Person-Centered Practices, Positive Supports and the Jensen Settlement Agreement

In July 2009, the families of three people at the Minnesota Extended Treatment Options (METO) program, located in Cambridge MN, filed a federal class-action lawsuit against DHS.  The lawsuit alleged that the METO program used restraint and seclusion in a way that broke the law and violated the rights of the people. The lawsuit was expanded to include all people who were served at METO from July 1, 1997 to May 1, 2011.  The lawsuit was based in part on a report by the  Office of Ombudsman for Mental Health and Developmental Disabilities.

Rather than a trial, the people who brought the lawsuit (the Plaintiffs) and DHS entered into a settlement agreement. The Jensen Settlement Agreement contained numerous provisions which brought improvements to the care and treatment of people with developmental and other disabilities in the state of Minnesota. The Jensen Settlement Agreement was approved by the U.S. District Court for the District of Minnesota on Dec. 5, 2011.  

The Jensen Settlement Agreement Comprehensive Plan of Action was the implementation plan for the Settlement Agreement. The  Comprehensive Plan of Action (PDF) includes three parts:

• Part I addressed the closure and replacement of the Minnesota Specialty Health System (MSHS)-Cambridge facility with community homes and services.
• Part II addressed the modernization of Rule 40.
• Part III addressed the development of Minnesota's Olmstead Plan.

On September 4, 2020,  US District Court Judge Donovan Frank, the judge who oversaw the Jensen Case issued an order finding that DHS had substantially complied with all requirements of the Jensen Settlement Agreement, and that the court’s jurisdiction over the Jensen Case would come to an end.  On October 25, 2020, the court’s jurisdiction over the Jensen Settlement Agreement ended.

The Jensen Settlement Agreement resulted in major changes in how DHS treats people in its programs. As a part of the Jensen Settlement Agreement, DHS agreed to:

• Set a new course towards implementation of best practices for persons with disabilities.
• Train its staff in person-centered thinking and positive behavioral supports. 
• Serve people in the most-integrated setting consistent with the person’s goals, dreams and aspirations

The Jensen Settlement Agreement and Systems Change

The Jensen Settlement Agreement effected DHS systems change. Systems change is a process designed to change the components that cause a system to behave in a certain way.  

Two significant changes that came about because of the Jensen Settlement Agreement included the repeal and replace of Rule 40 with the Positive Support Rule.  These changes: 

• Required providers to use positive supports and limiting the use of restrictive interventions.
• Provided stronger oversight by DHS over the use of restrictive interventions.

Other changes that came about because of the Jensen Settlement Agreement included:

• DHS established three community-based crisis residential supports homes (Minnesota Life Bridge) for people with developmental disabilities who exhibit severe behaviors which present a risk to public safety to replace the Minnesota Extended Treatment Options program.
• DHS increased the capacity of Community Support Services to provide additional clinical support to community settings.
• DHS established the Single Point of Entry to increase cross-departmental collaboration for people in the community experiencing crisis.

Adopted in 2015, Minnesota’s Olmstead Plan is a roadmap with goals that the state must achieve for Minnesotans with disabilities to have the opportunity to live, learn, work and enjoy life in the communities they choose.  The catalyst for Minnesota’s Olmstead Plan was the Jensen Settlement Agreement.

• The Jensen Settlement Agreement required the state of Minnesota to develop an Olmstead Plan.
• While the Jensen Settlement Agreement focused on systems change within DHS, the Olmstead Plan involves systems change across multiple state agencies.

As part of the Jensen Settlement Agreement, DHS agreed to revise Rule 40 (Minnesota Rules parts 9525.2700 to 9525.2810). Rule 40 governed the use of aversive and deprivation procedures in licensed facilities that serve persons with developmental disabilities. DHS published the Notice of Adoption of Minnesota Rules, Chapter 9544, in the Aug. 17, 2015, edition of the Minnesota State Register (40 SR 179), completing the promulgation of the Positive Supports Rule. The Positive Supports Rule 9544, Positive Support Strategies and Restrictive Interventions became effective Aug. 31, 2015.  

During the Court’s Jurisdiction of the Jensen Settlement Agreement, the Quality Assurance and Disability Compliance (QADC) Services team was responsible for monitoring and reporting to the court on compliance with the Jensen Settlement Agreement.

