PHILOSOPHY OF PROGRAM
Henrico Area Mental Health and Developmental Services Community Support Services Division serve persons with Developmental Disabilities and children with developmental delay. Our Mission is to Support, Train, Educate, and Partner, thus making a positive difference in the lives of people we serve.
We firmly believe in the right of every individual to work in the setting of their choice and provide a continuum of services to support that belief. We have embraced the belief that if a person would like to be employed, every effort should be made to help them work. We firmly believe in the need for true inclusion in the community with relationships, valued roles and integrated participation. We employ person centered practices in our model, encourage individuals to choose options and activities and encourage individuals to work at the best of their ability. Work in an integrated setting is considered the optimal choice and individuals in the employment program are encouraged to consider this as their long-term outcome. Community activities in the naturally occurring setting are the optimal choice for full participation in one’s community. Activities in integrated settings are promoted and encouraged.
DESCRIPTION OF SERVICES
A full spectrum of services is designed to allow maximum choice and options for each individual. An individual may be “enrolled” in one area or location, but their choices for activities are defined by their ISP, not their “designation” used for classification/administrative purposes. The Commonwealth of Virginia is in the midst of a service transformation. As part of this transition, HAMHDS services are also redefining services and enhancing the opportunities for individuals to connect to and be members of their communities. The full array of services will be provided.
Organizational Employment is commonly called the workshop program, provides opportunities in a variety of areas such as employment, work training and enrichment activities, in both community and facility locations. Emphasis is placed on supporting individuals in work activities of their choice, with the goal to reach their maximum level of independence. Paid work occurs at Hermitage Enterprises in the Voc program and the STEP program and at Cypress Enterprises.
Activities include paid work and training in enhancing functioning in daily living, social, and communication and safety skills. Participants choose areas of interest and staff provides assistance in the development and implementation of each individual’s outcomes and actions that support those outcomes. As individuals meet their objectives, they are encouraged to expand their skills through mobile work crews, group and individual supported employment. For other individuals, maintenance of their skills is their primary objective and supports will be provided to ensure maximization of their abilities. Some individuals have special needs for training in ADL, social, communication, relationship building and other habilitation type programs. These options are provided along with the opportunity to work. Some individuals may be billed through Group Day Services; while others are supported through County funding.
Each individual who works will be paid for their work on either an hourly basis at minimum wage or a piece rated basis as per the Dept. of Labor 14(c) certificate, depending on the job they choose to do. All work performed outside of the two centers will be paid at minimum wage or above.
We encourage individuals to be aware of their wages and how these impact their benefits. We encourage individuals to understand the impact of working on their benefits. We have a staff person certified as a Work Incentive Specialist (WISA) to ensure individuals have access to benefits analysis.
For individuals who have been identified with substance use issues, the Case Manager will be notified for services to address these issues. We will notify them if the individual is pregnant to ensure timely and appropriate treatment.
The STEP (Skills Training for Employment) program is designed to help build skills in productivity, social interactions and stamina leading to employment. STEP melds the best from a workshop program, and a traditional day program into a program with a more focused emphasis on Skills Building in community settings. What differentiates STEP from the traditional programs for individuals with disabilities is that it integrates the following elements into one program:
- Volunteer activities in the community that target specific sill sets
- Paid work with individualized supervision and training (both center and community based);
- Stamina building exercises to help an individual prepare for a longer work day (both center and community based)
- Classroom work to help individuals improve their ability to respond to supervision, interact with co-workers and resolve differences.
- Activities that enhance the abilities of the individual to be engaged in community resources.
Program activities are carried out in the center and in various community locations. Examples of the type of community activities include volunteering at local service organizations, working at local companies, attending job fairs, and exposure to their communities for which individuals may otherwise not have an opportunity, such as going to the library or bank, with an emphasis on skill building. This program is in a smaller more office like setting and allows for individuals with sensory needs to be successful. Many individuals of transition age also find this setting more suitable for the supports they need to be successful. Program activities in the facility may include work activities, skill development, crafts, exercise, and in general building awareness of being a member of the community. Individual activities are focused on interests and on areas needing improvement as evidenced by the individual’s program plan. Billing for Group Day may occur when in the center while billing for Community Engagement and Coaching may occur when in the community. The county also provides funding for some individuals.
