Replacement behaviors are behaviors being taught as an alternative to the target behaviors. You will be required to gather data on these behaviors.
Habilitation data sheet
- Objectives will be written for the member and direct care providers are required to document their progress
Incident Reports
Incident Reporting is extremely important. Chapter 21 (Incident Management) of the Division's Policy Manual should be reviewed in it's entirety. An Incident is defined as an occurrence which could potentially affect the health and well being of a member or poses a risk to the community. A Incident Form is completed each time an incident occurs. Incidents include, but are not limited to: Death, neglect, allegations of sexual, physical, programmatic, verbal/emotional abuse, suicide threats and attempts, missing member, accidental injuries which may or may not result in medical intervention, violation of a member's rights, fraud, theft, community complaints, medication errors, behaviors, etc., etc., etc.
Incident Reports MUST be reported to your GMS supervisor immediately. Additionally a written Incident Report must be submitted to your supervisor so that it can be forwarded to the Division within 24 hours.
Write the answers to these questions on a piece of paper, and make sure to bring them to your in-person training.
1. True or False: After 15 days, a meeting is scheduled to make sure all parties are happy with the new placement.
2. What should providers say if they have any doubts regarding their ability to provide care for the consumer?
3. Name 5 of the provider's responsibilities.
4. True or False: Providers keep personal records and records for the consumer.
5. True or False: Mandatory forms must be submitted by the 10th of each month.
6. How quickly do you need to submit incident reports?
If a child needs immediate placement, this process can be very quick for CDH providers, and often occurs within a few hours.
There is generally no transition meeting for CDH placements.
*GMS will provide this book
DDD Eligibility of Services
Developmental Disability in regard to the State of Arizona QV System is defined as a severe chronic disability which is caused from:

Cognitive disability
Cerebral Palsy
These 4 disabilities result in substantial functional limitations in 3 or more of the following areas:

Receptive and expressive language
Capacity for independent learning
Economic self-sufficiency
Cognitive Disability
An intellectual functioning level (as measured by standard tests for intelligence quotient) that is well below average and results in significant limitations in daily living skills (adaptive functioning).
Severity may range from mild to profound.
Cerebral Palsy
A descriptive term used to describe a group of chronic disorders impairing control of movement. The disorders appear in the first few years of life and generally do not worsen over time.
There are four categories - spastic, athetoid, ataxic, and mixed forms - according to the type of movement disturbance
A lifelong disorder that causes abnormal neurological development. It is one of five pervasive developmental disorders and usually diagnosed by the age of 3.
Depending on the severity, some individuals may have issues with delays in language and development, and difficulty with social interactions.
A condition that affects the neurological (nervous) system where an individual has a tendency towards having sudden attacks (seizures). It is a physical sign or indication that something is wrong with the function or structure of the brain.
Although everyone has a natural tendency to experiencing a seizure at some time in their life, only those who suffer from repeated seizures, due to the disturbance in the brain, are identified as having epilepsy.
Seizure: a sudden, temporary interruption of the normal electrical/chemical activity in the brain, which can involve a loss of consciousness, stiffening of the body, and a series of muscle tightening and relaxation movements.
Sudden changes from light to dark/dark to light
Hormonal activity, particularly in women
Changing or stopping anti-convulsion medications abruptly
Flashing lights
Loud noises
Certain musical notes
Possible factors that may bring on a seizure may include:
Low sugar levels
Lack of sleep
Failure to take prescribed anti-convulsive medications - most common
What to do When Someone is Having a Seizure
Protect from injury
Remain calm
Stay with the person, and send someone for help if needed
If necessary, assist the person to the floor or ground
Protect the head from injury with something soft
NEVER put anything in the person's mouth
Be aware of your member's typical protocol when having a seizure
Reporting a Seizure
Time how long the seizure lasted and take note what the seizure looked like.
If there is a potential for injury or bruising to occur as a result of the seizure, complete an
incident report and submit it to your GMS supervisor immediately.
Write the answers to these questions on a piece of paper, and make sure to bring them to your in-person training.
1. List the 4 chronic disabilities that qualify someone for DDD services in the State of Arizona.

