Olmstead Plan Chronology

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

2022

January 21, 2022

The Olmstead Subcabinet met on January 24, 2022 to review and accept Proposed Plan Amendments. The group also approved the October 2021 Subcabinet meeting minutes. The Director's Report provided an overview of Olmstead Plan stakeholder survey results. Survey publicity included a social media and print ad. The survey had 199 respondents. More than 50 percent of respondents were direct, day-to-day, operational, or day-to-day care for a person with a disability or a person with a disability. The focus for next year is raising the number of respondents. About half of those respondents in that category understood the Minnesota Olmstead Plan. OIO will be looking for more plain language engagement in the future.

The workgroups are moving towards their next public engagement activities. Workgroup pages were to be updated in February 2022 with agendas and social media promotion that ties into topic areas. The public will be able to comment on any agenda or resources by an online form with multiple upload options. The hope is that the enhanced communication will build public awareness and engagement on the Olmstead Plan. Workgroups are scheduled to report to the Leadership Forum in late May 2022. The reports will be recommendations on the next steps for each group for the following year.

The Leadership Forum update included news of a new co-chair appointment. Curtis Shanklin took the role in December. The proposed meeting schedule for 2022 for the Leadership Forum is February 28, May 23, August 22, September 26, and November 21. Agendas, registration, and resource materials will all be posted on the Olmstead website and available for public review.

Other items in the Director's Report include an overview of the Olmstead Plan Satisfaction Survey.

Finally, the Subcabinet reviewed the 2021 Annual Report on measurable goals. The report covered 39 goals, 23 of which were met or on track to be met, 12 were not met or not on track to be met, and four were in process.

Areas where progress is being made on measurable goals include progress on movement of people with disabilities from segregated to integrated settings:

• 93 people moved from Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/DD) to a more integrated setting in the first three quarters of 2021, which was an increase of 16 compared with the same time period for the 2020 fiscal year. (Transition Services Goal One A)
• 488 individuals with a disability under the age of 65 moved from nursing facilities to a more integrated setting, a decrease of 205 compared to the same time period for 2020. (Transition Services Goal One B)
• 1,548 people moved from other segregated housing to a more integrated setting in the first three quarters of the 2021 fiscal year, an increase of 635 compared to the same time period in 2020. (Transition Services Goal One C)
• The percent of people at AMRTC who no longer meet hospital level of care and are currently awaiting discharge to the most integrated setting was reduced to 27.6 percent in fiscal year 2021. This was an improvement of 1.9 percent compared to the previous year. (Transition Services Goal Two)
• The average monthly number of individuals at Forensic Services moving to a less restrictive setting was 7.3 in the first three quarters of fiscal year 2021. This is on track to meet the 2021 goal of 4 or more. (Transition Services Goal Three)

Timeliness of Waiver Funding Goal One:

• Of the 947 individuals assessed for the Developmental Disabilities (DD) waiver in the 2021 fiscal year, 626 individuals (66 percent) had funding approved within 45 days of the assessment date. This was an improvement of 7 percent compared with the previous year.

Increasing system capacity and options for integration:

• The utilization of the Person-Centered Protocols continues to show improvement. During Fiscal Year 2021, the eight required criteria were present at a combined average 92.8 percent, an improvement of 0.6 percent over fiscal year 2020. (Person-Centered Planning Goal One)
• The number of people with disabilities who live in the most integrated housing of their choice increased by 1,095 individuals over the last year. This was 37 fewer individuals compared to the previous year. (Housing and Services Goal One)
• An additional 2,191 individuals received 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. That figure was down 1,214 individuals compared to the previous year. (Employment Goal One, Two and Three)
• The number of peer support specialists who are employed is 71, a drop of five compared to the previous year. (Employment Goal Four)
• There was an increase in the number and percent of students with disabilities in the most integrated setting. (Education Goal One)
• Accessibility improvements were made to 358 curb ramps, 16 accessible pedestrian signals, and 5.6 miles of sidewalks in the last year. (Transportation Goal One)
• The number of transit service hours in Greater Minnesota increased by 8,348 over the last year. (Transportation Goal Two)
• Compared to 2020, there was a 3.1 percent decrease in the rate of adults with disabilities who had an unplanned readmission after an acute inpatient hospital stay. (Health Care and Healthy Living Goal One)
• Compared to the previous year, there was a decrease in the rate of children and adults who used an emergency department for non-traumatic dental services. (Health Care and Healthy Living Goal Two)
• The number of individuals experiencing a restrictive procedure was reduced by 105 from the previous year. (Positive Supports Goal One)
• The number of reports of restrictive procedures was reduced by 49 from the previous year. (Positive Supports Goal Two)
• There was a reduction in the number of students experiencing emergency use of restrictive procedures and the number of incidents of emergency use of restrictive procedures. (Positive Supports Four and Five)
• There was an increase of 3.1 percent of people who are housed five months after discharge from the hospital (due to a crisis). (Crisis Services Four)
• 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 37.5 percent compared to the previous year. (Preventing Abuse and Neglect Goal Three)
• The number of students with disabilities identified as victims in determinations of maltreatment was reduced by 12.5 percent compared to the previous year. (Preventing Abuse and Neglect Goal Four)

