Home & Community Based Services Innovation Project

2024

This is a demonstration project of a new feature for people supported through Maine's Home and Community Based Services waivers (especially Section 21 and the anticipated lifespan waiver, but potentially also including Sections 29, 18, and 20). The demonstration project is patterned after behavior technician support under direction of a Board-Certified Behavior Analyst (BCBA or BCBA-D) as covered by private health insurance (especially under CPT codes 97151 assessment by BCBA, 97153 behavioral protocols by technician, and 97155 direct consultation by BCBA). We will provide a significant enhancement of the existing "Consultative Services - Behavioral" in Section 21 of the MaineCare Benefits Manual with primary goals of reducing use of behavior management plans, increasing access to community, reducing challenging behaviors, reducing frequency and intensity of crisis incidents, and improving respect for the human rights of people supported through the waivers. We will recruit people currently on intrusive plans (initially—and potentially exclusively—from underserved area of the state as defied in the RFA), with special focus on recruiting people under state guardianship. Behavior analysts (two doctoral level BCBA-Ds) have been recruited from a pool of behavior analysts oriented toward human rights and community inclusion and will be further oriented to the specifics of Maine regulations (especially Maine's implementation of the federal HCBS Settings Rule at MaineCare Benefits Manual Chapter I Section 6 and Maine's behavior regulations at 14-197 CMR Chapter 5). Direct Support Professionals (DSPs) or related personnel will also be provided training toward a Registered Behavioral Technician (RBT) credential from the Behavior Analyst Certification Board (BACB) and will be paid a stipend for participating in the training. In addition, DSPs implementing the plans with support from behavior analysts will be provided a stipend to encourage their participation and recognize the effort and attention to maintain fidelity to model. A third doctoral level BCBA-D (on the UMaine faculty) will be available as a resource to RBT trainees and will coordinate with the project director on proposing evaluation measures to the independent evaluator identified by OADS. The ultimate goal is for enhanced behavior support to be available to all people who need it who are supported through the waivers—potentially avoiding significant crisis events such as extremely expensive out-of-state placements and potentially addressing workforce crisis by allowing less use of 2:1 staffing when evidence-based practice is adopted—in a way that is effective and deeply respectful of the human rights of waiver participants. Measurable Objectives • At least 4 people supported by HCBS waiver in Maine initially on Behavior Management Plans (as defined in 14-197 CMR Chapter 5 Regulations Governing Behavioral Support, Modification and Management for People with Intellectual Disabilities or Autism in Maine, "Chapter 5") will receive enhanced behavior consultation from our team. (We have budgeted for 336 person- weeks of support, which could serve 4 people @ 84 weeks per person. If people supported by the HCBS waiver require less than 84 weeks of support during this project then we would be able to support more than 4 people.) • At least 16 direct support professionals or related personnel will receive training toward Registered Behavioral Technician (RBT) certification • Persons completing RBT training will demonstrate RBT competencies • Persons completing RBT training will sit for RBT certification exam • At least 80% of RBT trainees will achieve RBT certification • Rate of incident reports (aggregated across people receiving supports in this proposal) will decrease • 50% of people receiving supports in this proposal will transition to lower-level plans as classified in the 5-level scale in Chapter 5 • 75% of people receiving supports in this proposal will have a decreased rate of challenging behaviors • 75% of people receiving supports in this proposal will increase their access to the community

Performing Research or Evaluation, Continuing Education/Community Training, Demonstration Services

Quality Assurance, Quality of Life

Professionals and Para-Professionals, Family Members/Caregivers, Adults with Disabilities

None

State

N/A