Library: Policy

340:100-5-22.6. Alternative group homes

Revised 9-15-23

(a) Legal basis. Authority to operate alternative group homes is based on the Group Homes for Persons with Developmental or Physical Disabilities Act per Section 1430.1 through 1430.41 of Title 10 of the Oklahoma Statutes (10 O.S. §§ 1430.1 through 1430.41). Administrative and program requirements for alternative group homes are described in Oklahoma Administrative Code (OAC) 317:40-5-152, this Section, and OAC 340:100-6.

(b) General information. Alternative group homes:

(1) serve up to four service recipients who:

(A) have serious behavioral or emotional challenges or community protection issues in addition to intellectual disabilities and require continuous supervision and assistance to remain in the community; or

(B) were charged with a felony, determined by the district court as incompetent to stand trial due to intellectual disability, formerly known as mental retardation, and dangerous, and placed by the district court in the custody of the public guardian; and

(2) provide for the development of skills to assist service recipients to lead healthy, independent, and productive lives to the fullest extent possible.

(c) Provider approval criteria. In addition to OAC 340:100-6-12 requirements, prospective providers of alternative group home services must demonstrate a history of effective services and supports to persons with serious behavioral or emotional challenges or community protection issues. Provider approval requires review of historical information, when available, from Developmental Disabilities Services (DDS) Quality Assurance Unit and area office. The DDS director or designee must approve the location of the alternative group home prior to the implementation of services. Each prospective provider submits written documentation of:

(1) a history of services to persons who present serious behavioral or emotional challenges or community protection issues, including:

(A) past experience;

(B) number of persons served;

(C) provider's perspective on the greatest challenges in serving persons eligible for alternative group home services; and

(D) provider's philosophy for service provision;

(2) financial viability through fiscal information when requested, including the anticipated budget related to the rate for alternative group home services;

(3) service provision plans, including:

(A) anticipated number of homes;

(B) location;

(D) gender to be served;

(E) population to be served; and

(F) availability of psychological, psychiatric, and vocational services in the proposed location;

(4) plans for staffing and program coordination; and

(5) staff qualifications, including any additional training to be provided.

(d) Eligibility to receive services. To be eligible for services in an alternative group home, the person must:

(1) be in the custody of the public guardian per 22 O.S. § 1175.6b or 1175.6c; or

(2) meet the criteria for an intermediate care facility for individuals with intellectual disabilities level of care; and

(A) require 24-hour, on-site, awake staff supervision to ensure safety; and

(B) be found by the DDS director or designee to have serious behavioral or emotional challenges or community protection issues, such as:

(i) evidence of commitment of a sexually violent offense, sexually predatory act, or crime of sexual violence including, but not limited to:

(I) rape;

(II) lewd or indecent acts or proposals made to a child, per 21 O.S. § 1123; or

(III) forcible sodomy, per 21 O.S. § 888;

(ii) history of stalking or opportunistic behavior that demonstrates a likelihood to commit a sexually violent or predatory act;

(iii) documented pattern of acts of violence toward others;

(iv) experience ongoing, highly disruptive behavioral episodes that:

(I) are dangerous per 22 O.S. § 1175.1; and

(II) require close supervision and frequent intervention by staff;

(v) evidence of commitment of one or more violent offenses, such as:

(I) murder or manslaughter;

(II) attempted murder;

(III) arson;

(IV) assault;

(V) kidnapping; or

(VI) use of a weapon to commit a crime; or

(vi) severe ongoing self-injurious behavior.

(e) Services provided. Services provided are designed to assist service recipients in acquiring, retaining, and improving self-help, socialization, and adaptive skills necessary to reside successfully in a home and community-based setting.

(1) Services include supports to meet each service recipient's needs including, but not limited to:

(A) residential habilitation, such as assistance with the acquisition, retention, or improvement of skills related to activities of daily living, such as:

(i) personal grooming and cleanliness;

(ii) bed-making and household chores;

(iii) eating and food preparation; and

(iv) social and adaptive skills necessary to enable the service recipient to reside in a shared home;

(B) program supervision and oversight including 24-hour availability of response staff to meet schedules or unpredictable needs in a way that promotes maximum dignity and independence, while providing for supervision and safety. In addition to requirements in OAC 340:100-6-55, program coordination staff (PCS) must:

(i) serve no more than 18 service recipients;

(ii) ensure staffing levels meet (1)(H) of this subsection requirements; and

(iii) ensure records are maintained per OAC 340:100-3-40;

(D) recreational and leisure activities, including individual and group activities;

(E) assistance in money management;

(F) health care services provided per OAC 340:100-5-26 and OAC 340:100-5-26.3;

(G) medication administration per OAC 340:100-5-32; and

(H) management of staffing levels that provides supervision to ensure the safety of the service recipient, community, staff, other service recipients, and implementation of each service recipient's Individual Plan (Plan).