The following measurable goals have been targeted for improvement:

• Transition Services Goal Four to increase the number of cases adhere to transition protocols. (Transition Services Goal Four)
• Education Goal Two to increase the percent of students with disabilities enrolling in integrated postsecondary education settings.
• Positive Supports Three to reduce the number of reports of emergency use of mechanical restraints (other than auxiliary devices) with approved individuals.
• Crisis Services One and Two to increase the percent of children and adults who remain in the community after a crisis episode.
• Community Engagement Goal One to increase the number of individuals with disabilities participating in Governor's appointed Boards and Commissions, and other workgroups and committees established by the Olmstead Subcabinet.
• Community Engagement Goal Two to increase the number of individuals participating in public input opportunities increased and the number of comments received.

March 2022

The Leadership Forum met on March 31, 2022. The Director's Report noted an increase in engagement opportunities, which were to be discussed in greater detail in the May 2022 meeting.

Also on the agenda was an update on workgroup activities. The workgroups have provided an opportunity to get input from the community and discuss successes and processes.

• Data Collection workgroup highlighted that a survey was created to develop an inventory of available data sets in each agency.
• The Prevention of Abuse and Neglect workgroup has used surveys and community input events to help narrow down the recommendations to the top five areas to address prevention and education in the community.
• The Workforce Shortage and People with Disabilities Workgroup had a community input event on February 23, 2022. They continue to use survey outreach to learn more on how to support employment for people with disabilities.
• The Affordable, Safe, and Accessible Housing Workgroup launched a survey to get information from the public. There were 80 respondents. They determined the top three priorities were: locating available housing, financial assistance to pay rent, and housing to accommodate wheelchairs, walkers, and other assistive technology.
• The Juvenile Justice and Special Education Workgroup engaged with the Institute on Community Integration at the University of Minnesota to help determine data that has already been compiled to develop recommendations to the Leadership Forum on next steps.

The workgroups are to finalize their recommendations in April 2022 and then present them to the Leadership Forum on May 23, 2022. Those approved recommendations are to be presented at the Subcabinet Meeting on July 25, 2022.

While there was no formal presentation on the February 2022 Quarterly Report, the report was still reviewed and approved. The Leadership Forum heard that readability and flow of the report need to be addressed. Reports and terminology differ among agencies, which can lead to confusion, particularly for members of the public.

The quarterly report covered 25 measurable goals, of which 19 had been met or were on track to be met, four were not met or not on track to be met and two were in process.

Listed below are areas critical to the Plan where measurable progress is being made:

Progress on movement of people with disabilities from segregated to integrated settings:

• During the last four quarters, 119 individuals left ICF/DD programs to more integrated settings, exceeding the annual goal of 72. (Transition Services Goal One A)
• During the last four quarters, 681 individuals with disabilities under age 65 in a nursing facility longer than 90 days moved to more integrated settings. That figure was short of the annual goal of 750. (Transition Services Goal One B)
• During the last four quarters, 2,482 individuals moved from other segregated settings to more integrated settings, exceeding the annual goal of 500. (Transition Services Goal One C)
• During the last quarter, 28 percent of people at AMRTC no longer meet hospital level of care and are awaiting discharge to the most integrated setting. This goal is on track to meet the threshold of 30 percent or lower. (Transition Services Goal Two)
• During the last four quarters, the number of individuals at Forensic Services who moved to a less restrictive setting averaged 6.3 per month, exceeding the annual goal of four or more. (Transition Services Goal Three)

Timeliness of Waiver Funding Goal One

• There are fewer individuals waiting for access to a DD waiver. During the last quarter, 63 percent of all individuals were approved for funding within 45 days. The approval rate for each urgency category was 78 percent for Institutional Exit, 67 percent for Immediate Need, and 60 percent for Defined Need. This goal is not on track to be met.

