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Presentation to MDC Transition Planning Advisory Council

Presentation to the MDC Transition Planning Advisory Council

By Rebecca de Camara / June 15, 2015




1893 - Montana legislature formally recognizes work done by elderly couple in downtown Boulder home with 6 deaf and blind children          Montana Deaf and Dumb Asylum

1896 - moved to present location

1905 - separate school funded at Institution—The School for Feeble-Minded Children with initial enrollment of 15

1907 - school serving only children but question about what to do with feeble-minded adults; establish colony for males ages 6 and up

1956 - School had transitioned into an institution with a total population of 576 feeble-minded individuals; massive overcrowding; direct care employees recruited from North and South Dakota

1959 - term feeble minded replaced by mentally retarded

1962 - began accepting children as young as 3

1965 - population peaks at 1011

1967 - name changed to Boulder River School and Hospital

1967 - Montana legislature appropriate funds for Eastmont Training Center

1970 - newly appointed superintendent of BRSH established depopulation as institutions primary method of reform

1976 - population decreased to 276

1987 - facility name changed to MDC



1990s - Decade of litigation

1992 - campus redesigned for decreasing population

  • Home-like residential atmosphere

1996-2004 - Travis D. lawsuit

  • Class action lawsuit filed by Montana Advocacy Program
  • Challenged adequate provision of community services

1999 - Olmstead vs. L.C.

  • US Supreme Court issues opinion that services should be administered in the most integrated setting appropriate to individuals needs


  • MDC pop = 85
  • Eastmont pop = 45


  • HB727 passed by 2003 Legislature directed DPHHS to decrease use of Eastmont as an institution for DD individuals


  • Assessment and Stabilization Unit (ASU) built as secure option for facilities’ increasing behaviorally challenging population


  • Ongoing challenges facility had been facing reached a critical point
  • MDC received 7 immediate jeopardy citations
  • Level of citation takes place only when CMS determines a crisis situation exists to the extent that the health and safety of individuals is at risk


  • Sexual assault of MDC resident by MDC staff


  • Leadership change at facility
  • Gene Haire, former director of the Board of Visitors, selected as MDC’s new Superintendent

2013 Legislative Session

  • SB 254 MDC closure effort that nearly passed
  • SB43
    • Transfers investigative responsibility to DOJ
    • “each allegation of mistreatment, neglect, or abuse and each injury of an unknown source”
  • Though MDC avoided closure, there was a 10% decrease in the facilities budget
    • Closure of one residential unit
    • Staffing reduced to minimum safety requirements
    • Training and travel reduced to minimum
    • Vocational program decreased
    • All directly impacted quality of life for clients

2015 Legislative Session

  • SB 411 passed
    • Directs DPHHS in conjunction with Governor appointed transition planning committee to develop and implement a plan to close MDC by June 30, 2017
    • Transitions ‘most’ residents out of MDC and into community-based services by December 31,2016
    • Limits commitments after December 31, 2016


Regulated as 2 separate entities

  • ICF-IID—open campus/regulated by CMS; 42 CFR; capacity of 44 beds
  • ICF-DD (ASU)—secure unit/regulated by Quality Assurance Division of DPHHS;  Admin Rules of Montana; capacity of 12 beds


  • Current census is 53 residents; currently have 9 in ASU
  • Generally stay around this number; rarely fall below 50


  • Build in 2005
  • Needed to be a separate facility under different licensing provision I order to provide a level of security that is not allowed in an ICF-IID
  • Original purpose—clients with highly disruptive behaviors
  • New administration in 2011—new clients; stabilization and return to open campus
  • Unable to maintain this model

Operational challenges

  • Cottage layout is staff intensive; even  ASU which only houses 12 residents is divided into three separate units
  • Cottage layout has significant blind spots
  • Administration is isolated
  • Closure of unit 4 = more roommates


  • Admission to MDC requires commitment
  • Commitment statute—MCA 53-20
    • 18 years or older
    • Seriously developmentally disabled
      • Defined as—(a) person who has a developmental disability; (b) is impaired in cognitive functioning (c) cannot be safely and effectively habilitated through voluntary use of community based services b/c of behaviors that pose an imminent risk of serious harm to self or others
    • In need of commitment to residential facility


