Olmstead Plan Chronology

Department of Administration Governor's Council on Developmental Disabilities
July 1, 2019

2020

January 6, 2020

The OIO released a summary of the 2020 Plan draft amendments being proposed by Subcabinet agencies:

• There is one goal to increase the input that people with disabilities have in their choices and lives.
• There are three goals that increase the number of people moving from segregated to more integrated places.
• There is one goal to increase the number of accessible pedestrian signals.
• There is one goal to reduce hospital stays for people with disabilities.
• There is one goal to improve access to dental services for people with disabilities.
• There are five goals to decrease the use of restraints.
• There are three goals to improve crisis services.
• There are two goals to increase participation of people with disabilities in engagement activities related to the Olmstead Plan.

January 14, 2020

The Olmstead Executive Committee met to discuss the possible strategic areas of focus for the Subcabinet, including areas of intersection between agencies.

February 24, 2020

During the February 24 Subcabinet meeting, Commissioner Ho announced that a Status Conference was scheduled with the Court on April 2, 2020.

The Olmstead Subcabinet reviewed potential areas of focus as previously discussed by the Olmstead Executive Committee. Executive Order 19-13 includes the following as duties of the Olmstead Subcabinet:

• Work to identify and address barriers to providing services and meaningful opportunities within the most integrated settings for persons with disabilities throughout Minnesota.
• Work to identify and address areas of disparity in opportunities for individuals with disabilities to live, work, and engage in the most integrated settings.
• Engage communities with the greatest disparities in health outcomes for individuals with disabilities and work to identify and address barriers to equitable health outcomes.

The Executive Committee identified potential areas of focus of the Subcabinet that involve significant intersections in the work of Subcabinet agencies:

• Examine the relationship between students with disabilities and involvement in the juvenile and adult criminal justice system (Area 1). Youth with disabilities are at a higher risk for involvement in the juvenile justice system. Special education students and those with emotional or behavioral disorders or learning disabilities are arrested and incarcerated at a higher rate than their non-disabled peers. The rate is even higher for youth of color. The Subcabinet could begin to look at areas of intersection between agencies on this pipeline and coordinate on strategies.

• Examine the connection between the workforce shortage and career opportunities for individuals with disabilities (Area 2). Minnesota is faced with the dual problems of a direct care and support services workforce shortage and the need to provide additional employment opportunities for individuals with disabilities. The Subcabinet could examine those problems, identify potential ways agencies can coordinate to address those issues, and look at the potential for collaborative solutions.
• Implement the abuse and neglect prevention plan for people with disabilities (Area 3). In 2018 the Subcabinet adopted a Comprehensive Abuse and Neglect of People with Disabilities Prevention Plan. Efforts have been made to adopt some practices and measures in this area. The Office of Ombudsman for Mental Health and Developmental Disabilities (OMHDD) has created a public awareness campaign moving to implementation this spring. There is an opportunity to implement a multi-year comprehensive prevention plan.
• Examine data collection practices to ensure agencies are collecting data needed to identify and address disparities (Area 4). In order to identify areas of disparities and craft approaches to address those disparities, the Subcabinet must have access to appropriate data. Subcabinet agencies should evaluate where they already collect disaggregated data, identify areas where additional data collection is necessary, coordinate on data collection strategies when there are areas of agency intersection, implement mechanisms to collect data needed, and use appropriate resources to analyze data to identify disparities. This is particularly important in examining health care outcomes and racial and ethnic disparities.

There was consensus in support of the four areas of focus. There was also agreement that Area 1 should be split into two, one focusing on students and one focusing on adults. There was also a decision to add another focus area related to increasing affordable and accessible housing options. Commissioner Ho stated there would be follow-up to solidify which agencies want to be involved in workgroups for each issue, as well as identifying leads and agency point people. The new OIO Director will be asked to guide this work.

The Subcabinet also reviewed and approved the February quarterly report, including data acquired through January 31, 2020. This report included progress toward goals related to:

• Movement of people with disabilities from segregated to integrated settings (n = 641).
• Movement of individuals from waiting lists.
• Quality of Life measurement results.
• Increasing system capacity and options for integration.

More than three-quarters of the Olmstead Plan measurable goals (17 of 22) were met, on track to be met, or in process. Notable successes included:

• Progress on movement of people with disabilities from segregated to integrated settings:
• During the last four quarters, 220 individuals left ICF/DD programs for more integrated settings. This exceeds the annual goal of 72. (Transition Services Goal One A)
• During the last four quarters, 880 individuals with disabilities under age 65 in a nursing facility longer than 90 days moved to more integrated settings. This exceeds the annual goal of 750. (Transition Services Goal One B)

• During the last four quarters, 1,138 individuals moved from other segregated settings to more integrated settings. This exceeds the annual goal of 500. (Transition Services Goal One C)
• Timeliness of Waiver Funding Goal One:
• There are fewer individuals waiting for access to a DD waiver. At the end of the current quarter 59 percent of individuals were approved for funding within 45 days. Another 32 percent had funding approved after 45 days.
• Increasing system capacity and options for integration:
• The utilization of the Person-Centered Protocols continues to show improvement. During this quarter, of the eight person-centered elements measured in the protocols, performance on all elements improved over the 2017 baseline. Five of the eight elements show consistent progress and are at 97 percent or greater this quarter. (Person-Centered Planning Goal One)
• The adherence to transition protocol continues to show improvement. During this quarter, 81.5 percent of case files adhered to transition protocols. (Transition Services Four)
• There was an increase of 0.3 percent of students with disabilities receiving instruction in the most integrated setting. (Education Goal One)
• Accessibility improvements were made to 1,188 curb ramps, 43 accessible pedestrian signals, and 33.24 miles of sidewalks in the last year. (Transportation Goal One)
• There was a decrease of 2,280 incidents of emergency use of restrictive procedures in schools. (Positive Supports Goal Five)

