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DHS COVID-19 PROVIDER RESOURCES // ODP

ODP Announcement 20-056 :
Individual Transition Guide Announcement

Updated: May 11, 2020

Audience

Individuals and Families/Caregivers, Supports Coordination Organizations (ID/A, AAW, and ACAP), All Qualified Providers (ID/A, AAW, and ACAP), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/ID), Administrative Entities 

Purpose

The purpose of this communication is to announce the release of The Office of Developmental Programs’ (ODP) Individual Transition Guide. This guide is constructed for use during weekly well-being check-ins with individuals, caregivers and/or staff, as appropriate, to gather information related to transition and preparation for the lifting of stay at home orders that had been put in place during the COVID-19 pandemic. This guide can also be used by individuals, families, and providers to prepare for reintegration activities.

Discussion

Since SCs already conduct weekly check-ins for all individuals, except for those residing in public Intermediate Care Facilities (ICFs), the first step in planning and preparing for transition to community is to begin this discussion during the weekly check-in. For individuals and families that have requested less than weekly check-ins, ODP recommends the SC conduct outreach that informs as to the purpose of this transition planning discussion, as it relates to the lifting of the stay at home order.

Regardless of whether the person resides in a county that has been identified as scheduled to move to a yellow phase, this discussion should occur. This provides opportunity to prepare for when restrictions are lifted and offers an opportunity to work towards transition. SCs should be mindful that while this discussion should occur, not everyone may be ready for a conversation about transition, particularly if they are still dealing with outstanding issues identified on the SC wellness check-in tool. For example, if the tool revealed that the individual did not have their basic needs met, or perhaps may already be ill with COVID-19. 

The Individual Transition Guide includes probing questions within core areas, as well as additional resources that could incite discussion on important transition areas. Pay attention to these, as they may help the team support the individual to transition to desired settings. Much like the SC wellness check-in tool, the SC should utilize The Individual Transition Guide to drive the conversation and document any findings and next steps in a service note. ODP expects to update the Guide to reflect changes in services and supports, as necessary. 

This discussion is the first phase of transition planning and will evolve as the changes related to services due to COVID-19 outlined in Appendix K are revised. Teams should use the Individual Transition Guide in conjunction with the probe guidance in the ISP to assess COVID-19-related risks and determine, for each individual, what supports are needed for the individual to be able to safely resume activities or engage in new activities.

For questions about the Guide, ID/A SCOs should contact ODP SCO regional lead, for AAW and ACAP SCOs should email the Provider Support mailbox at RAbasprovidersupprt@pa.gov

Training

To assist with implementation of The Individual Transition Guide, ODP will host two webinars. One is for AEs and SCOs only. Those entities will receive an email with invitation to register. A second session titled "Individual Transition Guide for All Stakeholders" will be held on Friday, May 15, 2020 10-11 a.m. Registration is available at this link: https://attendee.gotowebinar.com/register/5683516748298657548 

A recording of the stakeholders session will be placed on www.MyODP.org within three hours after the stakeholder webinar.

Related Materials

    • Individual Transition Guide