340:2-3-73. Office of Client Advocacy (OCA) advocacy services specific to Hissom Class Members (HCM)s and former Northern Oklahoma Resource Center of Enid (NORCE) and Southern Oklahoma Resource Center (SORC) residents
(a) Representation. OCA provides ombudsman and advocacy services to former HCMs and NORCE and SORC residents of the facilities, per Oklahoma Administrative Code (OAC) 340:2-3-71. An OCA advocate is assigned to act as an independent resource to ensure the client's needs are met and ensure that he or she is provided with the information, skills, opportunities, and support to:
(1) make informed choices and decisions about their lives;
(2) live in homes and communities where individuals can exercise full rights and responsibilities as citizens;
(3) pursue meaningful and productive lives;
(4) contribute to their family, community, state, and nation;
(5) have interdependent friendships and relationships with others;
(6) live free from abuse, neglect, financial and sexual exploitation, and other legal rights violations; and
(7) achieve maximum health and full integration and inclusion in society; in an individualized manner consistent with unique strengths, resources, and priorities.
(b) OCA advocate assignment. OCA assigns an advocate to each HCM living in Oklahoma and to each former resident of NORCE and SORC. These OCA advocates are assigned for the client's lifetime, so long as they are residing in Oklahoma. • 1 Clients are provided choices regarding the OCA advocate assigned to represent them to the extent feasible considering the geographic location of the client's residence and OCA advocate caseloads. Requests for a change in the OCA advocate representing an individual are made to the advocate general or designee. • 2
(c) Personal Support Team (PST) membership. As a representative of a HCM or of a Developmental Disabilities Services (DDS) client living in a community residential placement, an OCA advocate is a member of the client's PST.
(1) As a PST member, the OCA advocate receives from the client's DDS case manager, timely notice of all PST meetings, including emergency PST meetings.
(2) The OCA advocate attends the client's:
(A) annual individual plan (IP) meetings;
(B) person-centered planning meetings;
(C) interim meetings;
(D) follow-up planning meetings;
(E) emergency PST meetings;
(F) PST guardianship assessment meetings;
(G) other PST meetings when significant issues are addressed, including when a rights restriction or an intrusive behavior intervention strategy is contemplated or recommended;
(H) PST capacity assessments; and
(I) other PST meetings, at the client's, guardian's, or involved family's or friend's request.
(3) Within the PST context, the OCA advocate assists the client and represents the client's interests without relinquishing priority to client safety and rights.
(d) Guardianship issues. The OCA advocate ensures a client has a current capacity assessment and attends capacity assessment meetings. When a client with a full guardianship has sufficient capacity to require no guardian or only a limited guardian, the OCA advocate promotes the filing of a petition with the guardianship court to terminate or limit the guardianship appointment. When the current capacity assessment for the client who does not have a guardian recommends a guardian or volunteer advocate, the OCA advocate participates with the PST to identify persons who might serve as the client's guardian or volunteer advocate. An OCA advocate encourages the development of friends in the community who might become the client's guardian or volunteer advocate. The OCA advocate monitors the implementation of the recommendations in the capacity assessment and advocates for timely achievement. When a guardian is needed and a suitable guardian is identified, the OCA advocate promotes the filing of a petition with the guardianship court to appoint a guardian.
(e) OCA advocacy and monitoring. OCA provides advocacy and monitoring to ensure compliance with rules, regulations, and policies, applicable to their client's health, safety, and well-being. In addition to the services described in OAC 340:2-3-71(h), OCA advocacy and monitoring activities on behalf of each client, include:
(1) verifying that Form 06CB034E, Residential Pre-Service Checklist, was completed and everything on the checklist is in place prior to any change in residence;
(2) visiting the client's home within 30-calendar days after the client moves into a new residence;
(3) conducting a face-to-face visit with the client at least once every three months and, more frequently as indicated; • 3
(4) completing a meaningful contact regarding each client served, at least monthly; • 4
(5) completing a service review at least once every six months; • 5
(6) verifying that direct contact staff completed required training in connection with each service review;
(7) requesting that DDS Quality Assurance staff conduct an administrative inquiry of suspected provider contract violations, per OAC 340:100-3-27;
(8) assisting the client and his or her guardian or representative with proposed financial agreements and contracts reviews between the client and the provider;
(9) reviewing documents and electronic files including, but not limited to: • 6
(A) assessments, IP, and interim IP documents;
(B) incident reports;
(C) Adult Protective Services and OCA investigation findings; and
(D) behavior data collection forms;
(10) attending mortality review meetings, per OAC 340:100-3-35;
(11) attending legal proceedings involving the client, including guardianship proceedings, as circumstances warrant;
(12) providing an annual copy of Form 15GR007E, Notice of Grievance Rights, Hissom Class Members, or of Form 15GR006E, Notice of Grievance Rights: DDS Service Recipients, as appropriate, to each client and/or guardian;
(13) monitoring the water temperature in homes every six months, using a thermometer to ensure the water does not exceed 120 degrees Fahrenheit;
(14) verifying that appropriate records are kept with regard to an individual's personal finances, at least once every six months; and
(15) advocating for the provision of adequate staff to be present in the hospital with HCMs only, prior to and during a hospitalization, as circumstances warrant.