Measurable goals targeted for improvement included:

• Transition Services Goal Three to increase the average monthly number of individuals leaving the MSH for a more integrated setting to 10 or more by December 31, 2019.
  • The planned responses to meet or be on track to meet this goal remained unchanged from the November 2018 quarterly report.
• Employment Goal One to increase the number of new individuals receiving Vocational Rehabilitation Services (VRS) and State Services for the Blind (SSB) who are in competitive integrated employment by 14,820 by September 30, 2019.
  • The number of referrals is decreasing:
    • Under the Order of Selection the Vocational Rehabilitation (VR) program has been operating with three of four service categories closed for several years. Only individuals in category one, those with the most significant disabilities, are currently being accepted for service. Individuals in categories two, three, and four, with fewer functional limitations, who apply for services are being placed on an indefinite waiting list. The predictable result is that because there is no expectation of receiving VR services soon, fewer individuals in those categories are being referred for services or are choosing not to apply.
    • For youth with disabilities, referrals are dropping slightly after increasing fairly rapidly during the first few years of Workforce Innovation and Opportunity Act (WIOA) implementation. The reason is a shift in priority to reaching students at a younger age, as early as grade nine, to provide pre-employment transition services (Pre-ETS), as required by WIOA. Students that young are not yet ready for intensive VR services, since they won't be ready to enter into employment for several years. Accordingly, we are seeing fewer students being referred for intensive VR services, while at the same time providing more non-intensive Pre-ETS services to younger students who are "potentially eligible" but not yet ready for intensive VR services.
  • Employment outcomes are diminishing:
  • As a result of WIOA the VR program is seeing an increase in the number of individuals with the most significant disabilities. More than 93 percent of people currently receiving services have three or more functional limitations. These individuals require more intensive services that take a longer time to provide in order to achieve competitive integrated employment. As a result, more individuals are spending more time receiving more intensive services before exiting the program. This is true of both adult populations and youth populations, for many of the same reasons as were discussed in the question about referrals above.
  • As described in the report, the number of individuals on the waiting list has dropped from more than 2,000 people to about 800 who are still interested, available, and in need of services. VRS plans to begin removing individuals from the waiting list later in 2020, beginning with individuals in category two who have been on the list for the longest period of time. If all goes well, VRS hopes to clear the waiting list by the end of the year. This will bring individuals with fewer functional limitations into the program, who will receive the VR services they need to achieve their employment goals. The hope and expectation is that over a period of months this will result in more successful employment outcomes.
  • Services for the Blind:
  • The data provided must be interpreted within the context of the current customer demographics and policies. The time and effort needed to obtain employment depends upon each customer's specific circumstances and the policies that define the processes that staff must follow. Under recent policy changes, SSB is now serving customers with more complex and long-term needs.
• Employment Goal Four to increase the number of Peer Support Specialists who are employed by mental health service providers by 82 by December 31, 2019.
  • As of December 2019, 1,175 individuals have successfully completed the peer training. Though the goal was not met, there has been some progress in the number of employed mental health peers in a number of services. Certified Community Behavioral Health Clinics all have added peers to their clinics and the hours of service that peers provide in ARMHS has increased slightly over 2018. Peers are also being hired as (non-reimbursable) staff in Community Support programs and a number of housing programs including the VA housing programs. DHS will continue to identify the barriers of employment for certified peer specialists, and possible strategies to address the barriers.
• Positive Supports Goal Four to reduce the number of students receiving special education services who experience an emergency use of restrictive procedures at school by 318 students or 1.98 percent of the total number of students receiving special education services.
  • For data reliability purposes, the student enrollment data is based on the state enrollment counts for students receiving special education services. It is worth noting that MDE does not have the ability to cross-check the districts' reporting of students experiencing the use of physical holds with the quarterly reporting of students experiencing the use of seclusion. Accordingly, a student may be counted more than once if they are both physically held and secluded. In addition, a student may be counted more than once if they move to another district and are physically held in both districts during the same school year.
  • Multiple districts reported a reduction in the use of restrictive procedures after implementing professional development grant activities over the past three school years. For the 2018–19 school year, while the use of physical holding increased, the use of seclusion decreased by 11 percent and the number of students experiencing the use of seclusion increased by 4 percent.
  • To improve data consistency and quality, MDE updated the seclusion reporting form based upon feedback from the 2019 Restrictive Procedures Workgroup. In addition, MDE conducted six trainings throughout the state to assist districts in understanding restrictive procedures laws and to assist them in developing processes to have more consistent understanding for terms and reporting. Data quality improvement also included a transition to improved software for data analysis.
  • MDE contracted with Management Analysis and Development (MAD) to facilitate the restrictive procedures stakeholders workgroup meetings beginning in December 2018. Facilitation focused on increasing stakeholder engagement in developing recommendations to the commissioner, including specific and measurable goals, implementation of strategies, and outcome measures for reducing the use of restrictive procedures statewide.
  • The 2019 workgroup reached consensus on a revised statewide plan, which includes specific targets to reduce the use of seclusion and number of students experiencing the use of seclusion in the school setting. In addition, the revised plan includes stakeholder support and goals for recommendations to the commissioner and the legislature in three areas: (1) funding for staff development grants, (2) expansion of mental health services, and (3) additional funding for technical assistance. These recommendations address identified needs to improve availability of mental health services across the state, increase staff capacity to implement evidence-based practices and positive support, and provide time for staff to meet and discuss student needs related to reducing emergencies and eliminating the use of a restrictive procedure.
• Crisis Services Goal Two to increase the percent of adults who receive adult mental health crisis services and remain in their community (e.g., home or other setting) after a crisis episode to 64 percent or more by June 30, 2019.
  • DHS has worked with mobile crisis teams to identify training opportunities that would help increase their capacity to address the complexities they are seeing and has committed to providing trainings in identified areas specific to crisis response. This training increases the teams' ability to work with more complex clients and situations effectively. (Unchanged from February 2018 quarterly report)
  • DHS has identified a few trends that might be affecting the number of adults remaining in the community. There has been an increase in individuals being seen in the Emergency Department (ED) for crisis assessments rather than in the community. With more individuals accessing crisis services from the ED there is a likelihood that they may be at a higher level of risk at the time they are seen by the crisis team and therefore more likely to need a higher level of care. There has also been an increase in the number of crisis beds added over the past few years. This allows for adults to be referred to adult residential crisis beds following a crisis rather than remaining in the community.
  • DHS will continue to work with providers to ensure timely and accurate reporting and explore trends that might be contributing to individuals presenting in crisis with the need for a higher level of care. DHS will also continue to work with mobile crisis teams in order to identify training opportunities and provide support most needed for serving people in crisis.

