View Comments on ‘Children’s Community Crisis Homes/Enhanced Behavioral Supports Homes’

Second 15-Day Comments

Received DateReceived From (Name or Affiliation)Comment
04/20/2023Amy Westling (Association of Regional Center Agencies) ARCA welcomes the opportunity to comment on the amended regulations proposed by the Department of Developmental Services (DDS) related to Community Crisis Homes (CCCH) and Enhanced Behavioral Supports Homes. Please see the attached comments concerning the proposed Children’s Community Crisis Homes (CCCH) and Enhanced Behavioral Supports Homes (EBSH) regulations. Darline Dupree

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15-Day Comments:

Received DateReceived From (Name or Affiliation)Comment
08/30/2022Disability Voices United Disability Voices United (DVU), a statewide advocacy organization directed by and for people with disabilities and their families, strongly supports the comments and suggestions of Disability Rights California (DRC) on the Department's August 15, 2022 modifications to the proposed regulations for Community Crisis Homes and Enhanced Behavioral Support Homes. DVU also strongly supports the August 26, 2022 comments submitted by Alison Morantz, Director of the Stanford I/DD Law and Policy Project (SIDDLAPP). Addressing the issues raised by DRC and SIDDLAPP would significantly strengthen the regulations, help minimize risk when restraints are used, and ensure that people served can meaningfully participate in the important debriefing process. DVU appreciates the Department's efforts to respond, with these modifications, to the comments raised by the community in writing and at the public hearing on the proposed regulations. Thank you for listening.
08/30/2022CSU Northridge, Avenues SLSThe proposed plan allows and suggests the emergency response of "prone" and "supine" containment, but does not list what specific training requirements and certifications are required by staff to implement such procedures. Most community support agencies require ALL of their direct care staff who implement crisis intervention to be trained and certified in a specific discipline (Mandt Traning www.mandtsystems.com), NCPI or PRO-ACT. It is also important to share my concern that "prone" and "supine" containments are suggested or allowed in the proposal. Prone containment is more likely to lead to serious injury (and even death) to both the people being restrained and the people restraining them and due to this, these techniques have been eliminated from trained certification in the disciplines listed above. I have been a certified trainer in these disciplines for over 30 years and would NEVER advocate for prone or supine containment being allowed in such regs; especially without a formalized training program and certification for staff. I believe that this language may have mistakenly been copied from older state behavior regulations from decades ago, which are outdated and no longer practiced.
08/30/2022William Leiner, Managing Attorney, Disability Rights CaliforniaDisability Rights California appreciates the opportunity to submit the attached comments regarding DDS's proposed Enhanced Behavioral Support Homes and Community Crisis Homes regulations. Please reach out to William Leiner at william.leiner@disabilityrightsca.org or 510-267-1237 if you have questions about this submission.

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08/26/2022Director, Stanford I/DD Law and Policy ProjectI strongly support the Department's effort to protect the safety of residents of EBSH and CCH, who tend to have the most severe behaviors, and think the most recent round of updates are good steps in the right direction, and also support the revisions proposed by Disability Rights California. The following are additional suggestions to further strengthen the regulations.

First, implementing physical holds correctly can be the major factor determining whether a client (or staff member) emerges safely from an episode of high-intensity aggression or property destruction. As the statute recognizes, intensive initial and ongoing training is required to ensure that appropriate holds are used and that they are implemented correctly. The statute should explicitly require that the 16 mandated hours of training must be provided through a nationally recognized vendor of empirically validated physical intervention/de-escalation techniques (such as ProAct, QBS SafetyCare, or CPI) that uses a "train the trainer" model in which trainers are trained for 32-40 hours by experienced, dedicated trainers, unless the EBSH/CCH can provide a compelling reason why these programs are not suitable for its clients. Otherwise, vendors may create their own ad hoc, in-house physical de-escalation programs simply to cut costs, which may put highly behavioral individuals (and staff) at risk. Any home that uses an in-house (not nationally recognized) program should be required to demonstrate that using an ad hoc "in-house" physical restraint protocol is at least as safe and effective as nationally recognized protocols, and not simply a way to cut costs. (To achieve this goal, perhaps the words "nationally recognized" could be inserted before the phrase "program for preventing and safely managing dangerous behavior.")

Secondly, the statute should specify that the use of 1:1 physical restraint should not be used except in emergency situations. All the physical restraint procedures sanctioned by the nationally recognized certification programs mentioned above require a minimum of 2 staff; the use of 1:1 restraint is only allowed if there is imminent danger of bodily harm to the client or others.

