Tuesday, February 25, 2025

Your Experience with DDS/DBH Coordination

DHCF head Wayne Turnage used his performance review testimony last week to talk about the troubling budget outlook for Medicaid, and there is no doubt that that that will be the big issue once the DC council starts budget hearings for FY 2026 later next month.  However, in the meantime, DDS still has not had its performance review hearing, scheduled for March 3.  As you know, I've been very focused in my blog recently on the kind of treatment people with disabilities receive when they get services from DBH.  Here is what DDS had to say in its pre-hearing questions on the subject of coordination with DBH:

28. Describe DDS’ collaboration with the Department of Behavioral Health. Include any specific partnerships on programs, initiatives, and events that DDS had with DBH in FY 24 and FY 25, to date.

In FY24 DDS and DBH collaborated to transition 147 DDS people to new behavioral health providers following the closure of the DBH Intellectual-Developmental Disability program at 35 K St.

In FY24, upon official notification that the 35 K St IDD clinic would be closing, DBH and DDS collaborated to ensure that patients were provided choice in the selection of new psychiatric service providers by: a. Collaborating on the official notification letters informing of the closing to ensure consistent messaging to CSAs, DDS service coordinators, DDS residential providers, guardians/decision makers, and patients. b. Identifying specific CSAs that had the capacity to take on the patients from 35 K St without delay, including the ability to schedule an intake within 7 days of referral. c. Requiring DDS service coordinators to work with the person and their interdisciplinary teams to choose a new psychiatry service provider.

DBH Provider Relations tracked 30- day, 60 -day, and 90- day follow-up appointments. Biweekly meetings between DBH Provider Relations and DDS Service Coordination were held throughout the transition to ensure patients were successfully placed with new providers. Currently, all DDS-linked patients have been placed with a new provider. DBH-IDD psychiatrist, Dr. Todd Augustus, has been available throughout the transition process to assist with questions/concerns and to consult with the 35 K St. Urgent Care Clinic on people with IDD who presented to UCC during the transition. In FY 25, DDS and DBH will continue this joint initiative to ensure that people with IDD receive high-quality and consistent behavioral health services. Dr. Augustus will provide ongoing consultative services to DDS and participate in interdisciplinary treatment team meetings for complex IDD cases, when requested. Dr. Augustus will also provide educational trainings to DDS and group home providers pertaining to mental health needs of IDD consumers through the DDS Nursing Roundtable. DBH and DDS have a well-established collaborative relationship which will continue to expand and evolve in FY 2025.

a. Does DDS encourage providers to contact DBH’s Community Response Team when an individual is in crisis or to contact 911?

The decision whether to call 911, the Community Response Team, or the Department of Behavioral Health (“DBH”) Assertive Community Treatment (“ACT”) team is made by the service provider, who acts based on the specific situation (i.e., whether there is a life-threatening emergency, or particular services are needed to ensure the safety of the person and staff). When 911 is called, a Crisis Intervention Officer (“CIO”) can be dispatched, meaning that a police officer with 40 hours of training in working with people who have mental illness and/or developmental disabilities will respond. Their training includes recognizing indicators that a person may have I/DD, communication procedures for people who have I/DD, and procedures for interacting with people who have disabilities. Two goals of the CIO program are to promote safe interactions between the police and citizens with mental health challenges and/or disabilities along with diversion of nonviolent mentally ill individuals, including people with dual diagnosis, from the criminal justice system to appropriate behavioral health services. Since June 2021, District 911 operators have been trained to identify situations involving mental health crises and to assess whether a police response is appropriate or whether they should redirect the call to the Community Response Team. Providers can also contact the Community Response Team directly or request DBH ACT services for people who receive those services as part of their mental
health treatment.

b. If someone receiving supports from both DBH and DDS needs housing and
supports, how do DBH and DDS work together to meet their needs?

DDS considers the suitability of the person’s current housing situation for meeting the person’s needs and, if necessary, explores the housing resources offered by DBH, DDS or other agencies. When a person requires individualized housing to promote their mental health recovery, DBH and DDS collaborate with the person’s ACT Team and the core service agency to identify housing options, rental subsidies, and community based behavioral health treatment services. If necessary, DDS will contact the Director of the DBH Housing Development Division or the Director of Residential Services and Supports to identify rental subsidies for the person. If the person receives housing supports from DBH and requires supports in the home and in the community, the DDS service coordinator works with the person and their circle of support to identify the appropriate waiver services based on the person’s assessed needs. The person selects a DDA provider for the service.

If you've had direct experience with DDS/DBH coordination, how has that worked out?  The DDS performance review hearing is an opportunity to testify and let the committee know what you've experienced - even if you can only send written testimony.

And if this isn't your topic but you plan to testify about some other aspect of DDS performance over the past year, you can take a look at all the committee questions, with DDS answers, here.by clicking here.


Sunday, February 16, 2025

DC DBH Hearing and Follow-up

In my January 28 entry, I encouraged readers to participate in Georgetown's survey about the interactions of people with disabilities with DC DBH (what's that? check here: Terms) and to participate in the then-upcoming performance review hearing for DBH.  I was happy to testify at the hearing - here's my testimony - and proud to be joined by two members of Project ACTION! as well as a concerned family member, who described direct interactions with DBH.  (Others were, I know, submitting written testimony as well.)  