The Subcabinet was provided with updates on the Olmstead Plan amendment process, including public input themes and agency responses for the first round of public comment. The feedback was compiled from six public comment sessions and emails and included 142 participants. A summary of the themes and responses from agencies for the first round of public comment can be found in the February 24, 2020 meeting materials. The March 2020 Revision of the Olmstead Plan was set to be reviewed for approval at the March 23, 2020 Subcabinet meeting.

Next steps for the Prevention of Abuse and Neglect Campaign were reviewed, and included the following:

• Establishment of a steering committee to monitor progress in implementing the campaign and adjust the plan as necessary. Members will include the agencies and offices contributing funding to the project, the OMHDD, the Governor's Council on Developmental Disabilities, and the vendor.
• Minnesota Housing, on behalf of the OIO will serve as the contracting entity with the selected vendor. Agency contributions will be managed through interagency agreements.
• The projected cost for the project is $774,800, of which DHS is contributing $180,000 and the OIO is contributing $400,000. The remaining balance is $194,800. Subcabinet agencies will be offered the opportunity to contribute to the remaining balance.
• The projected timeline for the campaign is 18 months with initiation occurring this spring, once the contract is executed.
• Progress on implementation will be reported to the Subcabinet two times a year.

March 25, 2020

This Subcabinet meeting was limited to 30 minutes. The agenda included the approval of the March 2020 Olmstead Plan Revision. The Plan approved during this meeting remained unchanged from the draft Plan amendment reviewed in December 2019. Other agenda items, including public comments, were moved to the May 18, 2020 Subcabinet meeting.

Commissioner Ho announced that Shelley Madore, the new OIO Director, began working on March 4, 2020.

April 6, 2020

A court order was issued that requested a brief explanation for each goal summarizing how it may be affected by the COVID-19 pandemic and whether further revision was necessary. In addition, the court requested that each of the following questions be addressed by May 15, 2020:

• To what extent are school districts providing special education services? If school districts are not providing special education services, what is being done to remedy this issue?
• To what extent are group homes properly staffed? If group homes are not properly staffed, what is being done to ensure proper staffing?
• Are group home staff receiving extra pay? If not, to what extent may extra pay be provided?
• To what extent are the staff at group homes using personal protective equipment? If staff are not using personal protective equipment, what is the plan to ensure that they will in the future?
• If a resident leaves a group home, is the resident discharged or allowed to return?
• In light of day programs being closed, have day program staff been redeployed to group homes? If not, is there a plan to do so in the future?
• What is being done to remedy job losses for people with disabilities?
• To what extent are the parents of adults with disabilities allowed access to visit them if they are hospitalized? If access is currently prohibited, is there a plan to remedy this issue in the future?
• What is being done to ensure that people with disabilities have access to computers or cellphones so that they may remain connected to the community virtually?
• How is information being provided to individuals with low or no reading skills?

May 11, 2020

The Subcabinet also reviewed and approved the May quarterly report, including data acquired through April 30, 2020. This report included progress toward goals related to:

• Movement of people with disabilities from segregated to integrated settings (n = 561).
• Movement of individuals from waiting lists.
• Quality of Life measurement results.
• Increasing system capacity and options for integration.