2. True or False: If you have a seizure, you have epilepsy.
3. What is the most common cause of seizures?

4. True or False: NEVER put anything in a person's mouth when they are having a seizure.

5. In the State of Arizona who determines if an individual qualifies for DDD services.
*Eligibility is determined by the Department of Developmental Disabilities
Seven Rights Before Administering Medication
When administering medications, you must ensure that all 7 rights are completed:
1. Right person
2. Right medication
3. Right time
4. Right dosage
5. Right route
6. Right physician
7. Right instructions
Many individuals in CDH/ADH homes will be taking some type of medication.
All medication
, specifically psychotropic medications

consent of the
guardian and licensed psychiatrists only
. A physician will approve any PRN medication that the individual can take, but the physician must give a written prescription before the provider can administer the medication.
PRNs are

prohibited with psychotropic medication.
Providers must record ALL medications in the Medication Log and turn the logs into the GMS offices by the 5th of each month.
Medication Errors
Medication errors can be described as:
Wastage of a Class II substance
Giving medication to the wrong person
Wrong method of medication administration
Wrong dosage administered
Missed medication
If a medication error occurs, you should call the pharmacy or physician to follow through with prescribed orders.
incident report (IR) must be completed and submitted to your GMS supervisor immediately
so that it can be forwarded to the Division within 24 hours.
Medication Errors
Many medication errors occur due to lack of appropriate labeling and/or lack of information about the patient's allergies.
Environmental factors, such as lighting and heating, can cause issues with the medication. Please take this into account when you store the member's medication.
Infections are caused by 2 main types of germs: bacteria and viruses. Bacterial infections can be cured by antibiotics, but viral infections cannot.
Viral infections may sometimes lead to bacterial infections.
Doctors and pharmacists in hospitals and health systems can tell you when antibiotics are needed.
Antibiotics are among the most powerful and important medicines known. Each time you take antibiotics weaker bacteria are killed, but more resistant strains may be left to grow and multiply.
Antibiotics Continued...
Antibiotics are often used before and after surgery to protect patients from infection.
Pharmacists in hospitals and health systems ensure that patients receive the right type of antibiotics.
If your consumer is prescribed antibiotics,
make sure to follow the instructions as labeled
Prescription Labels

A. Prescription # - This is used when calling the pharmacy for a refill or for insurance purposes
B. Doctor's Name and Phone Number
C. Member's Name - This medication is only for the person whose name is on the label.
give medications to another person even if they have similar symptoms.
D. Name of the Medication/Main Ingredient - You must make sure this matches what the prescribing doctor said. There also may be information about the strength of the medication (i.e. 10mg tablets).
E. Pharmacy Name and Phone Number
Almost half of all people do not correctly follow directions on prescription labels. Presecrition labels have
important information that you need to know.
F. Refills - The label will show the number of refills permitted. If no refills are allowed or you are out of the number of refills permitted, you must speak with the doctor.
G. QTY - "quantity" or how much is in the package
H. Expiration Date -

use the medication past this date.
save unused prescriptions.
I. Instructions - This describes how the medication should be administered and how frequently. If the instructions are confusing consult the prescribing doctor.
Sample Prescription Label
Prescription Label
The following are some common instructions you may find on a label:
"Take full course" means that your member should finish taking the entire contents of the prescription, even if they are feeling better. This is especially true if they are taking antibiotics because the infection can come back if they stop too soon.
"Take with food" means that you should administer the medication to your member after they have eaten a meal.
"Take 4 times a day" means they should take the medication 4 times throughout the day. If you have questions about what times to give the medication, please consult with the prescribing doctor.
"Take as needed as symptoms persist" means the medication can be taken when symptoms are present (PRN). PRN's must be prescribed by a medical doctor.
There are NO PRN's allowed when a member is taking psychotropic medications.

Prescription Labels
The package may also have brightly colored warning labels with additional information. Examples:
Safe storage instructions (i.e. keep refrigerated)
Instructions for use (i.e. shake well before using)
Possible side effects (i.e. may cause drowsiness)
Other must-know codes:

QD - Daily
BID - 2 Times a Day
TID - 3 Times a Day
QID - 4 Times a Day
Q4H - Every 4 Hours
AC - Before Meals
PRN - As Needed
PO - Orally
AS - In Left Ear
AD - In Right Ear
AU - In Each Ear
OS - In Left Eye
OD - In Right Eye
OU - In Each Eye
Medication Safety
To make sure medications are used safely and effectively it is recommended that you:
Keep a list of all medications that the member takes and medicines that they cannot take due to allergic reactions.
Learn the names of the drug products that are prescribed and given to your member as well as their dosage strength and schedules.
Ask if the member should avoid certain foods, beverages, other medicines, or activities while taking the prescribed medication.
Ask for any written information available on the drug product.
Question anything that you do not understand or that does not seem correct (i.e. if a different strength appears on a prescription refill and you were unaware of the change).
Show that you understand how to administer the medication to the member by repeating information about the prescription back to their doctor or pharmacist.
If you are unable to administer the medication for any reason, consult with GMS right away.
When the member is in a hospital or health system, you can ask to speak to the pharmacist if you have questions about their treatment or medication.
**Providers must keep all medication in a locked box out of the member's reach for the member's safety .**
Poison Prevention
Below are safety tips that every provider should use to prevent accidental poisonings:
Don't call medication "candy."
Use child-resistant closures on medicine and other products,
Keep all medications, both prescription and non-prescription, in their
original containers.
Always turn on the light when giving or taking medicine.
Check medications periodically for an expiration date, if the medication is not dated consider it expired 6 months after purchase.
Avoid putting medications in open trash containers in the kitchen or bathroom as they may be deadly when not taken properly.
Be aware that vitamins, particularly those containing iron, can be poisonous if taken in large doses.
If the member experiences accidental poisoning, and they are conscious call the Poison Control Center at 800-222-1222 for instructions. If the member is unconscious, first call 9-1-1 then administer first aid until help arrives. For both instances, an Incident Report must called in be sent to GMS so that it can be submitted to the Division within 24 hours.
Reminder about Medication
Consult a doctor on how to
ear drops
eye drops
eye ointments and gel
metered-dose inhalers
nose drops
rectal suppositories
any type of medication
* Remember to
if you have any questions/concerns!
keep Medication Logs, also referred to as Med Logs, for
medications the member takes!
You will receive additional training on this, but please remember to ask if you have questions.
Write the answers to these questions on a piece of paper, and make sure to bring them to your in-person training.
1. Do you need to write and submit an IR to GMS if a medication error occurs?

2. T/F - Is it okay to give a member expired medication?

3. Should you save unused prescriptions just in case the member needs them in the future? Why or why not?

4. What should you do if your member ingests a poisonous substances?

5. When should you keep a med log for the member?

6. T/F - PRNs are prohibited with psychotropic medications.
If the member has a med log already, please record any medication they take (i.e. aspirin). If the member does not have a med log and they take aspirin, it is not necessary to fill out a med log. In all instances however, you must have a signed consent form for all over the counter medication. Example: Cough medicine, allergy medication, eye drops, aspirin.
*Make certain you write the exact time the member takes their medication on the med log daily (i.e. 7am and 9pm).
Understanding Behavior
Person's Physical and Emotional Health
- examples: medications, impaired vision/hearing, acute/chronic illness, dehydration, constipation, depression, fatigue, physical discomfort/pain and lack of communication
Environmental Stressors
- examples: environment that is too large, has too much clutter, has excessive sensory stimulation, has no orientation clues like signs, has poor or no sensory stimulation, has no structure or is ever changing or new to the individual
Task Stressors
- examples: task is too complicated, there are too many steps, it is not modified for the individual's impairments or it is unfamiliar
Understanding Behavior
Whatever the cause, be sure to identify the specific challenges and consider possible solutions:
What was the behavior? Was it harmful to the individual or others? What happened before the behavior occurred? When did the behavior happen? Try to think of why the behavior occurred.
Positive reinforcement
, such as praise or tangible rewards, that follows a behavior will increase the likelihood of the behavior occurring again. Remember to catch the child/adult acting appropriately and praise him or her for that specific behavior.
Understanding Behaviors
Often, if you reinforce a negative behavior, that behavior will occur again. For example, giving a screaming individual a toy in a store will teach the individual to scream every time he wants something.
Replacement behavior is a term to describe replacing an inappropriate behavior with a more appropriate behavior. You cannot take a behavior away without replacing it with something more appropriate. If you do not replace it he or she may find a behavior even more inappropriate.
**Building a relationship with the member is tremendously helpful when working with their behaviors.
ABC Model of Intervention
Anything in the environment that may cause a specific behavior
Internal Triggers
- Thoughts, beliefs, emotions, wishes, and fears
External Triggers
- Events or situations that are visible to others
This is the behavior just before the target behavior that shows a behavior is soon to occur.
Anything that a person does that is observable and measurable. The target behavior is the specific behavior you want to address.
The result of the behavior which can be positive or negative.
Try soothing music or a massage to induce relaxation.
Divide tasks into small successive steps, provide assistance as needed.
Be patient, allow ample time, and try again at a later time.
Allow independence as much as possible, even if it is inconvenient.
If bathing is a problem, consider that the water (or the room) may be too hot or too cold, try varying the time of day to better suit the member's bathing habits.
Reduce outside noise, clutter, or number of people in the room.
Maintain structure by keeping the same routines and being consistent with reinforcers. (You may not take away privileges)
Help orient a person who is confused quickly with picture schedules, calendars and clocks. Write daily activities and routines as calendars so the person knows what to expect throughout the day.
Give praise for good behaviors and ignore negative behaviors as much as safely possible.
Behavior Techniques that are NOT Allowed
: Physical, Verbal, Sexual, Emotional
Use of locked rooms
Use of over correction:
A group of procedures designed to reduce inappropriate behavior consisting of:
Requiring an individual to restore the environment
to a state vastly improved from that which existed prior to inappropriate behavior
**This section will be complimented during the mandatory Article 9 training.
Requiring an individual to repeatedly practice a behavior
Application of noxious stimuli:
such as ammonia sprays or application of Tabasco sauce to the tongue
Physical restraints:
including mechanical restraints when used as a negative consequence to a behavior
Any other technique: determined by PRC to cause pain, severe discomfort and/or severe emotional distress
Other prohibited techniques: psych-surgery, insulin shock, electroshock or experimental drugs
**If you have any question on permitted or prohibited techniques, please consult your GMS Licensing Worker.