(f) Advocacy and monitoring services specific to HCMs and former residents of NORCE and SORC, who reside in private intermediate care facilities for individuals with intellectual disabilities (ICF/IID).
(1) The assigned OCA advocate conducts a face-to-face visit with a client living in a private ICF/IID at least once every 90-calendar days and more frequently, as warranted.
(2) Service reviews are not completed.
(3) The OCA advocate maintains a helping relationship with the client, assessing the realization of desired and targeted outcomes, and initiating change through referral or grievance as needed. During client contacts, the OCA advocate inquires about the client's satisfaction with current supports and provides information regarding available options for community supports.
(4) The OCA advocate, at least once every six months, contacts the client's guardian when one is appointed. The OCA advocate, in response to a client's expression of dissatisfaction with the current residential arrangements, contacts the guardian. These contacts reaffirm the availability of service options to clients for support in community settings. Contacts with the guardian occur in person, by phone or mail as circumstances warrant.
(5) The OCA advocate contacts the private ICF/IID case manager, informs the case manager of the OCA advocate's intent to attend yearly planning meetings, and requests notification in advance of yearly planning, interim, and emergency meetings.
(6) The OCA advocate participates in annual planning meetings at the private ICF/IID. The OCA advocate provides advocacy assistance regarding the client's expressed preferences. The OCA advocate brings the individual's expressed desires and any concerns expressed by him or her, the guardian, or other family members to the attention of the PST. The OCA advocate participates in interim meetings and addresses significant changes in the client's residence, work, health, or important relationships.
(7) The OCA advocate assesses the client's welfare and determines if OCA advocacy is needed. The OCA advocate develops a working knowledge of the facility's grievance procedure as well as other problem resolution processes and resources for change. The OCA advocate provides assistance, either directly or through referral, resolving concerns identified by the client or by others on the client's behalf, which may include contacting the Office of the State Long-Term Care Ombudsman.
(8) The OCA advocate provides information and encouragement to the client to consider community residential settings.
(g) OCA advocacy and monitoring services specific to HCMs and former residents of NORCE and SORC who are in Oklahoma Department of Corrections (DOC) or county sheriff custody. OCA advocacy and monitoring services for clients, who are in DOC or county sheriff custody, except those who are detained pre-trial, are contained in this subsection. The assigned OCA advocate:
(2) obtains copies of court documents that reflect the sentence the client is serving;
(3) assesses the client's welfare and determines if OCA advocacy assistance is needed. The OCA advocate provides assistance, either directly or through referral, resolving concerns identified by the client or by others on the client's behalf. OCA advocacy assistance is provided to enforce the rights of clients under the Americans with Disabilities Act and other federal and state laws, to the extent they are applicable to persons who are in custody; and
(4) provides OCA advocacy assistance with the DDS case manager to commence transition planning when the client has less than a year remaining to serve in custody. The OCA advocate participates in and monitors transition planning, representing the client's interests. • 11
(h) Services specific to HCMs and former residents of NORCE and SORC who decline DDS services. Clients and their legal representatives have the right to refuse DDS services, per OAC 340:100-3-11. The OCA advocate for a client, who has declined DDS services contacts the individual at least once every six months and remains available to assist him or her, when requested with OCA advocacy regarding non-specialized assistance. If the OCA advocate determines the client's need or desire for specialized supports has changed, he or she takes appropriate follow-up action with DDS case management. • 8
(i) OCA advocate services specific to HCMs on the Focused Advocacy List (FAL). Pursuant to court order, OCA formally assumed the responsibility of acting as advocate for plaintiff class-members identified in Homeward Bound, et al. v. The Hissom Memorial Center, et al. [85-C-437]. In response, OCA created the Focused Advocacy program to provide increased OCA advocacy supports to HCMs with limited or no family involvement. In addition to the activities described in (e) & (f) of this Section and OAC 340:2-3-71(h), OCA advocacy and monitoring activities on behalf of each client include:
(1) ensuring the assigned DDS representative is invited to the PST meetings when warranted to review and update progress in securing a volunteer advocate or guardian for all clients on the FAL;
(2) visiting each member on the FAL at least once every two months, and more frequently when warranted. Visits include home visits, worksite visits, and other face-to-face contacts;
(3) placing a priority on expanding HCM's circles of support to include persons, who are not paid to be involved in the HCM's life, which includes identifying relatives, not involved in the HCM's life who might be encouraged to become more involved;
(4) identifying HCMs who have the greatest immediate need of a volunteer advocate or guardian. OCA advocates must promptly inform the OCA Focused Advocacy manager when a HCM is identified as having a priority need; and
(5) ensuring a Team Review of Advocate/Guardian Participation (TRAGP) document is prepared for each HCM assigned to them at least annually and one is completed much more frequently whenever there is a significant change in circumstances warranting review of the involvement of persons who are not paid to be involved in the HCM's life. The TRAGP form includes information documenting the need for the individual to remain on, be added to, or be removed from the FAL. The Focused Advocacy Committee meets regularly to review TRAGP forms and determine if HCMs remain on the FAL or require prioritized identification of a volunteer advocate or guardian.