More than three-quarters of the Olmstead Plan measurable goals (10 of 13) were met, on track to be met, or in process. Notable successes included:

• Progress on movement of people with disabilities from segregated to integrated settings:
  • During this quarter, 24 individuals left ICF/DD programs for more integrated settings. After one quarter, 33 percent of the annual goal of 72 had been achieved (Transition Services Goal One A).
  • During this quarter, 211 individuals with disabilities under age 65 in a nursing facility longer than 90 days moved to more integrated settings. After one quarter, 28 percent of the annual goal of 750 had been achieved (Transition Services Goal One B).
  • During this quarter, 284 individuals moved from other segregated settings to more integrated settings. After one quarter, 57 percent of the annual goal of 500 had been achieved (Transition Services Goal One C).
• Timeliness of Waiver Funding Goal One:
• There are fewer individuals waiting for access to a DD waiver. At the end of the current quarter 59 percent of individuals were approved for funding within 45 days. Another 31 percent had funding approved after 45 days.
• Increasing system capacity and options for integration:
  • The utilization of the Person-Centered Protocols continues to show improvement. During this quarter, of the eight person-centered elements measured in the protocols, performance on all elements improved over the 2017 baseline. Six of the eight elements improved over the previous quarter. Five of the eight elements show consistent progress, performing at 96 percent or greater (Person-Centered Planning Goal One).
  • The adherence to transition protocol continues to show improvement. During this quarter, 81.8 percent of case files adhered to transition protocols (Transition Services Four).
  • The number of transit service hours in Greater Minnesota increased by 242,652 over baseline (Transportation Goal Two).

The following measurable goals were targeted for improvement:

• Transition Services Goal Two to decrease the percent of people under mental health commitment at Anoka Metro Regional Treatment Center (AMRTC) who no longer meet hospital level of care and are currently awaiting discharge to the most integrated setting to 30 percent or less (based on daily average) by June 30, 2020.
  • Approximately one-quarter of individuals at AMRTC no longer need hospital level of care, including those under a mental health commitment and those who need competency restoration services. Those committed after a finding of incompetency accounted for approximately 40 percent of AMRTC's census in this quarter.
  • For individuals under mental health commitment, complex mental health and behavioral support needs often create challenges to timely discharge. When they move to the community, they may require 24-hour-per day staffing or 1:1 or 2:1 staffing. Common barriers that can result in delayed discharges for those at AMRTC include a lack of housing vacancies and housing providers no longer accepting applications for waiting lists.
  • Community providers often lack capacity to serve individuals who exhibit these behaviors: violent or aggressive behavior (i.e., hitting others, property destruction, past criminal acts), predatory or sexually inappropriate behavior, high risk for self-injury (i.e., swallowing objects, suicide attempts), and unwillingness to take medication in the community.
• Transition Services Goal Three to increase the average monthly number of individuals leaving the Minnesota Security Hospital (MSH) for a more integrated setting to 10 or more per month by December 31, 2020.
  • The planned responses to meet or be on track to meet this goal remained largely unchanged from the November 2018 quarterly report. Additional information included in the comment on performance was:
    • The facility is seeing an increase in psychiatric acuity in individuals who are Mentally Ill and Dangerous (MI&D), which is one factor in the reduction of total moves. Another factor to consider would be the beginning of the COVID-19 Shelter in Place order in March 2020, which will reduce the number of community placements available.
• Positive Supports Goal Three to reduce the number of reports of emergency use of mechanical restraints, other than the use of an auxiliary device, to no more than 93 reports by June 30, 2020. Auxiliary devices ensure a person does not unfasten a seatbelt in a vehicle and includes seatbelt guards, harnesses, and clips.
  • The planned responses to meet or be on track to meet this goal remained unchanged from the November 2018 quarterly report.

The Subcabinet also reviewed and approved the Addendum to the March 2020 Olmstead Plan Revision after brief discussion. The addendum answers the questions outlined in the April 6, 2020, court order.

July 29, 2020

The Executive Committee met to discuss three questions, primarily focusing on the third:

• How has COVID-19 and the demands of our societal shift to address inequities and disparities impacted your agency's work and the challenges you encounter in developing policy for the disability community?
• How can the OIO team engage with agency teams on this work and in this environment?
• What advice do agencies have regarding the focus on how racial justice impacts the Subcabinet's six initiatives?
  

The discussion included a continued commitment to the previously identified six areas of focus for the Subcabinet. There was also a desire to work closely with OIO to further discuss the areas of focus. The Executive Committee decided to have a similar discussion with the full Subcabinet in August 2020, to identify and commit to the areas of focus for the Subcabinet over the next year.

August 24, 2020

The Subcabinet met and discussed successes related to Olmstead work. A full listing of successes by agency can be found in the meeting minutes.

The Subcabinet reviewed and approved the August quarterly report, including data through July 31, 2020. This report included progress toward goals related to:

• Movement of people with disabilities from segregated to integrated settings (n = 609).
• Movement of individuals from waiting lists.
• Quality of Life measurement results.
• Increasing system capacity and options for integration.