Behavior Modifying Medications
Behavior Modifying Medications are
if one of the following criteria is met:
They are administered on an "as needed" or PRN basis.
The ISP team determines that the dosage interferes with the individual's daily living activities.
They are used in the absence of a behavior treatment plan.
Behavior modifying medications are those drugs which are
, administered and directed specifically toward the reduction and eventual elimination of specific behaviors for which the drugs are prescribed.
Behavior modifying medications
As part of the individual's behavior treatment plan included in the ISP
When in the opinion of a license physician, they are deemed to be effective in producing an increase in appropriate behaviors or a decrease in inappropriate behaviors
Behavior Modifying Medications
Behavior modifying medications can be
justified by the prescribing psychiatrist
when the harmful effects of the behavior outweigh the potential negative effects of the medication (such as Tardive Dyskinesia).

Tardive Dyskinesia - characterized by slow, rhythmic, automatic, stereotyped movement either generalized or in a single muscle group, which occur as undesired, involuntary effect of therapy with certain psychotropic medications.

The individual/responsible person
must give informed, written consent
before behavior modifying medications can be administered.

Behavior Modifying Medications

provide monitoring of all behavior treatment plans (BTP), which include the use of behavior modifying medications to:

Ensure that data collected regarding an individual's response to the medication is evaluated
at least quarterly

at a medication review by the psychiatrist and a member of the ISP team, other than the direct care staff responsible for implementing the approved BTP.
Ensure that each individual receiving a behavior modifying is screened for side effects of Tardive Dyskinesia as needed and that the results of such screening are:
Documented in the individual's central case record
Provided immediately to the physician, individual/responsible person and ISP team for appropriate action in the event of positive screening results for side effects of Tardive Dyskinesia
Provided to the PRC/HRC and the DES/DDD Medical Director within 15 working days for review of the positive screening results
PRC - Program Review Committee HRC - Human Right's Committee
Behavior Treatment Plans
No one will implement a behavior treatment plan which:
Is not included as a part of the ISP(Individual Service Plan)
Contains aversive behavior intervention techniques which do not have approval of the PRC and review by HRC
All individuals that take behavior modifying medications
also be on an approved behavior treatment plan. Behavior plans can also be developed if the individual is not taking prescribed behavioral medications.
A behavior treatment plan should be used when:
A person cannot benefit from training opportunities due to behaviors
Those around the person cannot benefit from training opportunities due to the behaviors
When the person is taking behavior modifying medications
Behavior Treatment Plans
DES/DDD and the provider must monitor the following for all behavior treatment plans which include the use of behavior modifying medications

Quarterly medication reviews
Yearly screening for Tardive Dyskinesia
Monthly behavior treatment progress reports
In the event of an emergency, a physician's order for a behavior modifying medication may, if appropriate, be requested for a specific one time emergency use. This will be reported through a standard incident report as well as their responsible guardian. The responsible person will immediately be notified of any changes in medication type or dosage.
Baseline Data
All providers will be asked to document baseline data on the individuals you will be caring for. This will assist in the following areas:
It will help you learn more about the person; what they like, what they don't like, their routine, skills they know and the ones that need worked on, etc.
If the medication is changed, it will be important to monitor common side effects and the effectiveness of the new medication.
The target behaviors, the behaviors we want to change, and/or work on with the individual
* Direct Care Providers will submit this baseline data as well as information about how the behavior treatment plan is being administered on a data sheet, which will be provided by GMS.
Program Review Committee - PRC
The PRC is a specially constituted committee which meets to review for approval/disapproval, any new behavior treatment plan. Any changes to the BTP must also be approved by the PRC
prior to implementation.