What struck me in the hearing was that not only people with developmental disabilities, but quite a few others who testified about their direct experiences with CRTs, CPEP (Terms) or one of DBH's community service providers, had encountered insensitive or poorly trained staff who made them feel misunderstood or dismissed.  There was substantial discussion throughout the performance review, during testimony by public witnesses on February 3 and also in questions to DBH director Bazron on February 5, about inadequate staffing, as well as difficulties in reaching the Access Helpline and poor CRT response times.

Despite the evident need for improvement in DBH services, budget challenges are going to loom large in the upcoming fiscal year in all the DC government programs overseen by Deputy Mayor Wayne Turnage, who will address some of these funding concerns in his February 20 testimony this coming week.  These concerns will continue to be a prominent feature of budget hearings throughout the spring.

Wednesday, February 12, 2025

MEDICAID FUNDING AT RISK

Today I'm posting about an issue that affects people with disabilities in DC (and nationwide), as well as many others who rely on Medicaid for healthcare coverage - moves are underway on the Hill to cut federal Medicaid funding to some states (and DC).  

Councilmember Henderson gave an excellent summary of what we may be up against in her most recent newsletter:

Watching on the Hill - As Congress hammers out their next steps on budget and reconciliation, there is one phrase all Washingtonians should get familiar with – FMAP, the federal medical assistance percentage. Medicaid is jointly funded by the federal government and the states. FMAP is a formula to determine the federal government’s share for Medicaid expenditures using per capita income. In general, the federal government pays a larger portion of Medicaid costs in states with lower per capita incomes and vice versa for states with higher per capita income. No state can have a FMAP rate lower than 50% and higher than 83%. See here for the current FMAP rates for states. There are several proposals currently floating around Congress to reduce the District’s FMAP to 50%. This would fundamentally upend our public health system affecting hospitals, providers, and patients, as we would be required to pay more than any non-state. I’m writing about this because lot of people read this newsletter and I fear that the FMAP issue is going under the radar. The District does not enjoy the ability of having voting representation in the Congress, and right now, we need our allies!

Federal Medicaid matching also affects supports provided to people with disabilities, across the nation.  So - especially to allies who read my blog and actually have senators and voting representatives on the Hill - help DC (and maybe your own state as well, because there are moves afoot to reduce ALL FMAP to 50%) - WRITE TO YOUR SENATORS AND REPRESENTATIVE that you don't want them touching Medicaid! 

Tuesday, February 11, 2025

A Slight but Important Language Change

Over the past 10+ years, the "DD" in the name of my blog has stood for "Developmental Disability."  Starting today, it also stands for "Defending Democracy," since nothing could be more important in our city-which-one-day-will become a state.  I will still be focusing primarily on issues important for the disability community, but, as reflected already in my profile, " I strongly support statehood for DC, where I have lived since 1978, since without it no DC resident, disabled or non-disabled, will ever be fully empowered."  It's obvious we have a real fight ahead of us, so let's get busy!

Tuesday, January 28, 2025

PARTICIPATE IN THIS IMPORTANT SURVEY

While preparing for next Monday’s DBH performance review hearing, I also want readers to be aware of the survey being conducted by Georgetown University’s School of Medicine on the experience of people with disabilities and their caregivers with mental health services here in DC.  If:

- you or someone you care for relied on supports from 35 K before it closed

- you are a disabled person who has interacted with one of the DBH community service agencies

- you are a caregiver who has interacted with one of the DBH community service agencies

- you have experience supporting people with disabilities at one of DC’s community service agencies

Then this survey is for you!  And if Georgetown gets good participation from the community, the (confidential) information they collect will be indispensable to the DC council and to DBH itself as they focus on needed reforms to better serve DC residents.  As you know if you’ve been reading my blog lately, I’m very focused on this topic right now, and very much looking forward to the outcomes of the Georgetown survey.  Here's a short description:

"[Georgetown is] looking for participants who are either adults with physical and/or mental disabilities, the direct caregivers of adults with physical and/or mental disabilities, or community-based mental healthcare providers practicing in the DC area. The primary goal of this study is to identify perceived barriers to mental healthcare access in participants with disabilities and their caregivers…By collecting the perspectives of both patients and healthcare providers, the hope is to gain a better understanding of the experiences of the disabled community and…to continue addressing the barriers to mental healthcare access that still exist today."

For more information, take a look at the attached flyers for people and caregivers and for community providers, and be in touch with Mary Tresvalles (mat321@georgetown.edu) with any questions.  Please help if you can!


Friday, January 24, 2025

REGISTER TO TESTIFY AT DBH PERFORMANCE REVIEW

I want to share a quick follow-up (thanks to Marcia Huff in councilmember Henderson's office!) about the upcoming DBH performance hearing.  The link to sign up for this hearing on February 3 is now live. 

Also, DBH responses to the committee's preliminary questions are due by January 27 and will be posted on the same link after they are received.


Thursday, January 23, 2025

FY 2026 Performance Reviews Upcoming!