The Employment Resource Program (ERP) focuses on those individuals who have indicated they want to be employed in a more integrated setting, but for whatever reason have been working in the center-based work program. This program will provide intensive training and additional support in job search, job retention and job maintenance while offering trial work periods, situational assessments and job exploration. There is a partnership with Employment Specialists from the Individual Supported Employment program to assist in evaluation of the activities to make sure they translate to real world work experience. When ready, referrals are made to individual or group SE and the individual begins job development while still attending the center.
This program includes classroom and individualized training to assist a person in understanding and preparing for community employment. There are Training Specialists assigned who work together to provide services for each individual. These may include visits to work sites, situational assessments, help with resumes and interviews, discussion of work topics. Work training may include mobile work crews, which may be part time. The individual would still be able to participate in the organizational employment program when not working in the community. The optimum outcome would be full time placement at a community work site or group supported employment site.
The Employment Resource Program (ERP) is designed as a best practice to assist individuals in moving towards employment in an integrated community setting and was recognized in 2015 by the National Association of Counties (NaCO). Individuals from both Hermitage and Cypress participate in these activities. Billing may occur through Group Day Services or Community Engagement, depending on the setting and the person centered plan. County funding also supports some individuals.
Community Engagement is provided to those who are interested in community activities including volunteer work, participation in community groups and other community interactions. Individual outcomes and actions will detail those needs. We encourage movement to integrated settings whenever feasible or interest is expressed. We have emphasized community integration activities involving 3 or fewer individuals for the last three years and this will continue as our standard moving forward. Community Engagement is the type of activity, not an assigned program. Those enrolled in any center based program will also have an opportunity for community engagement activities, according the PCP/ISP of the individual.
A subgroup of this was implemented for individuals who may be nearing retirement age or want less work and more community opportunities during their day. The goal is to provide integrated community activities with seniors whose interests may mirror those in our services. Partnerships with Senior Connections and other groups who specialize in services for those who are aging is one of the key benefits.
Community engagement services occur in naturally occurring settings within the local community. These activities are chosen by the individuals based on their interests. Because many of the individuals we serve have not had the opportunity for full exposure to their communities, staff will explore interests and make suggestions of activities that may meet their wants or stated interests, may offer suggestions for new things not tried before and/or may offer the chance to explore something they never would have thought of as an interest. Volunteer assignments may be one area that is explored. Other activities may be social or recreational in nature, with the focus on helping individuals build relationships with community members. Transportation to and from sites will be included in this service. This will be provided under no more than a 1 to 3 staff to individual ratio and may be billed under Community Engagement.
For some individuals, there are barriers to their full participation and enjoyment of community activities, requiring specific training for a specific skill set or a set of skills. This training will occur on a 1 to1 level of support, will occur in naturally occurring settings and be billed under Community Coaching.
Person Centered Planning will be the guide for types of activities to explore. Skill building should be a piece of the service provided with the intent to assist the individual in participating to the best of their ability as independently as they are able; with the least amount of assistance they need to be successful. Natural supports will be encouraged.
Life Enrichment Program (LEP) provides services to individuals who require a high level of ongoing supports due to their functioning level, their medical conditions and/or physical or sensory involvement. Wide ranges of services are provided based on their personal interests and needs. Individuals are provided assistance and training in personal care, hygiene, social interactions, safety, communication and other skill development areas. There is a focus on community integration, but often the individuals who choose LEP are unable to participate full time in the community and enjoy center based activities that allow them time with friends and in less stimulating environments. Community activities may be similar to those in Community Engagement, but include leisure activities, completion of personal errands, participation in local events, and exposure to community activities. Services may be billed under Community Engagement or Community Coaching, depending on the ISP.
Program activities in the center may include work (generally for short periods of time), crafts, exercise, skill building such as word recognition, matching and name recognition, problem solving skills such as following more than one step directions and peer recognition are often the focus of games played. Music and activities involving music are often used to engage individuals in their surroundings. These services would be billed through Group Day. The County may also support some individuals.