PRC responsibilities:
The PRC must review and respond in writing on the day the behavior treatment plan was presented. The written response must be signed and dated by each member in attendance, forwarded to the ISP team and copied to the chair of the HRC (Human's Rights Committee). The written response will include:
A statement of agreement that the interventions approved are the least intrusive
That it is the least restrictive alternative
Any special considerations/concerns, including specific monitoring instructions
Any recommendation for change, with explanations
ISP Responsibilities
The ISP team must submit to the PRC and HRC committees any behavior treatment plan which includes:
Techniques that require use of force
Programs that involve the use of response cost; this means a procedure often associated with token economies, designed to decrease inappropriate behaviors, in which reinforcers are taken away as a consequence of inappropriate behaviors
Programs which might infringe upon the rights of the individuals
The use of behavior modifying medications
Protective devices used to prevent an individual from being injuring due to self-injurious behavior
Write the answers to these questions on a piece of paper, and make sure to bring them to your in-person training.

*If your member takes a psychotropic or behavior modifying medication, you are required by law to complete a Prevention and Support course. GMS offers this class, so please consult your GMS Licensing Worker to sign up.
GMS will write the behavior treatment plan (BTP) with the provider's input. Direct Care Providers are responsible for implementing this plan, recording corresponding data and submitting the finding to GMS before the 5th of each month. If you need assistance with implementing the plan, please ask your GMS Licensing worker for assistance.
Providers are very important in this process because they are most involved in their member's life and can relay important information about the member.
1. What usually happens if you reinforce a negative or positive behavior?

2. True or False: It is okay to lock rooms as a way to manage inappropriate behavior.

3. True or False: Psychiatrists should complete a medication review at least quarterly for individuals taking behavior modifying medication.

4. Name four possible interventions that manage inappropriate behavior.

5. True or False: Providers do not need to submit baseline data about how the BTP is being administered on a data sheet.
Individual Family Service Plan
The Individual Family Service Plan, also known as the IFSP, is created by team members consisting of professionals and family members.

This team uses the IFSP to review information about the member to develop and prioritize outcomes. The team identifies strategies, activities, and supports that will result in achievement of the outcomes.

The family, based on their resources, priorities, concerns and interests, as well as information gathered throughout the initial planning process, determines the outcomes for their child and family.
Sections of the IFSP
The following topics are sections within the IFSP:

Daily routine, activities, and interactions
Family resources, priorities, concerns and interests
Developmental history and observations
Medical history and health
Summary of child's present levels of development
Child/Family desired change-outcomes
Transition plan and timeline
Supports services needed to make progress towards outcomes
Individual Service Plan
The Individual Service Plan, or ISP,
is a plan developed with the member
and ISP team to ensure their success.
The ISP team includes:
The member
Their guardian
DDD Support Coordinator
School/Day/Work program staff
Guthrie Representative
Any other person the member wishes to be included
ISP Meetings
The ISP team will meet
30 days
after the member moves into an ADH/CDH home.
A 90 day review
is usually held to discuss programs, barriers, or make changes to the ISP plan.
If at any time a member of the team would like to reconvene or schedule a meeting, they may do so to discuss concerns or changes.
Sections of the ISP
The ISP is developed by the DDD Support Coordinator and distributed to members of the team.
The ISP has multiple sections. Some examples include:
The member's diagnosis
Current placement
Health/physical/cognitive development
Self-help skills
Risks to the member
Future goals
1. Name 4 members of the ISP team.

2. Yes or No: Can the team meet outside of the 30-day, 90-day, and annual review dates?
3. Who develops and distributes the ISP?
Emotional Abuse
Emotional Abuse
- chronic pattern of behaviors such as belittling, humiliating, and ridiculing an individual

Emotional Neglect
- the consistent failure of a parent or caretaker to provide an individual with appropriate, support, attention, and affection
Activities that lead to emotional abuse:
criticizing the individual for behavior that is developmentally normal
belittling and shaming the individual
using the individual as a scapegoat when things go wrong
treating the individual differently from others in the house
Recognizing Emotional Abuse
The signs of emotional abuse may be less obvious than other forms of maltreatment. Emotional abuse of a child is evidenced by severe anxiety, depression, withdrawal or inappropriate aggressive behaviors that result from acts or omissions by a parent or caretaker.
Physical Indicators
: eating disorders, sleeping disturbances, nightmares, speech disorders, stuttering, failure to thrive, developmental lags, asthma, severe allergies or ulcers
Behavioral Indicators
: biting, rocking, head banging, poor peer relationships, overly compliant, demanding, withdrawn, aggressive, self-destruction, or chronic academic under-achievement
Neglect is the