Increasing system capacity and options for integration

• The utilization of the Person-Centered Protocols continues to show improvement. Of the 165 cases reviewed during this quarter, the combined average of presence of the eight person-centered elements measured in the protocols was 94.2 percent. Four of the eight elements achieved 100 percent. This is on track to meet the 2022 goal of 90 percent. (Person-Centered Planning Goal One)
• The number of individuals experiencing a restrictive procedure is lower, with 169 individuals in the most recent quarter, compared to 177 in the previous quarter. (Positive Supports Goal One)
• The number of reports of use of restrictive procedures is lower, with 534 reports in the most recent quarter, compared to 604 in the previous quarter. (Positive Supports Goal Two)
• The number of reports of emergency use of mechanical restraints with approved individuals is lower, dropping to 21 from 32 in the previous quarter. After one quarter, the total is 24 percent of the annual goal of 88 and on track to be met. (Positive Supports Three)
• The number of people with disabilities working in competitive integrated employment through VRS and SSB services was 1,660, exceeding the annual goal of 1,495. (Employment Goal One)
• The number of employed peer support specialists was 77, which met the annual goal of 76. (Employment Goal Four)
• The percent of students receiving instruction in the most integrated setting was 63.38 percent, which meets the annual goal of 63 percent. (Education Goal One)
• During the last year, accessibility improvements were made to 509 curb ramps, 52 accessible pedestrian signals, and 17.57 miles of sidewalks, meeting the annual goal. (Transportation Goal One)
• On-time performance for Greater Minnesota Transit improved to 95.3 percent from 95.1 percent, exceeding the overall goal of 90 percent. (Transportation Goal Four B)
• The number of students experiencing emergency use of restrictive procedures and the number of incidents were greatly reduced. This met the annual goals, although the numbers were substantially affected by COVID-19 school closures. (Positive Supports Four and Five)
• During the last year 57.1 percent of adults remained in their community after a crisis, which met the annual goal of 55 percent. (Crisis Services Goal Two)
• There were nine fewer cases of vulnerable individuals being treated in emergency rooms due to abuse and neglect. This was a 22 percent reduction from baseline and met the annual goal to reduce by 5 percent compared to baseline. (Preventing Abuse and Neglect Goal Two)
• There were nine fewer individuals who experienced a repeated abuse or neglect repeat episode. This was a 54 percent reduction from baseline and met the annual goal to reduce by 15 percent from baseline. (Preventing Abuse and Neglect Goal Three)

The following measurable goals have been targeted for improvement:

• Transition Services Four to adhere to transition protocol for individuals experiencing a transition.
• Crisis Services One to increase the percent of children who remain in the community after a crisis.

Finally, the Leadership Forum reviewed amendments to the plan. Major recommendations aim to align the plan more closely with the Governor's Executive Order, which was very specific around moving towards better inclusion of people with disabilities in Black and Indigenous communities and communities of color. This includes everything from healthcare to education to employment to housing.

Representatives from agencies discussed several specific goals:

• Transition Services Goal One: The language was changed to "informed choice" based on comments from other Leadership Forum members. A new strategy was added in March to plan for and begin the development of informed choice training for the agencies. This includes requirements for meeting the individual's needs, tools, information, and opportunities. This will help the person understand their options. A plan for including these milestones will be developed by March 31, 2023. This is a way to promote a more person-centered planning process with additional monitoring and compliance.
• Housing and Services Goal One: DHS and Minnesota Housing are extending this goal for two more years and will look at the information regarding informed choice and race and ethnicity as it relates to housing. Additional changes include improving access to Housing Stabilization Services through Medical Assistance. This includes implementing the moving expenses option by December 31, 2022, and developing resources and making them available on the HB 101 website.
• Employment Goal Two: DEED proposed a change to combine the Medicaid-funded programs with Employment First Minnesota efforts by June 30, 2024. A baseline will be established that includes the number of individuals served on a Medicaid waiver. DEED wants to ensure people who are earning subminimum wages can provide input about their interest in working in competitive, integrated employment.
• Employment Goal Three: The goal focuses on the Employment Capacity Building Cohort (ECBC). There are 31 ECBC community teams that include school districts, vocational rehabilitation, and case managers. This ensures students with cognitive disabilities between the ages of 19 and 21 have more workplace experiences and opportunities for competitive, integrated employment.
• Department of Corrections: The first draft amendment is focused on a comprehensive review of policies and practices as well as improvement related to person-centeredness, inclusivity, accessibility, and equity. DOC is looking to do an equity review of policies.