Just over half of the Olmstead Plan measurable goals (11 of 20) were met, on track to be met, or in process. Notable successes included:

• Progress on movement of people with disabilities from segregated to integrated settings:
  • During this quarter, 21 individuals left ICF/DD programs for more integrated settings. After two quarters, 62 percent of the annual goal of 72 had been achieved (Transition Services Goal One A).
  • During this quarter, 233 individuals with disabilities under age 65 in a nursing facility longer than 90 days moved to more integrated settings. After two quarters, 59 percent of the annual goal of 750 had been achieved (Transition Services Goal One B).
  • During this quarter, 320 individuals moved from other segregated settings to more integrated settings. After two quarters, the annual goal of 500 had already been achieved (Transition Services Goal One C).
• Timeliness of Waiver Funding Goal One:
  • There were fewer individuals waiting for access to a DD waiver. At the end of the current quarter, 57 percent of individuals were approved for funding within 45 days. Another 32 percent had funding approved after 45 days.
• Increasing system capacity and options for integration:
  • The utilization of the Person-Centered Protocols continued to show improvement. During this quarter, of the eight person-centered elements measured in the protocols, performance on all elements improved over the 2017 baseline. Four of the eight elements showed consistent progress, performing at 96 percent or greater (Person-Centered Planning Goal One).
  • The adherence to transition protocol continued to show improvement. During this quarter, 71.9 percent of case files adhered to transition protocols (Transition Services Four).
  • The number of school districts that completed assistive technology training during the last year was 32. There are 18,702 students in those districts (Education Goal Three A).
  • The percentage of target population served by regular route level of service increased for each market area (Transportation Goal Five).

The following measurable goals were targeted for improvement:

• Transition Services Goal Two, to decrease the percent of people at Anoka Metro Regional Treatment Center (AMRTC) who no longer meet hospital level of care and are currently awaiting discharge to the most integrated setting to 30 percent or less by June 30, 2020.
  • Approximately one-third of individuals at AMRTC no longer need hospital level of care, including those under a mental health commitment and those who need competency restoration services. Those committed after a finding of incompetency accounted for approximately 54 percent of AMRTC's census in this quarter.
• Transition Services Goal Three, to increase the average monthly number of individuals leaving the Minnesota Security Hospital (MSH) for a more integrated setting to 10 or more by December 31, 2020.
  • The planned responses to meet or be on track to meet this goal remained largely unchanged from the November 2018 quarterly report. Additional information included in the comment on performance was:
    • The COVID-19 Shelter in Place order in March 2020 greatly reduced opportunities for individuals at the St. Peter facility to demonstrate readiness to reintegrate back into the community. All off-campus movement was discontinued. This included staff-escorted community reintegration programming to independent pass planning into the community. Having those experiences to demonstrate readiness is critical, and without it there is less support for reduction in custody. In addition, community placements for individuals have also been impacted by COVID-19 as admissions have been put on hold at times.
    • Another impact on reduced discharges, although not as prominent, was the death of George Floyd while in the custody of Minneapolis police and the impact of all the unrest in Minneapolis and elsewhere in the country. The St. Peter facility serves a very diverse population, and the coverage of this event has re-triggered trauma for many individuals. Traumatic events can destabilize individuals, and this has been the case for some of the individuals served. It is too early to measure the impact of all of this, but certainly it is impacting the readiness for provisional discharge.
• Positive Supports Goal Three, to reduce the number of reports of emergency use of mechanical restraints with approved individuals to no more than 93 reports by June 30, 2020.
  • The planned responses to meet or be on track to meet this goal remained unchanged from the November 2018 quarterly report.
• Employment Goal Three, to increase the number of students with developmental cognitive disabilities who enter into competitive integrated employment to 150 by June 30, 2020.
  • The Employee Capacity Building Cohort (ECBC) was on track to meet the 2020 annual goal of 150 students to obtain competitive integrated employment. In January 2020, community teams reported 73 students had competitive integrated employment. Given the current COVID-19 pandemic, the number reduced by June 30, 2020. Several businesses were unable to hire students as other staff in the companies were put on furlough.
  • Another factor that greatly affected the lower number was that some of the community resource providers, contracted through DEED, were unable to support the students in the community due to COVID-19. There were also families who were concerned for their health and well-being and disengaged in the employment process for their youth. The data for unemployment in Minnesota rose 5.7 percent from March to June, as reported by the US Bureau of Labor Statistics.
  • Twenty-five school districts and local partner teams provided supports to students through the ECBC during the 2019–2020 school year. The ECBC teams received professional development and coaching on the following topics: Workforce Innovation and Opportunity Act (WIOA) and limitations on the use of sub-minimum wages, Pre-Employment Transition Services, DB101 estimator, utilization of the Informed Choice Conversation, Minnesota Career Information System (MCIS) for students with disabilities, business engagement strategies, engaging families using a person-centered approach, high-quality transition programming and planning, and customized employment.
• Education Goal Three B, to increase the percent of students with disabilities in school districts that have completed MDE assistive technology training to 20 percent by June 30, 2020.
  • For the 2020–2021 school year, MDE will pilot the AT Teams training in an online format. Developing the content as an online option can provide just-in-time access and resources to individuals with disabilities, parents and guardians, and district staff regarding AT. Districts would be able to identify a local cadre and use the information and materials included on MDE's site to access the information and content to evaluate and improve AT provision and use in their district. Due to the COVID-19 pandemic, the ATTP will not expand to new schools during the 2020–2021 school year. Instead, building the online content will serve as a way to scale up the project.
  • It is anticipated that the AT Teams project will continue with much of the same content that was provided in previous years with an anticipated change in delivery method, activities, and timing. Fully converting to an online format will take multiple years to complete with the content from Year 1 being targeted for the next two years. In 2020–2021 AT Teams will be in the exploration and implementation phases of providing an online option for the AT Teams project.
• Crisis Services Goal One, to increase the percent of children who receive children's mental health crisis services and remain in their community to 85 percent or more by June 30, 2019.
  • There has been an overall increase in the number of episodes of children receiving mental health crisis services, and more children being seen by crisis teams. The number of children receiving treatment services after their mental health crisis has increased by more than 30 percent since baseline and by almost 50 percent since December 2016. While children remaining in the community after crisis is preferred, it is important for children to receive the level of care necessary to meet their needs at the time. DHS will continue to work with mobile crisis teams to identify training opportunities for serving children in crisis, and to support the teams as they continue to support more children with complex conditions and living situations.
  • DHS has identified a trend that might be impacting the number of children remaining in the community. There has been an increase in individuals being seen for crisis assessments in Emergency Departments (ED) rather than in the community. With more individuals accessing crisis services from the ED there is a likelihood that they may be at a higher level of risk at the time they are seen by the crisis team and therefore more likely to require a higher level of care.
• Crisis Services Goal Two, to increase the percent of children and adults who remain in their community after receiving crisis services to 64 percent by June 30, 2020.
  • DHS has identified a few trends that might be affecting the number of adults remaining in the community. There has been an increase in individuals being seen for crisis assessments in the ED rather than in the community. With more individuals accessing crisis services from the ED there is a likelihood that they may be at a higher level of risk at the time they are seen by the crisis team and therefore more likely to need a higher level of care. There has also been an increase in the number of crisis beds added over the past few years. This allows for adults to be referred to adult residential crisis beds following a crisis rather than remaining in the community.
• Community Engagement Goal One, to increase the number of individuals with disabilities participating in governor-appointed Boards and Commissions to 245 by June 30, 2020.
  • Staff from the Governor's Office gave a brief presentation on governor-appointed Boards and Commissions to the Community Engagement Workgroup in February 2020. The governor's staff answered questions and asked for feedback on the process. OIO will identify new partners to facilitate further learning opportunities for people with disabilities who are interested in applying for membership on governor-appointed boards and councils.
• Preventing Abuse and Neglect Goal Four, to decrease the number of students with a disability identified as victims in determinations of maltreatment by 10 percent from baseline to 18 students by July 31, 2020.
  • During the 2017–2018 school year, the MDE Student Maltreatment Team received and assessed 1,083 reports of alleged maltreatment. Of those reports, the Student Maltreatment Team opened 232 cases for on-site investigations. This included approximately 311 students identified as alleged victims of abuse or neglect. Of the 311 students, 161 were students with disabilities. Compared with the 2016–2017 school year, there was an increase of 79 reports of alleged maltreatment, a decrease of 2 cases investigated, and an increase of 36 students included in the onside investigations.