At last Saturday's Project ACTION! meeting, I reminded folks in the chat about upcoming performance review hearings before the DC council.  Here is the schedule:  DC council performance review calendar.  This is the first phase of DC council deliberations in preparation for the FY2026 budget.  A second phase of hearings, probably later in March, will address the budget itself.  

You'll see that - as was the case last year - the DDS performance hearing is quite late, not until March 3 - which will not provide much time between the hearing and the mayor's budget proposals.  As indicated in my previous blog posts in September, October and December of last year, I also have my eye on DBH during this budget season - that performance hearing is coming up soon, on February 3, so if you plan, as I do, to testify at that hearing, keep your eye on this link which should open up for witness signups in the next couple of days.

As you prepare for your testimony, and for your advocacy more generally, please recall this message that I included in an email on January 8:

As you read in my last post of 2024, there will be some continuity in the DC council’s oversight of DDS starting in January.  In fact, there is a lot of continuity in the council overall:  as you plan to testify or to contact your councilmembers over the coming year, you’ll want to use this page from my blog as reference: DC council contacts.  Another page in my blog, Terms and organizations, provides background on some of the terminology I use in my blog posts for your background.

The above resources will be helpful references for you as we come together in our advocacy throughout 2025 and beyond!  Very best to us all in this new, and challenging, year - 

Carol Grigsby (she/her/hers) is a dedicated advocate, focused on advancing rights and increasing opportunities for people with developmental disabilities in Washington, DC. A former member and chair of the DC Developmental Disabilities Council, I currently serve on several local groups focused on issues affecting the disability community. In addition to advocating for full inclusion of people with disabilities in our local community, I strongly support full rights and representation for residents of DC, where I have lived since 1978, since without real democracy no one in DC, disabled or non-disabled, will ever be fully empowered. Opinions in this blog are my own.


Tuesday, December 31, 2024

Some Good News for the New Year

This will be brief, and is certainly my final post of 2024!

I didn't want to let the year end, though, without confirming that our favorite DC council staffer, Sebastian Weinmann, wrote last week to say that DDS will remain under the jurisdiction of the council committee chaired by his boss, councilmember Janeese Lewis George.  At such a challenging time for the DC budget, and for DC more generally, this continuity is very welcome.

As you celebrate the turn of the year, add to your list for early 2025 a plan to testify at the DDS performance review hearing, to share your experience with DDA, RSA or both, with DC councilmembers.  As for me, I also plan to testify at the DBH performance review, since that department also has profound influence on persons with disabilities in DC.

The coming year will require courage and determination from all of us - so get ready!


Friday, December 6, 2024

CATCHING UP!

It’s hard to realize that I haven’t posted to this blog since mid-October.  Strangely, though, as I check websites that I would normally rely on for updated information, I find that they also have fallen behind.  Oh well, it’s been that kind of fall (now feeling like winter).

The last time I wrote, I was looking forward to the DC council hearing on the Psychiatric Institute of Washington and other psychiatric facilities, which took place on October 28.  Unfortunately, the nature of the hearing was somewhat different from what I had expected, and in spite of conversations I had had with Christina Henderson’s staff, barely a word was breathed about people with disabilities who may find themselves in any such circumstances.  Here is the written testimony I submitted after the hearing.

Like many of you, I was rattled by the election result and am concerned about what it could mean for DC.  We already need to be concerned about the state of the FY 2026 DC budget, and the election puts things even more in question.  I also had very sad family news which slowed me down even further in November, but am trying to put myself a bit more into the holiday spirit.  A wonderful holiday party last night, sponsored by Health and Joy, was a great start, although traffic from the lighting of the national Christmas tree caused problems for some of the attendees!

A good opportunity to see fellow advocates before the holidays are upon us, and to think ahead to 2025, will come when Project ACTION! holds its periodic in-person meeting downtown on December 14 – contact Tiffany Yuille to RSVP.  

As you prepare to testify at the DC council’s upcoming performance review hearings - just two months from now - something you may find helpful is the new “Civics Download” that the exclusively DC-oriented news source The 51st is making available - sign up for their newsletters, and make a donation while you’re there if you can – we want to keep this source alive as we head into uncertain times.

See you in the New Year, or (maybe) before!


Thursday, October 17, 2024

TWO EVENTS YOU WON'T WANT TO MISS

I’ll be brief, but I want to remind you about two free, but immensely worthwhile, events coming up that you’ll want to take in if you possibly can next week:

  • First is the annual meeting of the Quality Trust – which, despite the sound, is not a dry discussion, but rather a hugely enjoyable evening gathering where you can enjoy a few refreshments, visit with friends in a quiet setting near Gallery Place, and hear a little about what QT has been up to over the past year.  It’s Wednesday evening (October 23) and well worth your time, so register here:  Quality Trust October 23
  • Second is DC’s annual all-day Employment First summit on Friday October 25, at MLK library in that same neighborhood.  Here’s all the information you need, along with registration information:  Employment First October 25.  This is a great opportunity for networking, learning about new initiatives to encourage employment of people with disabilities in our community, and just generally have a great time.

Now – rush to a computer and register for both of these important events!