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Maryland offers "The New Directions Waiver" as a means of self-directing state and federal Medicaid dollars for individuals who qualify for supports due to their disability.

This offers the disabled individual the opportunity to use those dollars to best meet their own unique needs. However, it comes with the responsibility to create a plan, a budget, and find your own resources to make the plan a reality.

No centralized source of resources exists. The purpose of this blog is to direct others to resources in our communities and to provide one example of a self-directed plan. (*Caution: The self-directed plan described at the beginning of this blog is for an individual with a 5/5 needs rating, the highest possible rating in Maryland, and therefore the highest budget possible. Most will have a lower rating and a lower budget to work with.) It is also to share firsthand knowledge of experiences that may assist others who self-direct services.

Comments are welcome. Please share your knowledge with others.

Saturday, September 18, 2010

Emergency Resources in the Community

Yesterday, I held a training on behavior management and safe strategies for V's personal support staff. We have some new staff who have been trained by a local agency and their strategies and responses were not exactly on the same page with the staff who have been with us longer. My hope was to get them all using the same strategies and working well together with each other when they take V into the community. Although V has 2:1 staffing for community time, one of the staff mentioned during the training that she thought there may be circumstances where she would call the police for assistance. This has never happened in all of V's life and I have never had to give consideration as to what consequences such a action might have for all parties involved.

The trainer informed the staff that they had more and better training on how to manage V than the police have, and that such an action would probably result in V being placed in handcuffs and taken somewhere in a police car, and this would not be the best solution to the problem.

The fact that someone on staff was even thinking of this as a possibility concerned me enough to follow up on this topic with a personal friend who is the captain of the local police station. I asked him what would happen if my staff called the police while out in the community with V in a situation they did not feel they could safely handle. He confirmed what the trainer had told my staff, that they would probably put her in cuffs and take her to the emergency room in the police car. He was unfamiliar with the basket hold or other safe restraints and escorts that my staff have been trained in, and so this is probably the case with the officers on the city force.

He suggested that I call the community services division of his city and speak to Crystal,the director for guidance. I called her right away and spoke to her at length about my issue. She was not sure about the best recourse in such a situation, but suggested that I contact the Mobile Crisis team at the Crisis Center for the county department of health and hygiene.

I followed this advice and explained my situation to Beth at the Crisis Center. She explained to me that the people at the Mobile crisis Team were trained to talk to Verbal individuals who were in a mental health crisis, and that the team had a hands-off policy. When they respond to a crisis they bring police with them. She thought that a better resource, although not a perfect option, was to call the police non-emergency number and request a CIT officer, who is someone who has been through a 40-hour advanced mental health training and who she thought may be more likely to listen to the recommendations of the support staff.

Basically, my conversations made the Mobile Crisis Team aware that there is a population of people in the community that they are not prepared to serve. I wonder if an awareness of a gap in services might lead to some action to fill that gap.

My friend, the police captain, sent a follow up message to see if his referral had been helpful, and I filled him in, at the same time providing the contact information for our trainer in case he ever feels it would be appropriate to provide training to his officers for how to best manage citizens with autism or developmental disabilities in the community who are agitated and not necessarily able to talk it through.

I learned a lot through the question raised by my staff about using emergency resources in the community, and I have a lot more to learn to feel that I have a good solution for my staff in these situation. I need to provide them with guidelines and emergency contacts for exactly this kind of scenario, although, to date, they have never been unable to resolve a problem in community without additional help.

They have the contact information for my husband and I, doctors, therapists, etc... but what I think they actually want is just an extra strong body to assist in the moment. Since my husband and I are not always close by, I could give permission for them to call an off-duty staff member for assistance, since those people would have the necessary training and experience. I can provide the non-emergency police number for a CIT officer, although I don't know if that would be more helpful or harmful, and usually V calms down before anyone else can actually get to the location she is at anyway.

If anyone knows of any better solutions to these situations, please post your comments.