chronic failure
of a parent, guardian, or custodian to provide a person with adequate food, clothing, medical care, shelter, and supervision the creates a
substantial risk of harm
to the person.
Poverty is not neglect. Families with limited resources can provide basic care for their children by using free clinics or social services.
People do not always outgrow the affects of neglect.
Both physical abuse and neglect pose a serious health problem for children and adults.
Indicators of Neglect
Physical Indicators:
height and weight significantly below age level
lack of personal cleanliness
left unattended for long periods of time
in need of medical or dental care
dressed in dirty or torn clothing
chronic hunger
Behavioral Indications:
fatigue, dull appearance
running away from home
begging or stealing food
repeated acts of vandalism
poor school attendance
assumes adult responsibilities
Physical Abuse
Physical Abuse is any
non-accidental, willful, and/or malicious injury to a child or vulnerable adult
by a parent, guardian or custodian. Abuse is
rarely a single physical attack,
but rather a pattern of behavior that repeats over time.
The majority of parents who abuse their children are not mentally ill; fewer than 10% have a mental disorder.
Children are usually afraid to talk about their injuries or are too young to ask for help.
Indicators of Physical Abuse
Physical Indicators:
frequent injuries such as bruises, cuts, black eyes or burns
burns or bruises in an unusual pattern that may indicate the use of instruments, cigarettes, or other similar items
Behavioral Indicators:
passive, withdrawn, and emotionless
lack of reaction to pain
afraid to go home
cries excessively and/or sits and stares
gives unbelievable, inconsistent explanations for injuries
Sexual Abuse
Sexual Abuse is the
of a child or adult for the sexual gratification of another person.
80 - 90% of sex offenders are known to the child, or they are family members, friends, and neighbors.
Children and vulnerable adults typically do not have the experience or vocabulary to accurately describe adult sexual activity.
Indicators of Sexual Abuse
Physical Indicators:
physical signs of sexually transmitted diseases
evidence of injury to the genital area
difficulty sitting or walking
fear of being alone with the offender
unexplained sore throats, yeast or urinary infections
Behavioral Indicators:
excessive masturbation in young children or vulnerable adults
sexual knowledge or behavior beyond the person's developmental level
drug or alcohol abuse
avoidance of undressing
avoidance of the offender
Exploitation is the
illegal or improper use of an individual's resources
for another's profit or advantage.
Signs of Exploitation:
Nervous or afraid to discuss finances in front of certain people
Giving implausible explanations about financial matters
Unable to remember transactions
Fearful that they will be evicted or sued if money is not given to the exploiter
Unexplainable charges on cards
Shaken Infant Syndrome
Shaken Infant Syndrome occurs when adults are frustrated and angry with children and shake them strenuously.

This may cause damage and/or bleeding to the brain and could result in death.

It is most common in very young infants, but it has happened to even 3 to 4 year-olds.
Reporting Abuse/Neglect Procedures
Any person who has reasonable cause to believe that a child or adult is being abused or neglected may report to Child Protective Services or Adult Protective Services.
Child Protective Services: 1-888-SOS-CHILD
Adult Protective Services: 602-542-0010
Reporting Abuse/Neglect Procedures
If the provider suspects abuse of any kind they
report it.
Direct care provider's are "Manditory Reporters"
. Your GMS Licensing Worker, the Support Coordinator,
and the individual's guardian must all be notified immediately.

All allegations
be reported to

An incident report must be written by the person reporting the allegation to Guthrie Mainstream Services.

If the allegation is against another direct care provider, the individual (and possibly other members) will be removed from the home until the investigation is completed.
Write the answers to these questions on a piece of paper, and make sure to bring them to your in-person training.
1. True or False: Emotional abuse is easy to detect.

2. True or False: Families living in poverty are incapable of adequately providing for their children.

3. Name two physical and two behavioral indicators of physical abuse.

4. True or False: Most people who experience sexual abuse know their offender.

5. True or False: If you report allegations of abuse or neglect regarding a member, you must also write an incident report to Guthrie Mainstream Services.

Write the answers to these questions on a piece of paper, and make sure to bring them to your in-person training.
DDD Responsibilities
The Support Coordinator has a critical role in identifying what long-term care services are to be provided. The services are as follows:

Attendant care
Day treatment and training
Home heath aide
Home nursing
Home modifications
Intermediate care facilities for the cognitively disabled
Medical services
Nursing facility
Respiratory therapy
**Other services can be determined as the need arises.
DDD is
not responsible
for providing vision or dental needs.
All long-term care services being provided must be included in the ISP.
Other responsibilities that DDD has are outlined in the ADH/CDH Contract. Potential providers will have the opportunity to read this contract. Once signed the provider has a contract with GMS and the State of Arizona.
The ADH/CDH provider cannot be the legal guardian of any member served by the Division because it is considered a conflict of interest.