With the end of the Court’s Jurisdiction, QADC Services’ role is expanding to provide consultation and technical assistance on person-centered practices and positive supports for all DHS business areas. In addition to continuing to monitor a number of key provisions of the Jensen Settlement Agreement, QADC Consultative Services includes:

• Providing consultative services and training on positive behavioral supports and person-centered planning for persons with severe behavioral challenges. 
• Providing technical assistance on designing individualized supports around likely areas of behavioral risk including substance abuse.
• Conducting assessment and data analysis of positive supports efforts to identify positive supports compliance trends, gaps, opportunities for improvement and risks.
• Completing special reviews and reports in a variety of settings on transition planning and Olmstead issues related to admission, discharges, and other separations of persons from facilities.
• Other ad hoc services to help DHS ensure positive supports are being used and to help reduce use of restrictive practices

For additional information on QADC Consultative Services or to request technical assistance please contact QADCconsultation.DHS@state.mn.us. 

Successful Life Project

The QADC Services team includes the Successful Life Project.  The Successful Life Project team includes board certified behavior analysts, a registered nurse and a licensed social worker.  The Successful Life Project provides individualized and consultative clinical support to persons identified in the Jensen Settlement Agreement and their teams as well as other persons with severe behavioral challenges including persons who live in the same home as persons identified in the Jensen Settlement Agreement.

The services that the Successful Life Project provides to help prevent re-institutionalization and maintain the most integrated setting — which include helping the person’s care providers to use person-centered positive behavior supports and to address health or medication needs — are services that can, by extension, improve overall quality of life. 

Information on the Successful Life Project can be found in Bulletin 19-48-01 (PDF) or contact the Successful Life Project at SuccessfulLifeProject.DHS@state.mn.us.

Jensen Settlement resources

• Amended Jensen Order and Second Amended Comprehensive Plan of Action March 14, 2014 (PDF)
• Anxiety Disorders and Intellectual/Developmental Disability, DHS-7646A (PDF)
• Behavior Road Map (PDF)
• Commissioner's Respect and Dignity Statement (PDF)
• Communication and Intellectual/Developmental Disability, DHS-7646B (PDF)
• Court Monitor Status Report on Compliance Report (June 11, 2013) (PDF)
• Court Order Ending Court Jurisdiction Doc 879 (PDF) (September 4, 2020)
• Court order extending court jurisdiction until Dec. 4, 2016 (Sept. 3, 2014) (PDF)
• Court Monitor Status Report on Compliance Report (June 11, 2013)
• Depressive Disorders in People with Intellectual/Developmental Disabilities, DHS-7646C (PDF)
• Fetal Alcohol Spectrum Disorder, DHS-7676 (PDF)
• Final Approval Order for Stipulated Class Action Settlement Agreement (Dec. 5, 2011) (PDF)
• Jensen Settlement Agreement - A Brief Summary of Key Points (PDF)
• Jensen Settlement Agreement Frequently Asked Questions (PDF) (January 2016)
• Just Plain Wrong -- Report from the Office of the Ombudsman for Mental Health and Developmental Disabilities (September 2008) (PDF)
• Mental Wellness for People with Intellectual or Developmental Disabilities, DHS-7647 (PDF)
• Minnesota Governor's Council on Developmental Disabilities - The METO Lawsuit and the Jensen Agreement
• Personality Disorders and Intellectual/Developmental Disability, DHS-7646D (PDF)
• Putting the Promise of Olmstead into Practice: Minnesota's Olmstead Plan (PDF) (September 2015)
• Social Skill Development in People with Intellectual/Developmental Disabilities, DHS-7646E (PDF)
• Stress Management for People with Intellectual or Developmental Disabilities, DHS-7648 (PDF)
• The Settlement Agreement and Related Court Documents (June 23, 2011) (PDF)
• Trauma and Post-Traumatic Stress Disorder (PTSD), DHS-7646F (PDF)

Positive Supports Rule

• Positive Supports Community of Practice
• Rule 40 Advisory Committee Recommendations on Best Practices and Modernization of Rule 40

Olmstead

• Commissioner's Rights and Dignity Statement (PDF)
• U.S. Department of Justice Olmstead Site

Successful Life Project

• Behavior Road Map (PDF)
• Constipation Tip Sheet (PDF)
• Fetal Alcohol Spectrum Disorder (PDF)
• Mental Wellness (PDF)
• Stress Management (PDF)
• Anxiety Disorders and Intellectual/Developmental Disability (PDF)
• Communication and Intellectual/Developmental Disability (PDF)
• Depressive Disorders in People with Intellectual/Developmental Disabilities (PDF)
• Personality Disorders and Intellectual/Developmental Disability (PDF)
• Social Skill Development in People with Intellectual/Developmental Disabilities (PDF)
• Trauma and Post-Traumatic Stress Disorder (PDF)

Contact information

JensenSettlement.DHS@state.mn.us