All of the above activities are options for individuals who attend both Hermitage and Cypress Enterprises. Options at Cypress may be more limited due to the rural nature of the community; however, there are unique options open in Charles City and New Kent County not available in the larger Henrico area.
Contingencies: If there is a community based activity scheduled and there is a circumstance that interferes with the individual’s ability or availability to participate in that scheduled activity, contingency plans may be put into place.
Reasons why an activity may be postponed/rescheduled/canceled (not an inclusive list):
- The activity is canceled
- Weather may cause hazardous conditions, preventing driving
- Inclement weather for an outdoor event
- The individual is ill and cannot attend
- The individual declines to participate that day
- Staffing shortages due to illness or unexpected absences
Contingency plans may be offered and the individual given their choice of alternate activities. Choices may be (but not limited to):
- Another activity in the community on the same day may be substituted
- Another activity in the community on an alternate day may be substituted.
- The individual chooses to return to their home
- An alternative activity within the Group Day program may be offered.
Considerations for contingency plans include: staff availability, transportation options, weather and availability of alternatives in the community, to name a few.
Special Needs: Special considerations are provided to those with high needs in adult living skills or the need for assistive technology. Jigs and job modifications are offered. These may include special apparatus for a specific task, assistance with mobility or adjustment in work hours to accommodate medical needs. Risks are assessed annually as part of the person-centered planning process and are documented in their plan along with supports that will be provided to mitigate the risks. As individuals age, we will evaluate on the ability to provide services on a case by case basis.
We do not offer nursing services. Medication monitoring may be offered on a case by case basis during the day in the center based services. All staff must be certified in an approved Medication course. Medications will not be carried into the community; arrangements will be made to either give meds before/after or to schedule outings around medication requirements, if feasible.
Staffing at each location includes Training Specialists and Training Assistants who work directly with the individuals in the program. Each individual is assigned a Training Specialist as a primary contact. This person will work with individuals to identify outcomes and instructions for implementation, develop a Support Plan and to implement the plan. The Training Specialist is the liaison with the family/care provider and Support Coordinator/Case Manager on program issues. At Cypress Enterprises, one person is a Case Management level position so s/he can provide general supervision to the site. Training Assistants work in the program, assisting in the implementation of goals and providing support, however needed. Temporary Training Specialists from the Relief roster will also be used. These are fully trained staff who supplement the programs’ assigned staff for training, vacations and other days off.
All staff work in both the community based and center based components of the program; they work with a large variety of individuals daily, not just those on their assigned caseloads.
Capacity: Cypress Enterprises – 15 total – 3.5 staff – service ratio depends on the service being provided.
Hermitage Enterprises – total capacity is 90 with a total of 22 staff – service ratio depends on the service being provided.
Service ratios (staff to client ratios) are described in the description of the service and below.
Staff to client ratios varies, depending on the needs of the individuals and the activity. Some staff will have expertise in one type of activity and will spend their time within that one type of activity. Other staff will rotate between center and non-center based services. The highest ratio is 1 to 7 within the center but some situations/activities will require lower ratios. Community Based activities, in particular Community Engagement, occurs with no more than a 1 to 3 ratio but often may occur with a 1 to 2 or 1 to 1 ratio as needed or indicated by the ISP. Those activities where specific skill building occurs in the community under the definition of Community Coaching will be staffed at a 1 to 1 ratio. There will be adequate staffing assigned to ensure these ratios, including the use of temporary staff to supplement for vacations and other situations.
The team environment provides for meetings and communication that ensures continuity of activities for the individuals within the center. There will be adequate staffing to ensure services within the community are staffed as per the individuals’ PCP. Staff provides consistent coverage of all activities throughout the workday.
Staff report to a CSS Program Supervisor, who is responsible for the day to day operations of the programs while providing leadership, supervision and support. Other staff include business staff and a Marketing Specialist, whose responsibility it is to procure and maintain levels of contract work for the program and provide consultation on DOL issues. There is a part-time courier who is responsible for maintaining the warehouse space and completing deliveries to customers.