(i) An average of 14 hours of staffing per service recipient must be provided per billable day prior to filing a claim for habilitation training staff authorized per OAC 317:40-5-152.

(I) At least two awake-staff must be on duty during daytime and evening hours when service recipients are in the home.

(II) This requirement may be reduced to one awake-staff, when there are only one or two service recipients in the home.

(ii) Sufficient daytime staffing must be provided to:

(I) ensure adequate supervision in the home and community; and

(II) implement the Plan, except during the time the service recipient is in an authorized employment, vocational, or day services program that provides the needed supervision, security, and support identified in the Plan. Staff is trained per OAC 340:100-3-38.

(iii) At least one awake-staff must be on duty during hours when service recipients are asleep.

(I) The provider agency must have a provision to immediately provide additional staff in the home when the need arises.

(II) Staff on duty must be physically able and mentally alert to carry out the duties of the job.

(iv) The provider must:

(I) have staff available to provide necessary support and supervision when the service recipient needs to return from employment or other day services;

(II) provide activity options and supervision during all times when the service recipient is not participating in authorized employment activities; and

(III) ensure effective transition and coordination of supervision between alternative group home and employment programs or other authorized absences from the alternative group home program.

(2) In addition to the services in (1) of this subsection, services for wards of the public guardian are designed to ensure the service recipient is not dangerous to self or others.

(f) Alternative group home program requirements. In addition to compliance with applicable Oklahoma Human Services (OKDHS) and Oklahoma Health Care Authority (OHCA) rules, the provider ensures:

(1) staff implements security precautions protecting the service recipient, neighbors, children, vulnerable adults, animals, and others;

(2) staff implements outcomes and action steps detailed in the Plan to assist service recipients to function safely in the community and avoid criminal activity;

(3) collaboration and coordination occur with DDS staff, employment providers, therapists, and other entities and persons, such as law enforcement, corrections officers, schools, employers, mental health workers, and, when appropriate, the public guardian;

(4) written provider agency policies comply with OKDHS and OHCA rules;

(5) effective security and supervision of service recipients in the residence and community are provided;

(6) contingency plans are developed and implemented for:

(A) emergency relocation of a service recipient who created a danger or who is in danger;

(B) emergency staffing in the event changes are required to protect staff or others;

(C) general emergencies requiring evacuation of the entire home, such as fire or weather emergencies, per OAC 340:100-6-45; and

(D) elopement;

(7) legal and court requirements are followed, including adherence to Oklahoma laws governing registered sexual offenders;

(8) the health care coordinator (HCC) or other knowledgeable staff accompanies the service recipient to each medical or psychiatric appointment, taking current data summaries that indicate the rate of occurrence of medication-responsive symptoms or behaviors over the last one to three months. For visits to the physician prescribing psychotropic medication, the HCC presents Form 06HM073E, Referral Form for Psychiatric Treatment or Examination, per OAC 340:100-5-26;

(9) specific offense patterns are considered and addressed when determining appropriate program locations; and

(10) any modifications to the Plan including restrictive or intrusive procedures is supported by a specific, assessed need, and justified in the person-centered plan per OAC 3 17:40-1-3(b). When the Personal Support Team (Team) determines restrictive or intrusive procedures are essential for safety, the Team must develop a protective intervention protocol per OAC 340:100-5-57.

(g) Weapons. Dangerous or deadly weapons are not permitted in the alternative group home or on the premises. Providers are prohibited from assisting any service recipient to obtain or possess dangerous or deadly weapons including, but not limited to:

(1) guns, BB guns, air rifles, or other firearms;

(2) crossbows;

(3) paint guns;

(4) arrows;

(5) explosives;

(6) stun guns; and

(7) knives, except cooking and eating utensils.

(h) Substances and items prohibited in alternative group homes are:

(1) illegal substances; and

(2) alcohol.

(i) SoonerCare eligibility. The service recipient and guardian, with necessary support from the provider, establish and maintain SoonerCare eligibility, when possible.

