The new regulations overall have achieved the efficiency and reduced the redundancy evident in the current set of regulations.  Of concern as a provider are three areas: 1. The CHRIS system and its significant limitations and difficulties for providers; 2. The need for training for providers about human rights and the expectations of this department; and 3. Ways to communicate with providers on a regular basis regarding expectations, changes, etc. as it relates to the human rights department.  These three areas were evident in the survey done by Old Dominion in 2013 and do not appear to have been addressed in the new regulations. 

1. The CHRIS system, while useful for reporting, has some challenges as well.It is difficult to pull information for single programs within one larger agency so data is often skewed.The system is built on an old platform which does not always work well and requires specific things of the user and the computer before it will work.Finally, the system does not really allow for a dialogue between provider and licensing/Human Rights which would be very helpful in action planning and general technical assistance.

2. What is the intention of the HR Department in terms of training and ongoing technical assistance for providers? A suggestion, as it relates to training and ongoing communication with the Human Rights Division, may be that there is a representative who participates in a “consult” with affiliated services/programs to review current success in meeting HR regulations (without penalizing for initial error) then providing consult, feedback, and guidance on ensuring that guidelines are met. This type of collaboration with HR would be intended to help providers know more about expectations, regulations, and interpretation of regulations by local advocates, etc.

In terms of the regulations:

1. 12VAC35-115-105 appears redundant and more paperwork.  A person’s ISP is supposed to cover all of these areas.Why does another form/plan need to be created to address behavioral issues?12VAC35-115-105 A implies that this plan needs to be done for any behavioral intervention including restraints.  At times, restraints are done for clients who have not had a history of needing them.  It seems double work and more paper to address something that should already be in the ISP which is THE document guiding treatment.

2. 12VAC35-115-110 C 7 is of concern.Oftentimes when a restraint happens all other methods of de-escalation have been tried as restraints are a last resort.This particular regulation seems to imply that ALL ISP’s will need to have this regulation wording  in them even if a client has no history of needing restraint.Again the notion that restraints are a last resort is understandable in the regulations but to ask provider’s to document all of these things PRIOR to a restraint is not logical.At times there are clients who are restrained despite a history of not needing this in other placements or in the community.It appears to be an undue burden on providers to continue to document in the ISP and the behavioral plan and incident reports and CHRIS about interventions used.Once a restraint is done with a client the ISP should change to address new behavioral issues, de-escalation and other mental health needs of the client.