April 2022

The Olmstead Subcabinet met on April 25, 2022  to approve the April 2022 Olmstead Plan Revision and discuss the future of direction of the Plan.

The April 2022 Olmstead Plan Revision was reviewed and Subcabinet co-chairs provided a brief overview of the process the Leadership Forum used in reviewing, considering, and recommending Plan amendments. Some of the highlights included:

• New strategies to focus on informed choice in decision-making.
• New strategies to measure equity for individuals with disabilities from racially and ethnically diverse communities.
• New strategies from DPS, DOC, and MDVA to identify the impact of their services on individuals with disabilities that will lead to the development of measurable goals in 2023.

The April 2022 Olmstead Plan Revision was unanimously approved.

A general discussion about the future direction of the Olmstead Plan followed. Starting with the question of what success would look like four years from now to bring the Olmstead Plan to the next level, thoughts shared from Subcabinet members included:

• How the COVID-19 pandemic has impacted health, medical care, and access; brought attention to the intersection of racial disparities at the intersection of disability, race, and gender identity; and helped change the way MDH operates to make sure people have the information they need.
• Future success would include a focus on equity and identifying where disparities exist.
• Addressing the housing shortage and housing affordability crisis.
• Focusing goals more on people with disabilities, rather than general things.
• Addressing ways to provide more services to people with disabilities and more client-focused services.
• Reevaluating services provided by MDVA to make sure they have services as their disposal to help veterans with disabilities.
• Being intentional around person-centered planning, particularity in assessments for women and men who come into the custody of the DOC.

The question of how the Leadership Forum and Workgroups can move this work forward was also discussed, with Subcabinet members sharing:

• The Leadership Forum and Workgroups should evaluate their interaction with the Subcabinet and think about what agencies need to take this work to the next level.
• There is a sense of a greater discussion about Olmstead, but there is a disconnect when it comes to understanding the principles underlying Olmstead and the values of integration, inclusion, person-centeredness, and informed choice.

May 2022

The Leadership Forum met on May 23, 2022, to hear updates on workgroups and review the most recent quarterly report. The director's report noted website changes in coming months, including possibly expanding the availability of translated materials. The Olmstead Plan will be translated into Spanish, Hmong, and Somali, and any additional translated materials will be in those languages. The Olmstead Plan Satisfaction Survey will be open in July for public participation, with comments accepted through the end of August 2022. The survey will be offered in multiple languages.

Workgroups provided an update on their activities, including recommendations for the Leadership Forum.

Data Collection Practices recommended continuing to gather data from the Data Collection Practices survey, analyze results, and determine next steps.

• The purpose of the survey is to develop an inventory of datasets from all state agencies in Minnesota to highlight the presence or absence of disability related data (including data regarding persons with disabilities from diverse racial, ethnic and linguistic backgrounds and data related to broad categorical disability groups as well as specific groups) and to determine the ways the data may align with the Minnesota Olmstead Implementation Plan.

Prevention of Abuse and Neglect recommended ensuring people with disabilities are included as valued leaders and experts. Their knowledge and lived experiences will advise how to implement and evaluate the comprehensive abuse and neglect prevention plan. To achieve this the Abuse and Neglect Workgroup's (or any subgroups) will strive to have at least 50 percent of their membership be people with disabilities. All meetings and materials will be designed for greatest accessibility. The workgroup will focus on primary prevention areas from the comprehensive plan that include the following:

• Educate families, community members, and people who work with people with disabilities about the problem of abuse and neglect of people with disabilities. Give them information on options to report, where to access services, and ways to support the needs and wishes of people with disabilities who have experienced abuse or neglect.
• Prevent abuse and neglect from happening in the first place, by focusing on examining and eliminating the reasons why people are abused or neglected.

Workforce Shortage and People with Disabilities distributed a survey to workgroup members, Community Input Event attendees, and via OIO social media and the website. The question asked "What are the top five biggest barriers to you having a competitive integrated job? That means a job where you work with non-disabled people, and you get paid the same amount of money as everyone else." The group recommends distributing the survey to Greater Minnesota residents that are not currently receiving DEED, with a goal of getting it out in June 2022. A comparison will be done to determine similarities, gaps, etc. against the findings of a DEED survey distributed in March 2022.