(j) Natural supports. Persons who agree to provide natural supports to a service recipient living in an alternative group home must:

(1) work with the Team to develop a schedule, support strategies, and agreement for support. Each Plan contains a description of any natural support provided that ensures the safety and welfare of the service recipient and community. No arrangement is made for natural supports that violate existing court orders, security arrangements, or the Plan;

(2) keep commitments made, regarding supports; and

(3) document or report to the program coordinator or DDS case manager regarding supports provided.

(k) Refusal to participate. When a service recipient or guardian refuses to participate in service delivery described in the Plan:

(1) the provider:

(A) continues to implement the Plan as written; and

(B) immediately notifies the DDS case manager of the need for a Team meeting;

(2) the DDS case manager takes immediate action to convene the Team to address the situation; and

(3) steps in OAC 340:100-3-11 are followed.

(l) Record keeping. In addition to requirements of OAC 340:100-3-40, records of service recipients must include documentation of:

(1) the service recipient's registration with appropriate law enforcement authorities, when required, and documentation of subsequent registration notification to DDS;

(2) all agreements or plans with other agencies or persons who support the service recipient, including the guardian and family members that specifies the service recipient's supervision requirements when staff is not present; and

(3) any refusal by the service recipient to follow conditions of the Plan, protective intervention protocols, or treatment recommendations.

(m) Training. Staff or volunteers providing direct supports for service recipients in an alternative group home are required to complete necessary training requirements per OAC 340:100-3-38.13..

(n) Transportation. Providers of alternative group home services must ensure transportation is:

(1) available as needed for medical emergencies, appointments, day programs, and community activities per OAC 317:40-5-103; and

(2) supervised per this Section in accordance with each service recipient's needs.

(o) Emergency temporary alternative group home supports. Emergency temporary alternative group home supports are described in this section. Alternative group homes may serve additional service recipients when the DDS director or designee determines he or she requires alternative group home level of care and there are no other resolutions to the emergency.

(1) When an emergency situation exists in which the Team requests temporary alternative group home supports, the case manager submits a request and justification for the services to the DDS director or designee. The request must include:

(A) a description of outcomes the service recipient and his or her guardian desires, when appropriate, and the services and supports necessary to achieve these outcomes;

(B) objective evidence supporting the need for the alternative group home placement; and

(2) Within the first two weeks of the service recipient's admission to an alternative group home, the Team develops a transition plan with action steps or methods to achieve the transition including the names of persons or provider agency positions responsible for implementing assigned responsibilities.

(p) Transition. Teams plan for a service recipient's transition to appropriate services when it is determined the alternative group home program is no longer necessary.

(1) Within three months of the service recipient's admission to an alternative group home, the Team develops reasonable criteria for the service recipient's transition to a less restrictive environment that are:

(A) included in a written plan submitted to designated DDS State Office staff; and

(B) reviewed at least annually by the Team.

(2) All transitions from alternative group homes must be approved by designated DDS State Office staff. DDS State Office staff may adjust the transition date when necessary. • 1

(q) DDS-initiated transition. The DDS director or designee may initiate the transition process for a person receiving alternative group home services who can be effectively served in another residential environment.

INSTRUCTIONS TO STAFF 340:100-5-22.6

Revised 9-15-20

1.(a) The Developmental Disabilities Services (DDS) case manager:

(1) reviews existing legal documents and court minutes to determine if the transition requires modification of an existing court order;

(2) ensures the Team completes an assessment that identifies potential areas where the service recipient's or community's safety is at risk;

(3) consults with the positive support field specialist when potential risks are identified;

(4) reviews the service recipient's history, current circumstances, incident reports, court orders, Plan including the Protective Intervention Protocol, and other relevant documents;

(5) consults with other professionals when appropriate, such as sex education or treatment, autism trainer, or counseling, to review access to explicit material.Teams must exercise extreme caution and seek DDS State Office staff guidance prior to giving alternative group home residents access to sexually explicit media or materials that includes content that depicts rape, acts of sexual aggression including assault, abuse and/or violence; sexual harassment (verbal and/or physical); and sexual acts that are dehumanizing or degrading;

(6) submits referrals for needed services;

(7) ensuresa PIP is developed or revised, when necessary;

(8) reviews restrictions, at least annually or when requested by a Team member;

(9) immediately notifies DDS State Office staff of any transition plans considered by the Team; and

(10) reports any alternative group home vacancy immediately to DDS State Office staff.

(b) DDS State Office staff:

(1) reviews any existing court limitations or placement issues; and

(2) notifies the DDS case manager of approval or denial of the transition.

(c) DDS area staff completes tasks necessary for approved transition.