Staff is required to possess knowledge about persons with Developmental Disabilities, positive behavior supports, work training and person centered planning. In addition, staff will receive training, as needed, on skills needed to assist an individual in full participation and engagement in their activities.
Each staff person is required to attend 40 hours of training per year including mandatory training such as CPR and First Aid (every 2 years), Therapeutic Options, Human Rights and Infection Control, among others. Other training is provided by outside sources, the County and the Agency. Staff choose those optional training areas. Staff must also have a valid Virginia driver’s license, been screened for tuberculosis and have a criminal background check at the start of employment.
Training Specialists and Case Management level staff are required to have a Bachelor’s Degree or equivalent experience. CSS Supervisors are required to have a Bachelor’s Degree and supervisory experience or the equivalent combination. Training Assistants are required to hold a High School Diploma or equivalent.
Admission/Readmission/Continued Stay/Exclusion criteria:
Individuals must meet the following criteria:
- Residency in Henrico, New Kent or Charles City counties
- Must be age 18 or older
- Must be eligible for Support Coordination/Case Management Services
- There must be a diagnosis of Intellectual Disabilities
- Must be able to and want to participate in activities of their choice based on their ISP within the parameters offered.
Anyone denied services or found to be ineligible may appeal the decision by following the Henrico Area Mental Health and Developmental Services grievance procedure. The individual will be informed, in writing, as to the reasons why. This will be documented in their file. The Support Coordinator/Case Manager will also be notified and will assist in referrals to other services.
Services are offered at two locations to be geographically responsive to an individual’s residence. Both locations offer individuals options in the array of services. In general, those in Henrico attend Hermitage and those in New Kent and Charles City Counties attend Cypress. Requests for entry into a location outside the regular boundaries will be considered on a case by case basis. Services will be individualized and may include part time hours, intermittent hours and only hours when in the community receiving services.
Cypress Enterprises is open Monday- Friday from 8:30 a.m. – 2:30 p.m. Staff are available from 8:00 am to 4:30 p.m. Bay Transit provides transportation for residents of New Kent and Charles City Counties for a nominal fee and others may use Logisticare transportation vendors.
Hermitage Enterprises is open Monday through Friday from 7:45 am to 3:15 p.m. Staff are available from 7:30 am to 4:30 p.m. Transportation to and from the program is provided by a contract with VANGO Transportation for a fee, through private arrangements with another transportation provider or through a Logisticare transportation vender. Individuals choose their own transportation provider.
While these are the normal operating hours, services may be provided outside these hours as dictated by the activities and considered on a case by case basis.
Within the program day, transportation is provided to and from activities in vehicles owned by the County of Henrico.
Individuals, who meet eligibility criteria, are active in their program objectives, who wish to stay and whose needs can be met by the program are eligible for continued stay. Requests for readmission should follow the admission procedures and will be evaluated on a case by case basis based on the individual’s needs and goals.
Occupational Therapy may be offered on an as-needed individualized basis. The Agency enters into a working agreement with a contracted service that is renewable on an annual basis. These contracted services are reviewed to ensure the staff are licensed for their specialty. Work with these contracted Occupational Therapists becomes a part of the individual’s service plan with objectives and monitoring. These therapists work closely with Agency staff to ensure proper techniques and programs are used.
Depending on the individual’s needs, desires and plans, the goals of the program may include:
- To maximize an individual’s abilities with the long-term goal of transitioning individuals into community employment by:
- Providing opportunities for meaningful work in our facility with ongoing and continual supervision.
- Providing opportunities for exposure to work in a community setting through mobile work crews and group Supported Employment, whenever available.
- Increase consumer awareness of community employment options
- Increase the amount of time spent working while in the program
- Enhancing relationship building skills
- Enhancing general work habit skills such as dealing with supervision and following work routines
- To maximize independence and encourage community inclusion both in the center and in community environments by:
- Providing opportunities to participate in activities
- Providing skill building towards employment and recreational activities
- Promoting relationships
- Promoting natural supports
- Encouraging the expression of personal and cultural interests
- Making choices and increasing self-sufficiency to the best of their abilities, particularly in the area of improving work skills and skills that may assist them in being employed.
