340:100-11-2. Intake, Diagnosis and Evaluation Process
(a) Legal basis. Section 1414.1 of Title 10 of the Oklahoma Statutes (10 O.S. § 1414.1) requires Oklahoma Human Services (OKDHS) Developmental Disabilities Services (DDS) to provide care for individuals with a primary intellectual disability diagnosis and a secondary mental illness diagnosis. The Robert M. Greer Center (Greer) was established for this purpose and serves individuals through a contract with OKDHS.
(b) Admission criteria. • 1 All admissions are consistent with Part 483.440(b) of Title 42 of the Code of Federal Regulations, regarding intermediate care facility admissions, transfers, and discharges.
(1) Admission criteria for an individual served through Greer includes:
(A) clinical evidence the applicant has challenging behaviors placing his or her physical safety, environment, relationships, and community participation at risk, or creates a risk of involvement in civil or criminal processes; and
(B) clear evidence documenting why the applicant cannot receive appropriate treatment in his or her current environment or through less restrictive community supports. The DDS director or designee approves Greer admissions.
(2) A referral packet is submitted to the DDS director or designee and contains, when available:
(A) a physical examination within one-calendar year of referral;
(B) a list of current prescribed medications;
(C) information regarding hospitalizations in the last two-calendar years, including the reason for admission and prognosis;
(D) physician orders and progress notes up to one-calendar year;
(E) nursing notes up to one-calendar year;
(F) medical records up to one-calendar year;
(G) guardianship or legal papers;
(H) social history and recent social evaluation;
(I) psychological evaluation conducted at 16 years of age or older, by a licensed psychologist, which includes:
(i) intellectual disability diagnosis based on testing that yields a full scale intelligence quotient;
(ii) functional and or adaptive assessment; and
(iii) a statement noting the age of onset of the disability;
(J) dental records;
(K) immunization record;
(L) multi-disciplinary progress notes or assessments up to one-calendar year for:
(i) physical therapy;
(ii) occupational therapy;
(iii) speech therapy and hearing services;
(iv) nutritional services;
(v) vocational; and
(vi) educational records for enrolled students; and
(M) behavioral incident reports;
(N) direct care notes; and
(O) current Individual Plan or treatment plan to include behavioral support plans.
(c) Admission. Individuals considered for Greer admission are 18 years of age and older. When an applicant is 17 and a half and in need of treatment, the DDS director or designee may grant an exception to the age limit Former Greer residents are eligible for re-admission on the same basis as individuals initially seeking services. Admission is based on a referral packet review that includes:
(1) clinical evidence of mental illness, behavioral, or emotional problems, per the current edition of the Diagnostic and Statistical Manual of Mental Disorders, revised and published by the American Psychiatric Association;
(2) documented attempts, and reasons for failure, of techniques and supports applied in the applicant's current environment; and
(3) consideration of other available and appropriate community or Wavier services. Placement at Greer constitutes the least restrictive alternative to provide effective treatment to meet the applicant's needs when compared to other available options.
(d) Discharge. • 2 Greer is a short-term treatment facility and residents are transitioned out of the facility when they meet criteria to safely live in a less restrictive placement. When Greer determines a resident is stable and no longer meets criteria to remain, a discharge referral is provided to the DDS director or designee. Discharge planning includes:
(1) a review of pertinent Greer information, including data to support progress made;
(2) discussion with facility staff regarding community supports needed to maintain the resident's stability; and
(3) a referral to the area DDS transition coordinators to initiate the search for potential homes in the community with necessary supports.
(e) Post discharge activities. • 3 Greer staff is available after discharge to consult with the individual’s community personal support team.
INSTRUCTIONS TO STAFF340:100-11-2
1. (a) When a service recipient is considered for admission into the Robert M. Greer Center (Greer), the Developmental Disabilities Services (DDS) case manager:
(1) ensures the Personal Support Team (Team) completes an assessment that identifies areas where the service recipient's or community's safety is at risk;
(2) ensures the Team reviews the service recipient’s current circumstances, available community supports, incident reports, court orders, guardianship status, Individual Plan (Plan), Protective Intervention Protocol (PIP), prescribed medications, and other relevant circumstances related to the Greer referral;
(3) ensures the Team consults with the DDS positive support field specialist to discuss and document why the service recipient cannot receive appropriate treatment in his or her current environment;
(4) submits referrals for needed services; and
(5) submits a Greer referral to DDS state office when documentation indicates Greer is the least restrictive environment to meet the identified needs.
(b) DDS State Office staff:
(1) reviews existing court limitations or placement issues;
(2) provides service recipient programming recommendations for the current placement; and
(3) notifies the DDS case manager of the admission request's approval or denial.
(c) DDS area staff completes tasks necessary for admission.
2. When the Greer Discharge Committee approves a Greer resident for a community placement, the DDS transition coordinator:
(1) assists in locating community placements;
(2) meets with prospective case management and provider agency staff to discuss expectations and explain the Greer transition process;
(3) reviews the home location when community protection or health and safety concerns are present;
(4) provides the Greer assessments to the community Team;
(5) provides all eligibility documentation to intake and communicates transition dates to establish the plan of care (POC) start date;
(6) submits the Greer PIP to the DDS director of training and behavior support services for review and temporary approval for up to six months from the discharge date;
(7) attends the Greer transition meeting to ensure all services are in place prior to the transition;
(8) ensures a clinical pharmacy review referral is submitted to the DDS director of pharmacy services prior to the community placement;
(9) reviews the Plan prior to POC submission and provides recommendations for revisions as needed;
(10) works with the Team to identify and resolve transition related issues or concerns in the community placement;
(11) monitors progress for up to 18 months and attends the 30-calendar and 90-calendar day meetings and others as required to provide technical assistance;
(12) completes home visits at 15-calendar, 30-calendar, and 90-calendar days, and at six, 12, and 18 months post transition; and
(13) provides home visit summaries to the Team and to Greer.
3. If the service recipient experiences significant behavioral problems in the community placement, the DDS case manager contacts Greer for assistance.