Direct Care Providers must remember that the guardian makes the final decision for members. It is the guardian's responsibility.
Not all individuals with developmental disabilities have a legal guardian. These members provide consent on their own matters such as medical treatment, contracts, etc.
If an immediate and life-threatening emergency exists, the attending physician, after consulting with a second physician, may make a health care treatment decision without consent.
Public Fiduciary is when a parent or other family member is unwilling or unable to act as a guardian. A Public Fiduciary becomes the appointed guardian of the individual.
Private Fiduciary is a person or organization that performs guardianship duties on behalf of the individual.
The guardian must be willing and able to provide oversight of the person's care and resources.
Consent for Treatment
Juvenile Court
CDH providers
will need to participate in hearings
held at the Juvenile Court for the child in their care.

Often times, the court wants to hear from the direct care provider regarding the care and concerns of the child in the home.

Report and Review and Permanency hearings are typically held every 6 months.
Relationship with Birth Families
The members you will be working with may still have contact with their family members.
Providers should
support communication
with the member's family members by encouraging phone calls or sending holiday cards and letters.
Families may feel extremely guilty about not being able to care for their family member. If this is the case, encourage family members to participate at their will.
Relationship with Birth Families
Families can be overprotective of the individual you are supporting and may not realize that they are taking away member's rights. In this scenario, offer
gentle education
to the family and teach the family about the person's rights and abilities.
Some families may show up at your home without notice, want to visit when it is inconvenient for you, or they may not give the individual their money. When these things occur, it is a good idea to
talk with the family members and your licensing worker
to help you find a solution.
Relationships with School or Day/Work Program
COMMUNICATION is KEY. Keep your licensing worker involved if concerns arise.
Members may be afraid of doctors/denstists and need extra assistance to get through a appointment.
Remember to
be patient
with the member, especially because nurses and doctors may not be as patient as they should to be.
Some doctors may not understand people who have disabilities require additional patience. This may be frustrating, but remain calm and try talking with the doctor.
There may be numerous doctor appointments, but it is necessary to work through this.
It is the providers responsibility to take members to medical appointments.
If the member needs a referral, make sure to get a copy of it from their primary physician.

Medical Appointments
Role of the Licensing Worker
Your GMS licensing worker will help you stay in compliance with licensing rules and regulations.
They will offer 24 hour support and assistance to each family.
They will be as flexible as possible when scheduling trainings and home visits. A minimum of 4 home visits will be scheduled each year, and they will keep in touch with you throughout the year.
Our mission is to make this process simple and enjoyable as possible.
We pride ourselves in being good listeners, offering great supports and interacting with you positively and professionally.
Introducing Someone
What is the proper way to speak to or about someone who has a disability? Treat and speak about them the same way you would if someone did not have a disability.
How would you introduce someone who doesn't have a disability? You would give their name, where they live, what they do, or what they are interested in. You would not say, "This is ______ and they are disabled."
Every person is made up of many characteristics, and few want to be identified by just one thing. This same concept applies to individuals with disabilities as well.
In speaking or writing,
remember that children or adults with disabilities are like everyone else
Tips for improving language related to disabilities:
Speak of that person first
, then the disability, or don't discuss the disability at all.
Emphasize abilities, not limitations.
Do not label people as part of a disability group. Don't say "the disabled," say "people with disabilities."
Don't give excessive praise, attention, or patronize people with disabilities.
Choice and independence are important; let the person do or speak for themselves as much as possible.

Providers should always use people first language.

People first language
is about putting the person first, NOT their disability.
The Power of Language and Labels
Inappropriate use of words can perpetuate stereotypes and reinforce an incredibly powerful attitudinal barrier. This attitudinal barrier is one of the greatest obstacles facing individuals with disability diagnoses.

If we know about, or see, a person's diagnosis, sometimes we make assumptions about that person. As a result, we may give weight to this information by using it to determine a variety of information. Based on their diagnosis, a person's future may be determined by those with authority over them.

When incorrectly used as a measure of a person's abilities or potential, medical diagnoses can ruin people's lives.
Examples of People First Language
Incorrect Language
She's autistic
She's learning disabled
He's mentally ill
She's in special ed
Customer, client, consumer
Brain damaged
Article 10 and 11 will be discussed more in-person before signing the agreement.
Download and review the full text at the following links:
Article 10 explains the rules/regulations for a Child Developmental Foster Home License
Article 11 explains the rules/regulations for an Adult Developmental Home License
Write the answers to these questions on a piece of paper, and make sure to bring them to your in-person training
1. True or False: DDD is not responsible for providing dental or vision services.