INSTRUCTIONS TO STAFF 340:2-3-73
1. Office of Client Advocacy (OCA) advocate caseloads. Each OCA advocate is assigned no more than 50 clients, including Hissom class members (HCM)s, former residents of the Northern Oklahoma Resource Center of Enid (NORCE) and the Southern Oklahoma Resource Center (SORC), and other Developmental Disabilities Services (DDS) clients living in community residential settings.
2. Changes in the assigned OCA advocate. All requests by a client or the client's representative for a change in assigned OCA advocate are considered and addressed. Requests for an OCA advocate of a particular gender or other characteristic are considered in a manner that complies with all federal and state laws prohibiting discrimination on the basis of race, color, national origin, sex, age, religion, or disability.
3. Client contacts. Face-to-face visits are made with each client at least once every three months. A minimum of two visits each year must occur in the client's home.
4. In addition to the DDS Client Contact Manager (CCM) review, the OCA advocate is required to complete and document at least one meaningful contact every month. These contacts may be any type of informative contact with, or regarding a client served. This contact may be a phone conversation, email, visit, or a meeting with the client, family, guardian, provider, case manager, or team member. There must be at least one documented contact each month in addition to the DDS CCM review for each client caseload. Clients who are incarcerated or refuse services are the only exceptions to this Instruction.
5. Service reviews. An OCA advocate completes a service review every six months for each client. Sources of information for completing the service review include a home visit, the home record, observations, incident reports, verbal accounts by clients and persons involved in their lives, and other documentation made since the last service review. A completed service review is entered on the OCA Client Contact Manager database within five-business days of the home visit.
6. The OCA advocate reviews the DDS CCM database for each client on his or her caseload at least monthly and documents the review in the OCA CCM database. A review consists of opening and reading the content of the contact note, document, or incident report. The OCA advocate's documented review must state the time period and the number of CCM contact notes, documents, and incident reports present and reviewed. OCA advocates must state if any new information was obtained from the review and detail any identified issues requiring follow-up in the documented review. OCA advocates pay close attention to health and safety concerns and initiate informal problem resolutions, when appropriate.
7. The OCA advocate becomes familiar with and observes the rules and regulations in effect at the facility where the client is in custody, specifically those regarding what items are permissible to give to or receive from inmates in that facility. The OCA advocate does not provide anything facility rules prohibit.
8. This may include contacting the client's assigned-prison case manager, to ensure the facility is aware of the client's abilities and limitations relevant to the individual's classification, safety, and participation in vocational and other programs.
9. The OCA advocate provides information to the client's attorney and other officials including parole officers relevant to the client's conviction, sentence, appeal, prison classification, assignments, living, work, and education within the prison. This includes general information regarding the client's particular developmental disabilities, such as the potential for impaired understanding of consequences, vulnerability to exploitation, and learning challenges. The OCA advocate obtains the client's and/or guardian's written consent before releasing confidential information about the client.
10. When services are refused, the client and the client's legal representation are advised of any risks accompanying the decision to refuse services and are informed of the fair hearing process, per Oklahoma Administrative Code (OAC) 340:100-3-11. OAC 340:100-3-11 requires the Personal Support Team to engage in and document consideration and attempts to initiate alternatives, to resolving the concerns expressed by the client, legal representative, or both. Appropriate legal resolutions are sought when it is determined the exercise of the right to refuse services by a client, who has not been determined incapacitated to act on his or her own behalf presents a risk to the individual, per Oklahoma Statutes.
11. Persons who are in Oklahoma Department of Corrections custody are deemed not to be Waiver recipients. Therefore assessments, such as the capacity assessment are not required; however, it is appropriate for the OCA advocate to request assessments be completed as part of the transition process when the client is close to discharge from custody.