The Texas Health and Human Services Commission’s (HHSC) newly-released 2022 statewide strategic plan for intellectual and developmental disabilities (IDD) services provides a roadmap to improve access to care in the state. In the plan, HHSC names strategies to make IDD services more accessible and more user-friendly, as well as to improve workforce shortages.
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HHSC conducted two surveys to inform the development of the strategic plan between September 2018 and September 2019. The survey collected responses from family members or friends, service providers, and organizational staff to identify strengths and areas for improvement regarding satisfaction with disability services.
Key strengths identified from the survey were HHSC’s education-related disability services, providers or organization representatives’ satisfaction with evidence-based practices, and overall satisfaction from all survey respondents with services when a person with IDD lives in a medical or supported living environment.
From the surveys distributed to individuals engaged in the IDD community as well as other methods of stakeholder input, the strategic planning group and community stakeholders identified gaps and challenges related to coordination, access, and provision of services in the state.
The challenges identified in the existing IDD services system are listed below:
- Access to appropriate IDD services – Services and supports must be further expanded and funded to “provide an adequate network of resources and limited wait times” so that more individuals with IDD of all ages across Texas can access them.
- Needs of young children and public school students with IDD – Existing services for young children and public school students with IDD can be enhanced to provide a “progressive continuum that leads to a successful transition through different stages of life.” HHSC highlights that supporting these children and their families is necessary to create a solid foundation to navigate these transitions.
- Community-based behavioral health services for people with IDD – More extensive efforts are needed to provide individuals with dual diagnoses with access to quality behavioral health services, trauma-informed care, and opportunities for recovery. The plan stipulates that these supports should be “adequate in both their approach and intensity to avoid unnecessary crisis events, hospitalizations, or incarcerations,” and that these supports should be available in as many community settings across the state as possible.
- Transportation to services, jobs, and community activities – Accessible and reliable transportation allows people with IDD to utilize services, be involved in the community, and maintain employment, especially for those that live in rural areas where services are less plentiful.
- Access to community-based housing – Community-based housing for individuals with IDD must be improved, and this housing should be affordable, accessible, and integrated.
- Employment training and long-term supports – Employment services should expand to “provide support in maintaining employment and developing careers while communities and employers can create competitive and integrated jobs” so that individuals with IDD are not limited in the jobs they can obtain and the wages they receive.
- Satisfaction with IDD and related services – Improving HHSC’s monitoring of the satisfaction and preferences of people with IDD that are accessing the services to constantly make system enhancements.
- Ease of system navigation – Services and supports must be made easier to navigate. Individuals with IDD of all ages must be readily able to identify and connect with IDD services and benefits for which they are eligible.
- IDD services and supports workforce shortage – State agencies, professional associations, colleges, and employers must collaborate to develop, recruit, and retain more qualified providers to support individuals with IDD, as this workforce shortage has contributed to a lack of services or long wait times in some areas of Texas.
- Coordination and administration of services – IDD services and supports can be better coordinated to be made more consistent “and have a cross-agency approach to service provision, program coordination, training, and funding.”
- State agency communication with the public – People with IDD and their caregivers should be able to easily connect with agency staff or service representatives and easily locate information about agency performance. Communication between state agencies and the IDD community can be enhanced in many areas, including outreach, benefits management, service navigation, and performance reporting.
The strategic planning group and community stakeholders developed numerous comprehensive recommendations to address the challenge areas in the coming year identified above.
Some key recommendations are summarized below:
- Increasing self-determination and quality of life for people with IDD by efforts such as teaching them and their families about resources and services early and as eligibility and services change, increasing people’s understanding of their civil rights and legal protections, and enhancing the practice of teaching and utilizing self-determination and self-advocacy for all students with disabilities in school.
- Enhancing family-based alternatives, family supports, early childhood and education services through early childhood intervention and exploring the creation of a statewide system to ensure post-school success for special education students.
- Supporting community integration for people with IDD through efforts such as increasing access to affordable, accessible, and integrated community-based housing, increasing and expanding transportation options in both Medicaid and non-Medicaid delivery systems, and integrating meaningful day activities into community using person-centered approaches and choice.
- Expanding mental health and crisis intervention services by training law enforcement and community service officers to assist people with IDD during a behavioral health crisis and promoting long-term care or follow-up care for mental health needs.
- Expanding access to trained community service providers and educators for people with IDD through efforts such as improving wages, standardizing reimbursement rates, and establishing worker benefits for direct support professionals (DSPs).
- Increasing satisfaction and person-directed service for people with IDD and their families through efforts such as promoting flexibility and options to customize services for each person.
- Increasing IDD system integration and collaboration through efforts such as enhancing collaboration between state agencies and local organizations.
- Improving IDD system transparency and accountability through efforts such as enhancing the measurement and use of data by state agencies and contractors, and enhancing monitoring and measurement of special education services.