The Subcabinet also discussed the following question:

• How has COVID-19 and the demands of our societal shift to address inequities and disparities impacted your agency's work and the challenges you encounter in developing policy for the disability community?

November 13, 2020

The Executive Committee met to review the proposed 2021 meeting schedule, and to review the November 2020 quarterly report. The discussion addressed two additional topics:

Commissioner Harpstead (DHS) talked about how DHS is addressing the end of the court jurisdiction on the end of court jurisdiction on the Jensen cased. Commissioner Harpstead said DHS remains committed to the Olmstead Plan and the elements of the Jensen Settlement. DHS will continue to track their goals and milestones and to support OIO in producing quarterly reports as well as continuing to track the metrics for the Subcabinet.

OIO Director Shelley Madore provided a summary of the framework that will be used to support the Big 6 Workgroups. She will be reaching out to agency leads to develop workgroup membership to include external members. A requested Zoom waiver would allow community members can be more involved in the public engagement meetings. She will provide a walk-through of the new website at the December meeting.

December 21, 2020

The sub-cabinet met to discuss the November 2020 quarterly report, 2020 plan implementation report, OIO compliance recommendations and preliminary findings from the Quality of Life survey.

The meeting opened with roll call and a question for sub-cabinet members on what potential areas for systemic strategic change their agencies might be able to address. Several members talked about accessibility and accommodation, redesigning systems and staff adaptability.

The sub-cabinet reviewed and approved the November quarterly report, including data through October 31, 2020. This report included goals related to:

• Movement of people with disabilities from segregated to integrated settings (n = 629).
• Movement of individuals from waiting lists.
• Quality of Life measurement results.
• Increasing system capacity and options for integration.

More than half of the Olmstead Plan measurable goals (14 of 25) were met, on track to be met, or in process. Notable successes included:

• Progress on movement of people with disabilities from segregated to integrated settings:
  • During this quarter, 32 individuals left ICF/DD programs to more integrated settings. After three quarters, the total number of 77 exceeds the annual goal of 72. (Transition Services Goal One A)
  • During this quarter, 249 individuals with disabilities under age 65 in a nursing facility longer than 90 days moved to more integrated settings. After three quarters, 92 percent of the annual goal of 750 has been achieved. (Transition Services Goal One B)
  • During this quarter, 309 individuals moved from other segregated settings to more integrated settings. After three quarters, the total number of 913 exceeds the annual goal of 500. (Transition Services Goal One C)
• Timeliness of Waiver Funding Goal One
  • There are fewer individuals waiting for access to a DD waiver. At the end of the current quarter 59 percent of individuals were approved for funding within 45 days. Another 30 percent had funding approved after 45 days.
• Increasing system capacity and options for integration
  • The utilization of the Person Centered Protocols continues to show improvement. During this quarter, of the eight person centered elements measured in the protocols, performance on all elements improved over the 2017 baseline. Five of the eight elements achieved 100 percent. (Person Centered Planning Goal One)
  • The adherence to transition protocol continues to show improvement. During this quarter, 76 percent of case files adhered to transition protocols. (Transition Services Four)
  • The number of individuals experiencing a restrictive procedure is lower, at 561 individuals this year compared to 642 in the previous year. (Positive Supports Goal One)
  • The number of reports of use of restrictive procedures is lower, at 3,126 reports this year compared to 3,223 in the previous year. (Positive Supports Goal Two)
  • The number of people living in the most integrated housing of their choice increased by 1,132 from the last year. (Housing and Services Goal One)
  • The number of individuals in competitive integrated employment increased by 669 in the past year. (Employment Goal Two)
  • The percentage of people receiving community services within 30 days after discharge from the hospital was 94.6 percent and met the annual goal of 91 percent. (Crisis Service Four B)
  • The percentage of people receiving crisis services within ten days of referral was 96.5 percent. This met the annual goal of 90 percent. (Crisis services Goal Five)
  • The number of individuals with disabilities participating in public input opportunities increased by 11.5 percent and the number of comments increased by 173 percent over baseline. (Community Engagement Goal Two)

The following measurable goals have been targeted for improvement:

• Transition Services Goal Three to increase the number of individuals leaving the Minnesota Security Hospital (MSH) to a more integrated setting.
  
  • The St Peter facility continues to experience increased challenges in discharging individuals to more integrated settings due to the COVID-19 pandemic. Many community providers are unable to accept new admissions at this time, most often because they are experiencing staffing shortages due to illness. In addition to community provider's inability to serve new admissions, The St Peter facility has needed to restrict individual access to the community both in outings and passes. This has resulted in individuals being unable to practice community reintegration skills that are often required by the Forensic Review Panel, the Special Review Board, and/or community providers prior to an individual's discharge. In addition to COVID-related barriers, staff have noted challenges with finding placements that will accept individuals with criminal sexual conduct histories and meet accessibility needs for individuals who use a wheelchair.
    
• Positive Supports Goal Three, to reduce the number of reports of emergency use of mechanical restraints with approved individuals to no more than 93 reports by June 30, 2020.
  
  • The planned responses to meet or be on track to meet this goal remained unchanged from the November 2018 quarterly report.
• Lifelong Learning and Education Goal Two to increase the number of students with disabilities enrolling in integrated postsecondary education settings.
  
  • Minnesota saw a decrease in the percentage of students with disabilities enrolling in institutions of higher education through the fall of 2018. The trend for students with disabilities follows the trend for all students in general. During the same time period, enrollment in an accredited institution of higher education for students without disabilities declined by 2.9 percent (from 74.5 percent in 2014 to 71.6 percent in 2018). To be considered enrolled in an accredited institution of higher education for the purposes of SLEDS reporting, a student must be on a credit earning track towards a certificate, diploma, two or four year degree, or other formal award.
    
• Healthcare and Healthy Living Goal One to reduce the rate of readmission for children and adults with disabilities after an acute inpatient hospital stay.
  
  • The number and rate of all-cause readmissions among people with disabilities, with and without Serious Mental Illness (SMI), increased slightly in 2018 and 2019 from the lowest rate in 2017. An increasing rate of hospital readmissions is a negative trend. This means that people with disabilities are experiencing a "bounce-back" to the hospital as frequently as they were in previous years. No single cause has been pinpointed for the increase in 2018 and 2019. Health plans and hospitals have many reasons to strive toward improving these numbers, including the Integrated Care Systems Partnership initiative in Special Needs Basic Care.
    
• Healthcare and Healthy Living Goal Two to reduce the rate for children and adults with disabilities who use an emergency department for non-traumatic dental services.
  
  • After 2016, there was a significant decrease in the number of children using emergency departments for non-traumatic dental care from previous years. This may be as a result of a dental collaborative that incentives managed care plans to closely monitor and assist in helping people find preventative dental care.
• Crisis Services Goal Four A to increase the percent of people who are housed five months after discharge from the hospital (due to a crisis).
  
  • There has been an overall increase in the number of individuals receiving services. In June 2018, the number of people receiving services in a treatment facility was nearly double the amount of people receiving treatment in a treatment facility at baseline. This indicates more people are receiving a higher level of care after discharge. This includes Intensive Residential Treatment Services (IRTS) and chemical dependency treatment programs that focus on rehabilitation and the maintenance of skills needed to live in a more independent setting.
    
  • Additionally, a contributing factor to missing the goal may be the tight housing market which is still very high, and at times it was reported to be around 3 percent vacancy rates. When there is a tight housing market, access to housing is reduced and landlords may be unwilling to rent to individuals with limited rental history or other similar factors.

The sub-cabinet also reviewed and approved the 2020 annual report, including data acquired through October 31, 2020. This report included progress toward goals related to:

• Movement of people with disabilities from segregated to integrated settings
• Movement of individuals from waiting lists
• Quality of life measurement results
• Increasing system capacity and options for integration

The annual report provides an update on the progress on all of the goals in the Olmstead Plan and includes information already reported in the 2020 quarterly reports. Just more than half (26 of 47) of the goals were met, on track to be met or in progress. Twenty-one goals were not met. The report noted measurable progress was being made in several areas.