2. True or False: Providers make the final decisions for members.
3. Why is it important for the CDH provider to participate in court hearings?

4. If a consumer steals your car and wrecks it, is GMS responsible for the damages?
Write the answers to these questions on a piece of paper, and make sure to bring them to your in-person training.
1. True or False: It is the guardian's responsibility to take the member to appointments.

2. How many times will the licensing worker make a home visit each year?

3. What type of language should you use when speaking to or about a member?

Medical consents will be signed by the ADH/CDH provider and by the individual or individual's guardian.

This consent is valid for one year unless a serious medical procedure needs to be completed. In that case, an additional consent will need to be completed specifically addressing that procedure.

If a person does not have a guardian, the court may appoint someone to act as a Power of Attorney for that individual.
The person you are working with usually attends a school or day/work program.
It is important to
keep close contact
with these people because together you can make a strong support team for the member.
When concerns with school or day/work program need to be addressed, remember to
be respectful
. There may be a difference in opinion, but keep in mind, everyone is working towards the common goal of discovering what is best for the member.
Correct Language
People with disabilities
She has autism
She has a learning disability
He has a mental health diagnosis
She receives special education services
Brain injury

Thank you for participating and completing the first section of the ADH/CDH training.

Please contact your GMS Licensing Worker to schedule an appointment to complete the second part of the ADH/CDH Training.

During this session, please come prepared with any questions as well as the
quiz answers
throughout the first training section.

*If unable to contact your GMS Licensing Worker or GMS after hours staff, report major incident to the DDD After Hours Line at 602-375-1403.*
To continue providing care to individuals with disabilities,direct care providers
must renew their license every year.

In order for GMS to renew your license,
10 hours of continued education is required annually
. It is suggested that you start working toward your renewal 3-4 months in advance. The following is a list of courses that GMS offers to meet the continued education requirement:
Prevention and Support
Direct Care Worker Skills (DCW)
Article 9 (Credit hours only if yours has expired)
CPR/First Aid (Credit hours only if yours has expired)
Cultural Sensitivity Training
Incident Report Training
As additional courses become available throughout the year, a GMS representative will update you on continued education opportunities via
It is your responsibility to complete these 10 hours of required continued education before your license is up for renewal.

Continued Education
Helpful Pointers
In addition to keeping an updated file with your member's information, it is also necessary to keep a copy of records needed for your license.

By doing so, you can recognize when required trainings, car registration and insurance, and additional documents expire. This allows you to be proactive and submit the new and valid copies to your GMS representative before it expires and becomes an issue.

Because various documents are needed, it is
highly recommended that you have a scanner.
By having a scanner, you can submit paperwork electronically, which makes it easier to keep track of documents and is GMS's preferred method. When original receipts are required, they cannot be submitted electronically.
Payment Schedule

Providers will receive a check on the 15th of each month for services provided the previous month.
(Posted pay days are available at each center if the 15th falls on a week-end)

Providers are paid once a month.

This payment is non-taxable.

If you do not pick up the check in person at the Ability Center on the 15th, the check will be put in the mail at 5pm.

You also have the option to sign up for direct deposit.

Vendor Awareness
ADH/CDH providers are vendors/independent contractors.

GMS is not responsible for any damages members
may do to the provider's home or car.

For this reason, GMS recommends that the provider stay current on their car and home insurance. It is imperative that you inform your insurance carrier that you provide
"foster care" services in your home, particularly if you are a pool or pet owner.

Spend Downs
When a member's account is nearing $2000, the Support Coordinator will contact their provider and inform them of what amount the consumer needs to spend to balance the account.

If this occurs, providers must
submit a list of the consumer's needs
to their Support Coordinator and a check will be provided to
cover items on this list

Once the provider receives the check, they must go
purchase only the items specified on the list and save the original receipts

The provider should
make a copy of these receipts for their records

submit the
receipts and a tracking form to their GMS representative within 30 days.

Member's monies not accounted for by way of original receipts are required to be returned to the state within 30 days.
The following course information is provided as a brief overview. The Division's Complete Policy Manual can be locataed at www.azdes.gov "Oversite & Policy". Arizona Revised Statues (A.R.S) may be found at the Arizona Secretary of State website
The following information is provided as a brief overview. Additional Information can be found in DES/DDD Policy Manual Chapter 1600
Full transcript