Third, the definition of "physical restraint" as excluding "physical contact intended to gently assist a consumer in performing tasks or to guide or assist a consumer from one area to another" could be construed as excluding a physical escort procedure (such as a situation in which a consumer drops weight), even though such an escort procedure does require rigorous training to be carried out safely.

Fourth, reference should be made to the use of blocking pads (such as ukeru) as an alternative to restraint, since they are much safer and less restrictive. For example, homes could be required to demonstrate that they have tried to use blocking pads before resorting to physical restraint, or to demonstrate that blocking pad techniques are not suitable for their clients.

Fifth, far more extensive measures are required to deter underreporting. These might include: (1) financial penalties for failure to report instances restraint; (2) random audits that include interviews of staff; and most importantly, (3) whistleblower provisions that incentivize staff to report, anonymously if they choose, instances in which a home failed to report all instances of restraint.

Finally, there is an urgent need for greater data collection and information sharing on best practices in this area. The Department should play a role in facilitating free information exchange among the administrators of CCH and EBSH homes, and any other DDS-funded programs that frequently manage severe behavioral challenges in community-based settings. Creating a permanent forum in which administrators/managers could frankly discuss concrete challenges they are facing, share tips and strategies, and refine best practices would greatly improve client safety.
08/25/2022Amy Westling (Association of Regional Center Agencies)ARCA appreciates DDS’s efforts to address some of the issues previously raised by ARCA and welcomes the opportunity to comment on the amended regulations proposed by the Department of Developmental Services (DDS) related to Community Crisis Homes (CCCH) and Enhanced Behavioral Supports Homes. Darline Dupree

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08/23/2022Rhonda AldrichI disagree with this. It's bad enough you treated my son the last 2 years like a prison cell and now you want to continue this nonsense. Lockdown for 15 day is ridiculous and makes these adults have more mental health issues Behavioral issues and go stir crazy plus staff dissappear making it unsafe for the Homes. Ampro home Escondido! Very concerned conservator! My son says NO!

45-Day Comments:

Received DateReceived From (Name or Affiliation)Comment
07/18/2022California State University, Fullerton (Emeritus) Use of restraints has been researched for almost 50 years now. The data consistently indicate that more positive pro-active means of preventing severe challenging behavior (building relationships, developing effective means of communication and respecting those, using de-escalating conflict resolution) are far more effective in remediating challenges. Restraint is an archaic form of human rights violation that is outdated and often leads to more severe problems, injury, and even death. It's shocking that this is even a consideration.
07/18/2022Mary E Watson Section 59059.5 (a) Please clarify definition of aging out. That can be interpreted to be 1, 2, 3, or 4 years, or the point of entrance into a children's home. A discharge plan should start with admission and in that case would not necessarily need to be reviewed monthly. A true Transition Plan should be determined by the IBST including the frequency of review and criteria for frequency of review.
07/18/2022Mary E Watson, EBSH Administrator Please clarify in section 59060.5 Restraint Reporting Data (7)(b):

On the first day of the month following a consumer's admission and monthly thereafter ... shall submit a copy of the monthly log to the regional center's designee and to the Department at EBSHCCHMonitoring@dds.ca.gov.
If the consumer has no physical restraints does a log need to be submitted for each consumer or could the facility submit the Zero physical restraints on a facility log, similar to Disability Rights Reporting done monthly.
07/18/2022Diana Pastora Carson My name is Diana Pastora Carson. I am the Founder of Beyond Awareness, and I teach a Disability Studies course at SDSU. More importantly, I am a co-advocate, alongside my brother, Joaquin Carson.

My brother, a 53-year-old man, was a resident at Fairview Developmental Center, twice, for a total of 15 years. He has complex behavior and communication support needs. At Fairview, he was subjected to restraint during times of extreme dysregulation. At one time, these restraints resulted in 3 fractures in his vertebrae, 3 weeks in a wheelchair (a man who loves to walk, run, and ride bikes), not to mention the emotional trauma. Also of note, this incident triggered a class action lawsuit to find alternatives to restraint and seclusion within DC’s.

Furthermore, our family, along with Disability Rights California and many other friends and advocates, had to fight our regional center, for 3 years, in order to move Joaquin out of the DC, into supported living, because he was deemed “a danger to himself and others.”

But now Joaquin has lived in the community, in supported living, in his own home, near family and friends. For more than 10 years, he has succeeded in living an extraordinary life, safely, and he is my neighbor.

His home is designed in a durable fashion, and he is the only person living in his home. So he and his staff do not have the stressors of having to meet the needs of other individuals.