Affordable, Safe, and Accessible Housing conducted Community Input Events, surveys, and workgroup discussions and landed on recommendations to:

• Request data and information on the types of housing people with disabilities in Minnesota want, how much of that housing is currently available, how many people get the type of housing they want, and how those terms are defined.
• Gather data and information on rental housing access for people with disabilities who are black, indigenous, and people of color. Create a standard definition of accessible housing beyond ADA requirements that includes being near public transportation with sub-definitions based on type of need.
• Require state agencies to eliminate jargon and acronyms and provide plain language instruction guides on websites and materials. I.e., Decision Tree to be used by parents, advocates, and other community members.

The charge of the Juvenile Justice & Special Education workgroup was to explore the problem space, including:

• Research why more students with disabilities are arrested and jailed than non-disabled students.
• Find out why more students of color are arrested and jailed than their white peers.
• Find ways to reduce the number of students with disabilities who are arrested and jailed.

The group recommends engaging what is known with a scoping review.

The May 2020 Quarterly Report covered 12 measurable goals, of which seven are on track to be met, three are not on track to be met, and two are in process. Areas where progress is being made on measurable goals includes:

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 one quarter, 44 percent of the annual goal of 72 has been achieved. The goal is on track. (Transition Services Goal One A)
• In the current quarter, 208 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 has been achieved. The goal is on track. (Transition Services Goal One B)
• During this quarter, 906 individuals moved from other segregated settings to more integrated settings. After one quarter, 181 percent of the annual goal of 750 has been achieved. (Transition Services Goal One C)
• After three quarters, 30.4 percent of people at AMRTC no longer meet hospital level of care and are awaiting discharge to the most integrated setting. This is on track to meet the annual goal to reduce to 30 percent or lower. (Transition Services Goal Two)
• In the current measured quarter, the number of individuals at Forensic Services who moved to a less restrictive setting averaged 4.3 per month. This goal is not on track to meet the annual figure of five or more. (Transition Services Goal Three)

Timeliness of Waiver Funding Goal One

• During the last quarter, 58 percent of all individuals assessed for the Developmental Disabilities waiver were approved for funding within 45 days. The approval rate for each urgency category was 100 percent for Institutional Exit, 64 percent for Immediate Need, and 54 percent for Defined Need. This goal is not on track to be met.

Increasing system capacity and options for integration

• The utilization of the Person-Centered Protocols continues to show improvement. Of the 309 case files reviewed during this quarter, the combined average of presence of the eight person-centered elements measured in the protocols was 95.2 percent. Five of the eight elements achieved 100 percent. This is on track to meet the 2022 goal of 90 percent. (Person-Centered Planning Goal One)
• The number of individuals experiencing a restrictive procedure is lower, at 152 individuals in the last quarter compared to 169 in the previous quarter. (Positive Supports Goal One)
• The number of reports of use of restrictive procedures is lower, at 417 reports in the last quarter compared to 534 in the previous quarter. (Positive Supports Goal Two)
• The number of reports of emergency use of mechanical restraints with approved individuals was 24 reports in the last quarter compared to 21 in the previous quarter. After two quarters, the total is 51.1 percent of the annual goal to reduce to 88. The goal is on track. (Positive Supports Three)
• During Calendar Year 2021, on-time performance improved for Transit Link (98 percent,  up from 96 percent). On-time service decreased for Metro Mobility (94.8 percent from 96.4 percent) and Metro Transit (84.8 percent from 87.8 percent). The goal is in process to achieve the 2025 goal of 90 percent. (Transportation Goal Four A)

The following measurable goal is targeted for improvement:

• Transition Services Four to adhere to transition protocol for individuals experiencing a transition.

June 2022

The Subcabinet met on June 6, 2022, to discuss the Olmstead Plan. Co-chairs of the Leadership Forum, Lisa Harrison-Hadler (OMHDD) and Curtis Shanklin (DOC), provided an overview of the Leadership Forum's process to review, consider, and recommend Plan amendments to the Subcabinet. Highlights included:

• New strategies to focus on informed choice in decision-making
• New strategies to measure equity for individuals with disabilities from racially and ethnically diverse communities
• New strategies from DPS, DOC, and MDVA to identify the impact of their services on individuals with disabilities that will lead to the development of measurable goals in 2023:
• Review DOC policies related to person-centeredness, inclusivity, and equity
• Improve the response to the needs of individuals with disabilities on correctional supervision and experiencing unsheltered homelessness
• Define the primary disabling conditions chronically homeless veterans experience and determine how to best address those needs (MDVA)
• Ensure crime victims with disabilities have access to support services (DPS)
• Develop a juvenile justice mental health continuum of care that aids juvenile justice facilities and child welfare service staff in coordinating their response to mental health crises (DPS)
• Develop key questions that will identify disparate health outcomes for people with disabilities (MDH)