- Provide opportunity to all consumers to experience the community
- Provide opportunity to all to be an integral part of the natural community environment
On an annual basis objectives are developed to measure service access, effectiveness, efficiency, consumer and stakeholder satisfaction within the program. These measures may consider three important factors: program quality, customer value and/or financial performance. See program specific performance improvement goals and objectives.
There is no fee for the Organizational Employment work program. There is a fee charged by the County if the county contracted provider for transportation (VANGO) is chosen. The County of Henrico subsidizes the program.
Group Day, Community Engagement and Community Coaching are provided for a fee, which is billed in the equivalent to the current reimbursement rate specified by the State of Virginia Home and Community Based Waiver. Services are never denied based on an individual’s ability to pay.
PROCEDURES FOR REFERRAL, SCREENING, ADMISSION AND RE-ADMISSION
Referrals are received from the Henrico Area Support Coordinator/Case Managers. Employment and Day Services do not have a waiting list; as openings occur, they are filled. Once an opening in one of the Employment and Day Services programs is announced, Support Coordinator/Case Managers complete the Request for Day Services form. An assessment will be conducted. Program staff utilizes the information on these forms and complete a pre-admission assessment to determine who has the highest need and will be offered the opening. For a complete description, please refer to the Day Services Admissions Policy.
ORIENTATION OF THE CLIENT TO THE SERVICE
Within 30 days of program admission, individuals will be oriented to the program through the use of the Consumer Handbook and checklist. The Orientation checklist will be completed; placed in the record and progress notes will be kept as to the orientation results. Legally authorized representatives will be included in orientation activities as appropriate.
EMERGENCY CLINICAL CONSULTATION
Henrico Area Mental Health and Developmental Services Emergency Services staff provide emergency consultation. Emergency services are available on a 24 hours a day/7 days a week basis. Support Coordinator/Case Managers refer individuals in need of clinical services to Henrico Area Mental Health and Developmental Services Outpatient Division. Staff at Hermitage Enterprises and Cypress Enterprises may contact Emergency Services staff to assist with a crisis situation. Staff may contact Emergency Services staff or other Outpatient Clinical staff for consultation on behavioral programming.
Process/Documentation: Employment and Day Services provide a long-term program for individuals who choose it. Individuals are encouraged throughout the service to expand their opportunities through participation in more difficult jobs, mobile work crews, group and individual supported employment and/or in more integrated community activities outside the center.
The continued need/desire for the center-based work service will be determined with each quarterly review. When individuals indicate interest in mobile crews or group SE, the Training Specialist will notify the Program Supervisor. This individual will be offered opportunities as they arise.
If a person is interested in more integrated employment opportunities, the Training Specialist will notify the Case Manager through their quarterly review. These discussions of the interest in other work activities will include the individual, the family/caregiver and the Support Coordinator/Case Manager. The individual may be enrolled in the ERP program and will begin with job club meeting attendance, at a minimum. If interest in a work program or another day program is expressed, the Training Specialist notifies the Support Coordinator/Case Manager, who will assist the individual and their family in exploring other day support or employment options. Documentation will be maintained in progress notes.
Discharge from these programs may occur when the individual:
- no longer desires to attend
- moves from the catchment area
- is no longer having their needs met by the program or meets their goals
- no longer meets eligibility criteria.
- violates program rules or demonstrates inappropriate/dangerous behavior which requires a staffing intensity that interferes with the provision of services
Individuals may appeal the discharge decision by following the Henrico Area Mental Health and Developmental Services grievance procedure. Any discharge will be documented on the Agency Discharge Form and placed in the individual’s record. Recommendations will be made as to continued services. Program Staff will contact the Support Coordinator/Case Manager, who will work with the individual around day support/employment options. A copy of the Discharge Plans will be available to each individual.
When an individual is discharged due to behaviors or a change in needs, a team meeting involving the Support Coordinator/Case Manager, the individual, the family/caregiver and the Program Supervisor will occur. The meeting and the discharge will be documented in the record.
When an individual leaves the program to enter a new program, the program space will be held for 60 days. If within that 60-day period, the individual determines they would like to return, they may do so. After the 60-day period, the individual will be viewed as a new referral.