His staff, who by the way, are often underpaid and undertrained, do not have the option of restraint. And they do not feel the need to restrain. And they do not have the desire to restrain, because his environment is designed to keep him and his team members safe. For example, there are no things hanging on walls that can be thrown, his appliances are bolted to the floor, his toilet tank is embedded within the wall so that the lid of the tank cannot be removed by him, and his windows are shatter-proof. We thought ahead and designed his home around his individual support needs.

My point is this. When we focus on congregate settings as the only safety nets for people, and ignore other options that exist, we cannot envision and create environments that support people in humane, inclusive, and dignifying ways. So much more is possible. We have seen other options work. And we must do better.

I urge DDS to whole-heartedly consider the comments made by Will Leiner, Dr. Ruth Myers, Vivian Haun, Nina Spiegelman, and Julie Neward here, and avoid taking backward steps.

Furthermore, our family, along with Disability Rights California and many other friends and advocates, had to fight our regional center, for 3 years, in order to move Joaquin out of the DC, into supported living, because he was deemed “a danger to himself and others.”

But now Joaquin has lived in the community, in supported living, in his own home, near family and friends. For more than 10 years, he has succeeded in living an extraordinary life, safely, and he is my neighbor.

His home is designed in a durable fashion, and he is the only person living in his home. So he and his staff do not have the stressors of having to meet the needs of other individuals.

His staff, who by the way, are often underpaid and undertrained, do not have the option of restraint. And they do not feel the need to restrain. And they do not have the desire to restrain, because his environment is designed to keep him and his team members safe. For example, there are no things hanging on walls that can be thrown, his appliances are bolted to the floor, his toilet tank is embedded within the wall so that the lid of the tank cannot be removed by him, and his windows are shatter-proof. We thought ahead and designed his home around his individual support needs.

My point is this. When we focus on congregate settings as the only safety nets for people, and ignore other options that exist, we cannot envision and create environments that support people in humane, inclusive, and dignifying ways. So much more is possible. We have seen other options work. And we must do better.

I urge DDS to whole-heartedly consider the comments made by Will Leiner, Dr. Ruth Myers, Vivian Haun, Nina Spiegelman, and Julie Neward here, and avoid taking backward steps.
07/18/2022The Natalie Project My name is Julie Payne Neward. I am a sibling of a woman who is a survivor of sexual assault and project founder of The Natalie Project. www.thenatalieproject.org

I am here for the topic of restraints as trauma . Oftentimes restraints are used to manage behavior, which may be the result of sexual abuse. I have learned this from Dr. Susan Abend with the Right Care Now Project.

We need trauma-informed care/person centered planning and a debriefing meeting is key. A circle of support is key when there is trauma and securing/protecting that circle.

My sister's case never had a debrief and I wish we did.

I will support that in every aspect of the service system that serves our loved ones.
07/18/2022Stephen Myers PhD BCBA-dPlease see comments below. Thank you

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07/17/2022William Leiner, Managing Attorney, Disability Rights CaliforniaDisability Rights California appreciates the opportunity to submit the attached comments regarding DDS's proposed Enhanced Behavioral Support Homes and Community Crisis Homes regulations. Please reach out to William Leiner at william.leiner@disabilityrightsca.org or 510-267-1237 if you have questions about this submission.

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07/17/2022Mary E WatsonSection 59056- (d) Staffing Requirements: Each EBSH must have an administrator present and on duty a minimum of 20 hours per week per facility to ensure the effective operation of the facility. Proposed change: This time must be documented in the consumer file.

Documenting in the consumer file does not make sense, it is not documenting per consumer. An administrator is to ensure effective operation of the facility which includes many activities. Documentation in the facility file would be more appropriate.
07/13/2022Debra KircherWould it be possible to locate the Crisis Homes and EBSH homes with clients that have High Intensity and Dangerous type Behaviors only in rural areas, according to the regulations. It is very difficult for the staff in the homes, to keep clients quiet enough, and calm enough in order to avoid difficulties with the neighbors. Once neighbors are upset they tend to join together and it becomes hard to continue a harmonious experience for our clients in the community. In contrast the Crisis Homes located in Vacaville are both in rural areas and this has shown to work well with clients who elope, makes loud sounds, and are prone to property destruction. The neighbors are far enough away that they do not see things going on outside the home, which can create fears, and they are not inconvenienced by intermittent loud noise.
07/12/2022Amy Westling (Association of Regional Center Agencies)Please see the attached comments from ARCA. ARCA appreciates the opportunity to comment on the amended regulations proposed by the Department of Developmental Services (DDS) related to Community Crisis Homes (CCCH) and Enhanced Behavioral Supports Homes.

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Last modified: April 25, 2023