  • Several different kinds of commitment at MDC
    • Forensic –8/7 for sexually based offenses
    • Civil—36
    • Emergency—4
    • Voluntary—5
    • Court Ordered for Fitness Restoration—1

Discharge Process

  • Clients should be discharged when no longer meet commitment criteria
  • Unfortunately no longer meeting commitment criteria does not guarantee an existing community provider will be willing and able to serve
  • MDC’s ALOS is currently 3.4 years and the average length of time on the port list is 2.1 years
  • Half of MDC’s current population is on the port list
  • Working with providers to identify barriers:
    • Insufficient/inflexible reimbursement structure
    • Lack of community psychiatric and crisis support
    • Lack of start-up funds
    • Inability to staff


Client Profile

  • 49% of the individuals served have a co-occurring severe and disabling mental illness
  • 90% of the individuals committed to MDC have a co-occurring mental health diagnosis
  • 13% have been convicted of crimes, sentenced to DPHHS under a forensic commitment and placed at MDC to serve sentences
  • 85% of these forensic commitments have been convicted as sex offenders
  • 88% of MDC residents are Male
  • 64% of MDC residents are under the age of 35
  • Behavioral profile:
    • 74% present with aggression
    • 44% present with problematic sexual behavior
    • 38% present with self-harm

MDC currently has on staff:

  • Medical Director
  • Psychiatrist
  • Clinical Director 3 Behavioral Health Clinicians
  • Speech Pathologist and Board Certified Behavioral Analyst
  • Physical therapist
  • 2 Recreation Therapists
  • Vocational Supervisor
  • Dietician

This extensive list is supplemented by a dedicated group of direct support professionals, management, and administrative staff.

  • 39% of MDC 250 employees have worked more than 10 years at MDC for an average of 21.6 years
  • At the other end of the spectrum 16% have worked less than 1 year for an average of 5 months
  • Struggling to fill vacancies
    • Of the 30 current vacancies at MDC/ 25 are DSPs
    • Low unemployment rates
    • Highly competitive wage market
    • Less than ideal work environment

Current requirements for a DSP are:

  • High school diploma or equivalent
  • One year of work experience with developmental, behavioral, or psychiatric disorders
  • Starting salary $11.19 per hour

Treatment Mall

  • Comprehensive model of treatment
  • Originated in psychiatric inpatient treatment settings
  • Dozens of core classes, elective classes, and groups according to their treatment needs
  • Day starts with 8:30 community meeting follow by classes from 9-3
  • Mirrors schedule they will be expected to maintain in community

The facility has begun incentivizing class attendance through field trips at the end of each quarter for those clients who attend at least 90% of their classes.  Though field trips are extremely staff intensive and taxing on the facility they are a very welcome addition to our client’s lives.

There have been a lot of valid concerns expressed over the safety of both staff and clients at MDC.

Facility Safety

  • Mentioned earlier that DOJ had taken over MDC investigations in Spring 2014
  • Valuable to have outside set of eyes on the facility
  • Challenging to coordinate the needs of 2 separate agencies with their own administrative requirements
  • Requires ongoing collaboration
  • One of biggest challenges is “allegation’ not defined in SB43


  • Greatest safety challenge right now is ASU
  • 2-10 evening shift when have newest staff, most difficult clients and least structure creates a perfect storm for incidents
  • Ongoing concerns about client and staff safety
  • May of 2015, DPHHS’ Division of Quality Assurance issued an order for license revocation

May 22, 2015 the License Bureau accepted the abatement plan that was developed by the facility and a Provisional License was issued—provisional

  • license means that a facility is not in full compliance with the requirements but is attempting to comply
  • Our next review is scheduled for June 19, 2015
  • Benchmark Human Services
    • Organization out of Indiana
    • Instrumental in developing the accepted abatement plan
    • Developing behavioral management plans for each ASU client and training protocol for direct care and management staff
    • Outcome driven work