Wednesday, July 29, 2015

Concerns For HB 2789 (84th Legislature 2015) and the New 90.44 Trauma-Informed Care Training

For those who may not know Texas has modified required training for the ICF/IID program with the new requirement of Trauma-Informed Care Training.  Before everyone starts to cry and moan, it should be noted that this training is currently in an online form for DFPS ( It should also be noted that the new bill allows the training to be conducted online.  It's very likely that DADS will offer the training at some regional training sites, but that it will also be offered in an online format considering the content of the bill, now a law.

The law (Link to Final Bill) requires all "new employees to complete the training before working with individuals with intellectual and developmental disabilities."  Because of the requirement that the training be completed before a potential employee works with an individual, it is very likely that DADS will provide the resources online.  Most facilities will simply add this to their new employee orientation and perhaps complain a little about further training requirements without further compensation from the state- that's just the way it is always going to be as it appears now.

DADS has also offered providers the opportunity to give feedback and input on the proposed 90.44 Texas Administrative Code.  I can not stress enough that providers need to take this opportunity to provide feedback.  Information about the feedback and the new 90.44 can be found here on DADS website.  For the sake of review, I have some concerns that I would like everyone to consider.  Below is the full proposed 90.44 from the noted website: 

A license holder must ensure that an employee, contractor, or subcontractor who is hired by the license holder to work at a facility on or after XXX, and whose duties will require the employee, contractor, or subcontractor to work directly with a resident completes trauma-informed care training provided by DADS before the employee, contractor, or subcontractor works with a resident. For purposes of this section, “to work directly with a resident” means to serve on a resident’s interdisciplinary team, or to provide active treatment, health care services, or clinical services to a resident.

DADS has raised some serious questions and concerns with the proposed tag.  Consider the two closely related issues below as your write your concerns and provide your input:

1.  The law calls for "employees who work directly with..." individuals to have the training; however, the DADS rule goes further and requires the following to also have the training:  "Contractor, subcontractor".  Initially, that may not sound too bad, but consider this:  Is your physician going to be willing to take time out of his or her schedule to complete this online training and provide you the certificate?  Physicians are already pressed for time and we all know how hard it is to find Medicaid and Medicare physicians, so once you find them are you willing to risk them leaving your service over training requirements?  This Contractor and Subcontractor will include your physicians, R.N.s, dietitians, dentist and any other person who may work directly with the resident.  Solution: DADS needs to consider keeping this to "Employees Only" as it is written by the law and not read additional information into and put additional hardships on the ICF/IID programs.

2.  The new 90.44 also goes further and clarifies who "to work directly with a resident" means by stating that it is the person who serves "on the resident's interdisciplinary team, or to provide active treatment, health care services, or clinical services to a resident."  Once again this is very strict language written here.  This means that should your regular physician agree and complete the training, you'll be fine in that area, but consider further issues:  What if a specialist is called in to see a resident such as a Neurologist - that person will provide care and input for the IDTeam and by this rule it means that person will also have to take the training.  In addition, this could be stretched to include vocational sites.  Active Treatment is not defined as "formal" or "informal" by this proposed rule. As we all know informal active treatment may occur on a person's outside job site.  The resident goes to work and has a supervisor who will provide training and feedback - that is informal active treatment - so, based on this rule will the supervisor, let's say the grocery store manager, also have to take DADS training and provide a certificate to the facility?  If the supervisor does, how many of your employed people are likely to keep their jobs?  As for those individuals in the school systems, will your district require their special education teachers to take this training?  What about other teachers who may have contact with your resident?  What about teacher aides?  What about substitute teachers the district hires as you may not know when they will call them or who they will be?

The bottom line is that DADS has taken the basic law and for whatever reason expanded it to include everyone who has some influence or input into the resident's life.  On the surface this looks good and I certainly understand and appreciate DADS protective nature toward the residents; however, as it is currently written, it could include even a remote specialist, such as an gastrointestinal specialist, who might be a referral for an individual.  Before that specialist could see the individual and provide any services the facility will have to contact them and require that they take the training and send the certificate to the facility.  There will be some specialist out there who will do it I'm sure, but I'd be willing to wager that there will be a lot more who will thank you for your time and suggest you take the resident to someone else.  The current proposed rule for Trauma-Informed Care Training is a good and needed rule, but it simply needs some modification to ensure that it does not place the resident in jeopardy of not receiving needed services and the facility in jeopardy of non-compliance.  You need to write DADSA through as quickly as possible.  Be direct and point out concerns.  

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