• Progress on movement of people with disabilities from segregated to integrated settings
  
  • In the first three quarters of the 2020 goal, 77 individuals left Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/DD) programs to more integrated settings. This exceeds the 2020 annual goal of 72. (Transition Services Goal One A)
    
  • In the first three quarters of the 2020 goal, 693 individuals with disabilities under age 65 in a nursing facility longer than 90 days moved to more integrated settings. This is 92 percent of the 2020 annual goal of 750. (Transition Services Goal One B)
    
  • In the first three quarters of the 2020 goal, 913 individuals moved from other segregated settings to more integrated settings. This exceeds the 2020 annual goal of 500. (Transition Services Goal One C)
    
• Timeliness of Waiver Funding Goal One
  
  • There are fewer individuals waiting for access to a DD waiver. In the last quarter reported. Over the last four quarters, 59 percent of individuals were approved for funding within 45 days. Another 31 percent had funding approved after 45 days.
    
• Increasing system capacity and options for integration
  
  • The utilization of Transition Protocols continues to show improvement. Over the last four quarters, the number of cases adhering to protocols averaged 78.3 percent, which is an increase from 64.8 percent from the previous year. (Transition Services Goal Four)
    
  • The utilization of the Person Centered Protocols continues to show improvement. Over the last four quarters, of the eight person centered elements measured in the protocols, performance on all elements improved over the 2017 baseline. Six of the eight elements show progress over the previous year, and five of the eight are at or above 97 percent. (Person-Centered Planning Goal One)
  • The number of people with disabilities who live in the most integrated housing of their choice increased by 1,132 individuals over the last year. (Housing and Services Goal One)
  • An additional 3,405 individuals receiving services from Vocational Rehabilitation Services and State Services for the Blind, certain Medicaid funded programs, and students are in competitive integrated employment during the last year. (Employment Goal One, Two and Three)
  • The number of peer support specialists who are employed remained unchanged at 76. This was an increase of 60 over baseline. (Employment Goal Four)
  • There was an increase in the number and percent of students with disabilities in the most integrated setting. (Education Goal One)
  • There was an increase in the number of school districts that completed training in active consideration of assistive technology. (Education Goal Three A)
  • Accessibility improvements were made to 1,188 curb ramps, 43 accessible pedestrian signals, and 33.24 miles of sidewalks in the last year. (Transportation Goal One)
  • The number of transit service hours in Greater Minnesota increased by 242,652 over baseline during the last year. (Transportation Foal Two)
  • The number of individuals experiencing a restrictive procedure was reduced by 81 from the previous year and a reduction of 515 from baseline. (Positive Supports Goal One)
  • The number of reports of restrictive procedures was reduced by 97 from the previous year and a reduction of 5,476 from baseline. (Positive Supports Goal Two)
  • The percent of people receiving appropriate community services within 30 days of discharge from the hospital (due to a crisis) was 94.6 percent, which met the annual goal of 92 percent. (Crisis Services Four B)
  • The percentage of people receiving crisis services within ten days of referral was 96.5 percent, which met the annual goal of 90 percent. (Crisis Services Goal Five)
    
  • The number of individuals participating in public input opportunities increased by 11.5 percent over the previous year. The number of comments received increased by 173 percent over the previous year. (Community Engagement Goal Two)
    
  • The number of vulnerable adults who experienced more than one episode of the same type of abuse or neglect within six months was reduced by 25.4 percent from baseline. (Preventing Abuse and Neglect Goal Three)

The following measurable goals have been targeted for improvement:

• Transition Services Goal Three to increase the number of individuals leaving the MSH to a more integrated setting.
• Education Goal Two to increase the percent of students with disabilities enrolling in integrated postsecondary education settings.
• Education Goal Three B to increase the percent of students with disabilities in districts trained in active consideration of assistive technology.
• Health Care and Healthy Living Goal One to decrease the rate of adults with disabilities who had an unplanned readmission after an acute inpatient hospital stay.
• Health Care and Healthy Living Goal Two to decrease the rate of children and adults who used an emergency department for non-traumatic dental services.
• Positive Supports Three to reduce the number of reports of emergency use of mechanical restraints (other than auxiliary devices) with approved individuals.
• Positive Supports Four and Five to reduce the number of students experiencing emergency use of restrictive procedures and the number of incidents of emergency use of restrictive procedures.
• Crisis Services One and Two to increase the percent of children and adults who remain in the community after a crisis episode.
• Crisis Services Four A to increase the percent of people who are housed five months after discharge from the hospital (due to a crisis).
• Community Engagement Goal One to increase the number of individuals with disabilities participating in Governor's appointed Boards and Commissions, and the Olmstead Sub-cabinet Community Engagement Workgroup.
• Preventing Abuse and Neglect Goal Four to decrease the number of students with disabilities identified as victims in determinations of maltreatment.

The sub-cabinet also reviewed the 2021 Olmstead Plan amendment process and 2021 Meeting Schedule, and the OIO compliance recommendations on 2021 Olmstead Plan amendments.

Quality of Life Survey preliminary findings were presented to the sub-cabinet, with the full report of results to be provided at the February 2021 meeting.